Highlights

What people want at the end of life

Making end-of-life discussions a priority would ensure that terminally ill patients and their loved ones feel sustained rather than abandoned. See Editorial, page 1707

Acupuncture and stroke rehabilitation

The specific effect of acupuncture, compared with sham acupuncture, on recovery after stroke is uncertain. Of 10 trials identified in their systematic review, Kong and colleagues were able to summarize the findings of five trials that assessed the effect on functionality soon after stroke in a total of 368 patients. Acupuncture may not be as promising in stroke rehabilitation as was previously thought, and more rigorous research is needed, say the authors. See Research, page 1723

Results from systematic reviews of acupuncture’s effectiveness in stroke rehabilitation are conflicting. However, most of the reviews are based on small, heterogeneous trials. The question of effectiveness can be answered only with rigorously designed, large, multicentre trials, says Wu. See Commentary, page 1711

Herpes zoster, postherpetic neuralgia and health-related quality of life

A quarter of the people who saw a doctor because of shingles still had pain three months later. Drolet and colleagues report this finding from their prospective study that monitored the severity of pain, interference with normal activities and quality of life of 261 patients aged 50 years or more who had acute herpes zoster. These findings support the need for early intervention and prevention strategies to reduce the burden from herpes zoster and postherpetic neuralgia, say the authors. See Research, page 1731

The zoster vaccine appears to be underused, says Watson. In 2008, only 7% of potential recipients were vaccinated. This may, in part, be due to vaccine phobia, to the cost of the vaccine (about $150) because it is not covered by insurance, and to the logistics of using a frozen vaccine, which needs to be administered within 30 minutes after reconstitution. See Commentary, page 1713

Effect of antenatal peer support on breastfeeding initiation

Using peer support for expectant mothers does not appear to improve the chances of starting breast-feeding. In their systematic review of trials and other intervention studies, Ingram and colleagues found 11 studies and summarized the results of three high-quality randomized controlled trials to reach this conclusion. Targeted peer support may offer more promise, and the authors suggest that future research should be directed to this area. See Research, page 1739

Substituting placebo for established, effective therapy: Why not?

Some claim that even when established therapy exists, placebo controls are needed in randomized controlled trials. The justification for this ethically questionable practice is that it enhances scientific credibility, through a concept of assay sensitivity, whereby placebo controls ensure the ability to distinguish effective from less effective therapy. However, assay sensitivity is limited unless there is evidence that blinding has been effective. See Analysis, page 1749

An unusual presentation of amebic liver abscesses

A 47-year-old man presented with fever, abdominal pain and jaundice. On imaging, multiple lesions were found in his liver, which were later diagnosed as amebic abscesses. Broz and colleagues emphasize that serologic testing for Entamoeba histolytica is important in making this diagnosis, since antibodies will eventually develop in almost all patients with this condition. See Practice, page 1755

Age-related macular degeneration

Self-monitoring with an Amsler grid is critical to detect the progression of age-related macular degeneration early. Noble and Chaudhary emphasize that timely treatment may reduce the risk of permanent loss of vision. See Practice, page 1759