Open Reading Frame brings together a selection of recent publication highlights from elsewhere in the open access ecosystem. This week we take a look at the past few weeks in medicine.
Is screening for depression in primary care effective?
In many counties, guidelines recommend routine screening for depression in primary care in order to improve early diagnosis, but it remains controversial whether screening is effective. The evidence for this recommendation has been collated in a systematic review, which found very limited research investigating the effectiveness of screening. The researchers conclude that there is insufficient evidence to support recommendations for routine screening, and emphasize that more randomized trials should be carried out across varied settings before conclusions about the effectiveness of depression screening can be made.
Keshavarz et al. CMAJ Open
Scaling up HIV therapy: cost considerations
There is ongoing controversy about when to start antiretroviral therapy (ART) in HIV-infected individuals, and new World Health Organization guidelines recommend ART initiation in those with CD4 cell counts below 500 cells per µl, a higher threshold than previous recommendations. Country decision makers must now decide whether to expand ART eligibility, taking health benefits and cost into account. In a mathematical modeling study, earlier eligibility for ART was found to be highly cost effective in low- and middle-income countries, suggesting that scaling up ART through earlier eligibility should be considered as a priority healthcare intervention in resource-limited settings.
Eaton et al. The Lancet Global Health
Urine test for insulin resistance
Insulin resistance (IR), an early marker of type 2 diabetes, is currently assessed using blood measurements of insulin or C-peptide. New research has shown that a urine C-peptide creatinine ratio (UCPCR) could be used in place of blood measurements to measure IR. In a single-center study, IR was measured in 37 healthy volunteers and 30 patients with chronic kidney disease (CKD), and UCPCR results strongly correlated with serum insulin and C-peptide measurements in those with normal kidney function. These findings require validation in a larger study, but suggest that non-invasive urine-based tests could be used to detect IR and predict the development of type 2 diabetes in patients without CKD.
Oram et al. BMJ Open
Risk profiling of PSA-detected prostate cancer
Prostate-specific antigen (PSA) testing is used to screen for prostate cancer (PC) in older men, and can detect PC in patients without other clinical signs of disease. New research has evaluated the risk profile of PSA-detected PC in over 70,000 US men, showing that around 16 percent present with high-risk disease (HRD), defined as PSA levels of greater than 20ng/ml. The researchers also showed that black race and older age are associated with HRD, suggesting that PC screening and prevention strategies should be targeted to these groups.
Zhang et al. Frontiers in Oncology
Statins and calcium channel blockers: potential for adverse reactions?
Patients with comorbid high cholesterol and hypertension frequently take calcium channel blockers together with statins. The concomitant use of these drugs increases the risk of adverse drug reactions (ADRs), and in 2011 the US Food and Drug Administration set a dose limitation for simvastatin when taken together with the calcium channel blocker amlodipine. However, there is currently no dose limitation for other statins when prescribed together with calcium channel blockers. Research into interactions between these drug classes has been distilled in a systematic review, and the researchers identified a number of combinations with potential for ADRs. For example, the authors categorized pravastatin taken with nimodipine, and lovastatin taken with nicardipine, as “not recommended” due to enhanced vasodilatory effects. These results indicate that clinicians need to be more aware of the risks associated with prescribing these drugs together in order to improve patient safety.
Zhou et al. Therapeutics and Clinical Risk Management
Improving risk prediction in the ICU
A number of scoring systems based on clinical measurements are currently used to predict the outcome of patients admitted to intensive care units (ICUs), but these scores are not perfect and there is a need to develop more accurate risk prediction biomarkers. Research in the US has shown that raised levels of mitochondrial DNA (mtDNA) in the blood are associated with death in ICU patients, and measuring mtDNA can improve risk prediction using current scoring systems. These findings suggest that determining mtDNA levels could be a valuable addition to risk prediction tools in patients admitted to ICUs.
Nakahira et al. PLOS Medicine
Written by Claire Barnard, Senior Editor for BMC Medicine.