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....
Treating blood pressure variability
Peter Rothwell's name appears again, with this paper attempting to provide some answers to the problems raised by his one immediately preceding it. Given that blood pressure variability has emerged as a prognostically important factor, what drugs seem to best control it? Calcium channel blockers and non-loop diuretic drugs come out top, with ACE inhibitors, ARBs and beta- blockers actually increasing systolic blood pressure variability. These differences may be a way of usefully differentiating between anti-hypertensives, rather than treating them all as interchangeable, so long as they drop average systolic pressures.
Don't dally with radiotherapy
An observational study looking at the gap between breast surgery and radiotherapy, and the way it associates with subsequent local recurrence. The longer you leave things before starting radiotherapy, the more likely you are to run into trouble. This is as you'd expect, but probably politically useful to highlight.
This paper is a piece of epidemiological opportunism. To what extent could vaccinating just kids and adolescents provide herd immunity to a group of people who were otherwise unvaccinated? The authors argue that this is relevant because, at the moment, we just give flu vaccines to those at high risk, and perhaps we could widen this slightly to interrupt disease transmission. Yet, if we're serious about doing that, we should be looking at proper universal vaccination programmes. These are worth considering. Instead, this paper targets the religiously and socially isolated Hutterite communities of western Canada, persuading some of them to allow their youngsters to get flu vaccines. Vaccinating children and adolescents provides, as predicted, a significant but incomplete degree of herd immunity.
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