BMJ  2003;327:E243 (4 October), doi:10.1136/bmjusa.03070006 (published 30 July 2003)

BMJ USA: Minerva

Minerva

From BMJ USA 2003;July:398

There's now quite a lot of evidence that eating fish and omega 3 fatty acids protects people from coronary heart disease. But most studies have looked at general populations, rather than high risk populations. The nurses' health study—involving more than 120 000 women—produced a cohort of over 5000 with type 2 diabetes. In these women, a higher consumption of fish was also associated with a lower incidence of heart disease and total mortality ( Circulation 2003 ;107:1852-1857[Abstract/Free Full Text]).

"Elderspeak"'—the patronizing communication style often heard in nursing homes—may unknowingly reinforce dependency, isolation, and depression in elderly people. A study published in the Gerontologist (2003;43:242-247[Abstract/Free Full Text]) found that a brief intervention which teaches staff to minimize their use of elderspeak was successful. Anecdotally, the residents were apparently aware of a change in the way staff spoke to them, but time will tell if the hoped for benefits of such a change will occur.

A study of two homes for elderly people in the United States makes depressing reading. Not only was the physical environment not conducive to end of life care (noisy, crowded rooms, offering little privacy) but organizational factors also had their role (inadequate staffing levels and lack of supervision). Over half (54%) of the residents developed pressure sores, and 82% of these died with pressure sores ( Gerontologist 2003;43 [special issue II]:76-84[Abstract/Free Full Text]).

Most of us probably think that drug representatives don't really influence us. An emergency department that regularly hosts events funded by pharmaceutical companies participated in a prospective study of prescribed medicines. Over 14 weeks, 13 drugs were presented at 15 events. Outpatient prescriptions for these drugs rose by 116%, and use by the emergency department increased by 33% ( Academic Emergency Medicine 2003;10:424[CrossRef]). No wonder reps are so keen to pay for lunch.

Are we what we eat? A cross sectional study of almost 20 000 Dutch adults found that distinct patterns of eating are linked with cardiovascular risk factors ( American Journal of Clinical Nutrition 2003;77:1156-1163[Abstract/Free Full Text]). Independent of body mass index and other lifestyle factors, a "cosmopolitan" diet (lots of fried vegetables, salad, rice, chicken, fish, and wine) was significantly associated with lower blood pressure and high concentrations of HDL cholesterol. "Traditional" diets (lots of red meat and potatoes, little fruit, and few low fat dairy products) were linked with higher blood pressure and higher concentrations of cholesterol and glucose.

The level of radiation received by patients undergoing percutaneous cardiac interventions apparently depends on the time of day. Patients on the morning list receive less exposure than those patients "done" at the end of the day because the cardiologist requires fewer cinegraphic runs and frames. The authors of a study of one experienced cardiologist conducted over four months suggest that elective percutaneous angioplasty should be scheduled for the first six hours of the workload. Diagnostic procedures can be safely scheduled later ( British Journal of Radiology 2003;76:189-191[Abstract/Free Full Text]).

Operating on the wrong limb is unforgivable. But when orthopedic surgeons explicitly asked patients to mark their own limbs by writing "no" on the extremity not to be operated on, only 59% complied correctly; 37% made no mark and 4% made a different mark ( Journal of Bone and Joint Surgery 2003;85A:815-819). The authors say this indicates that patients still expect the surgical team to "take care of everything," but patients should be encouraged to take a more active role in their health care.

When spiritual wellbeing and end of life despair were assessed in a large sample of terminally ill cancer patients, the two were found to be inversely related ( Lancet 2003;361:1603-1607[CrossRef][ISI][Medline]). The authors say that spirituality based interventions should be rigorously tested in order to identify which ones best engender a sense of meaning and peace in people close to death.

Cigarette smoke is a short term respiratory irritant that should be avoided altogether by people with asthma. A prospective cohort study of 64 emergency departments identified that 35% of adults presenting with asthma were current smokers. Half of these admitted that smoking makes their asthma worse, but only 4% stated that smoking was responsible for their current exacerbation. As emergency departments see their fair share of people with uncontrolled asthma, this is probably a good place to target smoking cessation efforts ( Chest 2003;123:1472-1479[Abstract/Free Full Text]).

View larger version (108K): [in this window] [in a new window]   A 73 year old woman with speech and learning difficulties presented with healing full thickness burns on the back of her left thigh. Three weeks earlier she had injured her left thigh at an airport just before boarding a transatlantic flight. An ice pack was applied over the injured part during the flight, resulting in a full thickness burn. The frostbite injury was treated conservatively with dressings and eventually healed. Minor musculoskeletal injuries are often treated with elevation and ice packs. This case highlights the consequence of unsupervised application of an ice pack. Viswanathan Narayanan, specialist registrar, Yvonne Wilson, consultant, department of plastic surgery, Selly Oak Hospital, University Hospital Birmingham NHS Trust, Birmingham B29 6JD, UK

Culinary and medicinal herbs provide important sources of dietary antioxidants. But according to a study in the Journal of Nutrition (2003;133:1286[Abstract/Free Full Text]) there's a 1000-fold difference among antioxidant concentrations of various herbs. Of the dried herbs and spices tested, oregano, sage, thyme, lemon balm, clove, allspice, and cinnamon came out on top and may be an even better source of dietary antioxidants than many other foods such as fruit, cereals, and vegetables.

The important economic consequences of irritable bowel syndrome for employers are spelled out in Archives of Internal Medicine (2003;163:929-935[Abstract/Free Full Text]). The average total cost per patient with the syndrome was $4527 in 1998, compared with $3276 for a control employee. Medically related absenteeism from work cost the employer an average of $901 per employee treated for the syndrome compared with $528 for an employee without it.

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