By: Laura May, PA, The Independent
Friday, 3 October 2008

Employees who take regular periods of long-term sick leave die earlier than their colleagues, a study by the British Medical Journal said today.

Researchers found that workers with more than one absence requiring a doctor’s note on their records were 66 per cent more likely to die prematurely.

And workers who had to stay off work because of psychiatric problems were two and a half more likely to die of cancer.

Those who had to take time off because of circulatory disease were the most likely to die before their healthy colleagues. Researchers found they had a four time higher chance of a premature death.

BMJ 2008;336:166-167 (26 January).Editorials by Giuseppe Biondi-Zoccai, assistant professor in cardiology et al.

Aspirin resistance in cardiovascular disease carries a worse prognosis, but may be indicative of pre-existing higher risk.

Aspirin has clear benefits in cardiovascular disease. It reduces total mortality, cardiovascular mortality, and cardiovascular morbidity in people with cardiovascular disease or those at high risk of the disease; it is also cheap, relatively safe, and easy to use.

To date, most research has focused on whether aspirin resistance really exists. We don’t know whether aspirin resistance is a true abnormal response or whether it reflects normal variability in drug activity. Management of patients with aspirin resistance should include a comprehensive appraisal of thrombotic and bleeding risks, the likelihood of non-adherence to treatment, and access to other antiplatelet agents.

Mark J Bolland and colleagues, Department of Medicine, Auckland, New Zealand,  - BMJ, 15 January 2008

In 1400 healthy postmenopausal women, daily calcium supplementation was associated with a higher risk of myocardial infarction over five years. This effect could outweigh any benefits on bone from calcium supplements.

Clinical Review, BMJ  2007;335:929-932 (3 November).

Summary points

• A favourable outcome depends on early, aggressive, treatment
• Antimicrobial treatment must take into account both patient susceptibilities and local resistance patterns; advice from infectious disease or microbiology colleagues is often helpful
• Volume resuscitation and cardiovascular support should be titrated to simple clinical end points
• Subtle signs of organ hypoperfusion should be sought in physically robust patients
• The role of activated protein C and low dose steroids remains to be clarified
  

BMJ 21 December 2007;

Organised marathons are not associated with an increased risk of sudden death, despite the media attention they attract. In fact, marathons lower the risk of fatal motor vehicle crashes that might otherwise have taken place if the roads had not been closed

BMJ  2007;335:639 (29 September) NEWS:

Serum concentration of triglycerides is an independent risk factor for coronary heart disease.

Because triglycerides are so closely linked to obesity (p 425). Losing weight and taking more exercise is one of the best ways to keep triglycerides under control. In this study, lower concentrations were also associated with eating a decent breakfast.

BMJ 2005;330 (11 June).
ANTI-INFLAMMATORY MEDICATION (NSAIDs) MAY BE BAD FOR YOUR HEART

All drugs in the study were associated with an increased risk of myocardial infarction, which was statistically significant for rofecoxib, diclofenac, and ibuprofen; no protective effect was seen for naproxen.

If you want to read more JUST CLICK HERE.

BY: Mike Clancy, ER consultant, BMJ 2007;335:623-624 (29 September)

Acute chest pain is responsible for one in four emergency medical admissions in the United Kingdom observation and investigation is not easy, especially when the consequences of misdiagnosis include infarction, arrhythmia, and death.

The strategy of evaluating such patients in a chest pain unit based within or near the emergency department is used in 30% of emergency departments in the United States.

In theory, a chest pain unit should improve outcomes—but does it?

The ESCAPE trial by Goodacre and colleagues tried to answer this question.

The introduction of a chest pain unit had no significant effect on the proportion of people attending the emergency department with chest pain, the proportion of people with chest pain who were admitted, or the number of people admitted over the next 30 days.

Setting up a chest pain unit led to more patients being tested, but no reduction in the proportion of patients admitted.

The trial showed no benefits of chest pain units.

If you want to find out more about the effectiveness of chest pain units, just CLICK HERE.

Patients with cardiac chest pain should call emergency services 

BY: Will T Roberts, research fellow, Adam D Timmis, professor of clinical cardiology BMJ  2007;335:669 (29 September). 

In acute myocardial infarction, the risk of ventricular fibrillation is highest in the first 12 hours after onset of symptoms.

Key points

In acute myocardial infarction the most important means of saving life is to get the patient to a defibrillator and to start reperfusion therapy as soon as possible after the onset of symptoms