This week's journal reviews on Doctors.net.uk
Journal Watch is a service provided to summarise some of the most popular medical journals.
Doctors.net.uk has a panel of specialist advisers responsible for reviewing a range of journals of general medical interest and some more specialised publications.
General Journal Watch is written by Dr Druin Burch, Consultant in Internal Medicine
This week's journals include....
Paternal postnatal depression
An editorial coming on the back of a JAMA study suggesting high rates of postpartum paternal depression. My son is two and we're currently on holiday in Italy. Surrounded by wonderful wines and restaurants, we're focusing, instead, on applying suncream to a struggling infant and coping with his constitutional lack of needing much sleep. Only an occasional black truffle salami and fine bottle of Montepulciano D'Abruzzo keeps the holiday spirit fluttering. This editorial suggests we need to do more to screen and prevent paternal depression, but passes over the subject of what can be done when we find it. I recommend a trial of short trips to holiday homes in beautiful olive groves with panoramic views of mountains.
How should you diagnose diabetes?
A Chinese study suggesting that HbA1c levels of 6.3% or above could be used instead of fasting blood glucose levels of 7.0 mmol/L. I'd be happy to accept that it seems as good, but the real issue is whether we need something altogether different. Defining someone as diabetic isn't currently based on what it should be - a recognition that they've crossed a line from where one form of treatment is needed into one suiting another. Identifying those sorts of lines requires trials showing interventions conferring hard benefits, ones that exist for those with fasting glucose levels of 7.0 but not 6.9. Our knowledge of what helps the long-term prognosis for type 2 diabetics is way too poor to yet approach this point.
Oxygen for preterm infants
My experience with sick children is limited, consisting almost entirely of my son. I've been fortunate, the worst I've dealt with is a case of chicken pox requiring the constant comfort of an ‘In the Night Garden’ DVD. Exposing myself to a bad children's TV programme was only mildly unpleasant, but I'm aware other treatments for sick children can have seriously nasty side effects. Oxygen for pre-term infants is a famous example of the importance of evidence-based medicine, with theoretical decisions about how much to give without being responsible for deaths (too little) and blindness (too much). The early days of defining the risk of a treatment are exciting, the latter ones can be duller but they remain important. This admirable trial compares two oxygen saturation targets and gets us a little closer to a definitive figure but, as with many spheres of knowledge, we approach truth asymptotically.
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