JOURNAL SNIPS

Only a small selection of articles this month

Ann Intern Med 18 May 2010 Vol 152
630 From time to time there has been emerging literature of non-invasive testing for coronary artery disease, and in particular computed tomography coronary angiography. This may grow in importance as stress testing fades away under the new NICE guidelines. But like all tests, its predictive value depends on the pre-test probability, in this case of coronary artery disease. Once again we go to Marvell's Holland to get a good thorough Bayesian analysis of the value of CTCA based on their patients in Rotterdam. They conclude that this kind of imaging is most useful in the intermediate probability range. Those with low pre-test probability can be given the all clear after a negative stress test; those with a high probability should get a proper angiogram.

JAMA 12 May 2010 Vol 303
1841 Mortality from coronary heart disease is falling throughout the developed world, which includes Canada. Here a group of Ontarians examines why that should be, by looking at aggregated data for Ontario between 1994 and 2005 (adults aged 25 to 84). As in previous studies, a model called IMPACT explains the great majority of the decrease by a fall in risk factors - except obesity and diabetes, which move in the opposite direction - and an improvement in treatment. We are getting most of this right, then going home and eating too much and doing too little.
http://jama.ama-assn.org/cgi/content/abstract/303/18/1841

Lancet 15 May 2010 Vol
1695 What is an ecass and what are ninds? Clues: ecass is a word from the lost language of Atlantis, and ninds is an epithet. Possibly. Anyway, set a lot of very eminent researchers to work on ECASS, ATLANTIS, NINDS and EPITHET and you get a good idea of how effective alteplase is when given for stroke. As you might expect, time is of the essence: high odds of benefit (2.55) when given within 90 minutes but no benefit and possible harm when given beyond 270 min. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60491-6/abstract

Arch Intern Med 10 May 2010 Vol 170
804 Stroke medicine is an invention of the last two decades, spearheaded by neurologists in large centres who strove to prove that stroke units provide the best outcomes. It has taken a long time to tease out the processes of care which lead to better survival and better functional outcomes in stroke care, and this paper identifies a new one - detection and treatment of hypoxia. The other two factors which affect survival are attention to swallowing and DVT prophylaxis. It should be perfectly possible for any small hospital with CT scanning, alteplase, and a properly run ward with a good physio service to do as well as a stroke unit.
http://archinte.ama-assn.org/cgi/content/abstract/170/9/804

JAMA 5 May 2010 Vol 303
1699 Pneumococcal vaccination does not reduce the risk of myocardial infarction or stroke in men, thanks to a follow-up study of 84 170 men signed up with Kaiser Permanente in California. But there is evidence from several studies that influenza vaccine protects the arteries of the heart and brain, according to the first sentence of this paper.
http://jama.ama-assn.org/cgi/content/abstract/303/17/1699