Quad bike injuries soar
HOSPITAL admission from quad bike injuries have increased by more than 40% in less than 10 years, imposing a significant injury burden on the states, according to research published in the MJA. A retrospective data analysis of coronial records and hospital-treated injury data in Victoria from 2002–2003 to 2010–2011 discovered there had been 19 fatalities, 766 hospital admissions and 816 emergency department (ED) presentations. Men aged 15–29 years were the most overrepresented group among fatalities and admissions, and children were overrepresented in ED presentations. Fractures accounted for half of all admissions. “The popularity of quad bikes for both work and recreational use necessitates urgent adoption of a wide range of prevention measures”, the researchers wrote. They said prevention efforts had so far focused predominantly on rider training and the use of helmets, which were the least effective approaches. “Recently, efforts addressing higher-order approaches, such as vehicle stability, mandatory fitting of crush protection devices and design changes restricting the capacity of children to operate quad bikes and/or for passengers to be carried have been actively pursued at a national level in Australia. On a practical level, clinicians can play a pivotal role in discussions with users of these vehicles by providing proactive safety guidance.”

Keep antibiotic information campaigns local
A LOCAL, small-scale information campaign, involving health and communication professionals, has successfully reduced antibiotic use, according to research published in the BMJ. The community level, controlled non-randomised trial included more than a million residents of Modena and Parma in northern Italy (intervention group) and a control group of more than three million residents in provinces in the same region with no campaign. The researchers used a social marketing approach tailored to the local population, focusing on the use of antibiotics in upper respiratory tract infections. They said that rather than using “pushy messages delivered by health authorities”, the campaign used a social marketing approach to design messages aimed at the target audience, with the aim of “influencing behaviour by improving knowledge and attitudes towards more appropriate behaviours on antibiotic use”. After a 1-year campaign, the average prescribing rates during the 5-month follow-up period were 20 and 21 defined daily doses per 1000 inhabitants per day in the intervention and control areas, respectively, corresponding to decreases of 11.9% and 7.4% compared with the same period in the previous year. The researchers said the question of whether an educational intervention exclusively directed at doctors would have been more or less effective than the population campaign remained open. However, they said it should be acknowledged that the campaign had an indirect effect on doctors, and that improving population knowledge and attitudes towards more appropriate behaviours on antibiotic use could further decrease antibiotic prescribing.

Score predicts gastric band surgery success
A SIMPLE scoring system using four readily available preoperative clinical variables has been developed to predict the probability of diabetes remission after gastric band surgery, according to research published in The Lancet Diabetes & Endocrinology. The researchers said their DiaRem score would enable patients and doctors to assess the merits of Roux-en-Y gastric band (RYGB) surgery “as a way to achieve diabetes remission and establish whether additional measures should be taken to improve the odds of remission”. They found that early and late remission were associated with younger age, low HbA1c concentration, no combined use of insulin-sensitising agents (not metformin) and sulfonylureas, and high serum insulin concentrations. The researchers retrospectively analysed the outcomes of 690 obese patients with type 2 diabetes who underwent RYGB surgery between 2004 and 2011 at a single health clinic, with 463 (63%) achieving partial or complete remission. Multiple logistic regression models were used to identify independent predictors of remission. Patients were assigned a weighted DiaRem score (ranging from 0 to 22) based on the four factors. An accompanying comment said the DiaRem score “could help with selection of appropriate treatment and management of expectations held by both the patient and the multidisciplinary team involved in the patient’s care”.

Most breast cancer deaths in unscreened women
AN analysis of deaths following diagnosis of invasive breast cancer has found the majority now occur in the minority of women who are not regularly screened. In an analysis in Cancer, data for invasive breast cancers diagnosed at two US hospitals between 1990 and 1999 were followed to 2007. Among 609 confirmed breast cancer deaths, 29% were among women who had been screened and 71% among unscreened women. The majority of women who died of breast cancer had never had a mammogram before diagnosis. The researchers also found the death rate from breast cancer was high in younger women (16.9% in women under 40 years and 11.4% in those aged 40–49 years) but decreased to 8.1% and 6.1% in older women (aged 60–69 years and 70 years and older, respectively). “Our data … suggest less or less frequent screening at ages older than 69 years, but more or more frequent screening for women younger than 50 years”, the researchers wrote. “Regular screening increases the likelihood of detecting nonpalpable cancers. Detecting and treating breast cancer in younger women … may further increase the disease-free life years saved.”

Doctor incentive boosts cardiovascular outcomes
A PAY-for-performance (P4P) program in small US primary care practices with electronic health records (EHR) has resulted in “modest improvements” in cardiovascular processes and outcomes, according to research published in JAMA. The cluster-randomised trial involved primary care clinics with less than 10 doctors. All used the same EHR software that provided decision support and patient registry functionalities, and quality improvement specialists offered technical assistance. P4P clinics received $200 for each patient whose care met the performance criteria, and higher payments for patients with comorbidities who had Medicaid insurance or were uninsured. The maximum payment was $100 000 per clinic. The P4P intervention clinics had greater improvement, compared with the control clinics, in rates of appropriate antithrombotic prescription (12.0% v 6.1%), blood pressure control (with no comorbidities 9.7% v 4.3%; with diabetes mellitus 9.0% v 1.2%; with diabetes mellitus or ischaemic vascular disease 9.5% v 1.7%) and in smoking cessation interventions (12.4% v 7.7%). “This provides evidence that, in the context of increasing uptake of EHRs with robust clinical management tools, small practices may be able to improve their quality performance in response to an incentive”, the researchers wrote. An accompanying editorial said the research raised the question of how to “best use the limited but expensive primary care physician workforce in the most effective manner in the evolving health care delivery system”.

Behavioural therapy best for OCD patients
PATIENTS with obsessive–compulsive disorders (OCD) taking serotonin reuptake inhibitors (SRIs) should also be offered cognitive behavioural therapy consisting of exposure and ritual prevention (EX/RP) as it has superior efficacy and fewer adverse events compared with SRIs alone or SRIs combined with antipsychotics, according to research published in JAMA Psychiatry. The randomised clinical trial included 86 patients who, along with their usual SRI, received either risperidone, EX/RP or a placebo. The researchers found that patients receiving EX/RP had a significant reduction in OCD severity scores, while those receiving risperidone did not significantly differ from those taking placebo. More patients receiving EX/RP achieved minimal symptoms (43%) compared with risperidone (13%) and placebo (5%). Adding EX/RP was also found to be superior to risperidone and placebo in improving insight, functioning and quality of life. “Identifying who achieves minimal OCD symptoms from adding EX/RP to SRIs and whether such patients can then successfully discontinue their SRI warrants future research”, the researchers wrote. An accompanying editorial said the data presented by the researchers were “intriguing and thought provoking”. “They remind us that there are likely unique aspects of brain function that are differentially targeted by medication and psychotherapeutic approaches.”

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