This week in the BMJ
Volume 332, Number 7555, Issue of 17 Jun 2006Alternating pressure mattresses are more cost effective than overlays
Alternating pressure mattresses are more cost effective than overlays
Alternating pressure mattresses are just as good as alternating pressure overlays at preventing pressure ulcers, and more likely to be cost effective. In a randomised controlled trial of more than 1900 hospital patients aged > 55 years, Nixon and colleagues (p 1413) found that 10.7% of the patients given an overlay and 10.3% of the patients on a mattress developed a pressure ulcer of grade 2 or worse. A linked cost effectiveness analysis (p 1416) found that mattresses were associated with lower overall costs, mainly because patients had a shorter stay in hospital. Also, more patients in the overlay group than in the mattress group asked to change their devices because they were unhappy with them.
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Managing low back pain
The early identification of patients at risk for chronicity, and then preventing it, are the main challenges in the management of low back pain say Koes and colleagues on page 1430. Their clinical review revisits the diagnostic triage to exclude specific pathology and nerve root pain, discusses the value of imaging, and examines the evidence on active and passive treatment in acute and chronic low back pain.
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Guidelines on statin treatment should focus on high risk patients
Canadian, US, and European societies' guidelines on statin treatment for preventing deaths from coronary heart disease (CHD) could improve their effectiveness or efficiency by focusing on recommendations for people with the highest risk of CHD. Manuel and colleagues (p 1419) modelled outcomes of screening and treatment recommendations of six national and international guidelines on the Canadian population, and found that they varied considerably. The Australian and British guidelines were the most effective, potentially avoiding the most deaths over five years. The New Zealand guideline was the most efficient, avoiding almost as many deaths, but recommending treatment to the fewest people.
Sentinel node status has high prognostic value for melanoma
Sentinel node status is closely associated with prognosis of melanoma, and seems to be independent of tumor thickness and ulceration. Kettlewell and colleagues (p 1423) followed 482 patients with melanoma who consented to sentinel node biopsy. At mean follow-up of 42 months, 82% of the 367 patients with a negative biopsy, but only 42% of the 105 patients with a positive biopsy, were alive and disease free. The authors conclude that sentinel node biopsy should be considered in studies of adjuvant treatment, but it should not become a routine standard of care until data from randomised trials are available.
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Kidney function tests plus data on proteinuria give better estimate of mortality risk
Combining the results of kidney function tests and urine analysis may improve the accuracy of estimates of risk for all cause mortality in people with coronary disease. Tonelli and colleagues (p 1420) analysed data on proteinuria, kidney function, and all cause mortality of 4098 adults with previous myocardial infarction. Compared with participants without proteinuria or impaired kidney function, patients with both characteristics were at high risk (hazard ratio 2.39, 95% CI 1.72 to 3.30), and those with only one characteristic were at intermediate risk of dying from any cause.
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