{"id":23856,"date":"2013-01-21T13:00:40","date_gmt":"2013-01-21T12:00:40","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=23856"},"modified":"2013-01-21T13:00:40","modified_gmt":"2013-01-21T12:00:40","slug":"richard-lehmans-journal-review-21-january-2013","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/21\/richard-lehmans-journal-review-21-january-2013\/","title":{"rendered":"Richard Lehman’s journal review\u201421 January 2013"},"content":{"rendered":"

\"RichardJAMA Intern Med\u00a0 14 Jan 2013\u00a0 Vol 173<\/strong>
\nThe Archives of Internal Medicine<\/em> have now morphed into JAMA Internal Medicine<\/em><\/a>. It would be nice to report that this first issue is a cracker, but unfortunately journals can only be as good as the material that comes in, and the JAMA<\/em> truck seems to have been pretty empty this week. JAMA Internal Med<\/em> has thin pickings, and the \u201cparent\u201d journal JAMA<\/em> has nothing to interest this UK generalist.<\/p>\n

46\u00a0\u00a0 In the US medical literature, it seems to be thought scientifically and politically correct to use the label \u201cblack\u201d to mean anyone of African ancestry. But we must remember that the West Africans who were caught and survived the slave-boat journey to America are not likely to be typical of all Africans or \u201cblacks,\u201d who have the largest genetic diversity on the planet. Still, let\u2019s put aside these reservations and look at some North American \u201cblack\u201d epidemiology relating to stroke and hypertension. In this population, \u201cblackness\u201d confers a much higher risk of stroke for every increment of systolic blood pressure above normal. And because BP tends to be less well controlled in American black hypertensives than in whites, incident stroke before the age of 65 is 2-3 times commoner.<\/p>\n

NEJM\u00a0 17 Jan 2013\u00a0 Vol 368<\/strong>
\n201\u00a0\u00a0 The Patient Experience and Health Outcomes is a topic which deserves a book, but while I am trying to write it, you can take a look at this short Perspective<\/a> which restricts itself to the question \u201cDo patients’ reports of their healthcare experiences reflect the quality of care?\u201d By patients\u2019 reports, the authors seem to mean the kind of questionnaires that have long been used in research and are now increasingly used by providers to measure \u201csatisfaction.\u201d But the question as put is too poorly defined to allow an answer, so the discussion meanders back and forth. The fact is that it is possible for patients to be satisfied with truly dreadful care\u2014for example an unnecessary diagnostic procedure detecting an incidental tumour leading to an operation with life-threatening complications followed by immense gratitude from the patient who thinks their life has been saved. That said, most examples of patient dissatisfaction are markers of poor care in some way; because although there are some outrageously unreasonable patients, I think they are far outnumbered by patients who receive an outrageously unreasonable standard of care.<\/p>\n

207\u00a0\u00a0 The SPARTAC trial<\/a> set out to discover if giving short-course antiretroviral treatment to patients soon after the discovery of HIV infection had any advantage over treatment when their CD+ count had fallen to a prespecified level. I am simplifying: the trial actually recruited using a wider definition of \u201cprimary HIV\u201d but you will have to seek details from the full paper (free) using the link. It wasn\u2019t a big hit: \u201cWe found that a 48-week course of ART during primary HIV infection delayed a decline in the CD4+ count to less than 350 cells per cubic millimetre or the initiation of long-term ART, but this delay was not significantly longer than the 48-week treatment period.\u201d However, there were some promising subgroups and hints of long-term benefit, so the work goes on.<\/p>\n

254\u00a0\u00a0 It\u2019s time to stop watching the snow falling by the lamp-posts, close the curtains, poke the fire and get out some old DVDs. Now what have we here? The Star Wars trilogy, Lord of the Rings, Agatha Christie\u2019s Poirot: the Complete Collection\u2014and oh look, Drug Eluting Stents from NEJM<\/em><\/a> studios. Starring Giulio Stefanini as Sirolimus and David Holmes as Paclitaxel. How about it, folks? Nah\u2014let\u2019s have Game of Thrones. We prefer bare metal.<\/p>\n

