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Smoking duration the best indicator of COPD progression

22 May 2018Registered users

The number of years that an individual has been smoking is closely linked to the degree of structural lung disease, airflow obstruction and functional outcomes in chronic obstructive pulmonary disease (COPD). It is a better measure than pack-years or the number of cigarettes smoked per day, a large study from the USA has shown.

Patients with heart failure not being diagnosed in primary care

22 May 2018Paid-up subscribers

Only a quarter of patients with symptoms suggestive of heart failure are investigated and referred by GPs in accordance with NICE guidelines, a UK study has shown. Nearly 80% of heart failure patients were diagnosed in hospital. The investigators, from Imperial College, London, extracted data on patients diagnosed with heart failure between 1 January 2010 and 31 March 2013, using the Clinical Practice Research Datalink. This database contains electronic records from 7% of general practices in England.

C-peptide testing can identify risk of hypoglycaemia in insulin-treated type 2 diabetes

22 May 2018Paid-up subscribers

Low levels of C-peptide were associated with greater glucose variability and hypoglycaemia in type 2 diabetes patients on insulin,a UK study has found.

Composition of vaginal microbiota may increase risk of chlamydia infection

22 May 2018Paid-up subscribers

 Lactobacillus iners-dominated vaginal microbiota was associated with increased susceptibility to Chlamydia trachomatis infection in women, in a Dutch nested case-control study.

Temporary quadrupling of inhaled steroids can reduce severe asthma exacerbations

23 Apr 2018Registered users

A temporary four-fold increase in inhaled steroids for deteriorating asthma control reduced the incidence of severe exacerbations, in a UK study.

Exercise in middle age may reduce risk of heart failure

23 Apr 2018Registered users

Two years of high intensity exercise training, in previously sedentary healthy middle-aged adults, improved maximal oxygen uptake (VO2max) and reduced left ventricular (LV) stiffness, in a study from the United States. The investigators conclude that regular exercise training may protect against the future risk of heart failure with a preserved ejection fraction (HFpEF) by preventing the increase in cardiac stiffness caused by sedentary aging.

Marked regional variations identified in primary care opioid prescribing

23 Apr 2018Registered users

Opioid prescribing rates are increasing and show notable geographical variations across England. They are highest in the North and in areas of social deprivation, a study on primary care prescribing has shown. Virtually all the low prescribing areas were in the south of England and nine of the ten highest prescribing areas were northern clinical commissioning groups (CCGs).

Bicarbonate for dystocia improves maternal and fetal outcomes

23 Apr 2018Registered users

Administering a drink of sodium bicarbonate dissolved in water to women with dystocia an hour before oxytocin treatment resulted in better outcomes for both mother and child, compared with standard oxytocin treatment alone, a small trial from Sweden has found.

Quitting smoking improves survival in patients with lung cancer

22 Mar 2018Registered users

Patients with lung cancer who stop smoking have lower all cause mortality rates compared with those who continue to smoke, a UK retrospective cohort study has found.

Comparing cardiovascular outcomes in different diabetes drug classes

22 Mar 2018Registered users

Canagliflozin was associated with a lower risk of heart failure admissions compared with other classes of diabetes drugs, in a population-based retrospective cohort study from the United States.

Women with endometriosis at raised risk of ovarian cancer

22 Mar 2018Registered users

The risk of ovarian cancer is increased in women with endometriosis, a large cohort study from Scotland has shown. The study also found that women with endometriosis are likely to undergo more surgical procedures compared with women who do not have the condition.

Postnatal depression may have adverse effects on offspring

22 Mar 2018Registered users

The children of women with severe persistent postnatal depression (PND) are at substantially increased risk of preschool behaviour problems, poor academic attainment and adolescent depression, a UK longitudinal cohort study has found.

Anticoagulants underused in older heart failure patients with AF

27 Feb 2018Registered users

Overestimation of risk of bleeding leads to underuse of oral anticoagulants in frail elderly heart failure patients with atrial fibrillation (AF) despite their increased risk of stroke, a study in Heart has concluded.

Poor glycaemic control associated with accelerated cognitive decline

27 Feb 2018Registered users

Rates of cognitive decline were greater in patients with diabetes and prediabetes compared with those who were normoglycaemic, in the English Longitudinal Study of Ageing (ELSA).

Maternal sleeping position may raise the risk of late stillbirth

22 Feb 2018Registered users

Pregnant women who went to sleep in a supine position had a two-fold increased risk of late stillbirth, a UK study has shown.

Assessing suicide and self-harm risk in adolescents

22 Feb 2018Registered users

The incidence of suicide in adolescent boys is more than twice that among adolescent girls, whereas non-fatal self-harm is much more common in girls than boys, an English retrospective database study has found.

Self-taken swabs can detect bacterial vaginosis and candidiasis

23 Jan 2018Registered users

Lower vaginal swabs taken by patients are as reliable as high vaginal swabs taken by clinicians for the detection of vulvovaginal candidiasis or bacterial vaginosis, a UK study has shown.

