News in brief

TWO women were so bereaved after watching the televised funeral of Australian cricketer Phillip Hughes that it increased their ambulatory blood pressure (BP), according to a short report published in the MJA. The researchers said neither woman was a relative of Hughes and neither had met him, but both had an emotional response to the funeral. A woman taking an angiotensin II receptor antagonist had an increase in systolic BP (25 mmHg) while sitting to watch the funeral comparable with her responses to physical activity. The second woman, whose antihypertensive therapy included β-blockade, had the same increase in systolic BP while sitting to watch the funeral, a rise comparable with that for people with mild hypertension receiving mental stressor tests, and might have been greater if she were not taking β-blockade. The researchers wrote that such increases in BP reflected overall changes in the cardiovascular system at the time of emotional stress and were associated with heightened cardiovascular risk. “We therefore need to be aware of the significant impact that media technology may have on our health and consider preventive treatment strategies”, they wrote.

 

REMOVING titanium rings has become a problem in the emergency department (ED), but doctors in the UK have found a solution. In a letter published in Emergency Medicine Journal, the doctors described the case of a woman who presented to their ED with a painful, swollen finger with a titanium wedding ring. Usual methods to remove the ring failed, so the fire service was called, but their specialised equipment was not successful. After hand elevation for 8 hours, further attempts to remove the ring blunted two manual ring cutters. Finally a pair of large bolt cutters obtained from the theatre was successful, with the ring pulled apart by lateral traction on a pair of large paper clips. The patient made an uneventful recovery. The authors wrote that titanium rings usually required specialist cutting equipment such as dental saws, drills or diamond tipped saws, which could take up to 15 minutes to divide the ring, can burn underlying skin, may require an assistant to provide irrigation and might not be available in all hospitals. “Our method used simple equipment that is readily available in most hospitals at all times, took <30 [seconds] to perform and could be performed by a sole operator without damage to the underlying finger”, they wrote.

 

ULTRASOUND has limited value for the management of an undescended testicle (UDT) in children and remains widely overused, with an increasing trend over time, a Canadian study has found. The population-based analysis, published in Pediatrics, included the health records of 101 278 boys aged 0‒18 years who were diagnosed with inguinal or scrotal pathologies, including UDT and closely related conditions. “Ultrasound was used in 33.5% of provincial referrals and 50% of institutional referrals. Children who underwent ultrasound experienced an approximate 3-month delay in definitive surgical management. Ultrasound correctly predicted physical examination findings in only 54% of patients”, the authors wrote. Doctors in community practice and those with fewer years in practice were more likely to order an ultrasound. The authors wrote that while ultrasound might appear to be a harmless investigation, it could delay access to timely corrective treatment, and could mislead referring physicians and specialists. “This weighty misallocation of resources could be channeled to children in need; it is also an area of potential cost savings at a time when health care budgets are under scrutiny”, the authors wrote. Educational strategies targeting referring physicians were crucial, including the dissemination of guidelines, mandatory continuing medical education credits, telemedicine journal clubs, online “ask-the-expert” sessions and targeted efforts in medical school. “With the variety of communication and social media technologies available today, there is no better time to initiate a lasting change in practice”, the authors wrote.

 

US researchers have created a scoring system to stratify the risk for advanced colorectal neoplasia in adults, saying it will help decision making on colorectal cancer screening options for those considered to be at average risk. The system was based on a cross-sectional study, published in the Annals of Internal Medicine, which included 2993 people aged 50‒80 years, with a 9.4% prevalence of advanced neoplasia. The most common risk factors for colorectal neoplasia were used to identify lower-risk groups where non-colonoscopy screening strategies may be effective and efficient, and a higher-risk group where colonoscopy screening may be preferred. The researchers identified four risk groups, with risk for advanced neoplasia ranging from less than 2% among those with very low risk to 22%‒25% among those at high risk. They wrote that the model could be used to tailor screening on the basis of risk for advanced neoplasia. “Persons at very low or low risk could be screened effectively and efficiently with strategies other than colonoscopy, including sigmoidoscopy every 5 years, fecal immunochemical testing annually, both strategies combined, or another less invasive strategy”, they wrote. For those at high risk, screening with colonoscopy seemed to be warranted, while those at intermediate risk could continue to choose from the available tests. “Such risk-based tailored screening has the potential to increase the uptake and efficiency of colorectal cancer screening”, the researchers wrote. An accompanying editorial said the research demonstrated the use of simple clinical information for prediction of colorectal neoplasia risk. However, the editorial author wrote that until high-performing tools were available, “the best approach to optimize screening is to provide patients the best test they are willing and able to complete with high fidelity”.

