BMJ  2003;327:E186-E187 (4 October), doi:10.1136/bmjusa.03020008 (published 26 March 2003)

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From BMJ USA 2003;Feb:111

This section calls attention to new studies and systematic reviews selected by the Editor from journals published just as this issue went into production (approximately 2 months before publication). Studies are noted that might directly influence clinical practice decisions in primary care. Journals hand-searched for the Journal rack are: American Journal of Medicine, American Journal of Preventive Medicine, Annals of Internal Medicine, Circulation, JAMA, Journal of Family Practice, Journal of General Internal Medicine, Journal of the American Board of Family Practice, JNCI, Lancet, New England Journal of Medicine, Obstetrics and Gynecology, Pediatrics

Cardiovascular—A meta-analysis of 61 prospective studies involving 12.7 million person-years confirms that the increased cardiovascular risk associated with elevated blood pressure begins with pressures as low as 115 mg Hg systolic and 75 mm Hg diastolic. The relative and absolute increase in risk resulting from a given rise in pressure varies depending on the baseline pressure, age, and other parameters. (Lewington and the Prospective Studies Collaboration. Lancet Dec 14, 2002;360:1903-1913.)

Cardiovascular—A randomized trial involving 33 357 patients with hypertension and at least one other risk factor for coronary heart disease found that chlorthalidone was as effective as amlodipine and lisinopril in preventing the 5-year incidence of fatal coronary heart disease and non-fatal myocardial infarction. The diuretic was more effective than the other agents with respect to selected cardiac outcomes. (The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA Dec 18, 2002;288:2981-2987.)

Cardiovascular—A randomized trial involving 10 355 patients age 55 and older with hypertension and moderate hypercholesterolemia (LDL=120-189 mg/dL) found that pravastatin (40 mg/d) did not affect all-cause mortality or coronary heart disease over a mean follow-up of 5 years. (The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA Dec 18, 2002;288:2998-3007.)

Cardiovascular—A randomized trial involving 2475 patients who visited the emergency department with chest pain or other symptoms suggestive of cardiac ischemia (with normal or non-diagnostic electrocardiography) found that among patients without acute cardiac ischemia, the usual evaluation resulted in higher hospitalization rates than when the results of perfusion imaging were also considered. (Udelson et al. JAMA Dec 4, 2002;288:2693-2700.)

Cardiovascular—A survey of 1578 physicians found that their clinical thresholds for initiating lipid-lowering therapy and antiplatelet therapy were more stringent for patients with coronary artery disease than for those with peripheral arterial disease. General internists and family physicians' thresholds were less stringent than those of cardiologists but more stringent than those of vascular surgeons. (McDermott et al. J Gen Intern Med Dec 2002;17:895-904.)

Geriatric—A survey of 213 terminally ill patients in Winnipeg, Canada found that those who reported a loss of dignity were significantly more likely to report psychological and symptom distress, heightened dependency needs, and loss of will to live. (Chochinov et al. Lancet Dec 21-28, 2002;360:2026-2030.)

Gynecologic—A 10-country randomized trial involving 4136 women requesting emergency contraception within 120 hours of coitus reported pregnancy rates of 1.5-1.8% in patients who received mifepristone (10 mg), single-dose levonorgestrel (1.5 mg), or two-dose levonorgestrel (0.75 mg 12 hours apart). (von Hertzen et al. Lancet Dec 7, 2002;360:1803-1810.)

Gynecologic—A British randomized trial involving 894 women with uncomplicated menorrhagia found that sending an information pack (booklet and videotape regarding treatment options) before the appointment did not influence treatment choices, but conducting an interview to elicit preferences before the appointment did lower hysterectomy rates and costs. (Kennedy et al. JAMA Dec 4, 2002;288:2701-2708.)

Infectious Diseases—A randomized trial involving 148 college students with the common cold found no benefit from unrefined Echinacea compared with placebo in terms of effect on the severity and duration of symptoms. (Barrett et al. Ann Intern Med Dec 17, 2002;137:939-946.)

Infectious Diseases—Findings from a decision analysis model suggest that detecting and treating latent tuberculosis is cost saving among immigrants to the United States from Mexico, Haiti, sub-Saharan Africa, South Asia, and developing nations in East Asia and the Pacific. (Khan et al. N Engl J Med Dec 5, 2002;347:1850-1859.)

