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....
The Lancet:
Can we predict cardiovascular risk?
The estimation of cardiovascular risk is in a shameful mess. Despite decades of genetic research, we're reliant on taking a history and performing a brief clinical examination. Our laboratories stand largely idle, our polymerase chain reactions are underused and our advanced statistical tools humiliatingly disregarded. Can we avoid the shambolic prospect of simple clinicians being allowed to estimate cardiovascular risk, using little more than a simple coloured graph at the back of the BNF to help them? This paper suggests lipoprotein-associated phospholipase A2, a marker of inflammation in atherosclerotic lesions, might provide an appropriately expensive, technical and sophisticated way of supplying the risk-estimation we currently perform with unfortunate simplicity. It doesn't add much, and doesn't give as much information as measuring someone's belly and asking them if they smoke, but at least it has the potential to make things a little more complex and expensive.
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BMJ:
Are you weary of chronic fatigue syndrome?
I think what bothers doctors most about chronic fatigue syndrome is not any worry over whether it might be organic, non-organic, or some mix of the two, but the conviction that there's nothing they can do or say that does patients any good. This study randomises patients to normal care, to "supportive listening" or to visits from nurses encouraging them to gradually build up the amount of time they spend out of bed and active each day. The latter showed benefits at 20 weeks, when the intervention ended, but a year afterwards the groups were statistically identical. If a CFS patient complains they don't feel you've got anything to offer them that helps, offer them sympathy. After all, they're right.
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NEJM:
What's the impact of coronary CT scanning?
This prospective study aims to persuade you that having a computed tomographic (CT) examination of your coronaries is a good idea. Calcium will show up white, with high Hounsfield Units a shining symbol of danger on the radiologist's monitor. The sensible editorial on 1646 admits coronary artery calcium scores appear to be of predictive value, but dismisses them all the same. "The authors have not yet demonstrated that the added accuracy in risk stratification can actually aid clinicians in better treating patients or improving their clinical outcomes." That's well put, and is pointedly followed by a reminder that we need to demonstrate real benefits before we can accept the significant costs of the procedure. It isn't cheap and it causes cancer.
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