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The article discusses a study that which indicated the potential of a single baseline measurement of the Elecsys Troponin T high-sensitive assay to rule out acute myocardial infarction in a large number of patients if a low cut-off value is used. It cites the selection criteria for relevant papers published between January 2006 and December 2013. It also presents the summary estimates for sensitivity and specificity at various cut-off values.

STUDY QUESTION: Does prediabetes, the precursor of type 2 diabetes, increase the risk of pancreatic cancer? SUMMARY ANSWER: There is a linear dose-response relation between fasting blood glucose concentration and the rate of pancreatic cancer for both prediabetes and diabetes. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Type 2 diabetes is known to increase the risk of pancreatic cancer. This meta-analysis shows that the risk of pancreatic cancer is also increased with prediabetes, with every 0.56 mmol/L (10 mg/dL) increase in fasting blood glucose being associated with a 14% increase in the rate of pancreatic cancer. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Is there a cut point in annual surgeon volume associated with increased risk for complications after primary elective total hip arthroplasty, and, if so, can we quantify this risk? SUMMARY ANSWER In a cohort of first time recipients of total hip arthroplasty, we found that patients operated on by surgeons who had performed 35 or fewer procedures in the year before the index arthroplasty were at increased risk for dislocation and early revision. WHAT IS KNOWN AND WHAT THIS PAPER ADDS Though there is a general consensus that increased surgeon volume is associated with a reduced risk of complications, there is a lack of consensus around what constitutes a “low” annual volume. This study showed that in patients undergoing total hip arthroplasty, the risks for dislocation and early revision increased by about 48% and 44%, respectively, when they were operated on by surgeons with annual volumes ≤35 procedures. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Can one tablet containing aspirin, statin, and blood pressure lowering agents improve adherence and risk factor control compared with usual care of patients at high risk of cardiovascular disease in primary care? SUMMARY ANSWER Fixed dose combination treatment improved adherence to all the recommended drugs, but improvements in clinical risk factors were small and did not reach statistical significance. WHAT IS KNOWN AND WHAT THIS PAPER ADDS Two recent long term trials indicate large improvements in self reported adherence to the recommended drugs and modest improvements in risk factor control in high risk patients receiving fixed dose combination treatment. The main findings of this trial were consistent with those of the earlier trials, and acceptability for this treatment was high among general practitioners and patients. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Does thrombolytic therapy for acute ischaemic stroke have a similar time dependent benefit/risk ratio in clinical practice to that seen in pooled analyses of randomised clinical trials? SUMMARY ANSWER In patients with acute ischaemic stroke treated with thrombolytic therapy in routine clinical practice, the time dependent odds ratios for mortality and favourable early outcome are close to the values found in a pooled analysis of randomised clinical trials. WHAT IS KNOWN AND WHAT THIS PAPER ADDS Pooled analysis of randomised clinical trials of recombinant tissue plasminogen activator in patients with stroke has shown a time related decreasing benefit/risk ratio with increasing time between onset of stroke and treatment up to 4.5 hours. In an unselected cohort of patients with acute ischaemic stroke in clinical practice, there was also a clear association between shorter onset to treatment with thrombolytic therapy and better functional outcome, suggesting a similar magnitude to that observed in clinical trials. [ABSTRACT FROM AUTHOR]

STUDY QUESTION: Can three months’ intervention with a lipid based nutrient supplement containing either whey or soy protein improve regain of lean body mass, grip strength, physical activity, and immune recovery in patients with HIV starting antiretroviral treatment in a food insecure setting? SUMMARY ANSWER: Supplementation resulted in greater gains of lean body mass, grip strength, and immune recovery in Ethiopian patients with HIV, compared with patients initiating antiretroviral treatment without a nutrient supplement. No major differences between the two supplements were observed WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Poor nutritional status at initiation of antiretroviral treatment is associated with impaired treatment outcomes among African patients with HIV. This study shows that provision of a lipid based nutrient supplement during the initial phase of antiretroviral treatment has beneficial effects. [ABSTRACT FROM AUTHOR]

The article presents a summary of a research paper on the association between antenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn (PPHN) that was published on bmj.com. It notes the multifactorial treatment decisions about antidepressant use during pregnancy including the safety of the fetus/neonate. It finds that infants seem to be at increased risk for developing PPHN after exposure to selective serotonin reuptake inhibitors (SSRIs) during late pregnancy.

The article presents a summary of a research paper on the association between cardiovascular events and sodium-containing effervescent, dispersible and soluble drugs that was published on bmj.com. The study, which involved residents in Great Britain, showed that sodium-containing formulations of commonly prescribed drugs are associated with increased risk of cardiovascular events in patients. It adds that the increased risk was primarily driven by an increased risk of hypertension and stroke.

The article discusses a research paper on the link between body mass index and cardiovascular disease (CVD) mortality in east Asians and south Asians, based on data from the Asia Cohort Consortium. It references a study published online on bmj.com. The study concludes that body mass index shows a U-shaped association with death from CVD in individuals from east Asia. But the study also shows body mass index as a weak risk factor for cardiovascular death in individuals from southern Asia.

