Dementia risk from benzodiazepines
A LARGE prospective population-based study published in the BMJ has shown that new use of benzodiazepines is associated with a large increased risk of dementia. The French study included 1063 people aged 65 years and over who did not have dementia and did not start taking benzodiazepines until at least 3 years into the 15-year study. Results showed those who used benzodiazepines had a 50% increased risk of dementia compared to those who had never used them. “Considering the extent to which benzodiazepines are now prescribed, physicians and regulatory agencies should consider the increasing evidence of the potential adverse effects of this drug class for the general population”, the researchers said.

Brief counselling reduces drinking
ADULTS with risky or hazardous drinking habits benefit from behavioural counselling interventions, particularly brief, multi-contact sessions, according to a systematic review published in Annals of Internal Medicine. The review of 23 controlled trials found that, among adults who received behavioural interventions, consumption fell by 3.6 drinks a week from baseline, 12% fewer reported heavy drinking episodes and 11% reported drinking less over 12 months compared to control participants. The best evidence was for brief, 10–15-minute sessions on a multi-contact basis.

Go with your gut
A DOCTOR’S gut feeling is an important diagnostic sign and should not be ignored in decision making, particularly with children, according to research published in the BMJ. The researchers followed 3369 children and young people presenting in primary care who were assessed clinically as having a non-severe illness. Six children were subsequently admitted to hospital with a serious infection. Intuition by the initial clinician that something was wrong despite the clinical assessment substantially increased the risk of subsequent admission for a serious illness, and acting on this gut feeling had the potential to prevent two of the six cases being missed. The strongest contextual factor was the parents’ concern that the illness was different from previous experience. However, the study authors said the referral of “all children for whom an inexperienced clinician in primary care has a gut feeling that something is wrong has the potential to result in large numbers of unnecessary visits to the emergency department”.

Tonsillectomy bleeding reassurance
A STUDY designed to definitively resolve the question of whether dexamethasone — commonly given to children undergoing tonsillectomy to reduce postoperative nausea and vomiting — causes postoperative bleeding, has found it is not associated with more level II and III bleeding events compared with placebo. The prospective, randomised study of 314 children aged 3 to 18 years undergoing tonsillectomy, published in JAMA, involved giving the children a single preoperative dose of either 0.5 mg/kg of dexamethasone (maximum dose 20 mg) or saline placebo. Level II and III postoperative bleeding events were used as a reliable indicator for complications because they are documented by treating physicians, in contrast to level I bleeding events, which are self-reported.

Politics needs more science
A US congressman has called on politicians to think more like scientists. “This is not without precedent — not all legislators hold law degrees, but all must be comfortable thinking like lawyers when drafting a bill or reading a statute”, Rush Holt, a congress member who previously taught and researched topics such as solar spectroscopy and plasma physics, wrote in Nature. He said scientists needed to be clear thinkers and to have an appreciation of evidence, and be more alert to cognitive biases. His solution was to elect more scientists to public office — or provide resources to help legislators apply a more rigorous, analytical and far-sighted approach to the political process.

Posted 2 October 2012

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