Journals Watch - Sunbeds, ankle sprains and CPR

Not had the time to catch up on the latest research? Let Dr Jonathan Holliday bring you up to date.

Skin cancer knowledge was good but reported behaviour of sunbed use and sunburn was still high (Photograph: SPL)

Trends in sunbed use and sun care knowledge
Br J Dermatol 2010 doi: 10.1111/j.1365-2133.2010.09977.x

In 2000, 2004 and 2008, a total of 2,200 randomly selected subjects in Northern Ireland aged 16 and over were sent a questionnaire on care in the sun. In total, 3,623 people responded and they were analysed by demographic and socio-economic factors.

The respondents' skin cancer knowledge was good in 2008 (97 per cent). Reported sunburn increased through the years to 60 per cent in 2008, with 39 per cent of those aged 16-24 reporting sunburn at least once during the past year.

Twenty per cent reported sunbed use in 2008, a fall from 28 per cent in 2004, with greater reported use among those aged 16-24 and among women (31 per cent against 9 per cent men). The respondents reported that tanning made them feel healthier (42 per cent) and more attractive (47 per cent), and these attitudes were more likely among women.

Although skin cancer knowledge is good amongst the Northern Ireland population, reported behaviours of sunbed use and sunburn pose risks for future rises in skin cancer. At least sunbed use, although high, has fallen.

Acute lateral ankle sprains: can physiotherapy help?
BMJ 2010; 341: c5688

To those working with sports men and women, in schools or clubs, ankle sprain represents a significant issue. It is a common problem with an estimated 5,000 cases per day in the UK. Many of us send patients to the physiotherapist wondering whether it really makes any difference.

This review set out to answer that question. The treatment options compared were conventional treatment (no treatment, taping, splinting and even plaster casts) with exercises supervised by a therapist.

The results showed moderate or limited evidence for the effectiveness of additional supervised exercises in recovery and short-term return to sport. The groups most helped were athletes and soldiers who achieved an earlier return to work and to sport.

How significant is dry cough with ACE inhibitors
Am J Med 2010; 123: 1016-30

Just how common is dry cough with ACE inhibitors and do the prescription formularies acknowledge the scale of the problem? The authors of this US study used the Physicians' Desk Reference.

The authors searched for articles published between 1990 and the present for RCTs trials of ACE inhibitors with sample sizes of at least 100 patients in the ACE inhibitor arm. They found 125 studies.

The pooled weighted incidence for cough among patients using enalapril was 11.5 per cent, which was a ninefold increase on the figure in the Physicians' Desk Reference.

The withdrawal rate for enalapril due to cough was 2.6 per cent (31-fold greater rate than that quoted in the Physicians' Desk Reference). The results were apparently similar for other ACE inhibitors.

Chest compression-only versus standard CPR
Lancet 2010; 376: 1552-7

This was a meta-analysis of studies published between 1985 and August 2010 in which chest compression-only bystander CPR was compared with standard bystander CPR for adult patients with out-of-hospital cardiac arrest.

The authors ran their searches in two ways; the first included trials where patients were randomly allocated to receive one of the two CPR techniques, according to emergency service dispatcher instructions. The second included observational cohort studies of chest compression-only CPR. The primary end-point was survival to hospital discharge.

The primary analysis shows improved chances for patients where instructions to bystanders from emergency medical services dispatch are for chest compression-only CPR (14 per cent versus 12 per cent, risk ratio 1.22).

In the secondary meta-analysis of observational cohort studies, no significant difference was found.

Paediatric mortality related to influenza A H1N1 infection
Lancet 2010; doi: 10.1016/SO140-6736(10)61195-6

Young people aged up to 18 have been disproportionately affected by pandemic influenza A H1N1. All paediatric deaths related to pandemic influenza A H1N1 from 26 June 2009 to 22 March 2010 in England were identified and studied. There were 70 paediatric deaths.

The childhood mortality rate was six per million. The rate was highest for children under one-year-old and was higher for Bangladeshi (47 per million) and Pakistani children (36 per million) than white British children (four per million).

A total of 64 per cent had severe pre-existing disorders, while 21 per cent were previously healthy. Twenty-seven per cent of deaths occurred before hospital admission and these were in patients who were typically healthy or had only minor pre-existing disorders. A total of 64 per cent had received oseltamivir.

Targeted immunisation is advised for children with severe pre-existing disease and for those belonging to certain ethnic minority groups.

Medical abortion at home
J Fam Plann Reprod Health Care 2010; 36: 213-6

With increasing numbers of abortions demanded and increasing pressure on NHS resources, this study set out to discover just how acceptable it was to women to go home to expel the pregnancy.

Based in Scotland, where the majority of abortions are performed by the NHS, a service was started that allowed women at up to 56 days' gestation to be discharged home soon after misoprostol administration.

One to two weeks after the procedure, the women were sent a questionnaire regarding acceptability for them to complete and return anonymously. A total of 145 were sent out with 69 per cent returned.

Women chose to go home in order to get home sooner (53 per cent) and to be in the privacy of their own home (47 per cent). Bleeding was either as expected or better than expected in 81 per cent of respondents and 58 per cent said the same about pain.

Clearly, this does not quite translate to all parts of the country because the provision model varies in different areas, but it is good to know that it meets with patient approval.

Reflect on this article and add notes to your CPD Organiser on MIMS Learning


These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Consider creating a protocol to manage inversion injuries to ankles including knowledge of the Ottawa rules for X-ray.
  • Check that a regular refresher of CPR skills has been run for all practice staff.
  • Consider conducting an audit for influenza immunisation uptake with reference to the under-18 'at-risk' groups.
  • Dr Holliday is a GP in Berkshire and a member of our team who regularly review the journals

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