Early CT exposure increased cancer risk
AUSTRALIAN researchers have warned doctors to weigh the “undoubted benefits” of computed tomography (CT) scans against the potential risks after finding cancer incidence is greater in those who have had a scan at a younger age. The research, published in the BMJ, used 10.9 million Medicare records of people age 0–9 years in 1985 and those born between 1985 and 2005 to identify 60 674 cancers, including 3150 in 680 211 people exposed to a CT scan at least one year before any cancer diagnosis. The mean duration of follow-up after exposure was 9.5 years, with an absolute excess cancer incidence rate of 9.38 per 100 000 person-years at risk. “Overall cancer incidence was 24% greater for exposed than for unexposed people, after accounting for age, sex, and year of birth (incidence rate ratio (IRR) 1.24 (95% confidence interval 1.20 to 1.29); P<0.001). We saw a dose-response relation, and the IRR increased by 0.16 (0.13 to 0.19) for each additional CT scan”, the authors wrote. Incidence rates were increased for most individual types of solid cancer, and for leukaemias, myelodysplasias and some other lymphoid cancers. The authors said physicians, radiologists, patients and their families “need to work together to ensure that CT scans are limited to situations where there is a definite clinical indication, and where every scan is optimised to provide a diagnostic CT image at the lowest possible radiation dose”.

Feeding route for critically ill doesn’t change outcomes
PROVIDING early parenteral nutrition (PN) to critically ill patients in intensive care who have contraindications for early enteral nutrition (EN) does not change 60-day mortality or infection rates, according to Australian and New Zealand research published in JAMA. The multicentre, randomised, single-blind clinical trial involved 1372 patients in 31 community and tertiary hospitals in Australia and New Zealand. Of 682 patients receiving standard care, 199 patients (29.2%) initially started EN, 186 patients (27.3%) initially started PN, and 278 patients (40.8%) remained unfed. Time to EN or PN in patients receiving standard care was 2.8 days (95% CI, 2.3–3.4 days). In the early PN group, time to starting PN was a mean of 44 minutes after enrolment. Mortality rates did not differ significantly (22.8% for standard care v 21.5% for early PN). Patients who received early PN required significantly fewer days of invasive mechanical ventilation, but this did not result in a statistically significant shortening of ICU or hospital length of stay. An accompanying editorial said the article added “important knowledge to the ongoing debate about when, how much, and through what route critically ill patients should be fed”.

Pain conditions linked to suicide
A RETROSPECTIVE data analysis published in JAMA Psychiatry has found an association between specific pain conditions and suicide. The study involved a 1-year analysis of the association between baseline clinical diagnoses of pain-related conditions (arthritis, back pain, migraine, neuropathy, headache or tension headache, fibromyalgia, and psychogenic pain) and subsequent suicide death among more than 4.8 million individuals receiving care through the US Department of Veterans Healthcare System. The researchers observed elevated suicide risks for each pain condition except arthritis and neuropathy. When controlled for concomitant psychiatric conditions, associations between pain conditions and suicide death reduced, but significant associations remained for back pain, migraine and psychogenic pain. The researchers said that the increased risk for suicide should be considered in patients with pain conditions and “note that this risk may not be fully explained by concomitant psychiatric disorders”. “It may be useful to conduct a thorough suicide risk assessment in these patients and attend to other potential indicators of risk in those with pain, such as hopelessness and suicidal ideation”, they wrote.

Managing donors the key in blood transfusion future
IN a series of articles on blood transfusion published in The Lancet, the authors of one article say strategies on how to best use blood products, and the development of processes to improve quality, will make blood transfusion a safer and more effective treatment in the future. The authors wrote that the health risks surrounding blood transfusions and the continued rise in blood costs were driving the development of alternatives to donated blood. “In the future, management of the blood supply will probably involve much more sophisticated management of donors than presently”, the authors wrote, referring to the effect of donor-specific factors on the storage quality of blood. “As we accumulate additional information on our donor population, we could envision an intersection between enhanced donor management and the methods being developed in the application of personalised medicine”, they wrote. The Lancet said it was publishing the series of articles due to mounting evidence that blood transfusions made patients more susceptible to infections and increased the risks of poor outcomes such as longer hospital stays, cancer recurrences and multi-organ system failure.

Depression–hypo link in diabetes
A LONGITUDINAL cohort study has found major depression is a significant risk factor for severe hypoglycaemic episodes in adults with diabetes. The research, published in Annals of Family Medicine, included a sample of 4117 patients with diabetes enrolled in a US health plan who were observed for 2 years. The researchers wrote that when depressed patients with diabetes were compared with patients who had diabetes but not depression there was a significantly higher risk of a severe hypoglycaemic episode and a greater number of episodes. “The increased risk of severe hypoglycemic episodes in patients with comorbid depression may be due to poor self-care or psychobiologic changes associated with depression”, the researchers wrote. They said patients with depression and diabetes, compared with those with diabetes alone, had been found to have poor adherence to diet, smoking and physical activity recommendations, as well as poor blood glucose monitoring. However, they warned that because of poor glucose control, physicians might increase the dose of glucose-lowering medications or augment with an additional glucose-lowering medication, “which may subsequently increase risk of causing hypoglycaemia”.


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