Lancet\u00a0 19 Jan 2013\u00a0 Vol 381<\/strong>
\n205\u00a0\u00a0 Helicobacter pylori<\/em> has lived in mammalian stomachs for tens of millions of years, but we humans have spent the last 20 years trying to eradicate it. Its pattern of antibiotic susceptibility varies across the world, reflecting the various agents that have been used to attack it. In recent years, we have a lot of information from the Italian battlefield, but here we get a report from Taiwan<\/a>. These researchers decided to compare triple therapy with lansoprazole, amoxicillin, and clarithromycin for 14 days with a 10 or 14 day sequential regime which included these drugs plus metronidazole. You could go on tweaking these regimes for ever, of course, but there was a small difference in favour of the 14-day sequential regime in the Taiwanese population.<\/p>\n

242\u00a0\u00a0 Many Lancet seminars get bogged down in endless genomic detail and speculation, but because most hypertrophic cardiomyopathy<\/a> has now been shown to be due to mutations of just 11 genes, the authors can concentrate on clinical issues, which they do very well. \u201cAfter more than 50 years, hypertrophic cardiomyopathy has been transformed from a rare and largely untreatable disorder to a common genetic disease with management strategies that permit realistic aspirations for restored quality of life and advanced longevity.\u201d<\/p>\n

BMJ\u00a0\u00a0 19 Jan 2013\u00a0 Vol 346<\/strong>
\nWe naturally tend to associate sweetness with pleasure, and the excessive use of sugar was therefore always likely to attract the wrath of puritans. Jim Mann here<\/a> looks at the whole literature on sugar consumption in relation to body weight in adults and children. Alas, yes, too many sweeties will make you fat.<\/p>\n

Personally I don\u2019t like sweet things much, so I have to resort to fat to get fat. This is also successful. And if you want to lose fat, eating less fat can help\u2014though not much<\/a>. \u201cLower total fat intake leads to small but statistically significant and clinically meaningful, sustained reductions in body weight in adults in studies with baseline fat intakes of 28-43% of energy intake and durations from six months to over eight years.\u201d I am off to eat some roast duck. Who knows where I shall be in 8 years\u2019 time.<\/p>\n

I do wish the debate about cancer screening was less polarized. I blame the screeners, because they have been so shameless in overstating the benefits; but I don\u2019t want my own zealous scepticism to get in the way either. This study tries to assess the time-lag to benefit from screening for breast and colorectal cancer<\/a>, but because the data may be skewed and the sums are difficult, I\u2019m not sure whether to trust the conclusion, and the rather na\u00efve editorial by Julietta Patnick is no help<\/a>. She states that cancer-specific mortality is the end point most people agree on. I don\u2019t: I want to know about all-cause mortality. Some very carefully constructed and meticulously objective decision aids are needed for everyone who enters these screening programmes.<\/p>\n

The Winter Garden<\/strong>
\nThe laurels with the winter strive;
\nThe crocus burnishes alive
\nUpon the snow-clad earth;
\nFor Adoration myrtles stay
\nTo keep the garden from dismay,
\nAnd bless the sight from dearth.<\/p>\n

The pheasant shows his pompous neck;
\nAnd ermine, jealous of a speck,
\nWith fear eludes offence:
\nThe sable, with his glossy pride,
\nFor Adoration is described,
\nWhere frosts the waves condense.<\/p>\n

The cheerful holly, pensive yew,
\nAnd holy thorn, their trim renew;
\nThe squirrel hoards his nuts;
\nAll creatures batten o\u2019er their stores,
\nAnd careful nature all her doors
\nFor Adoration shuts.<\/p>\n

Why Adoration? It is because this is an extract from an ecstatic poem addressed to King David in his role as author of the Psalms by Christopher Smart (1722-1771). He may or may not have been in an insane asylum when he wrote A Song for David\u2014accounts differ\u2014but he probably did not mind, provided he could read the psalms and had his cat with him:<\/p>\n

