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969 Maybe if UK hospitals had electronic records equal to ours in general practice, they could cut their rates of venous thromboembolism by 40%. This happened in an US trial of a computer alert for identifying high-risk surgical patients.
1061 Here is the study that proved celecoxib was not a safe alternative to rofecoxib. Both drugs were tried out for the prevention of colorectal adenoma, but both trials were stopped early because of an increased rate of cardiovascular morbidity and mortality – rofecoxib being the more dangerous (see page 1092).
1112 Serotonin reuptake inhibitors are relatively safe drugs on their own, but beware of combining them with other drugs such as synthetic opioids (e.g. tramadol), tricyclics, sumatriptan, valproate and St John's wort. The resulting serotonin syndrome is nasty and occasionally fatal.
1179 Expect more of your post-myocardial infarction patients to be taking clopidogrel as well as aspirin, following this trial showing improved outcomes after thrombolysis.
1206 The wee small hours are a low-risk time for myocardial infarction, unless you have obstructive sleep apnoea, in which case your risk increases threefold. This is reduced by continuous positive pressure ventilation (see Lancet page 1046).
1293 Gender protects women from cardiac events, but aspirin does not. It does, however, reduce their risk of stroke.
947 Confused by the drug treatment of Parkinson's disease? Here's a nice simple add-on drug for motor fluctuations — rasagiline — one daily at fixed dose. There's a handy guide to these drugs on page 914.
1159 A big trawl through all randomised controlled trials published in December 2000 finds that standards of reporting have hardly improved over 20 years.
1246 Sexual intercourse is a subject of interest to most teenagers, many of whom give it a try before 16 – especially if they are from an Afro–Caribbean background, less so if Asian. Similar patterns apply to the number of partners and sexually transmitted diseases in later life.
1223 Computerised clinical support systems succeed in getting doctors to follow rules, according to this big systematic review, but 52 trials fail to prove any benefit in patient outcomes.
1245 Will MRI replace mammography for population screening? Not likely, as it costs 10 times as much for lower specificity.
1329 In clinical trials, immediate invasive treatment provides the best outcomes in myocardial infarction, but this study shows that in real-life America, there is no difference in 7-year outcomes compared with optimal medical treatment.
1338 Analysis of data from the big HOPE trial seems to show that vitamin E may increase rates of cancer and cardiovascular disease.
1453 Healthcare professionals who become addicted and seek help in the US show a 75% rate of cure at 5 years, with little difference between major opioids, alcohol, or anything else, unless there is a family history or coexisting psychiatric illness.
An interesting study in Arch Intern Med (165: 574) linked laboratory and pharmacy databases to detect patients who had high TSH results but no subsequent prescription for thyroxine. There weren't very many. Ann Intern Med (142: 481) looked at rates of myocardial infarction in Quebec following prescription of various NSAIDs: only rofecoxib was associated with an increase. Thalidomide inhibits cytokine production, and a trial in 50 pancreatic cancer patients with cachexia showed improved appetite and reduced weight loss (Gut 54: 540). Many COPD patients benefit from combined steroid and salmeterol inhalers — and this can be detected within a few days (Thorax 60: 301). Neurology (64: 1047) goes to Honolulu to examine the association between milk intake and Parkinson's disease: high consumers had 2.3 times the risk. The Women's Health Study was trawled for associations between migraine and stroke: in women, only migraine with aura carries an increase in risk (page 1020). ‘Cripes, mate, couldn't ya get to the dunnee in time?’ is a question often heard in rural north Queensland, if we are to believe a study in Austral J Rural Health (13: 28) which credits this region with the world's highest reported rate of faecal incontinence. Logical thinking is out of fashion these days, since fuzzy thinking is often more helpful in real life. Fans of this approach will want to read ‘Schopenhauer's prologomenon to fuzziness’ in Fuzzy Optimization & Decision Making (3: 227).
Plant of the Month: Cephalaria gigantea
A massive straw-yellow cornflower, smelling of hay, and covered with drunken bees.