This week in the BMJ
Volume 333, Number 7580, Issue of 9 Dec 2006Early use of oral antibiotics in severe community acquired pneumonia
This week in the BMJ
Early use of oral antibiotics in severe community acquired pneumonia
Switching intravenous antibiotics to the oral route after three days in patients with severe community acquired pneumonia shortens hospital stay and seems to be safe. Oosterheert and colleagues (10.1136/bmj.38993.560984.BE) randomised 302 patients with pneumonia, who were not in intensive care, to receive three days of intravenous and seven days of oral antibiotics or 10 days of intravenous antibiotics. Mortality rates and clinical cure rates were similar in the two groups, but patients in the oral treatment group were discharged earlier.
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This week in the BMJ
Occupational therapy for dementia improves function
Community based occupational therapy for elderly patients with dementia improves daily function and reduces the burden on carers say Graff and colleagues (doi: 10.1136/bmj.39001.688843.BE). One hundred and thirty five people over 65 with mild to moderate dementia were randomised to receive 10 sessions of occupational therapy, including cognitive and behavioural interventions, over five weeks or no additional treatment. The positive effect of treatment remained significant seven weeks after the intervention ended despite patients' limited learning abilities. The number needed to treat for a clinical improvement was 1.3.
This week in the BMJ
Should babies be left to sleep in infant car safety seats?
Young infants should not be left unattended to sleep in standard car safety seats as they may be at risk of hypoxia say Tonkin and colleagues (doi: 10.1136/bmj.39021.657083.47). They examined 43 consecutive infants presenting after an acute life threatening event and found that nine had been asleep in such seats at the time of a perceived change in colour and breathing. All infants seemed otherwise healthy. Car seats may cause forward flexion of the neck and lead to impaired airway function and oxygen desaturation.
This week in the BMJ
Tube feeding in advanced dementia can be harmful
Tube feeding patients with advanced dementia does not prolong life or improve its quality and can actually shorten the life of some patients. In an analysis and comment article, Hoffer (doi: 10.1136/bmj.39021.785197.47) reminds us that elderly patients who eat very little are usually not starving but have low energy requirements and exist in a state of metabolic homeostasis. Good practice comprises regularly weighing patients to be sure that weight loss is not life threatening and paying attention to the quality, characteristics, and presentation of their food.
This week in the BMJ
How to achieve strict glycaemic control in type 2 diabetes
Effective treatment of hyperglycaemia and strict glycaemic control are key to reducing microvascular complications in patients with type 2 diabetes. In a clinical review (doi: 10.1136/bmj.39022.462546.80), Heine and colleagues say that achieving this goal usually involves complex treatment with combinations of glucose lowering agents. Because the natural course of type 2 diabetes is characterised by a gradual decline in 
cell function, the usual stepped approach to management often results in recurrent hyperglycaemia. The authors discuss effective interventions that reduce treatment failure and improve long term outcomes.
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