BMJ  2005;330:E343 (19 March), doi:10.1136/bmj.330.7492.E343

BMJ USA: Minerva

Minerva

Shakespeare, the Bible, and Gray's Anatomy are the only three written works needed on a doctor's shelf, according to Amercan novelist and Nobel Prize winner Sinclair Lewis. Gray's Anatomy, first published in 1858, has undergone major surgery in its recently launched 39th edition, and has been fully restructured by body region rather than by organ system. The number of illustrations has risen to nearly 2000. But thanks to the removal of unnecessary "Victorian purple prose," the number of pages has shrunk from 2100 to 1600 (www.graysanatomyonline.com).

Non-steroidal anti-inflammatory drugs are often used to treat muscle injuries, but a study in the American Journal of Sports Medicine ( 2004;32: 1856-9)[Abstract/Free Full Text] indicates that they have similar effects to simple analgesics that don't offer anti-inflammatory properties. Lower cost, lower risk analgesics such as acetaminophen may be just as effective.

A paper with a corny title, "Fifty ways to leave your rubber," explores the many excuses men who have sex with sex workers in Kenya offer to rationalize unsafe sex. Observations made in bars, discos, and guesthouses in Mombasa fell into six categories: condoms are not pleasurable, they're defective, they're harmful, they're unnecessary, they're too hard to use, and external forces prohibit their use. Some of these barriers could be overcome with improved knowledge and the introduction of devices controlled by women. But focusing just on disease control is unlikely to have a positive impact in a world where the first aim is pleasure ( Sexually Transmitted Infections 2004;80: 430-4[Abstract/Free Full Text]).

Children who watch major sporting events on television may be exposed to unsafe and violent behavior when they watch the advertisements. A US study of televised sports and their 1185 commercials, aired before 9 pm, found that 14% of the advertisements showed unsafe behavior and 6% depicted violence. A shocking 49% of each of the 322 commercial breaks that were assessed contained at least one unsafe or violent advertisement. Parents are advised to supervise and switch off ( Pediatrics 2004;114: 694-8[CrossRef]).

Patients at London's Charing Cross Hospital are being treated like goods at a supermarket check out. They're being swiped—or rather, their bar coded wrist bands are. Familiar technology in a new setting is helping nurses deliver the correct drugs to inpatients. The scanner identifies the patient and then opens an individual drawer in a state of the art drugs cart. The bar code is also linked to a computer based prescriptions system and a robotic arm in the pharmacy that automatically stocks a drugs cabinet. Jokes about "sell-by dates" are making the rounds ( AMSPAR Professional 2004;19: 17).

Psychiatry lags far behind all other specialties when it comes to attitudes towards it as a choice of career among medical students. The reasons for not choosing it were numerous: "it's boring," "unscientific," "depressing," "stressful," and "frustrating"—all of which Minerva thinks could describe every single field within medicine on a bad day. A family history (although not a personal history) of mental illness was significantly associated with making a positive choice of psychiatry ( Psychiatric Bulletin 2004;28: 444-6[Abstract/Free Full Text]).

Over 23% of America's physicians received their medical training outside the United States, with most (64%) coming from low or lower middle income countries. This group includes more than 5000 doctors from sub-Saharan Africa, which represents 6% of all doctors practicing in sub-Saharan Africa now. Almost 86% of these Africans practicing medicine in the United States come from Nigeria, South Africa, and Ghana, and the vast majority were trained at 10 medical schools (www.human-resources-health.com/content/2/1/17).

A large Finnish study of work stress and smoking suggests a positive link between the two. A survey of more than 46 000 workers found that those with lower rewards and those who worked very hard for insufficient reward were more likely to be smokers. Those who smoked most intensely had higher job strain and a bigger imbalance between stress and reward. The authors say that the work environment should be taken into account when creating smoking cessation programs ( Journal of Epidemiology and Community Health 2005;59: 63-9[Abstract/Free Full Text]).

A 78 year old woman who had a right total knee arthroplasty in 1995 was referred with a three month history of a sharp sudden lateral right knee pain. She had a palpable lump over the fibular head. An x ray showed an aggressive expanding lesion of the proximal fibula. An ultrasound guided biopsy was performed and the histology showed no neoplastic features, but a granulomatous pseudo-tumor occurring in response to extensive wear particles generated by the total knee arthroplasty. The pathological process involves osteolysis secondary to wear debris, and usually takes place within the effective joint space. There is evidence of lysis in this case at both femoral epicondyles. The joint should be explored, the debris removed, and the polyethylene exchanged. This condition may be confused with primary bone malignancy. Sherif Mouneir Isaac registrar in orthopaedics sherifisaac{at}aol.com A L Ruiz consultant orthopaedic surgeon Stoke Mandeville Hospital Aylesbury HP21 8AL, UK N Athanasou consultant in pathology M Gibbons consultant orthopaedic surgeon P W Cooper medical photographer Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK

A BMJ reader was recently involved in trying to find the cure for a patient with intractable hiccups. His hospital's ear, nose, and throat (ENT) department was sadly lacking in knowledge, but a quick Medline and internet search revealed numerous treatments, including conventional drugs such as chlorpromazine, phenytoin, and atropine, but also granulated sugar, phrenic nerve crush, hypnosis, and folk remedies such as sneezing induced by black pepper and the induction of sudden fright. In the end what worked was vinegar, supplied by the hospital cafeteria. The mechanism remains unclear.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?