This week in the BMJ
Volume 332, Number 7535, Issue of 28 Jan 2006Stool tests don't reliably screen for coeliac disease in children
Stool tests don't reliably screen for coeliac disease in children
Detection of secretory IgA antibodies against gliadin and human tissue-transglutaminase in stool has limited value in screening for coeliac disease in children. Kappler and colleagues analysed stool samples of 20 children with newly diagnosed coeliac disease and 64 controls (p 213). Using recommended cut-off limits and combining the results from two commercial stool tests, they found a sensitivity of 82% and a specificity of 58%. They say that all diagnostic tests should be fully validated before they are marketed and used.
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Let's look at duplicate systematic reviews
Quality of systematic reviews may be associated with their length and the reviewer's previous sources of funding. Biondi-Zoccai and colleagues examined 10 recent overlapping systematic reviews on the same topic (the role of acetylcysteine for the prevention of contrast nephropathy) and found that their recommendations were in conflict (p 202). Longer manuscripts were associated with higher compliance with the QUOROM checklist, and reviewers who had had not for profit funding scored higher on an index of methodological quality. Overlapping meta-analytic efforts waste resources, say the authors, and constraints on space, reflected in length of manuscript and abstract, are important hurdles for quality.
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H pylori screening and eradication cuts dyspepsia—but at a cost
Community based screening and eradication of Helicobacter pylori offers long term relief from dyspepsia but does not save money. Lane and colleagues (p 199) randomised more than 1500 patients who screened positive for H pylori to eradication therapy or placebo. Over the next two years, quality of life was the same in both groups but 35% fewer participants in the eradication group consulted for dyspepsia than in the placebo group. Even so, overall costs to the NHS were higher in the eradication group.
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Providing study results to participants is complex
The recommendation that study results should be provided to participants requires further evaluation. In a qualitative study of 20 women who participated in a large trial of antibiotics in pregnancy and requested the trial results, Dixon-Wood and colleagues (p 206) found that feedback constitutes an intervention in its own right. Leaflets giving a summary of results may disappoint, or distress, people who wish to be unblinded in the interests of completing their own personal narrative. More needs to be known about appropriate methods for disseminating trial results to participants and about their impact.
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Rape victims want holistic post-rape services
Having a sensitive healthcare professional who provides counselling and examination, and access to HIV post-exposure prophylaxis with an HIV test, are particularly important to rape victims. Christofides and colleagues (p 209) interviewed 155 rape survivors and 164 community members from one rural and one urban site in South Africa on aspects of health service delivery that would most influence choice of service after rape. If other needs were fulfilled, travel time did not influence their choice.
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