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• W4236027830 abstract "A medical review once accused orthopaedic surgeons of being ‘Not part of the caring profession’. While this seems harsh, what is the evidence? In a prospective study from a university orthopaedic department in Salt Lake City, eight physicians performed their routine new patient examination on 400 patients referred to the spinal unit. Four of the physicians were spinal surgeons and four were non-operative spine specialists. All the patients completed a standardised questionnaire used to evaluate psychological distress. The physicians independently categorised the patients' level of distress. Psychological distress was common, occurring in 64% of patients, while 22% had high levels of distress. Non-operative spine specialists correctly identified 41.7% of highly distressed patients as being highly distressed, while spine surgeons only identified 19.7% correctly (P= 0.03). These were adult surgeons, so let us reassure ourselves that paediatric orthopaedic surgeons are a very different breed. Aren't they? Reviewer: David Isaacs, [email protected] The duration of antibiotic treatment for bacterial meningitis has traditionally been based on magic numbers1 rather than science. This has been rectified by a large randomised, double-blind, placebo-controlled trial comparing 5 with 10 days of ceftriaxone.2 The study of over 1000 previously well children, 3 months or older, in low-income countries in Africa and Asia randomised children with proven meningitis due to Haemophilus influenzae type b, Streptococcus pneumoniae or Neisseria meningitidis who were stable after 5 days of intravenous ceftriaxone to 5 more days of therapy with either ceftriaxone or placebo. Two of 496 in the 5-day group (one with human immunodeficiency virus (HIV)) relapsed, and none of 508 who received 10 days. There were no bacteriological failures in either group. Overall morbidity and mortality was not statistically different between the groups at 190 days follow-up. The study was not powered to look at these outcomes for different organisms, but there were no significant differences. In the pneumococcal group, 12 children died in the 5-day treatment arm and nine children died in the 10-day treatment arm, but survival with sequelae was more common in the 10-day treatment group (72 vs. 54 children). Almost two-thirds of all deaths (25 of 41) were in children with HIV. Although the study was conducted in resource-poor countries, it seems reasonable to extrapolate the results to resource-rich settings where pneumococci and meningococci are the main cause of bacterial meningitis. If a child with bacterial meningitis is stable after 5 days of appropriate parenteral therapy, antibiotics can safely be stopped. Reviewers: David Isaacs, [email protected]; Phil Britton, [email protected], Children's Hospital at Westmead Cystic fibrosis is a difficult disease to study because of its chronicity, and there is often a disappointing lack of evidence to support management. An Australian group has published an important randomised controlled trial.1 They wondered if standard practice of using oropharyngeal cultures as the basis for deciding on antibiotic treatment of infections in the first 5 years of life might miss early Pseudomonas. They hypothesised that bronchoalveolar lavage (BAL) might detect Pseudomonas earlier and that targeted treatment against Pseudomonas might delay long-term Pseudomonas colonisation and improve lung function. They randomised 170 infants with cystic fibrosis diagnosed by newborn screening to antibiotic therapy either directed by BAL before 6 months old and when hospitalised for exacerbations or to standard therapy based on oropharyngeal cultures. At 5 years, the outcomes in the two groups were virtually identical: prevalence of Pseudomonas from a BAL and appearance of high resolution chest computerised tomography scans. While disappointing for the researchers, this is an important negative study, and the authors are to be congratulated. Reviewer: David Isaacs, [email protected] Some research is heart warming. Cocoa products contain flavonol, which has been postulated to be good for cardiovascular health. A systematic review and meta-analysis trials of chocolate consumption by adults and cardiovascular outcomes is quietly encouraging for those with a sweet tooth.1 The authors found six cohort studies, one cross-sectional study but no randomised controlled trials. Chocolate consumption protected against any cardiovascular disease, and against stroke, but not against heart failure. Although there was considerable variability in the results between studies (i.e. heterogeneity), high chocolate consumption was associated with a 37% reduction in any cardiovascular disease and a 29% reduction in stroke. In support of a true causal effect, there appeared to be a dose response with higher chocolate consumption being more protective. Reviewer: David Isaacs, [email protected]" @default.
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• W4236027830 date "2012-04-01" @default.
• W4236027830 modified "2023-10-16" @default.
• W4236027830 title "HEADS UP" @default.
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• W4236027830 doi "https://doi.org/10.1111/j.1440-1754.2012.02441.x" @default.
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