Community-acquired pneumonia incidence before and after proton pump inhibitor prescription

Is the use of proton pump inhibitors (PPIs) associated with an increased risk of pneumonia? Several observational studies and meta-analyses have suggested that this is so since an initial report in 2004; hence this study.

Information was derived from a primary care database in the UK. Adult patients newly treated with a PPI were selected and matched individually, according to age, sex and year of prescription, with patients who had not been prescribed PPI. The risk of pneumonia was 1.67 times higher for patients exposed to PPI. However, it was noted that in the PPI cohort the relative risk of pneumonia was 1.19 in the 30 days after prescription, but was higher in the 30 days before prescription (1.92).

The results confirm the known crude association between PPI prescriptions and an increased rate of community-acquired pneumonia.

However, the analyses show that this increased risk predates PPI prescription, and is therefore unlikely to be caused by PPIs.

BMJ 2016; 355:i5813

Impact of providing patients with copies of their medical correspondence

In this report from Melbourne it is noted that in Australia, patients do not routinely get copies of the consultation letters and procedure reports sent to their general practitioners.

A randomised trial was designed to see whether such copies would lead to improved understanding, satisfaction or anxiety. The researchers noted no reduction in anxiety levels (p=0.52), no increase in understanding (p=0.73) or any increase in satisfaction (p=0.33) in participants receiving correspondence. However, 97% wished to receive correspondence in the future and 94% in the correspondence group reported it helped them understand their medical condition.

It is recommended that patients be offered the choice of receiving copies of their clinic correspondence and procedure reports.

Internal Medicine Journal 2017; 47, 68–75

Low-molecular-weight heparin and recurrent placenta-mediated pregnancy complications

Placenta-mediated pregnancy complications include pre-eclampsia, late pregnancy loss, placental abruption and birth of a small-for-gestational-age (SGA) neonate. These complications are leading causes of maternal, fetal and neonatal morbidity and mortality in high-income countries. In a previous study these researchers concluded that low-molecular weight heparin reduced the risk of these complications. However, there was heterogeneity in their results, so they decided to perform an individual patient data meta-analysis.

They analysed data from eight trials involving over 900 women, half of whom were treated with low-molecular-weight heparin and half who were not. Overall there was no significant difference in outcomes in the heparin or no heparin cohorts.

The researchers concluded that low-molecular-weight heparin does not seem to reduce the risk of recurrent placenta-mediated pregnancy complications in at-risk women.

Lancet 2016; 388:2629–41

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