{"id":43529,"date":"2018-11-26T18:43:03","date_gmt":"2018-11-26T17:43:03","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=43529"},"modified":"2018-12-06T11:56:53","modified_gmt":"2018-12-06T10:56:53","slug":"ann-robinsons-research-reviews-26-november-2018","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/11\/26\/ann-robinsons-research-reviews-26-november-2018\/","title":{"rendered":"Ann Robinson’s research reviews\u201426 November 2018"},"content":{"rendered":"

Ann Robinson reviews the latest research from the top medical journals<\/p>\n

<\/p>\n

\"\"<\/a>Lancet<\/b><\/strong><\/p>\n

Life in the old drug yet<\/u><\/b><\/p>\n

Cisplatin has been around for 50 years. It kills cells by damaging nuclear DNA and is used to treat a wide range of cancers. But it\u2019s far from perfect. Resistance and reduced uptake by cancer cells and side effects such as nausea, are good reasons to seek an alternative.<\/span><\/p>\n

The current gold standard treatment for human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (around 70% of total) is radiotherapy plus cisplatin. This study looked at whether replacement of cisplatin with cetuximab<\/a>\u2014an antibody against the epidermal growth factor receptor\u2014can preserve high survival and reduce treatment toxicity. The cisplatin group fared better. The estimated 5-year overall survival was 77\u00b79% in the cetuximab group versus 84\u00b76% in the cisplatin group, with similar levels of toxicity. So there\u2019s life in the old drug yet, and the search for something better goes on.<\/span><\/p>\n

Aspirin and fish oils to prevent colon cancer<\/u><\/b><\/p>\n

The management of colorectal cancer has improved, but it remains the second most common cause of cancer deaths in the UK. This randomised study asked<\/a> whether the omega-3 fatty acid, eicosapentaenoic acid (EPA) and\/or aspirin were better than placebo in preventing sporadic colorectal cancer in a high risk population. Unfortunately, EPA and aspirin didn\u2019t reduce the proportion of individuals who had one or more colorectal adenomas, but they both decreased the recurrence of some subtypes of adenoma. The authors say, \u201cthe larger effect size of aspirin adds to the weight of evidence for its use in combination with endoscopic screening and surveillance, which provides suboptimal protection against right-sided colorectal cancer.\u201d Not all adenomas are equal and, as we move to a precision medicine approach, it\u2019s likely that molecular stratification of individual subtypes will replace the more crude counting of total adenomas.<\/span><\/p>\n

NEJM<\/b><\/p>\n

New hope for peanut allergy<\/u><\/b><\/p>\n

Peanut allergy is becoming more prevalent and is the cause of more allergy-related deaths than any other food. A lifetime of vigilance and avoidance are the only solutions at present. Enter AR101<\/span>\u2014<\/span>a new peanut-derived, oral biologic drug that delivers a specified amount of peanut protein. The name evokes Orwell\u2019s sinister Room 101 where prisoners are exposed to their own worst nightmare. I’m not sure whether this is intentional or unfortunate. This well-conducted trial found<\/a> that highly allergic children who were given AR101 could eat higher doses of peanut protein and had a milder allergic reaction during a subsequent challenge, than those who hadn\u2019t received AR101. There were no deaths or life-threatening adverse events. Study limitations included a narrow demographic (predominantly white males), short follow up period (the exit challenge was 6 months after the intervention, so we don\u2019t know how long desensitisation lasts), and exclusion of those with severe asthma (who may be most likely to benefit from desensitisation) for safety reasons.<\/span><\/p>\n

Probiotics for children\u2019s tummy bugs<\/u><\/b><\/p>\n

The season of colds and tummy bugs is upon us and GPs, paediatricians, and A&E\u00a0<\/span>doctors are seeing lots of children with gastroenteritis. Parents and caregivers get a lot\u00a0<\/span>of random advice<\/span>\u2014<\/span>feed them\/starve them, stop the milk\/don\u2019t stop it, give them\u00a0<\/span>probiotics, and so on. A prospective, double-blind trial<\/a> enrolled nearly a thousand\u00a0<\/span>children aged 3 months to 4 years of age with acute gastroenteritis who presented to one of 10 US paediatric emergency departments and randomised them to a 5-day course of the probiotic Lactobacillus rhamnosus GG, or to placebo. Just over 10% got worse rather than better over a two week period, but in most, the diarrhoea lasted around two days. Other household members were infected in 10-14% of cases. There was no significant difference between the two groups for any of the measured outcomes. One piece of advice that I will be confident about giving the parents of children with gastroenteritis is<\/span>\u2014<\/span>don\u2019t bother with probiotics.<\/span><\/p>\n

Lung cancer: some positive results for brigatinib, but is it cost effective?<\/u><\/b><\/p>\n

