Tag Archives: BMJ

Top Medical Podcasts: ‘Diverticular Disease’ (BMJ)

Colonic diverticulosis refers to herniation of the mucosa and submucosa through the muscular layer of the colonic wall and may be the result of colonic smooth muscle over-activity. Diverticular disease may be defined as any clinical state caused by symptoms pertaining to colonic diverticula and includes a wide-ranging spectrum from asymptomatic to severe and complicated disease. 

Mohamed Thaha, Senior Lecturer & Lead Consultant in Colorectal Surgery, National Bowel Research Centre, Barts and The London School of Medicine and Dentistry, tells us more. 

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Top New Health Podcasts: ‘Flu Vaccine Season’ (BMJ)

With the annual flu season looming, GPs are anticipating a frenzy of vaccinations, perhaps more so than ever this year. As so many ‘flu and respiratory viruses circulate every year, and as the ‘flu vaccine is for one strain of influenza only, is the vaccine worth getting, and what are the risks associated with vaccinating vs. not vaccinating? 

 In this week’s episode, we discuss the high vaccine uptake in New Zealand, and the role that social distancing for COVID-19 may have played in their low numbers of seasonal flu. We also talk about whether or not the message we give to patients about the benefits and risks of vaccination is transparent enough, and how we might communicate better with them to allow them to make an informed decision. We feel pressure to increase vaccination rates, because we believe we are protecting people, but does the evidence support that?

Our guests: Nikki Turner is the director of the Immunisation Advisory Centre (IMAC) at the university of Auckland. She is an academic general practitioner, and a professor at the university. Jeff Kwong is a professor at the University of Toronto, and the interim director of the Centre for Vaccine Preventable Diseases at the university’s Dalla Lana School of Public Health. Newest Oldest Longest Shortest Random 

BMJ Podcast: What Is “Long-Covid” Syndrome?

Trisha Greenhalgh, professor of primary care health sciences at the University of Oxford has been a powerhouse of covid-19 evidence synthesis. She pulled together advice on doing remote consultations, on wearing masks to prevent spread, and a host of other information. She’s now turning her attention to “long-covid” – it’s becoming apparent that it’s not just an acute infection, patients are reporting chronic long term consequences of having the virus.

In this podcast, she describes what we know about long-covid, where the uncertainty lies, and what clinicians should be doing to help patients who are experiencing the symptoms.

Management of post-acute covid-19 in primary care https://www.bmj.com/content/370/bmj.m3026

Cognition & Brain Studies: Apathy, Not Depression, Associated With Dementia

‘Journal of Neurology, Neurosurgery & Psychiatry” (July 10, 2020):

jnnp-2020-July-91-7-677-F1.mediumWe tested the hypothesis that apathy, but not depression, is associated with dementia in patients with SVD. We found that higher baseline apathy, as well as increasing apathy over time, were associated with an increased dementia risk. In contrast, neither baseline depression or change in depression was associated with dementia. The relationship between apathy and dementia remained after controlling for other well-established risk factors including age, education and cognition. Finally, adding apathy to models predicting dementia improved model fit. These results suggest that apathy may be a prodromal symptom of dementia in patients with SVD.

Cerebral small vessel disease (SVD) is the leading vascular cause of dementia and plays a major role in cognitive decline and mortality.1 2 SVD affects the small vessels of the brain, leading to damage in the subcortical grey and white matter.1 The resulting clinical presentation includes cognitive and neuropsychiatric symptoms.1

Apathy is a reduction in goal-directed behaviour, which is a common neuropsychiatric symptom in SVD.3 Importantly, apathy is dissociable from depression,3 4 another symptom in SVD for which low mood is a predominant manifestation.5 Although there is some symptomatic overlap between the two,6 research using diffusion imaging reported that apathy, but not depression, was associated with white matter network damage in SVD.3 Many of the white matter pathways underlying apathy overlap with those related to cognitive impairment, and accordingly apathy, rather than depression, has been associated with cognitive deficits in SVD.7 These results suggest that apathy and cognitive impairment are symptomatic of prodromal dementia in SVD.

