{"id":50234,"date":"2021-05-10T08:50:05","date_gmt":"2021-05-10T07:50:05","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50234"},"modified":"2021-05-10T08:50:05","modified_gmt":"2021-05-10T07:50:05","slug":"alex-nowbars-journal-reviews-10-may-2021","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/05\/10\/alex-nowbars-journal-reviews-10-may-2021\/","title":{"rendered":"Alex Nowbar\u2019s journal reviews\u201410 May 2021"},"content":{"rendered":"

Alex Nowbar reviews the latest research from the top medical journals<\/em><\/p>\n

\"\"Maternal covid-19 infection<\/b><\/p>\n

A nationwide Swedish cohort study<\/a> found increased rates of some neonatal morbidities, including respiratory distress, with maternal covid-19 infection. However, the increased risk was minimal, and, given the multiplicity of data (lots of different outcomes were looked at), it\u2019s hard to know how genuine these findings are. The authors looked at 88\u2009000 infants, of whom 1.6% were delivered by mothers who tested positive covid-19. Infants were matched by maternal characteristics, and the neonatal outcomes were compared between infants of covid-positive and covid-negative mothers. Confounding cannot be eliminated as these are observational data. So we do not know if covid-19 itself mediated the difference, or if it could have been due to the mothers with covid-19 being treated differently, or that factors that made the women more likely to get covid-19 also influenced the neonatal outcome. Generally these data are reassuring that covid-19 isn\u2019t upping neonatal risk too dramatically.<\/span><\/p>\n

JAMA <\/span><\/i>doi:10.1001\/jama.2021.5775<\/span><\/p>\n

Education to reduce upper GI endoscopies for dyspepsia<\/b><\/p>\n

De Jong and colleagues randomised 119 patients<\/a> with uninvestigated dyspepsia to health education or usual care. I find this interesting given that usual care would, I imagine, include a level of education, or at least explanation. A year on, the proportion of patients having upper GI endoscopies was 39% in the education group and 82% in the usual care group. This is an impressive reduction in rates of a procedure with a low diagnostic yield (gastroscopy for dyspepsia) without compromising symptoms and quality of life. So what exactly was the education intervention, and can it be implemented widely? It was a web based tool with videos and 3D animations, so yes probably. I wonder what other procedures this approach could be applied to, because it sure sounds good. One slight caveat is that the results may only be generalisable to the type of patient who was prepared to participate in research rather than all comers. But even if there was some reduction in effectiveness, it would still be worth implementing to avoid gastroscopies that are unlikely to benefit patients.<\/span><\/p>\n

JAMA Intern Med<\/span><\/i> doi:10.1001\/jamainternmed.2021.1408<\/span><\/p>\n

Sexual acceptability of contraception<\/b><\/p>\n

Higgins and colleagues<\/a> explored the association of sexual function, satisfaction, and self reported sexual acceptability with continued contraception use over time in over 2000 women in Utah, USA. Contraception needs to be adhered to if it\u2019s going to be any good to anyone, so it\u2019s vital that factors affecting adherence are understood. Interestingly, more than half of the women felt that the contraception had improved their sex life. Contraception making their sex life worse was strongly associated with stopping the contraception method at six months. Sexual acceptability turns out to be really important. This is therefore an important topic to cover in contraception decision-making conversations\u2014just as much as mood, weight gain, and blood pressure get covered.<\/span><\/p>\n

JAMA Intern Med<\/span><\/i> doi:10.1001\/jamainternmed.2021.1439<\/span><\/p>\n

Immunological intrigue with paediatric brain tumours<\/b><\/p>\n

Immunovirotherapy is not my bread and butter, but it seems to do something for high grade paediatric gliomas (a condition with poor survival) in a single arm trial of 12 patients<\/a>. The therapy is a genetically engineered oncolytic herpes simplex virus (G207). It is designed to selectively infect and lyse tumour cells. It is also supposed to reverse tumour immune evasion. It is adminstered directly into the tumour and supplemented with radiation to enhance the efficacy of G207. The results of this phase I trial were favourable in terms of clinical response and safety. Hopefully, phase II will be promising too.\u00a0<\/span><\/p>\n

N Engl J Med <\/span><\/i>doi:10.1056\/NEJMoa2024947<\/span><\/p>\n

Tranexamic acid for C-section<\/b><\/p>\n

The era of randomised obstetric research is in full swing. In this trial, 4551 women undergoing caesarean delivery<\/a> were randomised to tranexamic acid or placebo in a double blind fashion. All participants received uterotonic agents prophylactically. The primary outcome was postpartum haemorrhage (defined as >1000\u2009mL estimated blood loss or receipt of transfusion within two days of delivery). The trial showed that tranexamic acid reduced this primary outcome compared with placebo (26.7% versus 31.6%). But the haemorrhage-related secondary outcomes (gravimetrically estimated blood loss, provider-assessed clinically significant postpartum hemorrhage, use of additional uterotonic agents, and postpartum blood transfusion) were not reduced, which calls into question whether the treatment makes a clinically significant difference. Thromboembolic event rates were very low but numerically higher in the treatment group. A quarter of participants did not receive the tranexamic acid or placebo within three minutes of delivery as required by the protocol\u2014one of the realities of trial conduct. This probably wasn\u2019t the reason for a lack of greater efficacy, though. This is an excellent trial. The resounding evidence for tranexamic acid that was expected (given that it is already in widespread use) did not come.<\/span><\/p>\n

N Engl J Med<\/span><\/i> doi:10.1056\/NEJMoa2028788<\/span><\/p>\n

Alex Nowbar<\/strong> is a clinical research fellow at Imperial College London.<\/span><\/i><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

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

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