27 Aug, 07 | by BMJ Group
Here is a painstaking meta-analysis of trials involving 64,000 people randomised to take calcium, vitamin D (in various doses) or placebo for the prevention of fractures and bone loss in people aged over 50. The main messages are well summarised in the editorial. Compliant patients halve their risk, so we need to get calcium and a good dose of vitamin D (at least 800 IU) into our patients (and ourselves, where applicable) by some means or other.
An annual fasting blood sugar is now part of the routine follow-up of all patients with coronary heart disease – and this Italian study of patients after recent myocardial infarction shows why. Their incidence rate for impaired FBS was 27.5% per year, as opposed to 1.8% in the general population. The study attempted to measure diet but not exercise (except by treadmill test capacity) and confirms the benefit of a Mediterranean intake, rich in vegetables, fruit, fish and olive oil.
I approach every new review of polycystic ovarian syndrome with a mixture of dread and curiosity. They are all long, inconclusive, and apt to wander off into inaccessible realms of sex hormone metabolite ratios and transvaginal follicle measurements. Don’t look for clear definitions or diagnostic pathways: you will always be disappointed. The treatment section here, however, is comprehensive and modestly useful. Although appetite suppressants have never been formally studied in this group, I suspect that for many they might be the most effective treatment.
I have not commented on the BMJ’s current debate about the literature of medical education, because most of it is so trite, but I was intrigued by the title of this personal article, inconvenient truths about effective clinical teaching, by Brendan Reilly. It is brilliantly wise and well-written, and worth more than the entire archive of most journals on the subject.