Breathing self-management programme improves quality of life in asthma

23 Jan 2018

A breathing retraining exercise programme, incorporating a training DVD and accompanying booklet, achieved similar improvements in quality of life scores as conventional face to face training in patients with asthma, in a UK study.

Triple antiplatelet therapy no better than standard regimens after ischaemic stroke

23 Jan 2018Registered users

Intensive antiplatelet therapy with three agents did not reduce the incidence and severity of recurrent stroke or transient ischaemic attack (TIA) but did significantly increase the risk of major bleeding in the TARDIS study.

Benzodiazepines and Z-drugs are being widely used long term

23 Jan 2018Registered users

A UK primary care survey has found that many patients are taking benzodiazepines or Z-drugs, recommended for short-term use, for at least a year.

Referral to a commercial type 2 diabetes prevention programme can stop progression to diabetes

20 Dec 2017Paid-up subscribers

Patients with non-diabetic hyperglycaemia referred by their GP to a Weight Watchers diabetes prevention programme had a significantly reduced risk of developing diabetes, a UK study has found.

Position during second stage of labour may influence spontaneous vaginal delivery rates

20 Dec 2017Paid-up subscribers

Nulliparous women, undergoing epidural analgesia, who adopted a lying down position were more likely to achieve a spontaneous vaginal delivery than those in an upright position during the second stage of labour, a UK study has found.

Are differing emotional responses to alcohol associated with choice of drink?

20 Dec 2017Paid-up subscribers

Emotional responses to drinking appear to vary according to the type of drink imbibed and differ between men and women, an analysis of data from the Global Drug Survey (GDS) has found.

Heavy drinking and smoking associated with visible signs of ageing

20 Dec 2017Paid-up subscribers

The risk of developing age-related visible signs, such as arcus cornea and earlobe crease, was higher in smokers and heavy drinkers in a prospective study from Denmark.

Dyspareunia in women associated with physical and mental health conditions

23 Nov 2017Paid-up subscribers

The third National Survey of Sexual Attitudes and Lifestyles in Britain (Natsal-3) has found a strong association between women reporting painful sex and poor physical health and depressive symptoms.

Depression not associated with poor glycaemic control in new diabetes cases

23 Nov 2017Paid-up subscribers

Neither depression nor diabetes distress appear to be related to glycaemic control in newly diagnosed patients with type 2 diabetes, the results of a UK prospective cohort study suggest. However, depressive symptoms at diabetes diagnosis were associated with a higher risk of macrovascular complications, notably myocardial infarction (MI) at two years’ follow-up.

Mortality risk raised during induction with methadone in opioid substitution therapy

23 Nov 2017Paid-up subscribers

Patients undergoing opioid substitution treatment have an increased mortality risk during the induction phase with methadone but not with buprenorphine, a meta-analysis has found. Mortality risk is also raised in the period immediately after leaving treatment with both drugs.

Exercise can prevent depression

23 Nov 2017Paid-up subscribers

If healthy adults exercise for a minimum of an hour each week, their risk of incident depression can be reduced by 12%, a Norwegian prospective cohort study has found. 

Depression in midlife does not raise risk of dementia

23 Oct 2017Registered users

Depression may be a prodromal feature of, rather than a risk factor for, dementia, a UK prospective cohort study has found. A total of 10,308 participants (6,895 men) in the Whitehall ll study, aged 35-55 at recruitment, were followed up between 1985 and 2015. 

Homelessness is an independent risk factor for mortality

01 Jun 2009Registered users

Although the higher mortality risk associated with homelessness can partly be explained by an increased prevalence of morbidity, homelessness itself confers an additional risk, a retrospective cohort study has shown. 'In this study, homelessness itself has been shown to be an independent risk factor for the high mortality seen in this group. In addition to interventions addressing morbidity in homeless people, intensive targeted social interventions directed to homelessness itself may be needed to lower mortality in this highly disadvantaged social group.'

Stroke risk similar in paroxysmal and sustained AF

23 Jan 2008Registered users

Current guidelines advise treating paroxysmal AF in the same way as sustained AF but the evidence is weak, with only one retrospective analysis comparing the risk of stroke in patients with paroxysmal AF vs chronic AF (analysis of the SPAF trials, performed 15 years ago and limited to patients treated with aspirin). The ACTIVE W trial showed that warfarin is more effective than aspirin plus clopidogrel for the prevention of vascular events (stroke, embolism, MI and vascular death) in patients with AF. A recent substudy of this trial looked at the risk of stroke in 1,202 patients with paroxysmal AF compared with 5,495 with sustained AF, and the effectiveness of thromboprophylaxis in these patients. ' This substudy has shown that the risk of stroke is similar, irrespective of whether AF is paroxysmal or sustained, and that anticoagulation therapy is equally effective in both groups. Other factors, such as age and cardiovascular comorbidity, remain central to the ultimate choice of thromboprophylaxis in these patients.'