BMJ  2006;332:186 (21 January), doi:10.1136/bmj.332.7534.186

Minerva

Minerva

Quite a few randomised controlled trials have shown that parental presence during the induction of anaesthesia doesn't seem to reduce children's anxiety, but in practice many anaesthetists observe otherwise. In trying to predict which child-parent pairs will benefit from a parent being present, an analysis of over 550 children showed that the presence of a calm parent benefits an anxious child, but an overly anxious parent offers no benefit (Anesthesia and Analgesia 2006;102: 81-4[Abstract/Free Full Text]).

In 1984 a Civil Aviation Authority survey of male helicopter passengers flown to off-shore oil rigs found their average weight to be 79.4 kg. A survey in 2005 found their average weight was 87.6 kg, which was enough to require a re-calculation of load factors on flights to ensure safety. The rise in average weight also adds further epidemiological evidence that, as a nation, the British are getting heavier (The Log [British Air Line Pilots Association] 2006;66: 21).

Ice is often used in treating tennis elbow. But a small controlled trial involving 40 patients with unilateral tennis elbow found that ice applied in a bag to the outside of the affected elbow for ten minutes after exercising offered no additional benefit to exercise alone. The level of pain reported at the end of the four week treatment programme and three months later was significantly reduced, and because tennis elbow is not a self-limiting condition, this was put down to the exercise programme (British Journal of Sports Medicine 2006;40: 81-5[Abstract/Free Full Text]).

Applying pressure to acupressure points on the ear can reduce anxiety, and in a randomised double blinded trial comparing pressure applied to true and sham auricular points in elderly people being taken to hospital with isolated broken hips, it's a technique that seemed to make the ride to hospital a better experience. Patients in the true intervention group reported significantly less pain and anxiety, and had a lower heart rate on arrival at hospital than patients in the sham (control) group (Academic Emergency Medicine 2006;13: 19-23[CrossRef][ISI][Medline]).

A research scientist offers some email icons for the medical profession: (:-o) for a bearded doctor with a stethoscope around his neck and (:-_"-:) for mouth to mouth resuscitation. To see an icon of a doctor awe-struck after his article has been accepted by a learned journal (and many others) go to the MJA (2006;184: 48)[Medline].

A placebo controlled trial of testosterone replacement therapy in men with moderately severe heart failure reports that hormone replacement therapy improved exercise capacity and symptoms without significantly changing handgrip strength or muscle bulk. The researchers were interested in the effects of testosterone because androgens are important determinants of anabolic function and physical strength as well as possessing anti-inflammatory and vasodilatory properties, and chronic heart failure is associated with a metabolic shift towards catabolism, vasodilator incapacity, and loss of skeletal muscle bulk (European Heart Journal 2006;27: 57-64[Abstract/Free Full Text]).

A bakery in the United States has been held accountable for causing a gastroenteritis outbreak at 46 weddings that took place over one weekend in 2002. The norovirus outbreak affected up to 2700 people, and up to 39% of the wedding guests surveyed. Two bakery workers had experienced norovirus type illnesses during the week before the wedding weekend, but they had stayed at work to complete the order for the 46 wedding cakes, all of which had required direct hand contact to complete the finishing touches (Epidemiology and Infection 2005;133: 1057-63[CrossRef][Medline]).

A 64 year old man with a 30 year history of ankylosing spondylitis had an x ray examination to assess his increasing thoracic kyphosis. He gave no history of trauma. A thoracic x ray examination showed gas in the T8/T9 disc. Subsequent computerised tomography with reformatting confirmed the presence of gas and showed a potentially unstable transdiscal fracture at the same level. If intradiscal gas is seen in the context of ankylosing spondylitis, a fracture must be excluded. J Lee (jeffrey.lee{at}nnuh.nhs.uk), specialist registrar in rheumatology, T Marshall, consultant radiologist, P Merry, consultant rheumatologist, Norfolk and Norwich University Hospital, Norwich NR4 7UY

Orthopaedic literature is full of data about two limbs or multiple joints from the same person, and if studies aren't appropriately designed to deal with correlations within individuals, this practice could lead to false interpretation and possible bias. A systematic review that attempts to determine how often non-independent limb or joint observations are included in clinical studies concludes that in 2003 a striking 42% of studies published in orthopaedic journals with a high impact factor fell into this trap (Journal of Bone and Joint Surgery (Am) 2006;88: 41-5).

In March 2004, the US Food and Drug Administration issued a warning about worsening depression and suicidal risk in patients treated with 10 of the newer anti-depressant drugs available. Many of the drugs under examination were selective serotonin reuptake inhibitors. But, according to a study in the American Journal of Psychiatry (2006;163: 41-7)[Abstract/Free Full Text], the risk of suicide attempt is highest in the month before treatment is started and declines progressively thereafter, and when the 10 drugs under FDA scrutiny were compared with older drugs, an increase in risk after starting treatment was seen for the older drugs only.

Most patients referred for elective cosmetic surgery on the NHS don't have marked levels of dysfunction. But a survey of consecutive patients referred to one regional plastic surgery and burns unit says that the level of functioning shown by most new patients is related to personal preoccupation rather than objective abnormality. Body dysmorphic disorder accounted for seven per cent of those seeking elective cosmetic surgery, and current thinking indicates that surgery is unhelpful for these patients (Journal of Plastic, Reconstructive and Aesthetic Surgery 2006;59: 54-64[CrossRef]).

For those of us who struggle to get into the routine of regular exercise, there's some good news. A study of young men in the American Journal of Clinical Nutrition (2006;83: 24-9)[Abstract/Free Full Text] reports that accumulating multiple short bouts of exercise throughout the day (ten three minute episodes to be exact) is as effective at reducing postprandial blood fat concentrations as a single 30 minute exercise session.

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