The article discusses a research paper on the effect of smoking on the efficacy of antiplatelet drugs. It references a study by Joshua J. Gagne et al., published online on bmj.com. It shows that clopidogrel, an antiplatelet agent, reduces cardiovascular death, myocardial infarction and stroke in smokers, but these clinical benefits were limited in non-smokers. It examines results of randomized trials, which revealed a 15 percent reduction in death, myocardial infarction and stroke in smokers.

The article summarizes a study evaluating the relation between high ambient temperatures with the changes in the risk of myocardial infarction on an hourly timescale. Paper-adds including data at an hourly temporal resolution from 11 conurbations in England and Wales showed that higher temperatures were associated with increased risk of myocardial infarction, with reductions in risk at longer lags being consistent with heat, in the six hours after exposure, above a threshold of 20°C.

The article presents a study which examines the effectiveness of mobile phone based self-monitoring of patients from primary care with poorly controlled asthma in Great Britain. The study has conducted a parallel group randomised controlled trial and an analysis of costs. The results of the study have revealed that the paper based model of asthma care is less expensive than the mobile phone supported model.

STUDY QUESTION: To what extent have menopausal hormone treatment and mammography screening contributed to the observed changes in incidence of invasive breast cancer in Norway since the mid-1990s? SUMMARY ANSWER: The changes in incidence trends of invasive breast cancer in Norway over the past 20 years may be fully attributed to mammography screening activity and use of hormone treatment, with about similar contributions of each factor. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Both mammography screening and hormone treatment are known to increase the risk of invasive breast cancer and have been suggested as explanatory factors for the recent changes in incidence trends of invasive breast cancer in many developed countries. By modelling both factors simultaneously, their individual and combined contributions to the observed changes in incidence can be quantified. [ABSTRACT FROM AUTHOR]

STUDY QUESTION: Do proton pump inhibitors (PPIs) increase the risk of hip fracture in postmenopausal women even after accounting for other lifestyle and dietary risk factors? SUMMARY ANSWER: Regular use of PPIs was associated with an increased risk of hip fracture in postmenopausal women, particularly among those with a history of smoking. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Previous studies of the association between PPI use and hip fracture have had limited information on important lifestyle and dietary factors associated with fracture. This study shows an increased risk of hip fracture even after controlling for these other factors, and risk seems limited to women with history of smoking. [ABSTRACT FROM AUTHOR]

STUDY QUESTION: Does dietary n-3 long chain polyunsaturated fatty acid (LCPUFA) supplementation of pregnant women with a fetus at high risk of allergic disease reduce immunoglobulin E associated eczema or food allergy at 1 year of age? SUMMARY ANSWER: n-3 LCPUFA supplementation in pregnancy did not reduce the overall incidence of immunoglobulin E associated allergies in the first year of life, although immunoglobulin E associated eczema was lower. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Several mechanistic studies have suggested that higher intakes of n-3 LCPUFA during pregnancy modulate the neonatal immune response towards a less allergenic phenotype. n-3 LCPUFA supplementation in pregnancy did not reduce the incidence of immunoglobulin E associated food allergies in the first year of life, but the incidence of atopic eczema was lower. [ABSTRACT FROM AUTHOR]

This paper provides the first US estimates and rates of non-fatal conductive energy device (CED)-related (eg, Taser) injuries relative to other types of legal intervention injuries treated in hospital emergency departments (EDs). The data used for this study were from the National Electronic Injury Surveillance System (NEISS), including the Firearm Injury Surveillance Study (NEISS-FISS) and the All Injury Program (NEISS-AIP). Of an average annual 75 000 suspects treated for non-fatal legal intervention injuries, 11% had injuries that were associated with the use of a CED or Taser. Of the suspects with non-fatal CED-related injuries, 90.1% were males, 72.6% were 20-44 years of age, and 55.2% were injured to the trunk. Most suspects with CED-related injuries (93.6%) were treated and released from the hospital ED. The authors conclude that NEISS is a useful data source for CED-related injuries in the US; estimates from NEISS emphasise the importance of implementing CED safety guidelines by law enforcement officers and training of medical personnel to help reduce the risk of severe injury and potential adverse health consequences. [ABSTRACT FROM AUTHOR]

Aims: To analyse the level of funded research in clinical pathology in a recent bear and bull market to act as a predictor for future funding during the current global financial crisis. Methods: The level of funding for research published in three clinical pathology journals in 2005 and 2008 to coincide with the bear market of March 2000 to October 2002 and with the subsequent bull market to October 2007 was determined using a Medline query. Other parameters examined were the type of article, affiliation of the first author and the pathology subspecialty. Results: Approximately 30% of publications were funded and did not differ between the 2 years studied. Original research papers were more likely to be funded than case reports or reviews. Research from university departments of pathology was more likely to be funded than from hospital pathology departments but there were more publications from hospital pathology departments. The proportion of research in the different subspecialties that was funded did not differ significantly between each other and between 2005 and 2008. Conclusions: Based on data from the previous bear market, which was the longest and deepest of the post 1950 era, and the subsequent bull market, which led to the all-time high in the Dow Jones Industrial Index, funding for clinical pathology research does not seem to be affected by bull or bear markets. [ABSTRACT FROM AUTHOR]