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Podcast: “MedDiet” Alters Gut Micriobiome In Older People, Improves Frailty, Cognition, Inflammation

We observed that increased adherence to the MedDiet modulates specific components of the gut microbiota that were associated with a reduction in risk of frailty, improved cognitive function and reduced inflammatory status. 

Dr Philip Smith, Digital and Education Editor of Gut and Consultant Gastroenterologist at the Royal Liverpool Hospital interviews Professor Paul O’Toole; who is Professor of Microbial Genomics, Head of School of Microbiology and Principal Investigator in APC Microbiome Ireland, an SFI funded centre at University College Cork, Ireland, on “Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status: the NU-AGE 1-year dietary intervention across 5 European countries” published in paper copy in Gut in July 2020.

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Diet Infographic: Most “Macronutrient Diets” Reduce Weight & Blood Pressure In 6 Months (BMJ)

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From a BMJ Study article (April, 2020):

Compared with usual diet, moderate certainty evidence supports modest weight loss and substantial reductions in systolic and diastolic blood pressure for low carbohydrate (eg, Atkins, Zone), low fat (eg, Ornish), and moderate macronutrient (eg, DASH, Mediterranean) diets at six but not 12 months. Differences between diets are, however, generally trivial to small, implying that people can choose the diet they prefer from among many of the available diets (fig 6) without concern about the magnitude of benefits.

Introduction

The worldwide prevalence of obesity nearly tripled between 1975 and 2018.1 In response, authorities have made dietary recommendations for weight management and cardiovascular risk reduction.23 Diet programmes—some focusing on carbohydrate reduction and others on fat reduction—have been promoted widely by the media and have generated intense debates about their relative merit. Millions of people are trying to lose weight by changing their diet. Thus establishing the effect of dietary macronutrient patterns (carbohydrate reduction v fat reduction v moderate macronutrients) and popular named dietary programmes is important.

Biological and physiological mechanisms have been proposed to explain why some dietary macronutrient patterns and popular dietary programmes should be better than others. A previous network meta-analysis, however, suggested that differences in weight loss between dietary patterns and individual popular named dietary programmes are small and unlikely to be important.4 No systematic review and network meta-analysis has examined the comparative effectiveness of popular dietary programmes for reducing risk factors for cardiovascular disease, an area of continuing controversy.

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Study: Middle-Aged Knees With Meniscal Tears – No Benefits To Surgery Over Exercise Therapy (BMJ)

Exercise or Surgery - Meniscal Tear in Middle-Aged Knees BMJ

Conclusion: The study was inconclusive with respect to potential differences in progression of individual radiographic features after surgical and non-surgical treatment for degenerative meniscal tear. Further, we found no strong evidence in support of differences in development of incident radiographic knee osteoarthritis or patient-reported outcomes between exercise therapy and arthroscopic partial meniscectomy.

Objective: To evaluate progression of individual radiographic features 5 years following exercise therapy or arthroscopic partial meniscectomy as treatment for degenerative meniscal tear.

Design: Randomized controlled trial including 140 adults, aged 35-60 years, with a magnetic resonance image verified degenerative meniscal tear, and 96% without definite radiographic knee osteoarthritis. Participants were randomized to either 12-weeks of supervised exercise therapy or arthroscopic partial meniscectomy. The primary outcome was between-group difference in progression of tibiofemoral joint space narrowing and marginal osteophytes at 5 years, assessed semi-quantitatively by the OARSI atlas. Secondary outcomes included incidence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis, medial tibiofemoral fixed joint space width (quantitatively assessed), and patient-reported outcome measures. Statistical analyses were performed using a full analysis set. Per protocol and as treated analysis were also performed.

Results: The risk ratios (95% CI) for progression of semi-quantitatively assessed joint space narrowing and medial and lateral osteophytes for the surgery group were 0.89 (0.55-1.44), 1.15 (0.79-1.68) and 0.77 (0.42-1.42), respectively, compared to the exercise therapy group. In secondary outcomes (full-set analysis) no statistically significant between-group differences were found.

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