This week in the BMJ
Volume 331, Number 7512, Issue of 6 Aug 2005Perioperative
blockers may do more harm than good
Perioperative 
blockers may do more harm than good
Perioperative use of blockers to prevent major cardiovascular events may not be justified in patients having non-cardiac surgery. In a systematic review and meta-analysis of 22 randomised controlled trials that included 2437 patients, Devereaux and colleagues (p 313) found that blockers slightly reduced the composite outcome of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal cardiac arrest (relative risk 0.44). However, blockers also more than doubled the risk for bradycardia and increased the risk for hypotension, both conditions that needed treatment. Furthermore, the beneficial results depend on methodologically weak trials.
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Elderly people recuperate better in a community hospital
Elderly people who need treatment for an acute illness can take better care of themselves independently after undergoing rehabilitation in a community hospital based in the locality than in a district general hospital. Green and colleagues (p 317) randomised 220 patients and found that the median length of hospital stay for both groups of patients was 15 days, but patients who stayed in a community hospital scored better on the Nottingham extended activities scale six months later. The groups did not significantly differ in satisfaction with care and carer burden.
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Cholinesterase inhibitors for Alzheimer's lack evidence
Good evidence is lacking to support treating Alzheimer's disease with cholinesterase inhibitors. A systematic review by Kaduszkiewicz and colleagues (p 321) included 22 double blind randomised controlled trials with the follow-up ranging from six weeks to three years, but the trials scored poorly on a predefined checklist of criteria of methodological quality. Further, the outcomes measuring cognition did show beneficial effects of cholinesterase inhibitors, but these effects were minimal (ranging from 1.5 points to 3.9 points on a 70 point Alzheimer's disease assessment scale).
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Supplements don't protect the elderly from infections
Multivitamin and multimineral food supplements don't seem to protect elderly people living at home from infections or improve their quality of life. In a pragmatic double blind controlled trial, Avenell and colleagues (p 324) randomised 910 people aged over 64 to supplementation or placebo. They found no significant differences in frequency of attending primary care for infection, antibiotic prescriptions, hospital admissions, adverse events, compliance, self reported days of infection, and quality of life.
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Reduced antibiotic prescribing did not result in more complications
Antibiotic prescribing for childhood upper respiratory infections halved between 1993 and 2003 in the United Kingdom, but hospital admissions for peritonsillar abscess and rheumatic fever have not increased. Sharland and colleagues (p 328) extracted data from drug prescribing and hospital admission databases. Admission rates for mastoiditis and simple mastoidectomy increased in the observed period by 19%, but the general practice research database did not show an increase in mastoiditis or referral for mastoidectomy.
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