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At the heart of general practice since 1960

GPs miss access targets ­ but patients don't mind

Vitamin E ineffective in dementia

Vitamin E is not effective for treating mild cognitive impairment, a new US trial reveals.

The three-year study randomised 769 patients with mild cognitive impairment to daily 2,000 IU vitamin E, 10mg donepezil or placebo.

Overall, 16 per cent of patients suffered progression to Alzheimer's disease during the course of the study. The risk of progression was the same in patients taking vitamin E or placebo. Donepezil appeared to reduce the risk of progression by 20 per cent, but the finding was not significant.

New England Journal of Medicine 2005;352:2379-2388

Immediate treatment in epilepsy

Immediate treatment with antiepileptic drugs in patients with single or infrequent seizures has short-term benefits but does not affect long-term remission.

Medical Research Council researchers randomly assigned 722 patients to immediate treatment with anti-epileptic drugs and 721 to deferred treatment.

Immediate treatment increased the time to the first seizure by 40 per cent, second seizure by 30 per cent and first tonic-clonic seizure by

50 per cent. But after five years of follow-up there was no difference in relapse rates between groups, with three-quarters of patients in each seizure-free.

The Lancet 2005;365:2007-2013

Improving mixed hyperlipidaemia

Co-administration of ezetimibe and fenofibrate is effective at improving lipid profiles in patients with mixed hyperlipidaemia, a joint US/French study reports.

The researchers randomised 625 patients with mixed hyperlipidaemia and no history of heart disease to 10mg ezetimibe, 160mg fenofibrate, a combination of the two or placebo.

The combination reduced LDL-cholesterol by 20 per cent and increased HDL-cholesterol by

19 per cent, with the effects significantly greater than placebo.

European Heart Journal 2005:26:897-905

GI risk with medium-dose aspirin

Doses of aspirin over 100mg per day increase the risk of gastrointestinal bleeding by as much as higher doses, a new meta-analysis concludes.

US researchers collated data from 31 clinical trials including 192,000 patients in order to compare the risk from low, moderate and high doses of aspirin.

The incidence of any bleeding event was

3.7 per cent of patients taking less than 100mg aspirin, 11.3 per cent in those taking 100-200mg and 9.8 per cent in those taking more than 200mg.

The rate of fatal or life-threatening bleeds was 0.3, 0.5 and 1.6 per cent respectively.

American Journal of Cardiology 2005;95:1218-1222

Otitis media: watchful waiting backed

Watchful waiting is as effective as prescribing antibiotics for children with non-acute otitis media, US researchers report.

Their study included 223 children who were assessed as having non-severe otitis media using a defined screening tool.

Two-thirds of patients assigned to watchful waiting did not require antibiotic treatment during 30 days' follow-up. In comparison, antibiotic treatment produced more successful treatments, but also more adverse events and higher rates of microbial resistance.

Pediatrics 2005;115:1455-1465

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