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Sulphonylureas and the risk of adverse cardiovascular outcomes

24 Sep 2018Registered users

The use of sulphonylureas as a second-line substitution for metformin in type 2 diabetes is associated with increased rates of myocardial infarction (MI), all cause death and severe hypoglycaemia, a population-based cohort study has found. The study used data from the UK Clinical Practice Research Datalink (CPRD) to analyse a cohort of type 2 diabetes patients retrospectively. The CPRD contains medical records from more than 14 million patients registered at more than 680 general practices.

Labour induction vs expectant management in nulliparous women

24 Sep 2018Registered users

Induction at term significantly reduced the Caesarean section rate, compared with expectant management, in low-risk nulliparous women in a large multicentre trial from the US. However, it did not confer any benefits in terms of perinatal outcomes.

Length and quality of sleep may affect cardiovascular risk

24 Sep 2018Registered users

Sleeping for more than 8 hours a night was associated with an increased risk of mortality and poor quality sleep with an increased risk of coronary heart disease (CHD), a large meta-analysis has found.

Apathy associated with incident dementia in the elderly

24 Sep 2018Registered users

Apathy symptoms may identify older patients who are at increased risk of developing dementia, a Dutch prospective cohort study has found.

Improvement in glycaemic control in type 1 diabetes tails off after five years

25 Jul 2018Registered users

In patients with type 1 diabetes, clinically meaningful and sustained HbA1c improvement rarely occurs more than five years after diagnosis, a UK study has found.

Can nicotine preloading help smokers quit?

25 Jul 2018Registered users

The use of a nicotine patch before quitting may have a modest effect on abstinence, a large pragmatic randomised trial has found. A total of 1,792 adults were enrolled from Nottingham, Birmingham, Bristol, and London.

Raised resting heart rate associated with increased mortality risk

25 Jul 2018Registered users

A high resting heart rate and an increase in resting heart rate over a decade are associated with a greater risk of death from cancer and other causes as well as cardiovascular disease (CVD), a study from Australia has found.

Patients prescribed opioids for analgesia at risk of dependence

25 Jul 2018Registered users

A systematic review and meta-analysis has estimated that the incidence of iatrogenic opioid dependence or abuse in patients prescribed opioids for pain is almost 1 in 20.

Patients at risk of STIs not attending sexual health services

25 Jul 2018Registered users

More than 80% of women and nearly 90% of men who reported having unsafe sex in the past year did not consult sexual health services, findings from the third National Sexual Attitudes and Lifestyles (Natsal 3) study have shown.

Earlier onset of type 2 diabetes increases mortality risk

25 Jun 2018Registered users

Onset of type 2 diabetes at a younger age is associated with increased mortality, mainly from earlier death from cardiovascular disease (CVD), a study from Australia has found.

Active surveillance vs immediate treatment for CIN2

25 Jun 2018Registered users

Active surveillance may be a suitable option in selected, particularly younger, women with CIN2, a systematic review and meta-analysis has concluded.

Emollient bath additives of little benefit in childhood eczema

25 Jun 2018Registered users

A multicentre pragmatic randomised trial of the clinical effects of emollient bath additives (EBAs) in children with eczema has concluded that their benefits are at best limited.

Exploring the barriers to fitting IUCDs in primary care

25 Jun 2018Registered users

A general practice study has revealed a reluctance among GPs and practice nurses to fit intrauterine contraceptive devices (IUCDs). An online survey was sent to 69 practices in the south east of England and 208 individuals responded. More than two-thirds of the respondents were GPs and nearly a third were nurses. When asked about statements relating to potential barriers to providing or recommending IUCDs, respondents who were not trained to fit IUCDs were more likely to identify with more barriers than those who had been trained.

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.

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.'