BMJ  2003;327:E100 (4 October), doi:10.1136/bmjusa.02030004 (published 28 August 2002)

BMJ USA: Minerva

Minerva

This article originally appeared in BMJ USA

Allowing people to carry guns marks a major cultural difference between the United States and European countries. Data from random digit dial telephone surveys conducted throughout the United States challenged Minerva's preconceptions that Americans consider it their right to carry concealed firearms everywhere ( Injury Prevention 2001;7:282-285[Abstract/Free Full Text]). Asked about their feelings of safety, most said they felt less safe (as more states have made it easier to carry guns), and an overwhelming 90% of citizens said they thought ordinary people should not be allowed to bring guns into public places.

More headaches: the "triptans," 5HT1 agonists, may be expensive drugs, but compared with non-triptan therapies they more than pay for themselves in cutting the number of days taken off work, as well as cutting overall medical costs. A cost-benefit analysis from the United States concludes that sumatriptan treatment offers a positive ratio of $25 for each working day lost to migraines ( Mayo Clinic Proceedings 2001;76:1093-1101[Abstract]). Perhaps employers should think about keeping a stock of triptans in the office.

Polygraph lie detectors rely on simultaneous blood pressure measurements, rates of breathing, and sweating. High definition thermal imaging of "concealed blushing" seems to work just as well (it picks up 75% of people guilty of lying and 90% of those innocent) and is easier and quicker to perform. Liars seem to give off a rapid thermal signature of warming around the eyes that can be detected without physical contact and analyzed without expertise. The technology might be usefully incorporated at airport check-in desks ( Nature 2002;415:35[Medline]).

Patients sometimes get more than they bargained for when they're admitted to the hospital. It's been suggested that on entering the hospital each patient should be automatically warned about the 10% risk of nosocomial infections, because the consequences of not providing a warning might result in legal action on the issue of consent to treatment. But such warnings could result in a massive loss of confidence because hospital treatment is designed to cure or alleviate dangerous conditions, not make things worse ( Clinical Risk 2001;7:242).

Having recently needed an inhaler and discovered for herself just how tricky they can be to use, Minerva was worried to discover that the ability to learn inhaler technique is related to cognitive function and dyspraxia. Elderly patients who had problems with inhalers were subsequently found to score poorly on mini-mental tests and dyspraxia tests ( Postgraduate Medical Journal 2002;78:37-39[Abstract/Free Full Text]). Minerva wonders if poor inhaler technique could be considered another screening test for early cognitive impairment.

Seeing blood in the toilet bowl is always shocking, but are we any good at assessing how much is actually there? Thirty subjects took part in this volume assessment exercise and showed that most people (including doctors and nurses) overestimate the amount of blood seen in the pan. More worrying—from a clinical point of view—is that larger volumes tended to be considerably underestimated ( ANZ Journal of Surgery 2001;71:650-651[CrossRef][Web of Science][Medline]).

Receiving a false positive result in screening programs has undesirable results. One month before the next screening round was due, women who had been given the "all clear" (after having had abnormal results on mammography and being referred for more tests three years earlier) remained significantly more anxious than those who had previously had a normal result. This was sufficient to deter 15% of them from attending at all next time around ( Journal of Public Health Medicine 2001;23:292-300[Abstract/Free Full Text]).

Minerva enjoys a good foot massage, but results from a small, single blind trial of reflexology for irritable bowel syndrome do little to dispel her skepticism about the therapy. Reflexology made no difference—statistically or clinically—to the experience of pain, altered bowel habit, or abdominal distension ( British Journal of General Practice 2002;52:19-23). As this trial was designed in consultation with reflexology practitioners, their claims of success in cases where orthodox medicine has failed may have to be reassessed.

In the United States over 88 Internet cigarette vending sites have been identified; almost half of them are based in New York. Over 80% of them mention the legal minimum age for buying cigarettes, but only 28% feature any government health warnings ( Tobacco Control 2001;10:352-359[Abstract/Free Full Text]. Whether vending practice bears any relation to legal obligations is unclear, but a study of Californian teenagers (p 360-363) found that among established smokers only a surprising 2.2% reported trying to buy cigarettes on the Internet, so perhaps such concerns are overstated.

View larger version (160K): [in this window] [in a new window]   The most common foot problems in people with diabetes are foot ulcers (with or without infection) and gangrene (sometimes leading to amputation). Neuropathy predisposes to ulcers by reducing the perception of pain and discomfort caused by foreign bodies in the shoe, ill fitting footwear, and walking. A 43 year old man with type 2 diabetes who presented with pain, redness and swelling of his right foot. On examination we found a neuropathic ulcer on the first metatarsal head, with surrounding cellulitis. Examination of his footwear revealed a drawing pin at the same site as his ulcer. These pictures re-emphasize the importance of looking at the shoes of people with diabetes who have, or are at risk of, foot ulcers. Desikan Kamalakannan, visiting fellow, Varadarajan Baskar, clinical lecturer, John Usher, senior house officer, Baldev M Singh, consultant, Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton WV10 0QP, UK

A Scandinavian study shows how conservative treatment dramatically reduced the need for surgery to arthritic thumbs. Thirty three patients on the surgical waiting list were randomized to receive either technical accessories or accessories plus splints, alongside extensive support on how to deal with the activities of daily living. After just seven months, 70% no longer required surgery, and over the next seven years, only two of the remaining 19 patients still wanted an operation ( Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 2001;35:415-417[CrossRef][Web of Science][Medline]).

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