BMJ  2005;331:E392 (15 October), doi:10.1136/bmj.331.7521.E392

BMJ USA: Minerva

Minerva

Minerva

A lively debate about whether or not parenthood is a right lights up the latest issue of the Archives of Disease in Childhood ( 2005;90: 782-5)[Abstract/Free Full Text]. One writer wants to see more focus on parental responsibilities than parental rights, less on the right to have a child, and more on the needs and welfare of all children. The other side claims that since the experience of parenthood is central to individual identity in most societies, the United Nations Universal Declaration of Human Rights could be invoked.

People who have received kidneys from living donors are apparently reluctant to accept them before they have had a chance to talk to the donors. Their main concern is to establish for themselves that the donor genuinely wants to give the organ—because of the impact that the donation may have on the donor's health. Donors, on the other hand, make instant voluntary decisions about becoming donors, and don't regret doing so. Further findings of this interview study were to be presented at the annual conference of the British Sociological Association's Medical Sociology Group in September in York.

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.

Whether using statistics to explain or baffle, the statistical adviser for the Swiss Medical Weekly offers the following rules of thumb on their use ( 2005;135: 337-8)[Medline]. First, give all the data if there are few. Second, for a preliminary study based on a convenience sample, summarize data with descriptive statistics. Third, for a random survey or randomized controlled trial, calculate confidence intervals. Fourth, for observational studies, calculate confidence intervals by using multivariate models. Finally, if statistics don't offer added value, he says, simply leave them out.

For most of us, alcohol makes it harder for us to walk in a straight line, but not so in people with essential tremor. Before alcohol, gait analysis showed that in those with essential tremor more missteps were taken than in those without tremor, and ataxia scores were higher. Alcohol intake produced the interesting effect of reducing the number of missteps and improving ataxia scores. One explanation is that alcohol has a reversible effect on receptors involved in the pathology of essential tremor ( Neurology 2005;65: 96-101[Abstract/Free Full Text]).

This 11 year old girl presented to our accident and emergency department having woken in the middle of the night with gross swelling of the lips. Her airway was secure and she was otherwise well. She was immediately treated with chlorphenamine, prednisolone, and adrenaline (epinephrine) without any rapid effect. She was admitted for observation and tested for C1 esterase inhibitor deficiency. This protein deficiency is a rare but important cause of angio-edema and should be considered in any patient presenting like this with no obvious cause of anaphylaxis. Moiz Moghal senior house officer accident and emergency department Barnsley Hospital NHS Foundation Trust Barnsley S75 2EP, UK moizmoghal{at}hotmail.com

If performances are to succeed, be they from actors or doctors, they must appear truthful. The skill of a good performer blinds the audience to the artifice that is employed. Bedside manner, for example, is often switched on with a show of interest that lives only in the lips and cheeks while the eyes remain dead. These sorts of antics rarely fool patients. Writing in the Journal of the Royal Society of Medicine ( 2005;98: 323-4)[Free Full Text] a doctor who has long worked with non-medical performers says that the more a medical performance is based on understanding, the more likely it is to be therapeutic.

Some of us were brought up to believe that Heberden's and Bouchard's nodes (firm swellings at the distal and proximal interphalangeal finger joints, respectively) found in isolation are not particularly indicative of anything pathological. But an x ray study in the Annals of the Rheumatic Diseases ( 2005;64: 1214-6)[Abstract/Free Full Text] refutes this. The authors report a positive relation between both types of nodes and underlying radiographic changes of osteoarthritis, especially the formation of osteophytes.

Medical concerns over ear cleaning cotton swabs 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 swabs. 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 swabs cause infections, perforations, or wax impaction ( Journal of the Royal Society of Medicine 2005;98: 360-1[Abstract/Free Full Text]).

You don't have to have brittle bones to sustain rib fractures with a chronic cough, but it helps. A single center review of cough induced rib fractures over nine years found that 78% were in women; most fractures were found in the sixth rib and at the lateral aspect of the rib cage. Bone densitometry was performed in half the patients, and 65% of these had osteopenia or osteoporosis ( Mayo Clinic Proceedings 2005;80: 879-82[Abstract/Free Full Text]).

A randomized 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).

Nasal surgery may help severe migraine: a report of 21 people who had surgery to stop the opposite surfaces of their nasal cavities or sinuses pressing against each other suggests this endoscopic procedure may be an option in those patients whose migraine fails to respond to drug treatment. The procedure more than halved the number of days with migraine and reduced severity of symptoms ( Cephalalgia 2005;6: 439-43[CrossRef]).

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