BMI impact on BP therapy
THE type of antihypertensive treatment used may explain higher cardiovascular event rates in lean patients, according to new research published in The Lancet. In a randomised controlled trial funded by Novartis, 11 482 participants were grouped according to body mass index (BMI) — normal weight, overweight and obese — to assess the effect of BMI and different treatment regimens on cardiovascular deaths, non-fatal myocardial infarction and stroke. The researchers found those taking a combination of the Novartis angiotensin-converting enzyme (ACE) inhibitor benazepril and the diuretic hydrochlorothiazide who had normal BMI had significantly worse outcomes — a 68% higher event rate — than those with a high BMI. However, a combination of benazepril and the calcium channel blocker amlodipine was equally effective across all weight categories and, compared with the diuretic combination, significantly reduced heart-related events in normal weight (difference 43%) and overweight (24%) individuals. However, an accompanying commentary said thiazide diuretics were contraindicated in obesity because of their metabolic effects. “If the indication is hypertension, amlodipine-based treatment should be used irrespective of body size. Conversely, if the indication is prevention or treatment of left-ventricular dysfunction, a diuretic-based regimen should be used, again irrespective of body size”, the commentary said.

Risk for preterm babies persist
RESEARCH into the short-term outcomes of very preterm babies published in the BMJ shows that overall survival increased from 40% in 1995 to 53% in 2006 but the pattern of major neonatal morbidity and the proportion of babies affected did not change. The researchers examined admissions of babies born between 22 and 25 weeks’ gestation to neonatal units in England, with 666 admissions in 1995 and 1115 in 2006. The researchers said increased admissions, increased survival and unchanged rates of major adverse outcomes suggested that the while the total number of children surviving extremely preterm birth free from impairments would rise, so would the number with long-term health problems. “This represents an important increase in workload for health, educational, and social services”, they wrote. A second study in the same issue of the BMJ, which examined the neurological and developmental outcomes of children born at less than 27 weeks’ gestation, found that the high risk of serious impairment at age 3 years persisted in preterm babies and increased as gestation shortened, from 20% of survivors at 26 weeks’ gestation to 45% at 23 weeks.

Benefits with longer term tamoxifen
NEW research shows 10 years of adjuvant tamoxifen therapy can reduce breast cancer mortality during years 10–14 after diagnosis. The research, published in The Lancet, found recurrence of breast cancer and mortality during the second decade after diagnosis were reduced more effectively by 10 years of tamoxifen than by 5 years. Although the longer treatment increased side effects, the reduction in breast cancer deaths was greater than the increase in deaths from side effects. Based on the worldwide Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) trial of 12 894 women with early breast cancer who had completed 5 years of treatment with tamoxifen, women were randomly allocated to continue tamoxifen to 10 years or stop at 5 years. Among 6846 women with oestrogen receptor (ER)-positive disease, the longer term therapy reduced the risk of breast cancer recurrence (617 recurrences in 3428 women allocated to continue vs 711 in 3418 controls), reduced breast cancer mortality (331 vs 397 deaths), and reduced overall mortality (639 vs 722 deaths). “Longer follow-up of ATLAS (and a meta-analysis of all such trials) will be needed to assess the full benefits and hazards throughout the second decade”, the researchers wrote. An accompanying commentary said if other trials confirmed the study results, it would herald a change of practice.

Sleep protection
A RANDOMISED controlled trial of protected sleep periods for medical interns working overnight shifts in US hospitals has found it can improve alertness the next morning. The research, published in JAMA, was part of a themed issue on medical education. The 103 interns and senior medical students who took part in the trial at two hospitals were randomly assigned to either a standard intern schedule (extended-duty overnight shifts of up to 30 hours), or a protected sleep period between 12:30 am and 5:30 am. Participants wore wrist actigraphs and completed sleep diaries. The study found that the protected sleep period allowed interns about twice as many sleep durations of 3 hours or more as the non-intervention group. “Although there is evidence that obtaining sleep (relative to no sleep) during prolonged duty helps reduce fatigue and that the amount of fatigue reduction increases with the amount of sleep, from this study we do not have evidence that this is also associated with improvements in patient outcomes”, the researchers wrote.

Christmas error
IRISH anaesthetists have issued a timely warning about the hazards of Christmas decorations. In a short article published in Anaesthesia, the anaesthetists said a clinical technologist had been called when a problem developed in a blood gas analyser in the intensive care unit of their hospital. “Many years’ experience had furnished him with an encyclopaedic knowledge of all the kit’s and the staff’s foibles. Deft removal of tinsel (which was in contact with the analyser’s screen) restored it to full working order”, they wrote. The problem? The tinsel wrapped around the analyser was touching the screen, with the “multiple touching” interpreted as an error.

Posted 10 December 2012

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