BMJ  2004;328:718 (20 March), doi:10.1136/bmj.328.7441.718

Minerva

If you're rushed into hospital, or even stumble into it, chances are you'll have your blood pressure measured. A prospective study of 171 patients in one emergency department having their blood pressure checked with manual and automated devices found that the automated device received a British Hypertension Society rating of "D" and failed to meet the criteria set by the Association for the Advancement of Medical Instrumentation. The readings diverged considerably from a reference standard, and repeated measurements showed appreciable decreases in the measured blood pressures ( Academic Emergency Medicine 2004:11: 237-43[Medline]).

American paediatricians and family doctors are being encouraged not to prescribe antibiotics for children with ear infections, and to recommend painkillers only. The aim is to stop the rise in antibiotic resistant bugs caused by overuse of antibiotics. A spokesman for the Center for Communicable Diseases said, "Some kids may have a little bit longer course of their infection, but for society as a whole, we will be better served if we don't give them" ( Albany Times Union, 2 March 2004).

If we all walked briskly for 15 minutes each day, would we really keep the obesity epidemic at bay? Simulation of the efficacy of a population-wide campaign shows that 50% of eligible adults would have to perform athletic walking for almost 30 minutes to meet the goal of expending an extra 420 kJ a day across the population. This isn't realistic, say the authors ( American Journal of Public Health 2004;94: 437-40[Abstract/Free Full Text]).

Diclofenac residues have virtually annihilated the Oriental white-backed vulture in Pakistan. Five years ago, it was one of the most common raptors on the Indian subcontinent, but between 2000 and 2003 the population declined by at least a third, and up to 95% at some sites. Its decline is associated with renal failure and visceral gout. The phenomenon is not as bizarre as it sounds: in the past decade, diclofenac has been widely used in Asian livestock ( Nature 2004;427: 630-3[CrossRef][Medline]).

The 2003 outbreak of SARS had important psychosocial effects on Toronto hospital staff. Two thirds of the respondents to a survey reported SARS related concern for their own or their family's health and 29% indicated probable emotional distress; 45% of these were nurses. Regression analysis identified living with children, perception of a greater risk of death from SARS, lifestyle being affected by the outbreak, and being treated differently because of working in the hospital as the main factors linked with being more concerned about health ( Canadian Medical Association Journal 2004;170: 793-8[Abstract/Free Full Text]).

The role of fathers in their children's wellbeing has probably changed over time. Several factors have been identified by a US study about what makes fathers get more involved in their children's health care. Not surprisingly, these included attendance at their child's delivery, children being young, fathers being older, and the child having health insurance ( Pediatrics 2004;113: 574-80[Abstract/Free Full Text]). Supporting the idea of universal health coverage for children might therefore go some way to get younger fathers and older children interested in preventive health care.

Memory clinics already flourish in departments of old age psychiatry—so why not in old age services generally? A more pertinent question, addressed in a naturalistic comparison in Psychiatric Bulletin ( 2004;28: 78-82)[Abstract/Free Full Text], is whether clinics offer any advantages over the traditional domiciliary visits. The authors conclude that memory clinics may be less suitable for patients with prominent psychiatric complications. Furthermore, the resourcing downside of combining the memory clinic approach with the domiciliary model is that it's likely to increase the clinical case load.

Hot on the heels of a certain infamous medical prisoner committing suicide, a national clinical survey of suicide in UK prisoners found that, of the 172 suicides recorded over a two year period, 49% were of prisoners on remand, and 32% of deaths occurred within seven days of the prisoner entering prison. Nearly three quarters had a mental health history, the commonest primary diagnosis being drug dependency ( British Journal of Psychiatry 2004;184: 263-7[Abstract/Free Full Text]). As hanging is the method most often used, prevention should concentrate on removing potential ligature points from cells.

Minerva struggled to perform the Lachman test at medical school, blaming her difficulties on her small hands. The test is the most reliable way of clinically diagnosing a ruptured anterior cruciate ligament and involves manual anterior tibial displacement at 20 degrees of flexion. Magnetic resonance imaging of 10 patients with an isolated rupture of the ligament confirmed the hypothesis that this injury leads to increased anterior tibial translation (the lateral side of the knee contributing more than the medial side) and tibial internal rotation ( American Journal of Sports Medicine 2004;32: 369-75[Abstract/Free Full Text]).

A 72 year old woman was admitted with fever, rigors, and generalised weakness. Blood cultures confirmed Gram negative septicaemia. The focus seemed to be the chest. She settled with intravenous antibiotics and was discharged. A week later she was readmitted with similar symptoms and discharge from the right ear. A leucocyte scan showed abnormal localisation of white cells around the right mastoid process, and computed tomography confirmed extensive cholesteatoma with lateral sinus thrombosis. She underwent modified radical mastoidectomy and made an excellent recovery. When a patient has sepsis, it is important to exclude a history of otorrhoea. Aloke Sen, senior house officer, R Bhatnagar, consultant, department of otolaryngology, Fairfield General Hospital, Bury, Lancashire BL9 7TD

Almost half the dramatic decline in deaths from coronary heart disease in England and Wales since the 1970s can be attributed to people stopping smoking, according to a paper in Circulation ( 2004;109: 1101-7)[Abstract/Free Full Text], and about 40% is attributable to medical treatment. Active promotion of primary prevention, in addition to maximising the population's coverage of effective treatments, is a strategy that might be effective in other industrialised countries.

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Masked mastoiditis

Dipan N Mistry, et al.
bmj.com, 28 Mar 2004 [Full text]