The five year survival rate for lung cancer remains shockingly low in the UK, at 9.5% overall. About 85% are non-small-cell lung cancers (NSCLC) and a small proportion (3-5%) of these are associated with a mutation of anaplastic lymphoma kinase (ALK) gene. The question asked in this pharma-funded study<\/a>, is whether brigatinib, which inhibits ALK, is more effective in advanced ALK-positive cases of NSCLC than the drug crizotinib. Progression-free survival over 12 months was higher with brigatinib than with crizotinib (67% vs 43%) with no new safety concerns. NICE preliminary guidance in September said it couldn\u2019t recommend brigatinib to treat ALK-positive advanced NSCLC on cost-effectiveness grounds, but final guidance is awaited.<\/span><\/p>\n

JAMA<\/b><\/p>\n

Intensive care for ICU staff<\/u><\/b><\/p>\n

Medicine and nursing are stressful professions, and nowhere more so than in intensive\u00a0<\/span>care units (ICUs). The question is whether a 5-day, multimodal programme, including\u00a0<\/span>education, role-play, and debriefing could reduce job related stress among ICU nurses? A\u00a0French study found<\/a> that it worked well. Job strain (as measured by questionnaires) was\u00a0<\/span>only reported by 13% of the intervention group compared to 67% in the control group.\u00a0<\/span>Absenteeism over the 6 month period went down from 8% in the control group, to\u00a0<\/span>1%<\/span>\u2014<\/span>which seems remarkably low. The training course consisted of a recap of nursing\u00a0<\/span>theory, simulation scenarios based on best practice that focused on patients with\u00a0<\/span>deteriorating conditions, and debriefing sessions that discussed soft skills and practices.\u00a0<\/span>I wonder whether it was having five days away from the daily stress of ICU to reflect and\u00a0<\/span>talk to colleagues, as much as the actual content of the course, that made a difference\u00a0<\/span>to these nurses.<\/span><\/p>\n

JAMA Internal Medicine<\/b><\/p>\n

Pause for thought<\/u><\/b><\/p>\n

The authors of this US study ask two questions:<\/a>\u00a0\u201cHow common are intimate partner violence (IPV), sexual assault, and posttraumatic stress (PTSD) among midlife and older women?\u201d and \u201cAre these exposures associated with women\u2019s experience of menopause?\u201d<\/span>
\n<\/span><\/p>\n

In a cohort of 2016 women aged 40-80, around 1 in 5 reported IPV and\/or sexual\u00a0<\/span>assault, and almost 1 in 4 had clinically significant symptoms of PTSD. After adjusting\u00a0<\/span>for obvious confounders, such as age, race\/ethnicity, educational level, body mass\u00a0<\/span>index, menopause status, hormone therapy, and parity, they found that emotional IPV\u00a0<\/span>and\/or current symptoms of PTSD was associated with difficulty sleeping, vasomotor\u00a0<\/span>symptoms, and vaginal symptoms. Women with a history of physical IPV were more\u00a0<\/span>likely to report night sweats, and sexual assault was (unsurprisingly) associated with\u00a0<\/span>vaginal symptoms.
\n<\/span>
\n<\/span>The authors admit to the problems of studies like this; \u201csymptoms including\u00a0<\/span>difficulty sleeping and night sweats are common with both PTSD and menopause,\u00a0<\/span>making these associations difficult to interpret.\u201d But there are two important messages\u00a0<\/span>for me: abuse is a common experience for many women, which leaves an indelible\u00a0<\/span>mark on their lives. And consultations about the menopause can be an opportunity to\u00a0<\/span>explore the life behind the symptoms.<\/span><\/p>\n

BMJ<\/b><\/p>\n

Night shifts and takeaways<\/u><\/b><\/p>\n

The combination of night shifts and an unhealthy lifestyle increases the risk of developing diabetes. Data from a large cohort in the US<\/a>, the Canadian Nurses\u2019 Health Study, and Nurses\u2019 Health Study II, was mined to follow 143 410 healthy women with no diagnosis of type 2 diabetes, cardiovascular disease, or cancer at baseline, to see whether they developed diabetes over the subsequent 22-24 years. Working at least three night shifts per month (in addition to day and evening shifts) was an independent risk factor for developing diabetes. Unsurprisingly, leading an unhealthy lifestyle (smoking, physical activity levels below 30 minutes per day, poor diet assessed, and body mass index of 25 or above) was also a significant risk factor for diabetes. The proportions of the joint association were \u201c17% for duration of rotating night shift work alone, 71% for unhealthy lifestyle alone, and 11% for an additive interaction between rotating night shift work duration and unhealthy lifestyle.\u201d The authors say \u201cmost cases of type 2 diabetes could be prevented by adhering to a healthy lifestyle, and the benefits could be greater in rotating night shift workers.\u201d Hospital administrators take note; night staff shouldn\u2019t have to rely on takeaways to sustain them.<\/span><\/p>\n

Ann Robinson<\/strong> is an NHS GP and health writer\/broadcaster. She works within her local community and is a trustee of the Anthony Nolan charity.<\/em><\/p>\n

Competing interests<\/strong>: None declared.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Ann Robinson reviews the latest research from the top medical journals […]<\/p>\n

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