BMJ  2004;328:370 (14 February), doi:10.1136/bmj.328.7436.370

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Over the counter emergency contraception reduces A&E workload

The number of patients requesting emergency contraception at the accident and emergency departments of two south London hospitals fell by more than half after a change in legislation permitted women aged over 16 to obtain progestogen-only contraception over the counter at pharmacies. The authors express concern over the high cost (£20 (28, $34)), limited opening hours of pharmacies, and patients' unawareness of the change in availability.

Emerg Med J 2004;21: 67-8[Abstract/Free Full Text]

Melanoma rates are higher in some jobs

Exposing your skin to the sun is not the only risk factor for developing melanoma, according to a nationwide survey of Swedish men followed for 18 years. The risk was greater in those so exposed (in Sweden largely confined to harbour masters and lighthouse keepers), but others with a higher than expected incidence included dentists, physiotherapists, and lithographers. Those in the latter group are exposed occupationally to artificial ultraviolet light, but their melanoma sites are not confined to exposed areas of skin, suggesting a generalised effect. A surprising finding was the increased relative risk in electrical fitters and telephone installers. Speculations on causes include exposure to polychlorinated biphenyls or even electromagnetic fields. Men employed in the fur industry also proved to be at risk, possibly related to use of dyes or chemicals such as trichloroethylene.

Occup Environ Med 2004;61: 117-26[Abstract/Free Full Text]

Analgesics are safe in presumed appendicitis

Pretreatment with analgesics does not cause delay in diagnosing appendicitis, nor does it lead to a greater risk of perforation. Textbooks have traditionally taught the opposite, but surgeons in Taiwan found no adverse effect when comparing, retrospectively, 115 adults with appendicitis who had been pretreated with 164 who had not. The authors did not take false positive operations into account.

Emerg Med J 2004;21: 41-3[Abstract/Free Full Text]

Treating pretibial haematomas in elderly people A safe and simple technique has been used in an emergency department to treat leg haematomas in elderly people (top). Under local anaesthesia a Yankauer suction catheter is inserted into the haematoma, the clot agitated and evacuated (middle), and the cavity irrigated. A compression dressing is applied (bottom). The authors claim the technique avoids overlying skin necrosis and infection and allows immediate mobilisation and discharge. Emerg Med J 2004;21: 69-70[Abstract/Free Full Text]

Ropinirole may help restless legs

A multicentre randomised controlled trial of ropinirole prescribed over a 12 week period suggests it has a role in improving the symptoms of restless legs syndrome. The dopamine agonist was given in the evening at a gradually increasing dose up to 4 mg. Although nearly 75% of patients reported improvement, there was also a high placebo effect. Sixteen of 146 patients who received the active preparation withdrew because of adverse events—most commonly mild to moderate nausea and headache. The authors call for follow up studies to confirm efficacy and lack of augmentation.

J Neurol Neurosurg Psychiatry 2004;75: 92-7[Abstract/Free Full Text]

Mobile speed cameras reduce injuries within 500 metres. A study in south Wales looked at injury rates before and after mobile speed cameras were used. During 17 months' follow up, crashes causing injury declined by 73% within 100 m of the camera, 24% between 100 m and 300 m, and the effect was still significant up to 500 m. It may be that the tailing-off effect is because many drivers slow only on encountering camera warning signs. As 2.9% of crashes in south Wales occurred within 500 m of a camera, the overall effect across the area was a 1.5% overall reduction. Credit: T WILLIAMS/REX Inj Prev 2003;9: 302-6[Abstract/Free Full Text]

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Assessing skin viabilty in pretibial haematoma

Beryl A De Souza, et al.
bmj.com, 16 Apr 2004 [Full text]