Mental Health—A survey of 58 patients with panic disorder found that approximately half received medication, that only two thirds had achieved an adequate dose and duration, and that about 40% of those not taking medication had received a prescription. (Roy-Byrne et al. J Am Board Fam Pract Nov-Dec 2002;15:443-450.)

Oncologic—A systematic review of the literature conducted for the US Preventive Services Task Force found no direct evidence that screening for prostate cancer reduces mortality. The authors concluded that the presence or magnitude of benefits cannot be established. (Harris and Lohr. Ann Intern Med Dec 3, 2002;137:917-929.)

Otolaryngologic—A randomized trial involving 76 patients with a history of frequent sinusitis found that a 6-month regime of daily hypertonic saline irrigation significantly improved sinus-related quality of life and decreased symptoms and medication use. (Rabago et al. J Fam Pract Dec 2002;51:1049-1055.)

Pediatric—Analysis of data for 20 366 mother-infant pairs found that newborn health outcomes were unaffected by an early discharge policy for newborns or by the subsequent extension of hospital stays following passage of a state law guaranteeing 48-hour hospitalization. (Madden et al. N Engl J Med Dec 19, 2002;347:2031-2038.)

Pediatric—A British randomized trial involving 629 infants with screen-detected hip dysplasia found that ultrasound examination at age 2 weeks or older resulted in lower abduction splinting rates and no increase in adverse effects when compared with clinical assessment alone. (Elbourne et al. Lancet Dec 21-28, 2002;360:2009-2017.)

Pediatric—An investigation of an outbreak of varicella among 88 children at a New Hampshire day care center suggested that prior vaccination offered limited protection (44% for all cases, 86% for moderate-severe disease) and that protection waned when more than 3 years had elapsed since vaccination. (Galil et al. N Engl J Med Dec 12, 2002;347:1909-1915.)

Pediatric—A randomized trial involving 10 Kaiser Permanente pediatric clinics found that screening for Chlamydia trachomatis among sexually active adolescent girls increased significantly through a quality improvement program that included the engagement of leaders, teams to champion screening, monthly meetings to identify barriers and find solutions, and audits. (Shafer et al. JAMA Dec 11, 2002;288:2846-2852.)

Primary Care Practice—Two cohort studies, one involving 5308 patients at a San Francisco hospital and the other 6511 patients at a Chicago hospital, found that those cared for by hospitalists had, after adjustment, reduced mortality, lengths of stay, and/or costs of care, compared with those cared for by non-hospitalists. (Auerbach et al. Ann Intern Med Dec 3, 2002;137:859-865; Meltzer et al. Ann Intern Med Dec 3, 2002;137:866-874.)

Primary Care Practice—A restrospective study of 97 patients at a Denver hospital found that patients cared for by hospitalists had significantly higher mean costs and longer lengths of stay. (Smith et al. J Fam Pract Dec 2002;51:1021-1027.)

Pulmonary—A French prospective study of 1041 patients with suspected pulmonary embolism reported a low incidence (1.8%) of venous thromboembolism among patients who received no anticoagulation and had a negative spiral computed tomogram or ultrasound examination and a clinical assessment consistent with low or intermediate clinical probability. (Musset et al. Lancet Dec 14, 2002;360:1914-1920.)

Rheumatologic—A randomized trial in Hong Kong compared celecoxib with diclofenac plus omeprazole in 287 patients who had used non-steroidal anti-inflammatory drugs for arthritis, had presented with a bleeding ulcer that subsequently healed, and were Helicobacter pylori–negative. There was no difference between groups in the 6-month incidence of recurrent bleeding or of renal adverse events. (Chan et al. N Engl J Med Dec 26, 2002;347:2104-2110.)

Rheumatologic—A randomized trial of 244 postmenopausal women age 44-77 found that discontinuation of therapy resulted in greater bone loss in women treated with estrogen than in those treated with alendronate or combination therapy (alendronate plus estrogen). (Greenspan et al. Ann Intern Med Dec 3, 2002;137:875-883.)

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Misleading measurements of blood pressure among the elderly

ANIL K SAXENA, MD; MRCP (Dublin), et al.
bmj.com, 13 Jun 2003 [Full text]