This week in the BMJ
Volume 333, Number 7572, Issue of 14 Oct 2006Calcium supplements in healthy children are unlikely to reduce fractures
Calcium supplements in healthy children are unlikely to reduce fractures
Calcium supplementation has little effect on bone mineral density in healthy children say Winzenberg and colleagues (p 775). Their meta-analysis of 19 randomised controlled trials, which involved more than 2800 healthy children aged 3-18 years, found that calcium supplements had no effect at the hip or lumbar spine. Upper limb bone density improved to a small degree. As they found only weak evidence that this effect persists, calcium supplements are unlikely to decrease fracture risk to a degree of major public health importance.
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MRI helps predict curative resection of rectal cancer
Preoperative high resolution magnetic resonance imaging can accurately predict the chances of achieving a surgically clear resection margin after rectal cancer surgery. The MERCURY Study Group (p 779) looked at preoperative imaging and pathohistology at the margins of surgical specimens from 408 patients with various stages of rectal cancer. Of the patients in whom imaging predicted that clear resection margins were achievable, 94% had a clear margin on histology. The authors conclude that this technique could be reproduced in multiple centres and could help avoid unnecessary preoperative treatment.
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Assessing and managing acute renal failure
Acute renal failure is common and morbidity and mortality are high if it is not managed optimally (p 786). Rachel Hilton highlights the easily recognisable symptoms of this condition, outlines mandatory investigations, and suggests early treatment to prevent long term sequelae. As more than 7% of hospital admissions may be complicated by renal impairment, knowing the pre-renal, intrinsic, and post-renal causes of acute renal failure and how best to assess renal impairment is important for clinicians across all specialties.
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Read industry supported drug reviews with caution
Industry supported meta-analyses are of inferior quality to Cochrane meta-analyses of the same drugs. Jørgensen and colleagues (p 782) systematically compared the methodology and conclusions of 24 Cochrane meta-analyses with industry supported meta-analyses and other meta-analyses that studied the same two drugs in the same disease. Cochrane reviews were more transparent and more often considered the potential for bias than industry supported reviews, which always recommended the drug without reservation. Reviews with no, undeclared, and not for profit support had similarly cautious conclusions to matched Cochrane reviews.
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Commercial cord blood banking: should we encourage it?
Commercial cord blood banks are encouraging parents to store umbilical cord blood and argue that cures for common ailments using stem cell techniques are only a few years away. But collection techniques have risks for mother and baby, and the chances of the blood being used are small. Leroy C Edozien (p 801) explains why he thinks that, although it seems like a good idea, this practice poses several ethical, legal, and management difficulties for NHS maternity units and should be discouraged.
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