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Richard’s Reviews: RSV, unnecessary interventions, weight loss and deadly drugs.

Posted on 29th October 2014 by Norah Essali

Evidence Reviews
Richard's Reviews RSV

Richard Lehman writes a weekly review of published journals for the BMJ. He summarizes the findings of new research and shares what he thinks about each study. In this post I will be reviewing a few of those interesting studies.

Journal: New England Journal of Medicine 21-28 August 2014 Vol 371

1. Study Title

Oral GS-5806 Activity in a Respiratory Syncytial Virus Challenge Study

What you need to know

Respiratory Syncytial Virus (RSV) commonly affects many infants and increases their hospitalization rates and their susceptibility to future respiratory viral infections. Current treatment for RSV is mainly supportive with no specific antiviral therapy. This trial tests an oral RSV-entry inhibitor called GS-5806 in double blind, placebo controlled study on healthy adults that were inoculated with RSV intranasally. GS-5806 was found to reduce RSV viral load and the severity of clinical disease. On the down side, GS-5806 caused low neutrophil counts and increased alanine aminotransferase. This seems to be a promising intervention, but it still has to be tested on a bigger population and on the target babies population.

Journal: The Journal of the American Medical Association 2014;312(7):712-718

2. Study Title

Effect of Oximetry on Hospitalization in Bronchiolitis. A Randomized Clinical Trial

What you need to know

This is a pretty interesting study that was done in Canada. The researchers were looking to see if there is an association between the rate of hospitalization in infants with mild to moderate bronchiolitis and their pulse oximetry measurements. They artificially elevated the oximetry measurements of one group by 3%, without the knowledge of the ER physician, while the other group’s oximetry measurements displayed the true value. Both groups true oximetry measurements had to be 88% or higher. The outcome was that those infants with the artificially elevated oximetry values were less likely to be hospitalized than their counterparts with the true, but lower values. This suggests that oxygen saturation should not be the only factor in the decision to admit, and its use may need to be reevaluated.

Journal: JAMA Intern Med August 2014

3. Study Title

1. How Cardiologists Present the Benefits of Percutaneous Coronary Interventions to Patients With Stable Angina.

2. The Effect of Information Presentation on Beliefs About the Benefits of Elective Percutaneous Coronary Intervention.

3. Patient Selection for Diagnostic Coronary Angiography and Hospital-Level Percutaneous Coronary Intervention Appropriateness

What you need to know

So this topic was very interesting to me because before reading about it, I thought that Percutaneous Coronary Interventions (PCI) provided a better outcome than medication for CAD. Now I know better. These are a set of 3 trials that basically have the same idea; PCI is being inappropriately performed on patients with stable angina or asymptomatic stenosis despite the fact that it has no added benefit over maximal medical treatment. They display that patients’ false belief that PCI will prevent future myocardial infarction is what prompts them to choose it over medication. Additionally, few cardiologists discussed the evidence-based benefits of angiogram and PCI for stable CAD, and some implicitly or explicitly overstated the benefits. In this scenario, the physicians’ approach to educating their patients is the main way this bias in decision making will be overcome.

Journal: The BMJ 23 August 2014 Vol 349

4. Study Title 

Associations between active commuting, body fat, and body mass index

What you need to know

In a nutshell; use public or active transportation, not just for the environment, for your health as well. “Men and women who commuted to work by active and public modes of transport had significantly lower BMI and percentage body fat than their counterparts who used private transport.”

5. Study Title

Use of clarithromycin and roxithromycin and risk of cardiac death: cohort study

What you need to know

Scary trial alert! This Danish study found that a 7 days course of Clarithromycin increased the risk of cardiac death when compared to other antibiotics. As Mr. Lehman points out, this makes you wonder if clarithromycin should be withdrawn since there are many safer alternatives to it.

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Norah Essali

Hi! I'm a medical student from Syria. I hope you find my posts useful! View more posts from Norah

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