{"id":125,"date":"2007-02-26T12:54:33","date_gmt":"2007-02-26T11:54:33","guid":{"rendered":"http:\/\/resource.bmj.com\/bmj\/2007\/02\/26\/ann-intern-med-20-feb-2007\/"},"modified":"2007-02-26T12:54:33","modified_gmt":"2007-02-26T11:54:33","slug":"ann-intern-med-20-feb-2007","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2007\/02\/26\/ann-intern-med-20-feb-2007\/","title":{"rendered":"Ann Intern Med  20 Feb 2007"},"content":{"rendered":"<p>This <a href=\"http:\/\/www.annals.org\/cgi\/content\/abstract\/146\/4\/233\">study <\/a>puts paid to the idea that <a href=\"http:\/\/www.annals.org\/cgi\/content\/abstract\/146\/4\/233\">tight glycaemic control<\/a> during on-pump <a href=\"http:\/\/www.annals.org\/cgi\/content\/abstract\/146\/4\/233\">cardiac surgery<\/a> improves outcomes. In this <a href=\"http:\/\/www.annals.org\/cgi\/content\/abstract\/146\/4\/233\">trial <\/a>it did the exact opposite.<!--more--><br \/>\nScreening for <a href=\"http:\/\/www.annals.org\/cgi\/content\/abstract\/146\/4\/244\">colorectal cancer<\/a> using guaiac-based tests for <a href=\"http:\/\/www.annals.org\/cgi\/content\/abstract\/146\/4\/244\">faecal occult blood<\/a> has sometimes been pooh-poohed for its lack of sensitivity, but a better test is now available, based on <a href=\"http:\/\/www.annals.org\/cgi\/content\/abstract\/146\/4\/244\">quantitative immunochemical detection<\/a> of <a href=\"http:\/\/www.annals.org\/cgi\/content\/abstract\/146\/4\/244\">human haemoglobin<\/a>. In an Israeli cohort of patients with symptoms or at increased risk of colorectal neoplasia, the predictive characteristics were pretty good judged against the gold standard of colonoscopy: sensitivity 94%, specificity 87% for cancer, less for other significant neoplasia. How it would perform in whole-population screening is another matter.<br \/>\nHow many doctors can immediately define sensitivity and specificity, and explain how these figures depend on the characteristics of the population studied? Most of us have acquired this knowledge from some kind of <a href=\"http:\/\/www.annals.org\/cgi\/content\/abstract\/146\/4\/256\">primer<\/a>, and make occasional fumbling attempts to convey it to our patients when the need arises. Might they do better with a primer of their own? Apparently so, judging from this <a href=\"http:\/\/www.annals.org\/cgi\/content\/abstract\/146\/4\/256\">trial <\/a>of such a document given to patients of high and low socioeconomic standing. But all it proved was that reading it gave them a bit more grasp of the principles, not that they were better able to make medical decisions.<br \/>\nComputerised prescribing systems commonly give warnings against prescribing cefalosporins to patients with a history of penicillin allergy, which we commonly ignore. Another drug with theoretical cross-reactivity is <a href=\"http:\/\/www.annals.org\/cgi\/content\/abstract\/146\/4\/266\">meropenem<\/a>. This Italian <a href=\"http:\/\/www.annals.org\/cgi\/content\/abstract\/146\/4\/266\">study <\/a>looked at skin tests to meropenem in penicillin-allergic subjects: 99% were negative.<br \/>\nIn the UK, the <a href=\"http:\/\/www.annals.org\/cgi\/content\/abstract\/146\/4\/289\">periodic health evaluation<\/a> has always been deeply unpopular. Here we consider ourselves quite busy enough, and resent patients coming in with their BUPA printouts expecting us to chase up borderline T-wave changes, slightly raised liver enzymes, highish triglycerides and all the rest; whereas in the USA, such endeavours are highly esteemed by patients and buoy up the health economy. A US <a href=\"http:\/\/www.annals.org\/cgi\/content\/abstract\/146\/4\/289\">systematic review<\/a> of studies of the PHE comes out in favour, while carefully dodging any analysis of its individual elements.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>This study puts paid to the idea that tight glycaemic control during on-pump cardiac surgery improves outcomes. In this trial it did the exact opposite. [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2007\/02\/26\/ann-intern-med-20-feb-2007\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38363,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[111],"tags":[],"class_list":["post-125","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-lehmans-weekly-review-of-medical-journals"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Ann Intern Med 20 Feb 2007 - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2007\/02\/26\/ann-intern-med-20-feb-2007\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ann Intern Med 20 Feb 2007 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"This study puts paid to the idea that tight glycaemic control during on-pump cardiac surgery improves outcomes. 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[...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2007\/02\/26\/ann-intern-med-20-feb-2007\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2007-02-26T11:54:33+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"540\" \/>\n\t<meta property=\"og:image:height\" content=\"350\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2007\\\/02\\\/26\\\/ann-intern-med-20-feb-2007\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2007\\\/02\\\/26\\\/ann-intern-med-20-feb-2007\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Ann Intern Med 20 Feb 2007\",\"datePublished\":\"2007-02-26T11:54:33+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2007\\\/02\\\/26\\\/ann-intern-med-20-feb-2007\\\/\"},\"wordCount\":343,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2007\\\/02\\\/26\\\/ann-intern-med-20-feb-2007\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/02\\\/richard-lehman.jpg\",\"articleSection\":[\"Richard Lehman's weekly review of medical journals\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2007\\\/02\\\/26\\\/ann-intern-med-20-feb-2007\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2007\\\/02\\\/26\\\/ann-intern-med-20-feb-2007\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2007\\\/02\\\/26\\\/ann-intern-med-20-feb-2007\\\/\",\"name\":\"Ann Intern Med 20 Feb 2007 - 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