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Clinical round-up: clinical news and drug updates for this month

All the information from the journals in February

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E-cigarettes ‘reduce chances of quitting’

E-cigarettes reduce the chances of quitting smoking and ‘should not be recommended as smoking cessation aids’, according to new research in The Lancet.

The team conducted a meta-analysis of 18 observational studies and two clinical trials, and found the use of e-cigarettes reduced the likelihood of a person quitting smoking by 28%.

But, coming just weeks after the Government issued its first approval for an e-cigarette to be prescribed by GPs in England, the study has been fiercely criticised by Public Health England and smoking cessation experts.

Professor Paul Aveyard, professor of behavioural medicine at the University of Oxford and a GP in Solihull, said the analysis was flawed by the sample population.

He said: ‘This review collates studies that enrol people who smoke and ask them if they have used e-cigarettes.

‘The problem is that people who were helped by e-cigarettes have left this population because they gave up smoking and therefore you leave only those who were not helped.’

Lancet 2016, online 14 Jan

GP bowel screening invites ‘boost uptake’

GP practices sending headed letters inviting patients for bowel cancer screening can boost uptake and enhance cancer detection.

Research from the British Journal of Cancer found nearly 40,000 additional people would be screened if practice invites were sent out nationally.

The researchers concluded this could enable an additional 61 people with cancer and 165 people with intermediate or high risk polyps to be identified and referred for treatment.

They added that GP practice names should be added to invitations sent by the NHS bowel screening programme.

They said: ‘Given the small one-off cost to modify the standard invitation letter, and the overall increase in uptake, we suggest that the bowel cancer screening programme consider adding GP endorsement to the screening invitation letter.’

Br J Cancer 2016, online 7 Jan

Offer CBT ‘in all cases of depression’

GPs should offer CBT as another option to all patients with depression that has not responded to antidepressants, UK researchers say.

A study funded by the NIHR Health Technology Assessment Programme found CBT reduces anxiety, improves mental health and induces remission in depression when used alongside usual forms of therapy, compared with those who did not have CBT.

Patients who had received CBT as an adjunct were found to be less depressed than those who had not, and less likely to use antidepressants for a sustained period.

The researchers evaluated patients three years after they had received CBT alongside other first-line treatments.

They said they believe CBT is cost-effective and provides ‘benefit in terms of health-related quality of life’ that is ‘sustained over time and therefore achieved at no additional cost’.

Lancet Psychiatry, online 6 Jan

Fall risk ‘increased by high-dose vitamin D’

Prescribing vitamin D at guideline-recommended high doses does not offer any benefit to older patients and could even put them at an increased risk of falls, Swiss researchers have warned.

They assessed whether giving high doses – including doses recommended

by the National Osteoporosis Society guidelines for patients with vitamin D deficiency – would be better at preventing functional decline in people over 70 who had already suffered a fall, compared with a more moderate dose.

But they found high-dose vitamin D did not slow decline in function, and those who took them were significantly more likely to suffer another fall.

Two-thirds of patients on the high dose fell during follow-up, compared with less than half of those on the lower dose.

The study featured 200 men and women assigned to take either high-dose vitamin D – 60,000IU vitamin D3, or 24,000IU combined with 300 calcifediol – or the low-dose of 24,000IU, once per month.

Dr Tony Brzezicki, clinical chair at NHS Croydon CCG and a GP in the borough, said it was unlikely many elderly patients would be on this high dose, but that it ‘should not be difficult to identify these patients from GP systems’.

JAMA Int Med 2016, online 4 Jan

Mindfulness ‘may have role in primary care’

Mindfulness-based therapies could be used in primary care to treat patients with mental health problems and improve quality of life, a new meta-analysis has found.

Researchers looked at six randomised trials of mindfulness-based interventions, involving a total of more than 550 patients. They included patients with mood problems, stress, depression and medically unexplained symptoms.

The team found the mindfulness approaches were associated with moderate, but significant, improvements in mental health-related outcomes and significant, albeit smaller, improvements in measures of quality of life.

While they admitted further research was needed, they said the results were ‘promising’ for primary care patients.

Ann Fam Med 2015;13;573-582

Therapeutics update

NICE considers gliflozins for type 2 diabetes

NICE draft technology appraisal guidance proposes canagliflozin, dapagliflozin and empagliflozin as treatment options in type 2 diabetes where metformin is contraindicated, a DPP-4 inhibitor would have otherwise been given, and where a sulfonylurea or pioglitazone are not appropriate.

Prescribe antivirals to patients with flu-like symptoms

The DH has advised GPs to prescribe antivirals for flu-like symptoms, whether or not the patient is in an at-risk group.

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