Middle meningeal embolisation cuts reoperation for chronic subdural haematoma by 60 per cent

The edition in brief

Seven randomised trials with 1,889 patients were pooled to test middle meningeal artery embolisation added to standard treatment for chronic subdural haematoma. Recurrence or residual haematoma fell (risk ratio 0.63, 95 per cent CI 0.46 to 0.85) and reoperation fell further (0.39, 0.28 to 0.56), with no increase in serious adverse events, neurological death, mortality or poor functional outcome, and benefit independent of when the procedure was done. Japanese insurance claims covering 8117 people aged 65 or over with severe Alzheimer's disease found oral cholinesterase inhibitors were continued for a mean of 1.5 years against 0.6 years for transdermal patches, raising the question of how long these drugs should run in advanced dementia at all. A meta-analysis of seven trials and 472 people with sarcopenia found strength training with whey protein or beta-hydroxy-beta-methylbutyrate improved fat-free mass and handgrip strength, with whey plus training outperforming supplementation alone and no clear effect from the beta-hydroxy-beta-methylbutyrate combination. In 96 older non-cardiac surgery patients, the 11 with moderate to severe preoperative daytime sleepiness had worse global cognition six weeks after surgery. A cluster randomised trial across 10 US sites trained 68 nephrologists in the Best Case/Worst Case communication tool for dialysis decisions: palliative care receipt did not change, while intervention patients were more likely to start dialysis and reported worse quality of life throughout.