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....
Tranexamic acid saves lives in trauma
I spend much of my Journal Watch time flipping through the week's research with a sense of weary depression. So much research is pointless, badly done, self-serving or foolish. This trial is one of the rare and wonderful exceptions. CRASH-2 enrolled over 20,000 trauma patients and randomised them to tranexamic acid or placebo within eight hours of injury. Four weeks later, 16% of those who got the placebo were dead compared to 14.5% of those who got the tranexamic acid. This is statistically significant, and for a cheap and safe drug applicable to vast numbers of people worldwide, it's heftily clinically significant too, despite the small absolute risk reduction. The trial represents a massive amount of work, carried out superbly and with the great good fortune of having a useful positive result. Terrific stuff.
Steroid injections for sore shoulders
Patients like injections into painful bits of their bodies; it makes them feel they're being taken seriously. We've already seen that injecting hard to reach joints is difficult, and that when you do it with real-time ultrasound guidance (which radically improves your targeting), you make no difference to outcomes. The strong implication is that a decent needle makes an excellent placebo, and that conclusion is consistent with this study comparing exercise alone with exercise and steroid injections. The injections gave a short-term improvement, which had vanished by three months. The trial was "pragmatic", which I think is the BMJ's euphemistic way of saying that it didn't bother to include a sham injection in its protocol.
HPV and oropharyngeal cancer
We've long known that viruses can cause cancer, and that human papillomavirus (HPV) is one of the suspect organisms. Here, however, it carries with it a little bit of good news. HPV (chiefly type 16 for those who have large wallchart of its different manifestations) is found in almost two thirds of oropharyngeal cancers. It's actually associated with a better prognosis than if you don't have it.
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