Reviews

This article originally appeared in BMJ USA

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). The 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, and Pediatrics. Studies are noted that might directly influence clinical practice decisions in primary care and have been classified by type of problem addressed.

CardiovascularSixteen-year follow-up data from the Nurses' Health Study affirm an association between high consumption of fish and omega-3 fatty acids and reduced risk of coronary heart disease (Hu et al. JAMA 2002 April 10;287:1815-1821).

CardiovascularA New Zealand randomized trial involving 223 postmenopausal women found that calcium supplementation was associated with an increased HDL concentration (mean 0.09 mmol/L) (Reid et al. Am J Med 2002 April 1;112:343-347).

CardiovascularA meta-analysis of 54 randomized trials concluded that aerobic exercise reduces systolic and diastolic blood pressure (mean of 3.8 mm Hg and 2.6 mm Hg, respectively) in both hypertensive and normotensive persons, and that aerobic activity should be a routine component of prevention and treatment plans for hypertension (Whelton et al. Ann Intern Med 2002 April 2;136:493-503).

CardiovascularEight-year follow-up data on 7680 patients enrolled in the LIPID trial reaffirmed that pravastatin reduces all-cause mortality, coronary heart disease death, myocardial infarction, and stroke in patients with previous acute coronary syndromes and average cholesterol concentrations (The LIPID Study Group. (Lancet 2002 April 20;359:1379-1387).

CardiovascularA British randomized trial involving 5126 patients with stable angina found that nicorandil achieved a 2% reduction in the combined incidence of fatal or nonfatal myocardial infarction or unplanned hospital admission, a 17% relative risk reduction (IONA Study Group. Lancet 2002 April 13;359:1269-1275).

CardiovascularMedicare data for 2.5 million cardiovascular and cancer operations revealed mortality rates that were 0.2-12% higher in low-volume hospitals, depending on the procedure (Birkmeyer et al. N Engl J Med 2002 April 11;346:1128-1137).

EndocrineA cohort study of 2903 residents of San Antonio found that the likelihood of developing type 2 diabetes within 7.5 years was less reliably predicted by a 2-hour glucose tolerance test than by a clinical prediction model that relies on age, gender, ethnicity, fasting glucose level, systolic blood pressure, HDL, body mass index, and parental or sibling history of diabetes (Stern et al. Ann Intern Med 2002 April 16;136:575-581).

EndocrineA cohort study involving 3157 young adults reported that dairy consumption was inversely associated with the risk of developing insulin resistance (Pereira et al. JAMA 2002 April 24;287:2081-2089).

GeriatricA British survey of 32 656 adults  age 75 found that more than half the people who failed a whispered voice test did not own a hearing aid, 60% of those who owned a hearing aid said that they used it regularly, and 46% of those wearing a hearing aid at the time of testing failed the test (Smeeth et al. Lancet 2002 April 27;359:1466-1470).

GeriatricA survey of 226 older adults with limited life expectancy demonstrated that preferences for treatments depended on what they were told about burden of treatment, possible outcomes, and their likelihood, and that all three variables must be addressed in determining patients' preferences. Although 99% would pursue a low-burden treatment that restored their health, 11% of these individuals would decline treatment if they were told it posed a high burden (Fried et al. N Engl J Med 2002 April 4;346:1061-1066).

Infectious DiseasesA Belgian randomized trial involving 416 patients with upper respiratory complaints and purulent rhinorrhea found that 10 days of amoxicillin shortened the duration of purulent rhinorrhea (9 vs 14 days) but did not alter the patients' chief complaints or duration of general illness or pain (De Sutter et al. J Fam Pract 2002 April;51:317-323).

Infectious DiseasesA New Zealand randomized trial involving 129 patients with the common cold found that giving a delayed prescription for antibiotics (instructions to fill the prescription after 3 days without improvement) resulted in less antibiotic use, lower body temperature, and no difference in symptom score compared to prescribing antibiotics immediately (Arroll et al. J Fam Pract 2002 April;51:324-328).

Infectious DiseasesA Dutch randomized trial involving 196 patients with lower respiratory tract infection found that roxithromycin cured patients no better than amoxicillin (Hopstaken et al. J Fam Pract 2002 April;51:329-336).

Mental HealthA cohort study of 1336 adults found to have depression when screened in the waiting rooms of primary care physicians found on follow-up that 23% had been referred to mental health specialists, 38% saw a mental health specialist with or without a referral, and managed care was not associated with poorer outcomes or lower likelihood of being referred to or seen by a mental health specialist (Grembowski et al. J Gen Intern Med 2002 April;17:258-269).

Mental HealthA randomized trial involving 340 adults with major depression found that over 8 weeks of therapy neither St John's wort nor sertraline was more effective than placebo (Hypericum Depression Trial Study Group. JAMA 2002 April 10;287:1807-1814).

NeurologicAn international randomized trial involving 592 patients with cerebrovascular disease combined with suspected vascular dementia or Alzheimer's disease found that galantamine improved cognition, activities of daily living, and behavioral symptoms over 6 months of follow-up (Erkinjuntti et al. Lancet 2002 April 13;359:1283-1290).

OncologicA British trial reported preliminary results of performing flexible sigmoidoscopy screening once at age 60 on 40 674 subjects. Colonoscopy was recommended for 5%, and sigmoidoscopy on the remainder found no polyps (or low-risk polyps) in 95%, distal neoplasms in 12%, and proximal neoplasms in 1%. There was one perforation from sigmoidoscopy and four from colonoscopy (UK Flexible Sigmoidoscopy Screening Trial Investigators. Lancet 2002 April 13;359:1291-1300).

OncologicA case-control study of 1913 couples found that circumcised men were less likely to have penile HPV infection, and monogamous women whose male partner had > 6 sexual partners were less likely to develop cervical cancer if the partner was circumcised (Castellsagué et al. N Engl J Med 2002 April 11;346:1105-1112).

OncologicAn analysis of unfavorable breast cancer treatment and outcomes among African-American women in Detroit found that, after adjustment, the association had more to do with socioeconomic status than with race (Bradley et al. J Natl Cancer Inst 2002 April 3;94:490-496).

PediatricTwo nonrandomized screening studies, one in Quebec involving 476 654 children and one in Germany involving 1.5 million children, found that screening for neuroblastoma was not associated with decreased mortality (Woods et al. N Engl J Med 2002 April 4;346:1041-1046; Schilling et al. N Engl J Med 2002 April 4;346:1047-1053)

UrologicMedicare data on 11 522 patients who underwent radical prostatectomy revealed that postoperative morbidity was higher (32% vs 27%) when performed by low-volume hospitals (approximately 1-16 patients/year) or low-volume surgeons (approximately 1-4 patients/year). The long-term incontinence rate was 18-19% and varied substantially surgeon-by-surgeon but not by volume (Begg et al. N Engl J Med 2002 April 11;346:1138-1144).