Annals of Internal Medicine tip sheet for March 18, 2008, issue

1. New Study: Growth Hormone Does Not Enhance Athletic Performance

A review of published randomized controlled trials that compared growth hormone (GH) to no-growth-hormone treatment in healthy people between 13 and 45 years of age found that lean body mass increased in people who took growth hormone but strength and exercise capacity did not.

People who took GH experienced soft tissue swelling and fatigue more frequently than those who did not take GH.

Authors conclude that claims that GH enhances physical performance are not supported by the scientific literature. GH, they say, may increase lean body mass but may not improve strength and may worsen exercise capacity and increase adverse events.

Note: This paper is being released early online at the Web site of Annals of Internal Medicine www.annals.org. It will appear in the May 20, 2008, print edition of the journal.

2. Testing Everyone Admitted to 3 Hospitals for MRSA Infection Greatly Reduced Disease in Hospital and After Discharge

A three-year program compared three strategies for tackling MRSA (methicillin-resistant Staphlococcus aureus) infection (Article, p. 409). Researchers compared no screening for MRSA with screening those admitted to the emergency departments and with screening all people admitted to the hospitals (universal surveillance). Universal surveillance was associated with a reduction by more than half of healthcare-associated MRSA bloodstream, respiratory, urinary tract, and surgical site disease occurring during hospital stay and in the 30 days after discharge.

An editorial writer notes that the rapid polymerase chain reaction (PCR)-based test used in the universal screening phase of the study was not used in the first two phases and thus could skew results (Editorial, p. 474). Further, the PCR-based test costs about $25 to $30 compared to the $5 standard culture lab test, so screening all patients with the fast test may have an economic impact on the hospital.

The writer suggests that a strategy of targeting high-risk populations for screening, such as nursing home residents, would be a more cost-effective way to confront MRSA infection. “The one-size-fits-all approach is probably not sensible for MRSA screening.”