“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.
- Is comprehensive geriatric assessment effective for older people admitted to hospital as an emergency?
- How effective are commercial and primary care led programmes for weight loss?
- What are the outcomes at age 1 year for infants born with gastroschisis?
Comprehensive geriatric assessment in emergency admissions
Comprehensive geriatric assessment is a process for taking account of elderly patients’ complex, multisystem problems and providing comprehensive interventions. Several studies and reviews have reported benefits from using the assessment, but have been limited in their scope, analysing only subgroups of inpatients or only specific conditions.
To gain a more extensive view of the evidence, Graham Ellis and colleagues did a meta-analysis of 22 randomised controlled trials, with a total of 10, 315 patients aged 65 or more, that compared comprehensive geriatric assessment with usual care. Their results confirm that comprehensive geriatric assessment in hospital is effective and gives a patient a significantly better chance of returning home and avoiding admission to residential care or worse. Furthermore, they conclude that a key feature of successful assessment seems to be treatment in discrete units with expertise in the care of older people and control over the delivery of care (as opposed to a mobile team visiting older patients wherever they are admitted to hospital and then making recommendations on care). From the studies that analysed costs of intervention, Ellis and colleagues are also able to say that comprehensive geriatric assessment seems to be cost effective for hospitals and might be cost saving for society.
In their linked editorial, Andreas Stuck and Steve Iliffe applaud the extra information this study has provided and sum up: “The clinical implications are clear—comprehensive geriatric assessment should become standard practice.”
Effectiveness of commercial and primary care led programmes for weight loss
In Kate Jolly and colleagues’ Lighten Up trial, 740 obese or overweight primary care patients who also had a comorbid disorder were randomised either to one of several weight loss programmes for 12 weeks or to receive, in the control group, 12 vouchers for free entrance to a local fitness centre. There were three commercial programmes: Weight Watchers, Slimming World, and Rosemary Conley; and three programmes provided by the NHS: a group weight loss programme (Size Down) and two primary care programmes of one to one support, led by nurses in general practice or with a pharmacist. The last option was for participants to choose any of the above.
For the primary outcome of weight loss at 12 weeks, only participants in the Weight Watchers and Rosemary Conley programmes had significantly greater weight loss than the control group. At one year only the Weight Watchers group—which had the highest attendance rate—was still effective. The primary care based programmes were ineffective and were the most costly to provide.
Editorialists Helen Truby and Maxine Bonham, authors of the BBC diet trial—which compared commercial programmes, but didn’t look at NHS interventions (BMJ 2006;332:1309-11)—conclude that the NHS has a lot to learn from Weight Watchers et al. On the other hand, Rachel Pryke argues in a rapid response that GPs shouldn’t be running weight loss programmes. Instead, they could be “sensitively raising awareness of the relevance of weight to health, assessing motivation and emotional fragility in order to ensure that chosen goals are feasible and will not erode self esteem further, (how often have we colluded with unrealistic targets and set our patients up to fail?) and increasing the numbers of patients that are signposted to local community services as a first line” (http://bit.ly/tGyHqN)
Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months
Ola Andersson and colleagues’ randomised controlled trial showed that delayed cord clamping decreased the risk of iron deficiency at age 4 months, in infants born at term in a country with a low prevalence of iron deficiency anaemia (doi:10.1136/bmj.d7157).