This week in the BMJ
Volume 328, Number 7438, Issue of 28 Feb 2004Adenoidectomy does not reduce recurrent otitis in young children
Adenoidectomy does not reduce recurrent otitis in young children
Neither adenoidectomy nor chemoprophylaxis reduces the risk of recurrent otitis media in young children. Koivunen and colleagues (p 487) randomised 180 children aged 10 months to 2 years who presented with recurrent otitis media to one of three groups: adenoidectomy, chemoprophylaxis with sulfafaruzole, or placebo. In the subsequent two years the groups had similar numbers of episodes of otitis media, visits to a doctor, antibiotic prescriptions, and days with symptoms of respiratory infection. In children under 2 years, adenoidectomy cannot be recommended as the primary method of prophylaxis for recurrent otitis media, the authors say.
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Pelvic rocking exercise does not help the baby to rotate
Hands and knees position and pelvic rocking exercise does not help babies to rotate from the posterior to the anterior position before birth. Kariminia and colleagues (p 490) randomised 2547 pregnant women to the exercise or to standard care during the last four weeks of pregnancy. They found no differences of persistent posterior fetal position, transverse arrest, mode of delivery, and duration of labour between groups.
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Drinking plenty of fluids may be harmful
Drinking extra fluids in the presence of acute respiratory infection may cause fluid overload and hyponatraemia, and may be harmful to patients. In a systematic review, Guppy and colleagues (p 499) report that no randomised trial compared increased or restricted fluid intake in patients with respiratory infection. Results of prevalence studies, and case series, suggest that increased fluid intake may cause harm. We should be cautious when adopting such a strategy until more evidence is available, the authors say.
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Low dose ramipril is not optimal in diabetes
Low dose (1.25 mg daily) ramipril does not reduce cardiovascular and renal events in patients with type 2 diabetes and albuminuria. After four years of follow up of 4912 diabetic patients enrolled in the DIABHYCAR trial, where participants were given low dose ramipril or standard care, Marre and colleagues (p 495) found that low dose ramipril had no effect on cardiovascular and renal outcome, but it slightly reduced albuminuria and blood pressure in the intervention group. The protective effect of ramipril may be dose dependent, the authors say, and high doses can be recommended for cardiovascular protection in high risk patients.
Single patient trials may guide treatment
When evidence on treatment effectiveness is lacking, single patient trials may guide treatment in individual cases. Harker and colleagues (p 503) give the denouement of an interactive case report in which a woman was given vitamin B-6 alternatively with placebo to alleviate pregnancy related nausea, vomiting, and lightheadedness. The trial showed that vitamin B-6 was ineffective. N = 1 trials may be useful when evidence to support treatment is poor or equivocal, the authors say, and may help patients and doctors decide about further treatment.
Does animal research benefit humans?
Animal studies are often of poor quality, and their contribution to clinical medicine requires rigorous evaluation. Pound and colleagues analysed 25 systematic reviews of animal studies and found only six investigating how animal research had informed clinical research. The methodological quality of the studies was poor, some were run simultaneously with clinical trials, and in some cases negative findings from animal trials did not prevent subsequent clinical trials. Systematic reviews of animal studies can provide important insights into the validity and value of animal research, say the authors, and should precede clinical trials.
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