The edition · Internal Medicine
An alpha-blocker before trial without catheter raised voiding success by about a quarter in acute retention
A meta-analysis of eight trials supports a simple ward step for men in retention from prostatic enlargement; small airway dysfunction flagged asthma patients at higher exacerbation risk; and telehealth mindfulness helped back pain, though less than hoped.
The edition in brief
A meta-analysis of eight randomised trials found that starting an alpha-1 blocker in men with acute urinary retention from benign prostatic enlargement raised the chance of a successful trial without catheter by 24.5 percentage points over placebo (95% CI 18.4 to 30.7), without a clear rise in adverse events. A narrative review by experts from ten countries, including India, sets out how to put guideline-recommended NT-proBNP testing for early heart failure in diabetes into practice, covering pathways, thresholds, resources and cost. In a Taiwanese cohort of 167 adults with stable asthma, small airway dysfunction on impulse oscillometry was present in 80% and was independently associated with future exacerbations (adjusted HR 3.26). The OPTIMUM trial of 451 primary care patients found that an eight-week telehealth mindfulness group programme improved chronic low back pain scores over usual care at six months, but the difference (-0.62 points) fell short of the prespecified clinically important one-point change.
Putting NT-proBNP testing for early heart failure in diabetes into practice
If you test NT-proBNP in patients with diabetes, set the pathway first: which threshold triggers echocardiography and what treatment follows.
Small airway dysfunction was linked to more asthma exacerbations
Consider small airway dysfunction in patients whose asthma is uncontrolled despite reassuring spirometry, and treat a recent exacerbation as a warning.
Telehealth mindfulness groups eased chronic back pain, but below the clinically important threshold
Consider offering a mindfulness group programme for chronic low back pain as a low-risk add-on, while being honest that the average gain is small.
Look for the precipitant in every case of acute urinary retention
Find and remove the precipitant, especially drugs and constipation, before attempting a trial without catheter.
Alpha-blockers before trial without catheter raised voiding success
Start an alpha-1 blocker when a man is catheterised for retention from benign prostatic enlargement, before the trial without catheter.
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