High-volume injections, with or without steroid, did no better than sham for Achilles tendinopathy at a year

The edition in brief

The BMJ Inject trial randomised 192 community adults with midportion Achilles tendinopathy to sham, high-volume injection, or high-volume injection with hydrocortisone, all with the same exercise programme; at 12 months neither injection improved pain and disability on VISA-A over sham, and the steroid injection's short-term benefit at six weeks was followed by worse outcomes at 26 weeks. A BJGP cross-sectional study of 3,053 English practices found heavier use of online triage forms was associated with more urgent suspected cancer referrals and investigations, but not with more cancers diagnosed or fewer emergency presentations. A BJGP qualitative study of 41 primary care staff described how non-specific symptoms attributed to a common 'interim' diagnosis can delay cancer, and how safety-netting and a fresh pair of eyes help. A small Turkish trial found a nurse-led home programme improved heart failure self-care. The pearl covers safety-netting.