BMJ 2006;332:498 (25 February), doi:10.1136/bmj.332.7539.498
Minerva
Minerva
"Turnaround teams" in financially challenged NHS hospitals have their eye on one thing only, and that's cash. But the advice from experts is that, rather than trying to capture more business (by seeking more referrals), hospitals should cut costs and reduce length of stay, thus increasing throughput (if demand exists). This strategy is sensible because GPs are busy trying to figure ways of making savings themselves, and in their case it's all about cutting referrals and seeking alternative services for their patients (Health Service Journal 2006; Feb 2: 21).
If you're struggling to make a difficult decision, forget about it. That's the advice of scientists who've found that complex decisions are best left to the unconscious. Do the homework, collect all the information you need, then forget about it all for a while (or use your dreams). Letting your unconscious do the work ultimately leads to more satisfying choices being made, because conscious deliberation covers only a subset of the relevant information (Science 2006;311: 1005-7
Anyone interested in taking a short sabbatical during the next 12 months and wanting a bit of an adventure might be interested in the international projects supported by the Scientific Exploration Society (www.sesexplore.org). The themes include health, botany, wildlife, and the environment. Anyone between the ages of 18 and 75 years can apply, but should be fit and self financing.
Fears have been expressed that, in areas of high immunity to malaria, insecticide impregnated bed nets are ineffectual, and that, in areas of high transmission, they can even be harmful by affecting the acquisition of natural immunity. A trial of impregnated bednets in an area of high transmission reports that providing bed net protection to children from birth, rather than from 6 months of age, significantly reduced the incidence of falciparum malaria and the rates of moderate to severe anaemia during the first 12 months of life, but not beyond that age. Earlier provision of bed nets also made no difference to cumulative mortality at 27 months of age (Bulletin of the World Health Organization 2006);84: 120-6).
A retrospective analysis of surgical admissions found a significant association between postoperative complications and patient complaints (Quality & Safety in Health Care 2006;15: 13-6). But in this study just 19% of surgical admission complaints were linked to a complication, while 12.5% were not (P = 0.01). The researchers suggest that patient complaints may serve as a marker for poor clinical outcomes, but, given that just 0.9% of surgical admissions were linked with complaints, other markers are probably more robust.
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Writing about your crisis is therapeutic. With support from Community Action Network, a new internet based project invites people who have had a crisis in their life—ill health, bereavement, difficult personal circumstances, etc—to write their stories and to post them on www.writedown.co.uk for £20. Entries will stay on the website for six months, and there are plans afoot to collate some of them into a book.
Chronic obstructive pulmonary disease limits exercise capacity, so researchers hypothesised that, by exercising with a smaller muscle mass, such patients would be able to perform more high intensity, musclespecific work. The test they used was one-legged cycling. Patients' peak oxygen intake, ventilation, and dyspnoea scores were similar during one-legged and two-legged exercise, but the patients were able to sustain their one-legged pedalling at a constant power for significantly longer than they could with two-legged exercise (Chest 2006;129: 325-32
A Lebanese team have discovered a new treatment for irritable bowel disease. They tested a non-absorbable antibiotic called rifaximin, used to treat diarrhoea, in patients with abdominal bloating and flatulence. The active drug proved more effective than placebo, and symptom improvement correlated with hydrogen breath excretion. Further work will address whether long term or cyclical treatment is best (American Journal of Gastroenterology 2006;101: 326-33[CrossRef][ISI][Medline]).
A teenager with type 1 diabetes reported that her glycaemic control was pretty good, and the average glucose reading on her meter memory fell within the normal range. However, her haemoglobin A1C result, measured at her diabetes clinic visit, was high, indicating poor diabetic control over time. She finally admitted to her confused doctor that she'd been using control solution (used to confirm that the glucose meter and test strips were working) instead of her own blood most of the time (Clinical Diabetes 2006;24: 45-7
In laboratory and animal studies, green tea is a potent neurone protector and rescuer, and a processor of amyloid precursor protein—which suggest that it should protect against cognitive impairment. But to date there's been no human evidence. A cross sectional assessment of a large geriatric community in Japan now confirms that a higher consumption of green tea is associated with a lower prevalence of cognitive impairment (American Journal of Clinical Nutrition 2006;83: 355-61
Guidance at bmj.com/advice
Rapid Responses:
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- Turnaround teams
- Andrew N Bamji
bmj.com, 27 Feb 2006 [Full text]
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