Br J Gen Pract 2007; 57: 695-9
I found this paper reassuring. It examined the clinical features that manifest prior to the diagnosis of a brain tumour. To a large proportion of patients, a new headache means a brain tumour, but this has been shown emphatically not to be the case.
A new headache will only result in a brain tumour once in a 1,000 times. Even in addition to other symptoms, like confusion, it is still only a four-in-1,000 chance. These figures back up the recommendation that a headache in the absence of other symptoms should not routinely be investigated. The most highly predictive new symptoms are weakness, which gives a 3.0 per cent risk of tumour, and first seizure, which gives a 1.2 per cent risk of a tumour, against a background risk of 0.013 per cent. With only 4,500 new primary brain tumours a year and a new headache being unlikely to be a tumour, this paper should help GPs resist requests for referral.
Effect of smoking ban on pub finances
Am J Public Health 2007; 97: 1,400-2
Critics predicted that a ban of smoking in pubs would affect the pub's profitability. This study from the US, where the tobacco industry claimed that bar revenues were hit by 30 per cent by their ban, compared the market value of bars in parts of the US where there was a smoking ban with bars where smoking was permitted. They found that there was no significant difference in the valuations for bars in the two areas, strongly suggesting that revenue had been unaffected by the smoking ban.
HbA1c as a predictor for diabetes
Am J Med 2007; 120: 720-7
We are now comfortable with using HbA1c as our key tool for monitoring diabetic control. This study looked at the predictive value of HbA1c in middle age and older healthy non-diabetic women, followed up over 10 years. Results were stark. Even with HbA1c values at the upper end of normal there was a significant increase in the risk of diabetes. Compared with those with an HbA1c of under 5 per cent, those with a value of 5.0-5.4 per cent triple their risk of developing diabetes. Between 6.0-6.4 per cent it is increased 29 times. I think this presents a good argument for using HbA1c in targeting our primary prevention efforts.
Arch Intern Med 2007; 167: 1,593-9
It is known that some people have a recurrence of cardiovascular events despite being on aspirin, and that in the laboratory it is possible to detect persistent platelet reactivity in the presence of aspirin (aspirin resistance). This systemic review examined whether there was a clear correlation between laboratory aspirin resistance and recurrence of cardiovascular events. It found that patients with laboratory aspirin resistance were indeed at a higher risk of a recurrent cardiovascular event. Whether this can be used in a practical setting is not clear.
Peer estimation of smoking
Am J Public Health 2007; 97: 1,399-400
If you think lots of your peers smoke, especially if you are young, there is a greater temptation for you to smoke. Set in Canada (where the legal age for smoking is 19) researchers telephoned smokers and asked them to estimate how many of their peers smoked.
Overall, half of the respondents overestimated by 20 per cent, and in the under-25-year-olds it was 71 per cent. If smokers had a correct perception of smoking prevalence, they might be less tempted to take it up.
Dr Hunter is a GP in Bishop's Waltham, Hampshire, and a member of our team who regularly reviews the journals
The quick study
Headache is unlikely to result from brain tumour: first-seizure is the most highly predictive new symptom.
Smoking bans do not affect pub revenue and therefore this should not be considered a valid argument against imposing a ban.
HbA1c is a diabetes predictor and should be used to target primary prevention efforts.
Aspirin-resistant patients are at higher risk of recurrent cardiovascular events compared with patients who respond normally to aspirin.
Smokers overestimate what proportion of their peers also smoke, and this phenomenon is exaggerated in the young.
Research of the week
Telephone asthma clinics
Br J Gen Pract 2007; 57: 714-22
It's a funny old world. Patients with hypertension, a disease with no symptoms, turn up religiously for their reviews, yet those with asthma, a condition with the alarming symptom of difficulty breathing are dreadful at attending reviews.
Set in a large UK general practice, this study compared telephone reviews with face-to-face reviews in asthmatic patients. It increased the attendance rate from 53 per cent with face-to-face to 68 per cent with telephone consultations.
Telephone consultations also increased the patient's confidence in their management, and were cheaper. There was no difference in morbidity between the two groups.
I feel perhaps it is time to move out of our comfort zone and introduce this system.