For I will consider my Cat Jeoffry.
\nFor he is the servant of the Living God, duly and daily serving him.
\nFor at the first glance of the glory of God in the East he worships in his way.
\nFor is this done by wreathing his body seven times round with elegant quickness.
\nFor then he leaps up to catch the musk, which is the blessing of God upon
\n**his prayer.
\nFor he rolls upon prank to work it in.
\nFor having done duty and received blessing he begins to consider himself.
\nFor this he performs in ten degrees.
\nFor first he looks upon his forepaws to see if they are clean.
\nFor secondly he kicks up behind to clear away there.
\nFor thirdly he works it upon stretch with the forepaws extended.
\nFor fourthly he sharpens his paws by wood.
\nFor fifthly he washes himself.
\nFor sixthly he rolls upon wash.
\nFor seventhly he fleas himself, that he may not be interrupted upon the beat.
\nFor eighthly he rubs himself against a post.
\nFor ninthly he looks up for his instructions.
\nFor tenthly he goes in quest of food.
\nFor having considered God and himself he will consider his neighbor.
\nFor if he meets another cat he will kiss her in kindness.
\nFor when he takes his prey he plays with it to give it a chance.
\nFor one mouse in seven escapes by his dallying.
\nFor when his day’s work is done his business more properly begins.
\nFor he keeps the Lord’s watch in the night against the adversary.
\nFor he counteracts the powers of darkness by his electrical skin and glaring eyes.
\nFor he counteracts the Devil, who is death, by brisking about the life.
\nFor in his morning orisons he loves the sun and the sun loves him.
\nFor he is of the tribe of Tiger.
\nFor the Cherub Cat is a term of the Angel Tiger.
\nFor he has the subtlety and hissing of a serpent, which in goodness
\n**he suppresses.
\nFor he will not do destruction if he is well-fed, neither will he spit
\n**without provocation.
\nFor he purrs in thankfulness when God tells him he’s a good Cat.
\nFor he is an instrument for the children to learn benevolence upon.
\nFor every house is incomplete without him, and a blessing is lacking in the spirit.
\nFor the Lord commanded Moses concerning the cats at the departure of
\n**the Children of Israel from Egypt.
\nFor every family had one cat at least in the bag.
\nFor the English Cats are the best in Europe.
\nFor he is the cleanest in the use of his forepaws of any quadruped.
\nFor the dexterity of his defense is an instance of the love of God
\n**to him exceedingly.
\nFor he is the quickest to his mark of any creature.
\nFor he is tenacious of his point.
\nFor he is a mixture of gravity and waggery.
\nFor he knows that God is his Saviour.
\nFor there is nothing sweeter than his peace when at rest.
\nFor there is nothing brisker than his life when in motion.
\nFor he is of the Lord’s poor, and so indeed is he called by benevolence
\n**perpetually\u2014Poor Jeoffry! poor Jeoffry! the rat has bit thy throat.
\nFor I bless the name of the Lord Jesus that Jeoffry is better.
\nFor the divine spirit comes about his body to sustain it in complete cat.
\nFor his tongue is exceeding pure so that it has in purity what it wants in music.
\nFor he is docile and can learn certain things.
\nFor he can sit up with gravity, which is patience upon approbation.
\nFor he can fetch and carry, which is patience in employment.
\nFor he can jump over a stick, which is patience upon proof positive.
\nFor he can spraggle upon waggle at the word of command.
\nFor he can jump from an eminence into his master’s bosom.
\nFor he can catch the cork and toss it again.
\nFor he is hated by the hypocrite and miser.
\nFor the former is afraid of detection.
\nFor the latter refuses the charge.
\nFor he camels his back to bear the first notion of business.
\nFor he is good to think on, if a man would express himself neatly.
\nFor he made a great figure in Egypt for his signal services.
\nFor he killed the Icneumon rat, very pernicious by land.
\nFor his ears are so acute that they sting again.
\nFor from this proceeds the passing quickness of his attention.
\nFor by stroking of him I have found out electricity.
\nFor I perceived God’s light about him both wax and fire.
\nFor the electrical fire is the spiritual substance which God sends from heaven
\n**to sustain the bodies both of man and beast.
\nFor God has blessed him in the variety of his movements.
\nFor, though he cannot fly, he is an excellent clamberer.
\nFor his motions upon the face of the earth are more than any other quadruped.
\nFor he can tread to all the measures upon the music.
\nFor he can swim for life.
\nFor he can creep.<\/p>\n

From Jubilate Agno<\/em>, written in confinement at St Luke\u2019s Hospital, 1759-63.
\nFOR I pray the Lord JESUS that cured the LUNATICK to be merciful to all my brethren and sisters in these houses.<\/p>\n","protected":false},"excerpt":{"rendered":"

JAMA Intern Med\u00a0 14 Jan 2013\u00a0 Vol 173 The Archives of Internal Medicine have now morphed into JAMA Internal Medicine. It would be nice to report that this first issue […]<\/p>\n

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