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:
Cancer survival in different countries
A murky paper, made even more dubious by the clarity of the accompanying editorial on page 99. Comparing survival rates in different countries, even if they're all First World ones, is a treacherous thing to do. The utility is mostly in looking at within-country trends, and here the news is good; in Australia, Canada, Denmark, Norway, Sweden and Britain, cancer survival is increasing. Why those countries persistently vary in their underlying rates is the murky topic, and very difficult to make anything truthful of.
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BMJ:
Does dental work help stop pre-term deliveries?
The removal of septic foci from the human body has been the subject of vast medical interest over the centuries, much of it deluded. The prophylactic removal of teeth, appendices and a range of other body parts has come into (and generally out of) fashion, while antiseptics have been (mis)used in attempts to sterilise non-sterilisable portions of our anatomy. Here, a Cochrane review looks at whether a bit of dental hygiene can help prevent women going into labour while their babies are pre-term. It can't.
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NEJM:
Eplerenone for mild heart failure
We've known since RALES that aldosterone antagonists were useful in heart failure - more precisely, we've known that spironolactone is helpful for those with systolic heart failure and NYHA class III or IV symptoms. Here, eplerenone is shown to reduce harms in those with class II systolic failure (but with a virtually identical average ejection fraction, a reminder that our enthusiasm for this measurement is not matched by the clinical utility of knowing it). The sensible editorial on page 79 urges us to treat these benefits as a class effect and to prescribe the very much cheaper spironolactone. It also promises us further data in the near future on whether these aldosterone-blocking drugs are useful for those with diastolic failure.
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