{"id":50006,"date":"2021-04-02T10:51:43","date_gmt":"2021-04-02T09:51:43","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50006"},"modified":"2021-04-02T10:51:43","modified_gmt":"2021-04-02T09:51:43","slug":"alex-nowbars-journal-reviews-2-april-2021","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/04\/02\/alex-nowbars-journal-reviews-2-april-2021\/","title":{"rendered":"Alex Nowbar\u2019s journal reviews\u20142 April 2021"},"content":{"rendered":"<p class=\"standfirst\"><em>Alex Nowbar reviews the latest research from the top medical journals<\/em><\/p>\n<p><!--more--><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-43001\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/09\/alex_nowbar.jpg\" alt=\"\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/09\/alex_nowbar.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2018\/09\/alex_nowbar-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><b>Covid-19 variant worries<\/b><\/p>\n<p><span style=\"font-weight: 400\">If you look at the totality of available evidence on covid-19 vaccines, they seem to be effective even against the emerging SARS-CoV-2 variants. However, this double-blind randomised trial of vaccine versus placebo set in South Africa suggests otherwise for the AstraZeneca vaccine. The trial found no efficacy of the vaccine against the B.1.351 variant in preventing mild to moderate covid-19 (and was inconclusive with regard to prevention of severe covid-19 because numbers were too small). This is fodder for those who support border restrictions and\/or aggressive testing to keep variants out of the UK, where so many have received this vaccine. It\u2019s also fodder for those who urge caution about removing other restrictions too soon. But, more importantly, it justifies the idea of vaccine boosters that target variants.<\/span><\/p>\n<p><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2102214\"><i><span style=\"font-weight: 400\">N Engl J Med <\/span><\/i><span style=\"font-weight: 400\">doi:10.1056\/NEJMoa2102214<\/span><\/a><\/p>\n<p><b>Semaglutide for NASH<\/b><\/p>\n<p><span style=\"font-weight: 400\">The main aim in treating non-alcoholic steatohepatitis (NASH) is to protect the liver (and thereby the rest of the body against the effects of liver damage). This 72-week double-blind randomised trial of semaglutide (at one of three doses) versus placebo used a primary endpoint of histologic resolution of NASH with no worsening of fibrosis. This is fair enough for a phase II trial because the aim is to discover whether the drug works at a physiological level. The secondary endpoint was an improvement of at least one fibrosis stage in those who started at stage F2 or F3 fibrosis (that is, not stage F1) with no worsening of NASH. Semaglutide increased the proportion of patients whose NASH resolved, but fibrosis stage was not affected. Semaglutide\u2019s known side effects were again demonstrated (nausea, constipation, and vomiting), as were its known weight loss effects. These results suggest it\u2019s worth moving forward with semaglutide as a potential NASH treatment.<\/span><\/p>\n<p><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2028395\"><i><span style=\"font-weight: 400\">N Engl J Med <\/span><\/i><span style=\"font-weight: 400\">doi:10.1056\/NEJMoa2028395<\/span><\/a><\/p>\n<p><b>Need your knees<\/b><\/p>\n<p><span style=\"font-weight: 400\">Chen and colleagues\u2019 analysis concludes that total knee replacements in people with a body mass index of \u226540 in the US are cost effective. This is such an important analysis because obese people can be refused surgery because of the risks of surgery. Surgeons naturally have to spend a lot more time worrying about the complications\u2014such as implant failure, deep vein thromboses, and infections\u2014and performing revision procedures than they do observing the increased quality of life that the operation delivers. The discomfort in front of one\u2019s eyes may seem more important to alleviate than the discomfort one doesn\u2019t see when the patient gets looked after by a non-surgeon after being turned down for surgery. The cost effectiveness of the operation was found in those under 65 and over 65 years old, and in those with multiple comorbidities.<\/span><\/p>\n<p><a href=\"https:\/\/www.acpjournals.org\/doi\/10.7326\/M20-4722\"><i><span style=\"font-weight: 400\">Ann Intern Med <\/span><\/i><span style=\"font-weight: 400\">doi:10.7326\/M20-4722<\/span><\/a><\/p>\n<p><b>Life expectancy and primary care<\/b><\/p>\n<p><span style=\"font-weight: 400\">The Americans may be catching on to something that we\u2019ve known in the UK for a while\u2014the tangible benefits of primary care. Basu and colleagues modelled the effects of increasing the density of primary care providers on life expectancy and mortality in areas of low density. They report \u201cPersons living in counties with less than 1 physician per 3500 persons in 2017 had a mean life expectancy that was 310.9 days shorter than for persons living in counties above that threshold.\u201d The correlation between reduced mortality and increased primary care provision doesn\u2019t tell us there is direct causation because there are buckets of known and unknown confounders, but there is reason to believe it would be worth upscaling primary care in underserved US areas. The implications for us in the UK is really that our approach is not to be sneered at.<\/span><\/p>\n<p><a href=\"https:\/\/www.acpjournals.org\/doi\/10.7326\/M20-7381\"><i><span style=\"font-weight: 400\">Ann Intern Med <\/span><\/i><span style=\"font-weight: 400\">doi:10.7326\/M20-7381<\/span><\/a><\/p>\n<p><b>Time on electronic health records<\/b><\/p>\n<p><span style=\"font-weight: 400\">It\u2019s easy to vilify the electronic health record (EHR), even though it\u2019s more efficient and error-resistant than paper. But why does choosing and buying a kettle on Amazon, say, feel so much easier than ordering a CT scan? Rotenstein and colleagues compared time spent on EHRs in different specialties and the distribution of time spent on different EHR activities. This analysis used data from Epic Systems across 351 ambulatory healthcare organisations in the US. In other words, it looked at the outpatient setting. Mean active daily EHR time was 46 minutes, 86 minutes, and 115 minutes for surgical, medical, and primary care specialties respectively. Medical and primary care specialties also spent a lot more time on EHR after hours\u2014a sure-fire route to burnout, although not necessarily the fault of the EHR. Most time was spent on notes, followed time spent on reviewing test results and making orders. Primary care physicians received dramatically more patient messages and prescription messages than surgical colleagues. The differences seem to reflect different practices amongst specialties\u2014that is, the type and amount of workload\u2014rather than revealing obvious areas for EHR improvement. Sure, the administrative burden on primary care is high, but now what? Where are the studies on reducing the number of clicks?<\/span><\/p>\n<p><a href=\"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/article-abstract\/2777845\"><i><span style=\"font-weight: 400\">JAMA Intern Med <\/span><\/i><span style=\"font-weight: 400\">doi:10.1001\/jamainternmed.2021.0256<\/span><\/a><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Alex Nowbar<\/strong> is a clinical research fellow at Imperial College London<\/span><\/i><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Alex Nowbar reviews the latest research from the top medical journals [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/04\/02\/alex-nowbars-journal-reviews-2-april-2021\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":45282,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[18902],"tags":[],"class_list":["post-50006","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-weekly-research-reviews"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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