Financial conflicts influence reviews of flu drugs
AN Australian study has shown that authors with a financial conflict of interest are more likely to report favourably on the use of neuraminidase inhibitors in the prophylaxis and treatment of influenza. This retrospective analysis, published in the Annals of Internal Medicine, assessed 24 systematic reviews of neuraminidase inhibitors conducted between 2005 and 2014. The reviews included 13 which examined prophylaxis and 24 for treatment, accounting for 37 distinct assessments. The researchers identified financial conflicts of interest using the index reviews, other publications, and web-based searches. The reviews were assessed by two independent investigators as being either favourable or not favourable to neuraminidase inhibitors. Among reviews with identified financial conflicts of interest, the study found that 88% were classified as favourable, compared with 17% for those without a financial conflict of interest. Authors without financial conflicts of interest were “more likely to include statements about the quality of the primary studies than those with financial conflicts of interest”, who were more likely to recommend the use of these drugs, the researchers wrote. The researchers said that “industry influence” may have contributed to inconsistent conclusions on the clinical use of neuraminidase inhibitors for influenza. The researchers wrote that these results indicated the reporting of financial conflicts of interest was not sufficient to mitigate the impact of industry affiliations. They proposed that “further measures may be necessary to ensure that industry collaborations do not comprise scientific evidence” such as greater availability of full clinical study reports, critical appraisal of the selection of evidence and outcomes assessed, and closer monitoring of the role of industry collaborators in interpreting results and making conclusions.

Increased placebo response in antipsychotic trials
PLACEBO response rates have been increasing in antipsychotic drug trials, while the change associated with medication treatment has decreased, a study has found. The research, published in JAMA Psychiatry, consisted of a meta-analysis of 105 randomised clinical trials (RCTs) of acute antipsychotic drugs published between 1960 and 2013. The RCTs, which included a total of 257 treatment groups with 21 892 participants and 39 placebo groups with 2882 participants, compared antipsychotics to placebos or active comparators in adults with schizophrenia or schizoaffective disorder. Because individual studies used different scales to measure pre–post change, the researchers standardised the change scores published for each treatment condition in the sample. The analysis showed that the placebo response had significantly increased since 1960. While the average placebo-treated patient in 1960s worsened by 3.5 Brief Psychiatric Rating Scale (BPRS) points, the average placebo-treated patient improved by 3.2 BPRS points in the 2000s. In contrast, the authors wrote that the average RCT participant receiving medication in the 1960s improved by 13.8 BPRS points, which diminished to 9.7 BPRS points by the 2000s. The authors said that possible causes for this trend included inflation of baseline scores and “the enrolment of less severely ill patients”. Higher expectations by patients as well as differences in the treatment settings for each study may have also been responsible, the authors wrote. To improve future RCTs of antipsychotic drugs, the authors suggested recruiting “more severely ill patients, limit study duration to no longer than 8 to 12 weeks” and to “maximize the probability of being assigned placebo as opposed to active medication”.

Low-risk lifestyles reduce chances of stroke
LOW-risk lifestyles can substantially reduce the risk of stroke, especially cerebral infarction, research has found. A study published in Neurology analysed data from a diet and lifestyle questionnaire completed by 31 696 women in Sweden, all of whom were free from cardiovascular disease and cancer in 1997. The questionnaire profiled five key lifestyle factors: diet, alcohol consumption, cigarette smoking, physical activity, and body mass index (BMI). The researchers defined a low-risk lifestyle as a healthy diet (top 50% of a Recommended Food Score), moderate alcohol consumption (5–15 g/day), never smoking, physically active (walking or bicycling for more than 40 minutes per day, and exercise more than 1 hour per week) and a BMI below 25 kg/m2. At follow-up in 2008 there had been 1554 incident stroke cases, including 1155 cerebral infarctions and 246 haemorrhagic strokes. The study found that a low-risk lifestyle considerably reduced the risk of cerebral infarction and total stroke, but not haemorrhagic stroke. Overall, stroke risk decreased by increasing the number of low-risk lifestyle factors. The authors wrote that participants with all five low-risk lifestyle factors had a 62% lower risk of cerebral infarction compared with women with no low-risk factors. The data also indicated that smoking was the lifestyle factor “most strongly associated with total stroke and cerebral infarction”, the authors said. All combinations, with the exception of physical activity and alcohol consumption, were associated with lower risk of cerebral infarctions, with little diversity in the strengths of associations for different combinations. Because the study was population based, the authors wrote that these results should be applied to all women. They wrote that due to the usually devastating and irreversible effects of a stroke, this study emphasised the importance of “primary prevention” in stroke treatment.  

Link between time of day and antibiotic prescription
DOCTORS are more likely to prescribe antibiotics unnecessarily towards the end of a clinic session, according to a research letter published in JAMA Internal Medicine. The researchers analysed the electronic health data from patient visits to 23 affiliated primary care practices, limited to adult patients presenting with acute respiratory infections (ARIs) with no pre-existing chronic illness or concomitant acute diagnoses for which antibiotics would be indicated. The visits occurred over two 4-hour sessions per weekday over 18 months. In total there were 21 867 ARI visits to 204 clinicians which met the inclusion criteria, and 44% resulted in antibiotic prescription. The authors found that overall antibiotic prescription for ARIs increased with every hour and reached a peak during the final hour of each session. The authors attributed these results to “decision fatigue”, which the letter defined as “the erosion of self-control after making repeated decisions”. As a clinic session continued the cumulative cognitive demand of decision making increased, which eroded the ability of clinicians to “resist making potentially inappropriate choices”. The authors suggested implementing measures such as time-dependent decision support, modified schedules, shorter sessions, mandatory breaks, or snacks to help prevent fatigue. They wrote that their findings should be interpreted in the context of the study design, where ARI visits were only analysed in a single health care system and other accumulating factors, such as glucose depletion, could have contributed to the findings.

Teens with cerebral palsy rate QoL as OK
ADOLESCENTS with cerebral palsy have a self-reported quality of life (QoL) similar to adolescents in the general population, with a significantly lower score only in the area of social support from friends and peers, a study has found. The research, published in The Lancet, involved a cross-sectional and longitudinal analysis of the QoL outcomes for individuals included in childhood and adolescent studies. A total of 431 adolescents made up the final study sample, with QoL data first being collected in 2004 when participants were aged 8–12 years, followed by another data collection in 2009 when participants had reached adolescence. Data measured physical wellbeing, self-perception, school life, pain, psychological conditions, and parental stress, with QoL scores compared against age-matched controls in the general population. The authors wrote that there was little difference between the least and most able groups when it came to QoL, with an average variation of less than 0.5 on strengths and difficulties (SD). The researchers found pain in childhood or adolescence was strongly linked with low adolescent QoL. Severity of impairment was associated with reduced QoL in just three domains (social support and peers, moods and emotions, and autonomy), with social support from friends and peers the only area where adolescents with cerebral palsy reported significantly poorer QoL than the general population. The authors said that the results underlined how “young people with cerebral palsy needed particular help with maintaining and developing peer relationships”. The similarity between QoL in adolescents with and without cerebral palsy provided “robust evidence about how young people with cerebral palsy feel about life” and should affect individual and societal attitudes. The authors wrote that interventions in childhood to alleviate psychological difficulties, parenting stress and especially pain needed to be encouraged due to their “longer term effect on adolescent QoL”.

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