This week in the BMJ

Volume 333, Number 7576, Issue of 11 Nov 2006

[Down]Evidence based interventions reduce knee pain in older people
[Down]Statin use does not reduce severity of pneumonia
[Down]Probiotics are relatively safe and beneficial
[Down]WHO needs a major refocus

This week in the BMJ

Evidence based interventions reduce knee pain in older people

A pragmatic multicentre trial in primary care shows that older people with knee pain benefit from two strategies for delivering evidence based care. Hay and colleagues (10.1136/bmj.38977.590752.0B) randomised 325 patients, aged over 55, with knee osteoarthritis to receive an algorithm directed enhanced pharmacy review, community physiotherapy, or an advice leaflet with follow-up telephone call (control). Compared with controls, patients in both intervention groups reported reduced pain and improved joint function and used fewer non-steroidal anti-inflammatory drugs in the short term. Physiotherapy reduced GP consultations for knee pain.



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This week in the BMJ

Statin use does not reduce severity of pneumonia

Statins are not associated with reduced mortality or fewer intensive care admissions in patients with community acquired pneumonia say Majumdar and colleagues (10.1136/bmj.38992.565972.7C). In this prospective study of 3415 adult patients with pneumonia admitted to six hospitals over a two year period, researchers recorded patients' medication at presentation and determined the association between statin use and illness outcome. Unadjusted data suggested a 20% reduction in adverse outcomes in statin users, but after adjusting for confounders statin use was associated with a 10% poorer outcome.



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This week in the BMJ

Probiotics are relatively safe and beneficial

The benefits of probiotic bacteria such as Lactobacillus and Bifidobacterium seem to outweigh any potential danger of sepsis say Hammerman and colleagues in their review of randomised trials, Cochrane controlled trials, and case reports (10.1136/bmj.39010.630799.BE). While anecdotes of Lactobacillus sepsis exist, retrospective reviews suggest no greater risk of systemic infection from these bacteria than from endogenous commensals. Prospective studies have reported that probiotic therapy is clinically useful and safe in immunocompromised adults and premature infants, although safety is relative not absolute.



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This week in the BMJ

WHO needs a major refocus

The World Health Organization has not lived up to its mandate and needs to be refocused, says Ruth Levine (10.1136/bmj.39020.383102.68) in her open letter to the incoming director general. The author points to an inadequate budget, lack of clear priorities, and tension between politics and science as the three mutually reinforcing problems that must be dealt with for the organisation to be effective. In the face of a growing number of narrowly focused public and private global health initiatives, WHO needs to take up the reins and lead.



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