Lancet 4 Sep 2010 Vol 376
784 The palliation of terminal dyspnoea is a subject is interesting, mainly in the context of heart failure, where many patients are dyspnoeic without substantial reduction in oxygen saturation. Nevertheless they frequently get symptomatic benefit from inhaled oxygen, some to the point of becoming dependent on an immediate oxygen source. For years I heard some of the authors of this study discuss a blinded randomised trial of room air versus oxygen for such patients, not just with those with cardiac dyspnoea but with a range of terminal conditions. And here at last it is: a landmark in evidence-based palliative care, showing that room air works as well as oxygen over a period of a week. However, I can foresee major problems in real life: "Are you trying to kill him doctor? They've delivered a cylinder of compressed air, but Eric needs his oxygen. I told them to take it away."
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61115-4/abstract
BMJ 4 Sep 2010 Vol 341
491 A worthy attempt to meta-analyse the data that exist about the outcomes of nurse-led interventions to improve control of blood pressure. Nurses using algorithm-guided protocols show some success in the USA, especially when they are given prescribing powers. But just what are we doing in hypertension? A recent review I read suggested that it really takes 14 office readings to determine whether a change of treatment is needed. Most of what we do to our patients with raised blood pressure is probably futile, and we urgently need better primary care studies to tell us how to do better.
http://www.bmj.com/content/341/bmj.c3995.full
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