“Research highlights” is a weekly round-up of research papers appearing in the print BMJ. We start off with this week’s research questions, before providing more detail on some individual research papers and accompanying articles.
- Can tranexamic acid reduce the rate of perioperative blood transfusions in patients undergoing radical retropubic prostatectomy?
- What is the life expectancy of people undergoing treatment for HIV compared with the UK general population?
- Does use of ACE inhibitors during early pregnancy increase the risk of malformations in live born babies?
- What were the local consequences of the government led implementation of a national electronic health records system in “early adopter” English hospitals?
Reducing bleeding during prostate surgery
Tranexamic acid has become an established treatment in cardiac surgery to reduce the rate of bleeding, and thus the need for perioperative blood transfusion. Unsurprisingly, its potential use has also been investigated in orthopaedic and liver surgery—and now in radical prostatectomy. Antonella Crescenti and colleagues conducted a randomised placebo controlled trial to assess the efficacy of low dose tranexamic acid in reducing the rate of blood transfusion in 200 patients undergoing open radical retropubic prostatectomy (still the standard surgical treatment for localised prostate cancer) and the long term safety of this treatment.
The results are promising if not startling: 34% of patients needing transfusion with active treatment compared with 55% of controls, and no significant difference in (rare) adverse events at six months’ follow-up. Being relatively inexpensive and simple to administer are other definite pluses for tranexamic acid.
HIV: outlook in UK shows the drugs work
There are common questions from patients with HIV, or those considering an HIV test, that doctors are expected to answer: How long have I got? What difference do antiviral drugs make? What’s the point of being tested for a terminal disease?
The reality and image of life with HIV and AIDS has changed with the development of antiretrovirals, and continues to evolve. We now have more drugs, better drugs, and drugs with fewer side effects than in the past—we also have a better understanding of HIV, and specialist services to care for patients living with the infection. But what has been the overall effect of these improvements?
In search of some modern, crunchy numbers to estimate the life expectancy for people undergoing HIV treatment, compared with that of the general population in the UK, Margaret May and colleagues examined outcomes for patients in the UK Collaborative HIV Cohort. The take home message is that the drugs work, say Elena Losina and colleagues in their accompanying editorial. And, starting treatment early is associated with better outcomes. All good reasons to encourage testing; particularly in males—who, unlike women of child bearing age, are not routinely offered screening.
Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses
In this cohort study by Øjvind Lidegaard and colleagues, oral contraceptives with desogestrel, gestodene, or drospirenone were associated with twice the risk of venous thromboembolism compared with those containing levonorgestrel, after adjustment for length of use (doi:10.1136/bmj.d6423).
Factors associated with variability in the assessment of UK doctors’ professionalism
J A Simpson and colleagues investigated potential biases arising in the assessment of doctors’ professionalism using multisource feedback, a method that is likely to be used in revalidation processes in the UK (doi:10.1136/bmj.d6212).
Honorary and ghost authorship in high impact biomedical journals
A study by Joseph Wislar and colleagues showed that 21% of articles published in six high impact, general medical journals in 2008 had honorary authorship, ghost authorship, or both, a decline from 29% in 1996 (doi:10.1136/bmj.d6128).