This week in the BMJ
Volume 329, Number 7468, Issue of 25 Sep 2004Dogs sniff out bladder cancer
Dogs sniff out bladder cancer
Dogs can be trained to identify people with bladder cancer. In a proof of principle study, Willis and colleagues (p 712) trained six dogs to discriminate between urine from patients with bladder cancer and urine from diseased and healthy controls. They found that at the end of seven months of training the dogs were able to select the urine of patients with cancer 41% of the time, whereas the success rate expected by chance alone was 14%.
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Basal cell carcinoma should be excised
Surgical excision provides the best long term results in people with basal cell carcinoma of the skin. Reviewing 25 randomised trials, Bath-Hextall and colleagues (p 705) found that little good quality research is available on the treatment of this most common cancer. Surgery, which showed the lowest failure rates, and radiotherapy seem to be the most effective treatments, but radiotherapy may cause scarring. Only one trial included adequate long term data on recurrence; most had a follow up period of six months or less.
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Advice may be sufficient for back pain
Patients with low back pain may not need physiotherapy. Frost and colleagues (p 708) randomised 286 patients with mild to moderate low back pain to routine physiotherapy or advice from a physiotherapist to remain active. They found that after 12 months patients who had physiotherapy were more likely to report enhanced perceptions of benefit, but this was not shown by disease specific or generic outcome measures. Advice may be all that is needed for these patients, say the authors.
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Wound infections are not classified consistently
Adopting different classifications of wound infections may limit the comparison of infection rates between hospitals. Wilson and colleagues (p 720) used four commonly used scales to assess and classify wounds in 4773 surgical patients. They found that the agreement between definitions was poor, limiting the use of the scales for comparing hospitals' performance. Small changes in interpretation of a definition resulted in important variations in the detection of infections.
Advances in treatment may affect cost effectiveness analysis
Economic evaluations in health and medicine usually ignore possible future advances in treatment, but these can have major implications for cost effectiveness analyses. Salomon and colleagues (p 733) say that, particularly when technological innovation is rapid, technological change is one of the many factors that can influence decisions regarding the optimal timing of treatment. Analysts should model the full spectrum of alternative options, so that decision makers have estimates of their cost, benefits, and risks when faced with difficult choices about imperfect treatments.
What's new in narcolepsy?
A structured sleep history and assessment in a sleep laboratory are helpful in finding the cause of excessive daytime sleepiness. Reviewing the clinical features and neurobiology of narcolepsy, Zeman and colleagues (p 724) say that levels of hypocretin-1 and hypocretin-2, the neurotransmitters regulating the sleep-wake cycle, are reduced in people with narcolepsy and cataplexy. In Europe around 3-5 people in 10 000 are affected, and moderately effectively treatments are available, with newer ones being investigated. Patients with suspected narcolepsy should be referred to a sleep disorder service and reviewed regularly.
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Cancer risk in coeliac disease is lower than thought
People with coeliac disease have only a slightly higher risk of cancer, not the doubling previously suggested. West and colleagues (p 716) reviewed 4732 adults and children with coeliac disease from the UK general practice research database and more than 23 000 controls and found that most of the excess risk occurs in the first year after diagnosis. This study also confirms that women with coeliac disease have lower rates of breast cancer than controls.
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