Prostate cancer treated and diagnosed earlier
THE proportion of men with prostate cancer receiving treatment with curative intent has increased substantially since 1993, according to research published in the MJA. The research was based on men diagnosed with prostate cancer at 11 public and six private hospitals in Victoria from 2008 to 2011 whose prostate cancer notifications were received by the Victorian Prostate Cancer Registry. Management data for these men was compared with patterns of care in 1993. The researchers found there had been a dramatic “stage migration” towards earlier diagnosis of prostate cancer. “Our finding that 71.0% of men received surgery, radiotherapy and/or brachytherapy contrasts with results of the 1993 Victorian study, in which 25% of men received initial treatment with curative intent”, the researchers wrote. They said the “vast majority” of men in the 2008–2011 study were diagnosed with localised disease and only 3.3% were diagnosed with metastatic disease. “Of particular interest was our finding that having a prostate cancer notification made by a private hospital was an independent factor for not receiving radical treatment, even after age and of risk of disease progression were taken into account”, they wrote.

Double dose not needed for flu
THERE are no virological or clinical benefits from double doses of oseltamivir for patients admitted to hospital with severe influenza, according to research published in the BMJ. The large randomised controlled trial in South East Asia included 326 patients, including 246 children under 15 years of age, with severe human influenza (seasonal, pandemic and bird flu strains), who were randomly allocated to double or standard doses of oseltamivir. Nearly 80% of patients were infected with influenza virus A, 40.8% with A/H3N2, 22.1% with A/H1N1-pdm09, 11.7% with seasonal A/H1N1, 5.2% with A/H5N1 and 16.2% with influenza virus B. The researchers said the double dose of oseltamivir (150 mg twice a day or paediatric equivalent) was well tolerated but did not confer additional virological or clinical benefits over the standard dose. They found no differences between the treatment arms after 5 days, and no differences in clinical failure rates, mortality in hospital, or rates of adverse events between the dose regimens. An accompanying editorial by Drs Ian Barr and Aeron Hurt, from the WHO Collaborating Centre for Reference and Research on Influenza in Melbourne, said the research findings could help to preserve oseltamivir stocks during a future pandemic “through better use of currently available drug resources if clinicians were to prescribe only regular rather than double doses”.

Nicotine replacement therapy works
NICOTINE replacement therapy and other licensed drugs can help people quit smoking, according to a new systematic review published in The Cochrane Library. The overview of previous Cochrane reviews collected evidence from 267 studies involving 101 804 people. A successful quit attempt was defined as a person who stopped smoking for 6 months or longer. Three widely licensed medications — nicotine replacement therapy (NRT), bupropion and varenicline —as well as cytisine all improved smokers’ chances of quitting. The odds of quitting were about 80% higher with single NRT or bupropion than with placebo, and 2–3 times higher with varenicline than with placebo. Varenicline was about 50% more effective than any single formulation of NRT (patches, gum, sprays, lozenges and inhalers), but similar in efficacy to combining two types of NRT. Based on two recent trials, cytisine improved the chances of quitting nearly fourfold compared with placebo. Among other treatments tested, nortriptyline was more effective than placebo but did not offer any additional improvement when combined with NRT. Overall, NRT, bupropion and varenicline were considered low-risk treatments, although the researchers said the results were less clear-cut for varenicline.

Multivitamins no use even in poorly nourished
RESEARCHERS have found multivitamins have no effect on total or cause-specific mortality in a nutrient-deficient population. The results, in a research letter published in JAMA Internal Medicine, involved a 26-year follow-up from the Linxian Dysplasia Nutrition Intervention Trial, which evaluated the effect of multivitamin supplements on cancer incidence and mortality in a Chinese region with extremely high rates of oesophageal and gastric cardia cancer and multiple vitamin and mineral deficiencies. The randomised, double-blind, placebo-controlled trial of multivitamins, conducted from 1985 to 1991, included 3318 people aged 40–69 years who had received a previous cytologic diagnosis of oesophageal squamous dysplasia. Participants were followed for another 20 years after stopping supplementation. “Poorly nourished populations should benefit most from multivitamin supplementation, making the present study a strong test of their potential beneficial effects”, the authors wrote. “However, like the well-nourished [Physicians’ Health Study II] population, no benefit of multivitamins for total mortality was observed in our study.” There were 2239 deaths during follow-up (1985–2010), including 42% from cancer, 21% from heart disease, 25% from cerebrovascular disease, and 12% from other causes. “Overall, multivitamin supplements had no effect on total mortality or mortality from any of the specific causes of death examined (including cancer mortality) among all participants”, the researchers said.

Call to track inflight medical emergencies
US researchers have called for systematic tracking of all inflight medical emergencies, including subsequent hospital care and other outcomes, to better guide interventions in future emergencies. In a study, published in the New England Journal of Medicine, the researchers studied the records of inflight medical emergency calls from five domestic and international airlines to a physician-directed medical communications centre between January 2008 and October 2010. There were 11 920 emergencies resulting in calls to the centre (1 medical emergency per 604 flights) and the most common problems were syncope or presyncope (37.4% of cases), respiratory symptoms (12.1%), and nausea or vomiting (9.5%). “Physician passengers provided medical assistance in 48.1% of in-flight medical emergencies, and aircraft diversion occurred in 7.3%”, they wrote. Of 10 914 patients where postflight follow-up data were available, 25.8% were transported to a hospital, 8.6% were admitted and 0.3% died. “On the basis of our data, we estimate that 44,000 in-flight medical emergencies occur worldwide each year”, the researchers wrote. “Medical emergencies during commercial airline travel, although rare when considered on a per-passenger basis, occur daily; traveling physicians and other health care providers are often called on to aid ill passengers. A basic knowledge of in-flight medical emergencies and awareness of the resources available can help them be effective volunteers.”

Review of gestational diabetes screening
A SYSTEMATIC review of the test characteristics of various screening methods for gestational diabetes has found that, while the 50 g oral glucose challenge test (OGCT) and the fasting plasma glucose level are similarly effective in identifying women who do not have gestational diabetes mellitus (GDM), the OGCT is better at identifying women who do. The review, published in Annals of Internal Medicine, found that, at 24 weeks, OGCT (at a threshold of 7.2 mmol/L) and fasting plasma glucose level (at a threshold of 4.7 mmol/L) had similar sensitivity (88% v 87%) but differed in specificity (99% v 52%). “Because fasting glucose level better predicts fetal overgrowth and such overgrowth can be modified by metabolic management during pregnancy, a practical option may be to offer women their choice of screening with the OGCT or the fasting plasma glucose test”, the researchers wrote. Measurement of HbA1c was not a good screening test for GDM, “but further study may demonstrate its potential value for identifying overt diabetes in pregnancy”, they wrote. A second review of the benefits and harms of treating gestational diabetes found that while treating gestational diabetes resulted in less preeclampsia, shoulder dystocia and macrosomia, the current evidence did not show an effect on neonatal hypoglycaemia or future poor metabolic outcomes. “There is little evidence of short-term harm of treating GDM other than an increased demand for services”, the researchers wrote.


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