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....
Our midwives were reassuring over the prospect of having our first child at home. Only a tiny number of deliveries, they said, needed emergency obstetric input. Fine; could they predict which ones those were in advance? Oh, they said, only a very few. This sensible editorial cites evidence showing that home births are very safe - only 0.2% of neonates die. They point out that this is reassuring only if you overlook the fact this death rate halves if you have your baby in a hospital. Midwives seem easily able to confuse low risks with no risks. We were lucky: with the prompt help of an obstetrician, our son survived his unexpected shoulder dystocia.
Dietary advice for poorly controlled diabetics
It's an excellent idea: seeing what effect a nutritional intervention can have on people whose sugars are bad despite a full rack of drug treatments for diabetes. It deserves better than this tiny study from New Zealand of less than 100 patients. The results were positive. An expensive intervention of multiple sessions of nutritional advice led to those randomised to it losing an extra kilo of weight after 6 months. Potentially, this sort of minimal effect is deeply meaningful, and larger longer studies are desperately needed.
Metastatic prostate cancer
If your metastatic prostate cancer proves resistant to the various modes of castration, you're in trouble. This trial isn't going to help you much, although it's packed full of hope for future years. Sipuleucel-T immunotherapy consists of targeting prostate cancer cells via personalised vaccines, using a method that became increasingly opaque to me the more I read about it. The authors explain it's "a type of therapeutic cancer vaccine, consisting of autologous peripheral-blood mononuclear cells (PBMCs), including antigen-presenting cells (APCs), that have been activated ex vivo with a recombinant fusion protein (PA2024). PA2024 consists of a prostate antigen, prostatic acid phosphatase, that is fused to granulocyte-macrophage colony-stimulating factor, an immune-cell activator." It's more pithy to point out it added 4 months to median survival. It may not herald very much by itself, but lying behind it is the strong hint of promise from further developments in related cancer vaccines.
Go to the Journal Watch page
to see all monthly and weekly reviews.