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....
Oxygen versus air for dyspnoea
A remarkable trial, enrolling over 200 patients with terminal diagnoses and symptoms of breathlessness. Each patient had a decent arterial oxygen level (>7.3 kPa) and nasal cannulae attached to a concentrating device. Within a week, there was improvement for all, and it turned out to be entirely unrelated to whether their concentrator was delivering oxygen or plain room air. I'm not sure what we take from this, since the outcomes were subjective ones anyway. We can't easily extrapolate them to people who are told they're definitely not receiving oxygen. Placebos are powerful things, and learning to use them effectively requires careful research and a careful willingness to mislead.
Migraines increase the risk of death
A smaller Icelandic study, with under 20,000 participants, but one with a longer follow-up and a greater number of events - given the participants had been born between 1907 and 1935, more than half of them were dead by the time the study concluded. The risk of death for those with migraines and auras increased, but not by much - a relative risk of one and a fifth. The article's conclusions are a mess. They correctly point out that they've got no clinical relevance and we need to focus on traditional risk factors, but they manage to leap from there to saying "more research is needed on the association between migraine and mortality". That might benefit their careers, but it's hard to see the wider utility of it.
Approaches to ovarian cancer
Oops - did I just mention the habit of oncology to provide us with trials of little significance to non-specialists, and of no interest whatsoever to journalists looking for breakthrough stories of miracles? Here's one of just that type, and it compares interval debulking surgery with neoadjuvant chemo vs primary debulking and chemo in those with ovarian carcinomas. There was no difference. "Complete resection of all macroscopic disease (whenever it was done) was the strongest independent variable in predicting overall survival."
Go to the Journal Watch page
to see all monthly and weekly reviews.