STUDIES CAST DOUBT ON VALUE OF BED REST
Bed rest is overrated as a treatment for ailments from heart attack to back pain, according to an analysis of 39 studies involving more than 5,000 patients.
"Overall, there was no evidence that bed rest has any significant beneficial effect when used as a treatment or when used after surgery," Australian researchers concluded. "Indeed, in some disorders it seems to be harmful."
The findings "support modern recommendations that bed rest should no longer be offered for acute low back pain, myocardial infarction [heart attack], pulmonary tuberculosis or acute infectious hepatitis," they said.
Bed rest, the study authors noted, is often prescribed by doctors not only for immobilized patients but also for many conditions ranging from arthritis to psychiatric illness. "Ideas about bed rest seem so entrenched that medical practice has been slow to change--even when faced with evidence of ineffectiveness," researchers said.
Their analysis, based on a review of research published during the past 30 years, tested "the little-challenged assumption that bed rest will be good for most illnesses"--a notion that goes back at least to the ancient Greek physician Hippocrates.
They evaluated 39 studies of bed rest for 15 different conditions. In 24 of the studies, patients were treated with bed rest following a medical operation or procedure. None of the outcomes--such as frequency of headaches after a spinal tap--improved significantly, and eight worsened.
Another 15 of the studies tested bed rest as primary treatment for an illness or condition. Outcomes either failed to improve or worsened. The conditions that worsened with bed rest included acute low back pain, labor, certain pregnancy-related cases of hypertension, heart attack and acute infectious hepatitis.
The analysis was conducted by researchers at the University of Queensland, and their findings were reported this month in The Lancet, a British medical journal.
DATA SHOW BENEFIT OF USING COLONOSCOPE
The current practice of using a flexible sigmoidoscopy to screen for colon cancer misses about 5 percent of precancerous lesions, according to a study by researchers at the National Naval Medical Center in Bethesda.
Flexible sigmoidoscopy involves examining up to 25 inches of the colon. By comparison, another screening technique, colonoscopy, enables doctors to examine the entire colon, which is three to four feet long. Standard practice, however, is to screen for colon cancer using flexible sigmoidoscopy. That is because colonoscopy costs more than a sigmoidoscopy exam, requires more patient preparation, carries more risks of intestinal perforation and must be performed under a mild sedative.
The latest findings suggest, however, that colonoscopy is better able to detect advanced precancerous lesions that could be missed by a sigmoidoscopy exam.
Philip Schoenfeld and his colleagues at the naval hospital gave follow-up colonoscopy exams to 300 patients who had received a sigmoidoscopy. They then compared the results in patients who had been diagnosed with polyps of the colon and those whose sigmoidoscopy exam had shown no abnormalities.
The study found that 5 percent of both groups had additional polyps higher in the colon, which were detected by colonoscopy but were out of reach of a sigmoidoscope.
"Flexible sigmoidoscopy may not be as appropriate a screening test as we would wish," Schoenfeld said. While the procedure can detect colon cancers, he said that "it may not be as comprehensive" as other procedures. He reported his results yesterday at the annual meeting of the American College of Gastroenterology in Phoenix.
Also at that meeting, researchers from Temple University Medical School in Philadelphia reported an intriguing study on where colon cancers are found. Frank K. Friedenberg and his colleagues reviewed more than 11,000 records of colonoscopies performed from 1985 to 1998 at Albert Einstein Medical Center in Philadelphia. They found that 65 percent of cancers diagnosed in 1985 were in regions of the colon accessible by sigmoidoscope exam. By 1998, only 48 percent of tumors were in areas able to be reached by the sigmoidoscope.
Why the difference occurs is not known, Friedenberg said, although the growing use of colonoscopies is clearly allowing doctors to find the disease in places they once could not reach easily.
Friedenberg said that the findings have already changed the way that he screens his patients. "We should look for reasons to do colonoscopies in patients because it really is a better test for cancer," he said.
MORE WOMEN REPORT RECEIVING MAMMOGRAMS
The percentage of women over 40 who said they'd had mammograms increased nearly 33 percent between 1989 and 1997, the Centers for Disease Control and Prevention said last week.
A 1997 survey found that 84.8 percent of women reported ever having had a mammogram, up from 63.9 percent in 1989. During the same period, the CDC said, women who reported receiving a mammogram within the previous two years increased from 54.3 percent to 71.3 percent.
Donald Blackman, a CDC medical epidemiologist, said the findings indicate that health officials need to do more to encourage women to receive repeat screenings.
The 38-state survey questioned 20,511 women in 1989 and 38,027 in 1997.
An estimated 175,000 women will be diagnosed with breast cancer this year, and 43,300 will die, the CDC said. Early detection allows for treatment that can increase the chances of survival.
--The Associated Press