The BMJ Today: Staffing levels, Alzheimer’s disease, blood pressure variability, and otitis media

• “If staffing were a drug, doctors would be asked to prescribe it,” Margaret McCartney says in her latest column. So she thinks it is a pity that NHS England has told NICE to stop work on discovering what constitutes safe staffing levels. Simon Stevens has decided to bring the operation “in house” and is asking Chief Nursing Officer Jane Cummings to look at the question. It would be nice to think that the results would be just as evidence based and transparent as if NICE was doing it. But when inquiries are carried out in the depths of the Department of Health, they do not always see the light of day.

•McCartney’s previous column, on the so-called “breakthrough” discovery of a drug that might work against Alzheimer’s disease, has prompted a well informed response from David Torgerson, director of the York Trials Unit, at York University. He agrees that she is right to be cautious about the effectiveness of the drug, but not because of the relatively small size of the study but because of the nature of testing for subgroups within an overall negative trial.
“If the overall trial showed no effect but a subgroup did then it is important to interpret these findings cautiously. Firstly, if those with a mild disease benefited then it follows that those with severe disease got worse (as the overall trial did not show anything). Is this likely to be true? If not then it is likely to be a chance finding?” Torgerson says a similar thing happened in another trial of a drug from Eli Lilly called raloxifine. It was thought that it might be effective in a sub-group of the original trial subjects, but in a replication study in that group, it was found there was no effect.

•Two more research studies are reported today in the Research News section of the The BMJ‘s website. One, from the Annals of Internal Medicine, showed that variability in blood pressure readings taken over seven visits in just over two years was associated with increased risk of heart disease and death. It was a retrospective analysis of a large US prospective cohort study of 25814 people with hypertension but no cardiovascular disease events during the first 28 months of the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
The researchers did warn that their study was a secondary analysis, but still concluded that the data added to the growing body of evidence on the prognostic value of blood pressure variability as a risk factor for cardiovascular disease.

•Finally, a study published in the Canadian Medical Association Journal suggested that a simple procedure with a nasal balloon could reduce the effect of hearing loss and avoid the unnecessary use of antibiotics in children who have otitis media with effusion. But in a related commentary, experts from the Centre for Research in Evidence Based Practice at Bond University in Queensland, Australia, said several barriers to adopting auto-inflation existed. They noted that doctors needed to know about the technique’s effectiveness and how it is done, and they must be able to instruct children and families in how to use it.

Annabel Ferriman is senior news editor, The BMJ.