Volume 192 - Issue 4
In Other Journals
Author: Ann Gregory
Med J Aust 2010; 192 (4): 234. || doi: 10.5694/j.1326-5377.2010.tb03487.x
Published online: 15 February 2010
Published online: 15 February 2010
Never too late
It’s generally accepted that most patients diagnosed with lung cancer are in the last months of their lives.1 However, a meta-analysis of 10 observational studies has determined that for patients with early stage lung cancers there may be a significant survival benefit if they stop smoking even after (rather than before) diagnosis.2 The five-year survival in these post-diagnosis “quitters” was in the order of 60-70% compared with about 30% in those who continued to smoke. Further, it was suggested that this benefit was due to a reduced likelihood of cancer progression rather than a reduction in cardio-respiratory deaths. In a linked editorial,1 Treasure and Treasure said that the sooner in their lives people stopped smoking the better, but the real gain would be in stopping young people from starting altogether.
1. BMJ 2010; 340: b5630
2. BMJ 2010; 340: b5569
Dental wisdom
Over many decades, the regular extraction of wisdom teeth (third molars) was seemingly based on a multitude of dental health care practitioners’ beliefs, values, biases and anecdotal evidence. In today’s world of evidence-based medicine (and dentistry), such practices may be not only not evidence-based but also unethical, say Kandasamy and colleagues. In a review, they said that the removal of third molars primarily to avoid late incisor crowding is not supported by evidence; further, the procedure can lead to complications. They do acknowledge that there are clear indications for the removal of third molars associated with pathology; however, otherwise, these teeth are, generally speaking, best left alone and monitored periodically.
Aust Dent J 2009; 54: 284-292
Death by negligence
Out-of-hours primary care in the UK is coming under closer scrutiny as an inquest begins into the deaths of two patients, according to a news report in the BMJ. One patient had received an excessively high dose of diamorphine; the other had experienced a heart attack but was not sent to hospital. Both patients had been seen by the same doctor, who usually practised in Germany but had been flown to the UK to provide out-of-hours care. Since 2004, primary care trusts (rather than GPs) have been responsible for out-of-hours services in England; however, there is concern that trusts are not consistently monitoring the quality of care provided. Further, under European Union (EU) rules, doctors in the EU are free to work in other member countries without the stringent checks that apply to other foreign doctors. The doctor involved in these two cases was suspended from the UK medical register but allowed to go on practising in Germany. However, the doctor was prosecuted by German authorities for causing death by negligence, given a nine-month suspended sentence, and ordered to pay €5000.
BMJ 2010; 340: c286
Beyond antibiotics
Standard therapy for Clostridium difficile infection hasn’t changed since the 1970s — incongruously, antibiotics for an antibiotic-associated condition.1 However, adding monoclonal antibodies to the usual regimen of either metronidazole or vancomycin could significantly reduce recurrence, if not the initial severity, of infection. In a randomised placebo-controlled study involved 200 patients with current symptomatic infection, US researchers found that adding a single infusion of two neutralising, fully human monoclonal antibodies against C. difficile toxins A and B to usual treatment reduced the recurrence rate of C. difficile infection to 7% compared with 25% in the placebo group.2 However, there were no significant differences between the antibody and the placebo group in the severity of diarrhoea during the initial episode of C. difficile infection. The researchers had previously found: efficacy for the combined antibodies in a hamster model; and, safety, in a phase I study in healthy volunteers; they say this treatment now deserves further study. An editorialist said this novel approach to breaking the cycle of C difficile infection offered hope in the battle against this increasingly prevalent and difficult-to-manage disease.1
1. N Engl J Med 2010; 362: 264-265
2. N Engl J Med 2010; 362: 197-205
Dr Ann Gregory, MJA