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:
Exhaled nitric oxide and asthma
We treat asthmatics on the basis of symptoms and peak flow measurements, and very rarely on the result of arterial blood gases and a general sense of panic. This trial is on the lookout for biomarkers. It starts by noting the potential utility of sputum eosinophil counts and goes on to demonstrate a similar potential when keying prescriptions of inhaled corticosteroids and long acting beta agonists to measurements of exhaled nitric oxide.
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BMJ:
Heart disease trends by sex and time
An intriguing paper since it suggests that something we've all been taught is complete rubbish. A woman's risk of heart disease does not, it says, rise after menopause. Instead it argues that the reason woman start catching up with male heart risk in later life is because male risk is weighted towards male youth, and does not rise so quickly with older age as a woman's. Careful work like this might have helped us avoid foolishly mistaking HRT for a life-saving treatment.
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NEJM:
Rivaroxaban for AF
As the days of warfarin depart from this earth, its successors crowd together waiting to occupy the stage. This non-inferiority trial of rivaroxaban (a factor Xa-banisher, as the name helpfully suggests) in patients with atrial fibrillation shows it to be just as good clinically without any of the fuss of INR measurements and all the problems that come with it. The authors point to a significant drop in intracranial haemorrhage and fatal bleeding with rivaroxaban, but overall bleeding rates were actually the same. There's a real chance that rates of catastrophic bleeds actually will be lower with these new agents, but I think it hardly matters: even without that benefit we're still going to switch as soon as we practically can.
Read more..
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