BMJ  2005;331:412 (13 August), doi:10.1136/bmj.331.7513.412

Minerva

A randomised study of heparin with continuous passive motion administered by an Arthroflow device in trauma patients, compared with heparin alone, found the incidence of deep vein thrombosis was 25% in the heparin only group and 3.6% in patients who also had their feet passively extended and plantarflexed. No complications or compliance issues arose with the device ( Journal of Bone and Joint Surgery (Br) 2005;87-B: 1117-22).

Medical concerns over ear cleaning cotton buds were first reported in 1972. Of 1000 patients attending one ear, nose and throat clinic, 325 responded to a survey about their use of cotton buds. Fifty three per cent said they used them, but the frequency was the same in people who were attending the clinic with ear complaints as in those with nose and other problems. Twenty per cent of the respondents said they didn't believe that cotton buds cause infections, perforations, or wax impaction ( Journal of the Royal Society of Medicine 2005;98: 360-1[Abstract/Free Full Text]).

A descriptive study of behavioural problems in older patients on acute care wards notes that most incidents that were documented in the neuropsychiatric inventory used in the study did not get into the patients' general charts. Chronic under-reporting may give a completely distorted view of the level of stress experienced by both patients and the staff looking after them ( Gerontologist 2005;45: 535-8[Abstract/Free Full Text]).

Pigmented gums are a well established sign of active smoking, but what do they represent in children? A case-control study using oral photographs from 59 non-smoking children found excessive gingival pigmentation in up to 78%. Seventy one per cent of these children had at least one parent who smoked, whereas only 35% of those without pigmentation had a parent who smoked. The authors propose that visible pigmentation in children could serve as a useful tool for educating parents ( Pediatrics 2005;116: e186-90[Abstract/Free Full Text]).

Advertising directly to consumers is loved by drug companies, feared by doctors, and banned by a lot of countries. But what's all the fuss about? A comprehensive systematic review published in Quality and Safety in Health Care ( 2005;14: 246-50)[Abstract/Free Full Text] says just four studies out of 2853 were robust enough to be included. The review concludes that consumer advertising is associated with increased prescribing of advertised products and has a big impact on patients requesting specific drugs and doctors' confidence in prescribing. Direct advertising resulted in no additional health benefits.

Japanese anaesthetists investigating the common phenomenon of patients yawning as they go under general anaesthetic say it may be a clinical indicator of a transient arousal shift during progressive loss of consciousness. Using electroencephalographic bispectral index (EBI) monitoring, and using a transient increase during a continuing decrease in the EBI as the criterion for an arousal response, the sensitivity and specificity of yawning as a sign of arousal were 77% and 80%, respectively. The positive predictive value of a yawn indicating arousal was 84% ( Anesthesia and Analgesia 2005;100: 382-4[Abstract/Free Full Text]).

About 300 people who try to commit suicide by self poisoning (about 6% of all suicides) might expect to reach hospital alive each year in England. A multicentre study in Quarterly Journal of Medicine ( 2005;98: 589-97)[Abstract/Free Full Text] concludes that, although suicide rates can be reduced slightly through improved medical management, interventions shouldn't be restricted to emergency care. The time taken to present for help has the biggest impact on outcome, but it's difficult to know what intervention might encourage people determined to kill themselves to seek medical help more rapidly.

One third of patients with a first ever stroke reported a change in taste, according to a prospective study in Stroke ( 2005:36: 1690-4)[Abstract/Free Full Text]. Of the 102 conscious and medically stable patients who participated in the study, 30% had loss of taste, and 6% had impaired taste on one side. Specific risk factors included being male and also having a problem with swallowing. Taste disorders can in the long term result in abnormal weight loss as well as obesity, but generally taste disorders after stroke have a good prognosis.

Given half a chance, would you want to see your own pathological specimens, removed during surgery? Minerva confesses that she did when she had a myomectomy. When 47 patients were invited to the pathology department to view their own specimens, 33 said they wanted to, but only 14 made the visit. All 14 said it helped them understand the need for surgery better, and the issues around tissue retention. They also said they were more likely to consent to the use of excess tissue for research ( Journal of Clinical Pathology 2005;58: 891-3[Abstract/Free Full Text]).

Premenopausal and postmenopausal women enjoy cardioprotective effects with grape polyphenols. Concentrations of both low density lipoprotein cholesterol and triglycerides dropped significantly after taking grape supplements compared with placebo. Other beneficial effects were a reduction in whole body oxidative stress (as measured by urinary isoprostanes) and levels of plasma tumour necrosis factor, implicated in inflammatory processes ( Journal of Nutrition 2005;135: 1911-7[Abstract/Free Full Text]).

A 30 year old alcoholic man presented to accident and emergency with a two day history of severe abdominal pain radiating to his back. Acute pancreatitis was confirmed, with a serum amylase concentration of 838 IU/l (normal range 28-100 IU/l) and by abdominal ultrasound. Four days after admission he complained of flashing lights in both eyes. When he woke the next day he could see only hand movements with his left eye. Fundoscopy showed a left macular infarction with a cherry red spot. Cotton wool spots encircled both optic discs. These features are typical of Purtscher's retinopathy. The patient's eyesight never improved beyond counting fingers. Purtscher's is a rare, microvascular, embolic retinopathy. The emboli are thought to be leucocyte fibrin platelet aggregates formed in response to enzymatic activation of the complement cascade. Purtscher's can also occur after major head injury or chest trauma. Steven Harsum (harsum{at}doctors.org.uk), senior house officer, Leonard Yuen, senior house officer, Kunal Dansingani, senior house officer, Clare Davey, consultant, Department of Ophthalmology, Royal Free Hospital, London NW3 2QG

 

The emergence of cancer as a public health problem in the 20th century has its roots in a whole host of sexual, political, social, and medical issues. A late 19th century writer, for example, argued that rising cancer deaths among men could be blamed on a "want of proper exercise, and excess of food" emasculating men and leaving them subject to "women's diseases." The notion that cancer is a women's disease was based on the high prevalence of breast and uterine cancers and reinforced by the belief that disease of the reproductive organs defined "women's nature" ( American Journal of Public Health 2005;95: 1312-21[Abstract/Free Full Text]).

---

Guidance at bmj.com/advice

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

Related Article

US flu mortality estimates are based on solid science

Lone Simonsen, Robert Taylor, Cecile Viboud, Jonathan Dushoff, and Mark Miller
BMJ 2006 332: 177-178. [Extract] [Full Text]