Journals Watch - Trochanteric bursitis and obesity

Not had time to read the latest research? Dr Jonathan Holliday brings you up to date with the journals.

Steroid treatment of GTPS was shown to be just as effective as no intervention at 12-month follow-up (Photograph: SPL)
Steroid treatment of GTPS was shown to be just as effective as no intervention at 12-month follow-up (Photograph: SPL)

Steroid injections for greater trochanteric pain syndrome Ann Fam Med 2011; 9: 226-34
The effect of steroid injection for greater trochanteric pain syndrome (GTPS) was compared with standard expectant care by the department of general practice at Rotterdam University; 120 people attending one of 81 GPs were randomly allocated to treatment or control groups. Primary outcomes of pain severity and recovery were evaluated at three and 12 months. Adverse events were documented at six weeks.

At three months 34 per cent of the expectant group had recovered compared with 55 per cent of the injection group. Pain severity at rest had reduced in both groups, but more so in the intervention group.

At 12 months, 60 per cent of the expectant group had recovered compared with 61 per cent of the injection group. Pain severity at rest had again reduced in both groups but at this point there was no difference between the two groups.

Surgical treatment of stress urinary incontinence Am J Obstet Gynecol 2011; 204(5): 444.e1-444.e6
This study from the Mayo clinic used patient satisfaction as the measure of success following surgical treatment for stress urinary incontinence.

A total of 371 women were assessed following surgery; 76 per cent were treated with a polypropylene midurethral sling (MUS) and 24 per cent underwent surgery with autologous rectus fascial sling (ARFS). Some also had concomitant surgery such as hysterectomy (43 per cent of the MUS group and 12 per cent of the ARFS group).

Results showed that 65 per cent of the MUS group were 'completely satisfied' compared with 48 per cent of the ARFS group. Predictive factors for unfavourable outcome included increasing age, previous pelvic surgery, increased BMI and severe prolapse.

The authors concluded that the overall satisfaction rate of 61 per cent was 'modest' and that patients should be warned of this and of the possibility of persistent symptoms requiring further treatment.

School-based obesity prevention programme BMJ Open 2011; doi:10.11 36/bmjopen-2010-000026
This was a three-phase pilot study involving 398 children spread over six schools in southwest England. We know from the Health Survey for England (2008) that 19 per cent of girls and 18 per cent of boys are obese, with 34 per cent of boys and girls overweight or obese.

The third phase of the Healthy Lifestyle Programme (HeLP) project involved 204 children in four schools.

Baseline physical measurements were taken and TV/screen-based activity was assessed prior to randomisation into two intervention schools and two control schools.

The intervention involved assemblies, rugby and dance workshops, parents' evenings, drama workshops and one-on-one goal setting. With so much effort and commitment it was a relief to know that the children enjoyed and engaged with the project.

In the control group, the number of overweight or obese children increased from 26 per cent to 32 per cent at 18 months and remained at 32 per cent at 24 months.

The intervention group remained static at 24 per cent at 18 months and fell to 22 per cent at 24 months.

The question remains whether these findings will result in programmes being incorporated into schools' curriculum.

Parents' view on confidentiality with adolescents J Adolesc Health 2011; doi:10.10 16/j.jadohealth 2011.02.006
If confidential healthcare is provided to adolescents they are more likely to seek care, disclose sensitive information and return for future visits. We are advised to see adolescents on their own in order to facilitate confidential care. This study sought to document parental views of confidentiality in adolescents.

While parents identified several benefits to confidential care, they believed that they should be informed about a wide range of topics, even if their child did not want them to know.

Their views were described as 'complex and conflicting' and it underlined the need for professionals working with adolescents to ensure that parents understand the limits of confidentiality.

Rate of titration of antihypertensive medication Heart 2011; doi:10.1136/hrt.2010.221473
The aim of this systematic review carried out by the department of primary health care at the University of Oxford was to model BP response after initiating antihypertensive medication.

The researchers included 18 trials (4,168 patients) that had initiated antihypertensive medication in hypertensive patients who were either drug naive or had a placebo washout from previous drugs. Office BP measurements were taken at a minimum of two-weekly intervals for a minimum of four weeks.

It was estimated from these data that the time to reach 50 per cent of maximum BP lowering effect was one week and so estimates of maximum efficacy can be made early after starting therapy, perhaps sooner than most of us do.

The effect of aqueous cream on skin Br J Dermatol 2011; doi:10.1111/j. 1365-2133.2011.10338.x
This study set out to quantify and document the damage that Aqueous Cream BP does to skin. The researchers took the forearms of six healthy females and applied the cream twice daily for 28 days.

At the end of this time the skin was tape-stripped and various tests, including corneocyte maturity and size, protease activity levels and transepidermal water loss,were estimated. They found treatment with Aqueous Cream BP was associated with increased inflammatory and desquamatory protease activity.

Although Aqueous Cream BP is still considered a treatment for eczema and dry skin, this study shows that both inflammation and skin barrier function are worse with chronic use of Aqueous Cream BP.

  • Dr Holliday is a GP in Berkshire and a member of our team who regularly review the journals

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

  • Review your practice protocol on the management of greater trochanteric pain syndrome.
  • Design a poster for your waiting room highlighting the dangers of obesity in childhood.
  • Audit the number of patients in your practice who are using Aqueous Cream BP as a treatment for eczema and dry skin, and hold a practice meeting to discuss whether their treatment should be changed.

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