Clinical Insights: colchicine, hospital referrals and carpal tunnel syndrome

Clinical insights take a look at some of the recent clinical research published across BioMed Central’s journals.

A role for colchicine in cardiovascular disease?

Inflammatory mechanisms play a major role in cardiac disease progression. Colchicine, a treatment for gout, is one of the oldest known drugs still prescribed today. A new systematic review suggests that its diverse anti-inflammatory effects may also have benefits in a wide range of cardiovascular diseases.

Researchers have conducted a systematic review and meta-analysis to provide a more comprehensive understanding of colchicine in the prevention of adverse outcomes in various cardiac diseases. Fifteen randomized controlled trials met the inclusion criteria and were included in the final analyses.

Pooled results from all randomized controlled trials (RCTs) demonstrated only mild side effects, mostly related to gastrointestinal symptoms, and no serious adverse events. Colchicine also reduced the rate of pericarditis recurrence, post-pericardiotomy syndrome, and atrial fibrillation post cardiac surgery or radiofrequency ablation.

Therapies aimed at reducing inflammation are at the forefront of secondary prevention of cardiovascular complications and Colchicine appears to be safe and effective in reducing adverse outcomes in cardiac disease.

Verma et al., BMC Cardiovascular Disorders

Templates to increase quality of hospital referrals

Referral letters are an important route of communication between general practitioners (GPs) and secondary care doctors. Incomplete or unclear referrals can make evaluation and prioritisation of incoming patients difficult. Results of a new study suggest that using templates can produce higher quality referrals.

In a randomized controlled trial, 14 community GP surgeries were randomly assigned to receive specially designed referral templates or continue with normal referral practice. Templates were developed for patients in four diagnostic groups: dyspepsia, suspected colorectal cancer, chest pain and chronic obstructive pulmonary disease. A total of 500 patients were included, with 281 in the intervention and 219 in the control arm.

The referral quality in each of the four groups was higher in the intervention than control group and on average the quality of the referral letters increased by 18%. Simple, tailored templates can improve communication between primary and secondary care and hopefully lead to better health care.

Wåhlberg et al., BMC Health Services Research

Carpal tunnel syndrome linked to occupational factors

Carpal tunnel syndrome (CTS) is a common neuropathy caused by compression of the median nerve. There is increasing evidence that development of CTS is promoted by highly repetitive manual tasks, but how it relates to occupation factors is still unclear. The results of a new study suggest that occupational biomechanical factors play a substantial role in the causation of CTS.

The researchers analyzed systematic reviews and carried out a meta-analysis on primary studies to synthesize the observational evidence on effects of biomechanical risk factors on the development of CTS in workers. Four studies, where the exposures were measured with objective methods, were included in the final analysis.

There was a dose-response relationship between cumulative occupational exposure to force and repetition but no further evidence that CTS is caused by working with a computer keyboard or mouse. These results suggest that CTS should be considered as an occupational disease after certain biomechanical exposures at the workplace.

Kozak et al., BMC Musculoskeletal Disorders

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