journal papers

...now browsing by category

 

Severe ankle sprains do better with 10days BK POP – The Lancet

Saturday, February 14th, 2009

A UK study published in the Lancet compared tubigrip and BK POP immobilisation for severe ankle sprains in 584 patients.

It showed that the BK POP group did better at 3 months but by 9 months there was no significant differences. Interestingly, given the recent discussions on whether leg injuries warranting immobilisation should be given DVT prophylaxis, the study only found 3 DVT’s and 2 PE’s.

Should we be reverting back to BK POP – or perhaps these days applying a fibreglass BK back slab for 10 days?

Posted in journal papers | No Responses »
Tags: , ,

Daily LMWH for adult patients with leg plasters?

Wednesday, January 21st, 2009

The Cochrane review (2008) found that daily LMWH (eg. Enoxaparin) significantly reduced the risk of DVT in patients who have an above knee or below knee plaster cast applied.

The incidence of DVT in untreated patients was found to be 4.3-40% and daily LMWH resulted in a significant difference in DVT rates to 0-37% (odds ratio 0.49, 95% confidence interval = 0.34 to 0.72).

The review thus recommended daily LMWH as risk of major bleeding events was extremely rare although 8% reported minor bleeding.

BestBets.org published their finding based on available studies in 2007 which also found a level of support for use of LMWH in such patients but questioned the cost-effectiveness.

This is not generally current practice in Australia and would add cost and complexity to management of limb injuries requiring plaster – should we be changing our practice or await further studies?

Posted in journal papers | 1 Response »
Tags: ,

New Year’s Eve rave parties – time to read up on GHB

Thursday, January 1st, 2009

Yes, it’s New Year’s Eve 1.30am and all is quiet on the Western front, just the calm before the storm.

And yes, yours truly is doing a double shift overnight because the senior registrar became ill and, between the few patients arriving at present, I decided to flip through my EMA journal which just arrived today.

There is a reassuring article on gamma hydroxybutyrate (GHB) which suggests we can generally avoid intubation of these patients as their initial low GCS usually returns to a high GCS within 2 hours (median 76 minutes) and close observation with nursing in lateral position appears to be safe.

Still, I can do without an influx of mass intoxications from the big NYE rave party that is rumoured to be being held in a nearby rural area.

Given the increasing use of fireworks (and some fairly heavy duty ones at that) in the homes around the hospital, it seems amazing that there have not been any presentations with injury relating to these as yet.

It’s now 2pm, the 1st wave on revelers are now arriving, intoxicated and all with lacerations – sounds like NYE should be part of the medical student and intern rosters to get practice suturing.

Well hope everyone else is out partying safely while I work.

Posted in journal papers | No Responses »
Tags:

Australian ghost writer or just careless?

Wednesday, December 24th, 2008

“A PROMINENT Sydney medical researcher has been caught up in a US Senate investigation into whether big pharmaceutical firms allegedly are paying ghostwriters to write journal articles favourable to their products.”

See Sydney Morning Herald article 24th Dec 2008.

Author allegedly denies being paid but was assisted by the pharmaceutical company to write the paper which took 3 years to prepare.

Seems that he failed to mention an important contradictory finding that had become published in the interim.

Are authors responsible for ensuring their paper is accurate up to the moment of publication rather than just at the time the research finished, or is it the responsibility of the journal’s editors to address this issue?

Posted in journal papers | 1 Response »
Tags: ,

Seems antioxidant tablets increase risk of death

Friday, October 24th, 2008

See this blog for a summary of the latest research.

Conclusion:

“Taking the antioxidant vitamins A (and its precursor beta-carotene) and E singly or in multivitamins is dangerous and should be avoided by people eating a healthy diet. On a diet like that recommended here, the intake of these and other important vitamins should be high, with no need for supplementation.”

Lucky I never wasted my money on buying them as seems I get enough of the good oils and vitamins from my fish and chips and pizza with capsicum – although I got to watch the latter – if only they could genetically engineer away the substance in capsicum that makes me get GOR! :)

And just in case they were telling white lies about using good fats in the fish and chips, I am a bit impartial to blueberries on low fat yoghurt and a little piece of 75% cocoa chocolate.

Ahh.. yes the total calories a bit of a problem… well it wasn’t while I had to run all over the department and take Xray request slips to the radiology department until some bright spark thought upon the concept of fax machines.

As Kevin Rudd has found out with his bank deposits guarantees, there are consequences good and bad to most actions and inactions.

So guess its only once a month treat now for the fish and chips :(

Posted in journal papers | No Responses »
Tags: ,

Renal colic and microhaematuria

Thursday, October 23rd, 2008

Some radiologists and radiology registrars insist on a urinalysis before they will agree to CT KUB scans on patients with suspected renal colic.

A new study published this month in BMJ by Xafis et al confirms what we know:

Presence of microhaematuria supports diagnosis of renal colic in patients with acute flank pain but its absence does not exclude the diagnosis of renal colic.

In the published study, presence of microhaematuria had sens. 67%, spec. 58%, PPV 86% and NPV 31% for CT +ve urolithiasis in non-pregnant patients without ureteric stents with acute flank pain.

Thus, waiting for a urinalysis or not performing a CT KUB just because there is no microhaematuria does not seem to be a logical thought process.

It MAY be reasonable to postpone a CT KUB in patients highly likely to have renal colic in whom other conditions are unlikely, in the hope that the pain will settle and a CT can be avoided and thus radiation exposure minimised.

I have created some articles on the OzEmedicine wiki:

Posted in journal papers | No Responses »
Tags: ,