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Antithrombotics blamed for haemorrhagic stroke The rate of haemorrhagic stroke in older (>75 years) patients may be due to increased use of drugs to prevent thromboses, an Oxford study suggests (Lancet Neurology online: 1 May 2007; doi:10.1136/thx. 2006.071837). Analysis of the Oxford Community Stroke Project and the Oxford Vascular study showed that rates of haemorrhagic stroke have nearly halved in the under‐75s but not overall. In older patients, the overall rate of haemorrhagic stroke has doubled and stroke associated with antithrombotics has increased more than sevenfold. MHRA adds more to pseudoephedrine debate The proposal by the Medicines and Healthcare products Regulatory Agency to reschedule pseudoephedrine and ephedrine products to prescription‐only status has provoked an outcry from pharmacists' representa‐tives. In response, the MHRA has released additional infor‐mation ‐ some previously confidential ‐ to support its case (www.mhra.gov.uk). The new data include studies from the Association of Chief Police Officers, the USA and the United Nations. Trading standards officers in Cleveland also report that, despite a campaign to pharmacists to promote awareness of the risks that these products may be used to manufacture methamphetamine, teenagers covertly visiting pharmacies were able to buy a total of 45 boxes of Sudafed together with iodine and matches. New IBS guidelines The British Society for Gastroenterology (www.bsg. org.uk) has published new guidelines for the management of irritable bowel syndrome. Taking into account new diagnostic criteria, the guidelines state that management is multifactorial and includes psychological and pharmacological therapies. No single treatment helps more than a fifth of patients. Antispasmodics, soluble fibre (eg ispaghula and sterculia) and antidepressants may help some patients, but there is only limited evidence to support the effectiveness of any drugs. There is currently no evidence‐based approach to selecting treatment. Department launches Vascular Programme The Department of Health has grouped its strategies to tackle heart disease, stroke, diabetes and renal disease into a single Vascular Programme. Regionalised briefing information for health authorities and trusts avail‐able on its website (www.dh.gov.uk) includes evidence for strategies promoting cost‐effective statin prescribing, faster access to thrombolysis and improving diabetes management. Pharmacists can make a difference in HF Following UK research showing that medicines use review by pharmacists did not reduce admissions or deaths in patients with heart failure (BMJ Online: 23 April 2007;doi: 10.1136/bmj.39164. 568183.AE), a US study has shown that pharmacists can improve adherence and reduce admission and A&E visits (Ann Intern Med 2007;146: 714‐25). The study involved 314 low‐income patients with heart failure, randomised to usual care or personalised and written information about their treatment and how to take it. After nine months, medication adherence was significantly higher among patients who received the intervention (79 vs 68 per cent) and doses were taken on time more often (53 vs 47 per cent). Exacerbations resulting in visits to A&E or hospital admissions were reduced by 19 per cent. Follow‐up revealed that these gains were lost within three months after the intervention ended, suggesting that patients need continuous support. No better with weekly stop smoking support Weekly support for people attempting to stop smoking does not increase cessation rates above those associated with nicotine replacement therapy (NRT) alone, say UK investigators (Thorax Online First: 4 May 2007. doi:10.1136/thx. 2006.071837). They compared cessation rates for up to one year in 925 smokers (at least 10 per day) in general practice who were prescribed NRT and randomised to basic support (consultation before and one and four weeks after quitting, and a telephone call around quit day) or weekly support (additional phone calls at 10 days and three weeks, plus another consultation at two weeks). Cessation rates were about 22 per cent for both groups after four weeks, declining to 7‐8 per cent at one year; there were never any significant differences between the groups. The authors say such rates are no greater than with NRT alone and neither basic nor weekly support was effective. GPs should offer only enough support to be sure that NRT is used properly and refer patients who need more to specialists they say. Fewer antidepressants, more country walks? The mental health charity MIND has accused doctors of prescribing antidepressants without fully considering nonpharmacological alternatives. MIND says GPs wrote 6 per cent more antidepressant prescriptions in 2006 than in 2005, and 10 per cent more for SSRIs. The charity is calling for greater recognition of ecotherapy, which involves getting out doors and being active in a green environment as a way of boosting mental well being. It cites its own research involving 20 people, of whom 71 per cent reported decreased depression after a walk in a country park. One injection a year reduces fractures A single annual infusion of the bisphosphonate zoledronic acid reduces the risk of fractures in postmenopausal women with osteoporosis, a new study has shown (N Engl J Med 2007; 356:1809‐22). Zoledronic acid is not currently licensed for the treatment of osteoporosis. Compared with placebo, zoledronic acid reduced the risk of fractures of the hip (1.4 vs 2.5 per cent) and morphometric vertebral fracture (3.3 vs 10.9 per cent); it also reduced the risk of clinical fractures by one‐third. Zoledronic acid was associated with more cases of serious atrial fibrillation (in 50 vs 20 patients). Anticholinesterases cut beta amyloid in AD Postmortem studies have revealed that treatment with an anticholinesterase is associated with a reduction of 70 per cent in beta amyloid deposits in the brains of patients with dementia (Neurology 2007;68:1726‐1729). No reduction in tau protein was found. The study analysed protein deposits in the brains of patients with Lewy body dementia but it is suggested the findings are relevant to patients with Alzheimer's disease. The Alzheimer's Society (www.alzheimers. org.uk) believes this may be the first evidence of how drugs may affect disease progression. Diabetes targets better but still shortcomings A report published by the Healthcare Commission has found that 9 out of 10 patients with diabetes now have regular monitoring of blood pressure, cholesterol levels, longterm glucose levels and weight. However, education and awareness is still lacking, eg 17 per cent did not know whether they had type 1 or type 2 diabetes. A survey by Diabetes UK is less encouraging. Diabetes Heartache ‐ The Hard Reality of Cardiovascular Care for People with Diabetes says the provision of education courses is patchy, only 60 per cent of patients with diabetes are taking a statin, and cardiovascular targets are not being met in many patients. Copyright © 2007 Wiley Interface Ltd