“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.
- What is the value of laboratory tests for the diagnosis of serious infections in children in ambulatory settings?
- Does vitamin D supplementation reduce mortality and admissions to hospital of low birthweight infants in a low income setting?
- Does evidence based information on risk increase informed choice in colorectal cancer screening?
- How soon can anticoagulation be stopped after venous thromboembolism without increasing the risk of recurrence?
Vitamin D for low birthweight babies
Understanding the non-classic health benefits of vitamin D is currently a hot topic among researchers in public health. Vitamin D deficiency has been associated with increased infectious disease in several populations. However, there have been few adequately powered trials of vitamin D to decrease infectious disease morbidity and mortality in key high risk populations—for example, infants and young children in low income countries.
Geeta Trilok Kumar and colleagues did a randomised controlled trial to address this question. They enrolled just over 2000 low birthweight term neonates born to families living in the Delhi slums and randomised them to either daily vitamin D supplementation (combined with breast milk) for six months or placebo. They studied this group partly because of its high mortality, and partly to find out whether the study hospital’s routine practice of providing vitamin D supplements to preterm infants should be extended to this other group of at risk children. Although supplementation increased the infants’ vitamin D status, it didn’t seem to affect the primary outcome of hospitalisation or death during the first six months of life. However, a secondary analysis suggested that vitamin D treatment did improve growth and decreased the proportion of stunted children.
Reviewers felt that despite the negative result this trial was a useful contribution to knowledge about the potential benefits of vitamin D, especially given the technical challenges of carrying out the study in a low resource setting
Objective information on cancer screening improves patients’ informed choice
Many screening programmes for diseases have become highly controversial, with opponents claiming that patients are given biased and incomplete information about the risks and benefits of screening in order to boost uptake of screening services. With all the heat generated on the subject, it’s nice to find a gleam of light as well, produced by Anke Steckelberg and colleagues’ study of the impact of evidence based risk information on informed choice in colorectal cancer screening. Recipients of the evidence based risk information were indeed more likely to make informed choices than those who received the standard information leaflet. They were also less likely to have a positive attitude towards screening, but there was no difference in actual and planned uptake of screening after six months. Thus, the results of this trial can be seen as a win-win situation for both “sides” of the debate.
Three months’ anticoagulation is usually enough after venous thromboembolism
Among patients who have experienced venous thromboembolism, the condition often recurs after the anticoagulant treatment is stopped. However, anticoagulant treatment carries a risk of major bleeding, so determining optimum duration of treatment is important. Florent Boutitie and colleagues investigated this question by reanalysis of individual participants’ data from seven trials, and they conclude that in most patients, where the risk of recurrent venous thromboembolism is not high enough to justify indefinite anticoagulation, treatment can be stopped after three months. They also found that risk of recurrence after stopping anticoagulants is doubled in patients with proximal deep vein thrombosis or pulmonary embolism compared with those with isolated distal deep vein thrombosis, and that risk is also doubled if thrombosis was unprovoked rather than provoked by a temporary risk factor.
In her accompanying editorial, Saskia Middeldorp discusses the results in more detail, including the pros and cons of such meta-analysis of individual patient data compared with analysis at study level and the still unanswered questions about better risk stratification of patients.
How to get published in the BMJ
We’ve produced a short video to help you find out about getting research published in the BMJ. It includes interviews with published authors and clips from short films that accompany some of our important research articles. We also have a presentation that the BMJ editors give at conferences. This slideshow includes among other things, how to write a research paper, scientific misconduct, and how to please editors. You can find the material at: http://www.bmj.com/video/.
We can also supply the video in DVD format if you would like to include it in a presentation but do not have a suitable internet connection—email eking@bmj.com for more details.