 

BURNS and infection are the most common indications for surgical intervention in young children in conflict zones and humanitarian settings, according to a retrospective study by Médecins Sans Frontières (MSF). The research, published in JAMA Surgery, was based on paediatric surgical cases carried out in 2012‒2013 by the MSF Operational Centre Paris program in 20 locations, including South Sudan, Yemen, Syria, Gaza, Pakistan, Nigeria and the Philippines. Operative indications, type of intervention and mortality were determined for each procedure. Among all age groups, 59 928 surgical interventions were performed in dedicated trauma, obstetric and reconstructive centres. Of these, 30.1% involved preteen patients (< 13 years) and 7.6% involved teenagers (13–17 years). The authors found that the proportion of violence-related injuries in the preteen group was significantly lower than in the teenage group. Burns, other accidental injuries and infections accounted for 50.1%, 16.4% and 23.4%, respectively, of cases in the preteen group. Interventions in the teenage group were principally caused by trauma-related injuries, including burns, traffic accidents and gunshot wounds. The authors found that crude perioperative case mortality rates were 0.07% in the preteen group, 0.15% in the teenage group, and 0.22% in the adult group (> 17 years). One third of cases were deemed urgent, with most of the remaining cases deemed semi-elective interventions. The authors concluded that their results highlighted that trauma and infection should be a focus when training surgeons to provide care in resource-poor and otherwise austere settings. “Further work is necessary to better delineate the nonemergency surgical needs in the humanitarian sphere and to assess long-term outcomes of surgical cases to judge efficacy of surgical intervention programs”, they wrote.

 

SATURATED fats are not associated with all-cause mortality, cardiovascular disease, ischaemic stroke or type 2 diabetes, according to a systematic review published in The BMJ. The authors analysed the results of observational studies from several countries on the relationship between saturated fats and/or trans fats and health outcomes in adults. Study design and quality were taken into account to minimise bias, and the certainty of associations were assessed using a recognised scoring method. The authors found no association between a higher intake of saturated fats and all-cause mortality, total coronary heart disease (CHD), cardiovascular disease mortality, ischaemic stroke or type 2 diabetes. However, there was no convincing lack of association between saturated fats and CHD mortality. The authors found the certainty of the associations between saturated fat and all outcomes to be very low. Total trans fat intake was associated with all-cause mortality, CHD mortality and total CHD. However, no association was found between trans fat and ischaemic stroke or type 2 diabetes. Industrial, but not ruminant, trans fats were associated with CHD mortality and total CHD. The certainty of the associations of trans fat with CHD outcomes was moderate, and low or very low for other associations. The authors wrote that their results highlighted the need for dietary guidelines that carefully considered the health effects of recommendations for alternative macronutrients to replace trans fats and saturated fats. “Development of reliable and valid methods of assessing fatty acid intakes in large longitudinal cohort studies with sufficient follow-up to observe clinical events and deaths must remain a priority to improve the quality of the evidence on which dietary advice is based”, the authors wrote. 

 

RESEARCH to assess the diagnostic and prognostic value of a panel of cerebrospinal fluid (CSF) biomarkers in patients with idiopathic parkinsonism has found early analysis of CSF biomarkers can aid in the diagnosis of parkinsonian disorders and may enhance prediction of Parkinson disease in dementia (PDD). The population-based, prospective cohort study, published in JAMA Neurology, included 128 non-demented patients with new-onset parkinsonism (104 with PD, 11 with multiple system atrophy, and 13 with progressive supranuclear palsy) who were followed up for 5‒9 years. CSF from 30 healthy control participants obtained at baseline was used for comparison. The researchers found the 104 patients with early PD had a different CSF pattern to those with progressive supranuclear palsy and the controls. In PD, high neurofilament light (NFL) chain protein, low Aβ1-42, and high heart fatty acid-binding protein (HFABP) at baseline were related to future PDD. Combined, the early biomarkers predicted PDD with high accuracy after adjusting for possible confounders. The researchers wrote that although additional, confirmatory studies were needed, “the diagnostic accuracy of high NFL, low Aβ1-42, and high HFABP (with 90% sensitivity and 71% specificity for PDD) is likely sufficiently high to be clinically useful”. “Changes in these biomarkers, even at the time of the diagnosis of PD, may alert physicians to a patient’s risk of developing dementia”, they wrote.

 

AN updated version of the Good Publication Practice guideline (GPP3) for communicating company-sponsored medical research expands guidance on authorship criteria and common authorship issues, improves clarity on appropriate author payment and reimbursement, and expands information on the role of medical writers. The update, published in Annals of Internal Medicine, was based on comments gathered from members of the International Society for Medical Publication Professionals (ISMPP), professionals invited to review GPP2, and a distribution list from the Medical Publishing Insights and Practices initiative that included investigators, researchers and journal editors. The development of the GPP3 guideline was initiated and sponsored by ISMPP. The authors wrote that they recognised that “to be effective, guidelines must be evidence based, well-understood, and widely followed”. They said this required active research, promotion, education and monitoring. “Awareness and knowledge of publication guidelines are generally high among publication professionals, especially those working in biopharmaceutical and medical communication companies … However, work is needed to ensure that good practice is followed in all sectors and all world regions. We encourage journals, congresses, and academic institutions to endorse GPP3 and help disseminate it throughout the research community”, they wrote.