Tuesday, June 6, 2023

Tom Nolan’s research reviews—11 May 2023

  1. Tom Nolan, clinical editor; sessional GP, Surrey

  1. The BMJ, London

Washing away viral infections

One legacy of covid is the thousands of grimy, empty alcohol hand rub dispensers that are still stationed in public places; little memorials to the time when we faithfully anointed ourselves on those excursions where proximity to other people and surfaces that they might have touched was unavoidable. Let’s not forget the period, before the alcohol gel dispensers appeared, when we all sang “happy birthday” in full as we washed our hands, safe in the knowledge that we had solid evidence from meta-analyses that handwashing with soap and water reduces the incidence of viral acute respiratory infections. Previous meta-analyses have mostly looked at data from high income countries, but now we have the first one looking exclusively at low and middle income countries. It found that, compared with no intervention, handwashing interventions (of various shapes and sizes and aimed at homes, schools, and childcare settings) reduced acute respiratory infections by about 17%.

Lancet doi:10.1016/S0140-6736(23)00021-1

Buying blood pressure machines online

Home blood pressure monitoring seems to be the norm nowadays—reviewing several days’ worth of blood pressure readings taken at home seems far more reliable than a rushed reading or two taken during a consultation. But how reliable are the machines that people are buying? A team of researchers, some of whom disclose personal fees from leading blood pressure machine manufacturers, went on Amazon and found the 10 best-selling blood pressure machines in 10 different countries. They checked how many of the machines were included on international and local lists of validated devices (such as the one on the British and Irish Hypertension Society website). Seventy nine per cent of upper arm and 83% of wrist cuff devices were unvalidated. Those with less money to splash out on a machine seem more likely to buy a non-validated device, with the study finding that unvalidated machines tend to be around half the price of those on lists of validated machines.

JAMA doi:10.1001/jama.2023.2661

Herbal injections for sepsis

Xuebijing is a herb based injection that has been licensed in China since 2004 for treatment of sepsis and multiple organ dysfunction syndrome. A large, multicentre, double blind, placebo controlled trial set in China has reported strikingly lower rates of death in patients with sepsis being treated with Xuebijing in intensive care units. Twenty eight day mortality in the Xuebijing injection group was 26.1% compared with 18.8% in the placebo group (P<0.001). To gain approval from the Food and Drug Administration (and perhaps subsequent approval from the Medicines and Healthcare products Regulatory Authority, if “near automatic sign off” goes ahead), two independent, adequate, and well controlled trials would typically be needed, and findings from trials conducted outside the US would need to be deemed to be applicable to the US population and medical practice. A linked editorial describes these hurdles in detail: the bottom line being that we’re unlikely to see Xuebijing in intensive care departments in the UK any time soon.

JAMA Intern Med doi:10.1001/jamainternmed.2023.0780

Duration of concussion symptoms

My first and hopefully last experience of being in a police van was after I fell off my bike and came around to find several police officers crowded around me. They helped me up and took me to the nearest train station—although in hindsight I should probably have asked for a lift to the local emergency department. I got a decent insight into recovery from concussion, with headaches for several days and feeling unusually tired and flaky for several weeks. A study of 2842 varsity athletes in the US who had concussion from playing sport looked at how long it took for them to return to baseline functioning. Most of the measurements, including tests of visual memory, mood, and balance returned to baseline within a week, but reaction time and visual memory took longer and had more variability.

N Engl J Med doi:10.1056/NEJMc2301706

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