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At the heart of general practice since 1960

GPC moves to end confusion over GPs' core services

Inadequate smear tests raise anxiety

Inadequate cervical smear tests significantly increase women's anxiety, UK researchers claim.

Researchers from King's College London used the Spielberger state-trait anxiety inventory to assess 226 women with normal test results and 180 women with inadequate tests.

Women with inadequate smears scored anxiety as 37.87 and concern as 8.7, compared with 34.8 and 4.8 for women with normal smears. High anxiety significantly reduced the chance that a woman would return for re-testing.

British Journal of Cancer 2004 November early online publication

Concern over high-dose vitamin E

Supplements containing vitamin E in high doses may be doing more harm than good, US reviewers warn.

Their study collated results from 19 trials involving 135,967 participants. All-cause mortality was reduced by 16 per 10,000 people in low-dose trials, but increased by 39 per 10,000 in high-dose trials.

The reviewers concluded that high-dose vitamin E supplements should be avoided.

Annals of Internal Medicine November 2004 early online publication

Bupropion effective in general practice

Treating smokers with bupropion (Zyban) in general practice is effective at improving the quit rate without exacerbating social inequalities, claim UK researchers.

In the study of 479 moderately dependent smokers who had previously tried NRT, 30 per cent were abstinent at six months and 22 per cent at 12 months, with results unaffected by variations in age, socio-economic group, nicotine-dependence and genetic profile.

Men were significantly more likely than women to quit with three times as many remaining abstinent at one year.

Addiction Biology 2004;9:227-32

ACE inhibitor of no benefit in stable CAD

Patients with stable coronary artery disease do not benefit from receiving an ACE inhibitor on top of standard treatment, the international PEACE trial concludes.

In the double-blind study, 8,290 patients with stable CAD and normal or slightly reduced left ventricular function were randomised to receive 4mg/day trandolapril or placebo as well as modern conventional therapy.

The incidence of death from cardiovascular causes, myocardial infarction or coronary revascularisation was 21.9 per cent in the trandolapril group and 22.5 per cent in the placebo group over 4.8 years of follow-up.

NEJM 2004;351:2058-68

Backing for 'test & treat' in dyspepsia

Testing and treating for H. pylori in dyspepsia is more efficient than endoscopy, a long-term Danish trial confirms.

Over 6.7 years' follow-up, 500 patients randomised to 'test and treat' or 'prompt endoscopy' showed no difference in symptoms. But the test and treat group used less medication and needed fewer endoscopies.

The results support the latest NICE guidance on dyspepsia, which advises test and treat or empirical treatment rather than prompt endoscopy.

Gut 2004;53:1758-63

Steroid injections benefit hip OA

Steroid injections for hip osteoarthritis can reduce pain and improve function, Swedish researchers say.

The study analysed 80 patients with hip OA who had suffered from pain at rest and on weight-bearing for more than four weeks. They were randomised to receive steroid or local anaesthetic injections.

At follow-up, researchers found steroids significantly improved the motion of the joint, with goniometric measures of flexion at 102, against 97 for anaesthetic.

Internal rotation improved from a score of 3 at baseline to 13 at three weeks; external rotation rose from 10 to 21.

Journal of Rheumatology 2004;31:2265-68

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