Comparative effectiveness of treatments for Helicobacter pyloriHitherto, the most widely used treatment to eradicate h. pylori has utilised 7 days of standard triple treatment (a proton pump inhibitor plus clarithromycin, with amoxicillin or metronidazole). However, with the development of antibiotic resistance, particularly to clarithromycin, the standard triple treatment is now challenged by several new treatments.This review and meta-analysis has examined evidence from 143 studies emulating 14 different regimens. The conclusions reached were that the standard triple treatment was inferior to the other regimens. It resulted in a 73% eradication rate compared with 94% for a 7-day course of a proton pump inhibitor with 3 antibiotics often amoxicillin, clarithromycin and 5-nitroimidazole. BMJ 2015;351:h4052Neuraminidase inhibitors for influenza As winter approaches in the UK, the debate is renewed as to whether the benefit of routine use is outweighed by the adverse effects, such as nausea and vomiting. Some light has been thrown on this as the Academy of Medical Sciences and the Wellcome Trust ((AMS/WT) has recently published a report on the neuraminidase inhibitor (NAI) antiviral drugs in seasonal and pandemic influenza treatment and prophylaxis.The most significant recommendation is that routine use of antivirals is not supported in patients with seasonal influenza unless the individual is seriously ill or the strain is very severe. The report also calls for high quality, adequately-powered randomised trials in hospitalised and high-risk patients (pregnant women and children) in a pandemic. Lancet 2015;386:1510A randomised, controlled trial of total knee replacementTotal knee replacement is a well-established procedure. However, high-quality evidence to support the effectiveness of the procedure, as compared with nonsurgical interventions, is lacking. Hence this trial, which involved 100 patients with moderate-to-severe knee osteoarthritis who were eligible for unilateral total knee replacement. Patients were randomly assigned to undergo total knee replacement followed by 12 weeks of nonsurgical treatment (total-knee-replacement group), or to receive only the 12 weeks of nonsurgical treatment (nonsergical-treatment group), which was delivered by physiotherapists and dietitians and consisted of exercise, education, dietary advice, use of insoles, and pain medication.The surgical treatment resulted in greater pain relief and functional improvement after 12 months follow-up. However, the surgical treatment was associated with a four-fold increase in serious adverse events. The commonest were deep venous thrombosis and severe stiffness in the operated knee.N Eng Med J 2015;373:1597-606

Comparative effectiveness of treatments for Helicobacter pyloriHitherto, the most widely used treatment to eradicate h. pylori has utilised 7 days of standard triple treatment (a proton pump inhibitor plus clarithromycin, with amoxicillin or metronidazole). However, with the development of antibiotic resistance, particularly to clarithromycin, the standard triple treatment is now challenged by several new treatments.This review and meta-analysis has examined evidence from 143 studies emulating 14 different regimens. The conclusions reached were that the standard triple treatment was inferior to the other regimens. It resulted in a 73% eradication rate compared with 94% for a 7-day course of a proton pump inhibitor with 3 antibiotics often amoxicillin, clarithromycin and 5-nitroimidazole. BMJ 2015;351:h4052Neuraminidase inhibitors for influenza As winter approaches in the UK, the debate is renewed as to whether the benefit of routine use is outweighed by the adverse effects, such as nausea and vomiting. Some light has been thrown on this as the Academy of Medical Sciences and the Wellcome Trust ((AMS/WT) has recently published a report on the neuraminidase inhibitor (NAI) antiviral drugs in seasonal and pandemic influenza treatment and prophylaxis.The most significant recommendation is that routine use of antivirals is not supported in patients with seasonal influenza unless the individual is seriously ill or the strain is very severe. The report also calls for high quality, adequately-powered randomised trials in hospitalised and high-risk patients (pregnant women and children) in a pandemic. Lancet 2015;386:1510A randomised, controlled trial of total knee replacementTotal knee replacement is a well-established procedure. However, high-quality evidence to support the effectiveness of the procedure, as compared with nonsurgical interventions, is lacking. Hence this trial, which involved 100 patients with moderate-to-severe knee osteoarthritis who were eligible for unilateral total knee replacement. Patients were randomly assigned to undergo total knee replacement followed by 12 weeks of nonsurgical treatment (total-knee-replacement group), or to receive only the 12 weeks of nonsurgical treatment (nonsergical-treatment group), which was delivered by physiotherapists and dietitians and consisted of exercise, education, dietary advice, use of insoles, and pain medication.The surgical treatment resulted in greater pain relief and functional improvement after 12 months follow-up. However, the surgical treatment was associated with a four-fold increase in serious adverse events. The commonest were deep venous thrombosis and severe stiffness in the operated knee.N Eng Med J 2015;373:1597-606