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Clinical round-up: March

Vitamin D ‘protects against cold and flu’

Taking vitamin D supplements protects against acute respiratory infections, including colds and flu, a Department of Health-funded study has shown.

It discovered daily or weekly vitamin D supplements halved the risk of acute respiratory infections in people with the lowest baseline levels (<25nmol/l).

Those with higher baseline levels did not benefit as much, but the risk was still reduced by 10%.

The paper concluded the infection risk reduction from regular vitamin D supplements was equal to that achieved with the injectable flu vaccine. The authors are recommending fortification of foods with vitamin D.

The team from Queen Mary University of London looked at data from 11,000 participants across 25 clinical trials.

Lead author Professor Adrian Martineau, clinical professor of respiratory infection and immunity at the university, said: ‘The bottom line is the protective effects of supplementation are strongest in those who have the lowest vitamin D levels, and when supplementation is given daily or weekly, rather than in more widely spaced doses.’

BMJ 2017, online 15 Feb

Excess deaths linked to ‘impact of cuts’

Almost 30,000 people may have died unnecessarily last year due to Government cutbacks to health and social care.

The claim comes from new research looking at official data, which showed the number of deaths in 2015 represented the largest increase in the post-war period.

The 30,000 excess included a spike in mortality in January 2015, most of which were among elderly people.

The team looked at four possible reasons for the spike, and having ruled out data error, cold weather and flu, found ‘clear evidence’ of ‘health system failures’. This included missed targets on A&E waiting times and ambulance call-out times, and rising rates of staff absences and unfilled vacancies.

Professor Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, said the study showed ‘the impact of cuts resulting from the imposition of austerity on the NHS has been profound’.

‘With an ageing population, the NHS is ever-more dependent on a well-functioning social care system. Yet this has also seen severe cuts,’ he added.

J R Soc Med 2017, online 17 Feb

E-cigarettes ‘safer than smoking’

E-cigarettes have been shown to be safer than smoking in a new long-term study carried out by Cancer Research UK.

The paper found that former smokers who completely switched from cigarettes for six months had significantly lower levels of toxic chemicals and carcinogens compared with those who continued to smoke cigarettes.

The difference was less marked in those who did not completely switch from tobacco cigarettes.

Researchers analysed saliva and urine of long-term e-cigarette users for the first time, comparing body level exposure to key chemicals.

Professor Kevin Fenton, national director of health and wellbeing at Public Health England, said: ‘This study provides further evidence that switching to e-cigarettes can significantly reduce harm to smokers, with greatly reduced exposure to carcinogens and toxins.’

Ann Intern Med 2017, online 7 Feb

Diagnostic support ‘boosts GP accuracy’

A diagnostic tool providing early support to GPs in consultations improved their diagnostic accuracy.

Research on the diagnostic support system tool found that it led to an absolute increase in diagnostic accuracy to 58%, compared with 50% when GPs used only their own judgement.

The tool requires GPs to enter an initial reason for the patient seeking a consultation, and then displays a list of potential diagnoses based on the patient’s age and gender. As more symptoms are added to the tool, the list of diagnoses is reordered based on the amount of information supplied and the diagnostic incidence of each condition.

GPs using the tool did not spend longer in consultation or order more tests.

The researchers from the University of Dundee concluded that the tool ‘has the potential to be employed successfully, and lead to improved coding, diagnosis and management, without significant costs in time, tests and patient satisfaction’.

BJGP 2017, online 30 Jan

NSAIDs ‘no better than placebo’ for back pain

NSAIDs are little better than placebo for back pain, and may do more harm than good, according to new research.

A team from the University of Sydney found NSAIDs reduce pain in the short term, but that overall, the effect was not clinically significant due to the small difference compared with placebo.

The NNT for patients to achieve a clinically important short-term benefit with NSAIDs was six, but this was offset by the two-and-a-half times greater risk of an adverse gastrointestinal event compared with taking placebo.

Results of 35 randomised trials comparing NSAIDs and placebo in back pain were analysed, featuring data from more than 6,000 patients.

The conclusions clash with recent NICE guidelines, which made NSAIDs the first-line option for low back pain.

Ann Rheum Dis 2017, online 2 Feb

Statins ‘lower the risk of VTE’

GPs could in future prescribe statins more widely for prevention of thrombotic complications.

A review of 36 studies of statins found people who took the drugs had a 15-25% lower relative risk of venous thromboembolism than non-users.

The researchers said the findings ‘suggest a role for statins in the primary prevention of VTE’. Co-author Professor Kamlesh Khunti, professor of primary care diabetes at the University of Leicester, said: ‘These results provide an extensive body of evidence on the clinical benefit of statins in of VTE, and may support a true protective effect.’

Lancet Haematology 2017, online 12 Jan

CPD Tip of the Month

Drug management for generalised anxiety disorder

First-line drug treatment is usually with an SSRI, but some patients may not be able to tolerate these drugs due to the varied side-effect profile. Here are some alternatives, with guidance on dose titration:

  • Pregabalin 150mg daily.
  • Duloxetine 20mg twice daily, increased after two weeks to 40mg twice daily.
  • Venlafaxine 75mg once daily, increased if required to a maximum of 225mg once daily.

You can also use β-blockers for a short period of time to relieve autonomic symptoms.

Case by case: anxiety disorders (1.5 CPD hours)