BMJ  2006;333:310 (5 August), doi:10.1136/bmj.333.7562.310

Minerva

Minerva

Christmas is coming and the goose is getting fat. Even though there are still five months to go, we like to have lots of time to prepare here at the BMJ. So we would be grateful if you would submit any papers and articles destined for the Christmas issue of the BMJ to http://submit.bmj.com by no later than the end of September.

An NHS psychiatrist hoping to make some extra cash to pay for a masters degree course has opted to try his hand on eBay, the online auction site. For a starting price of just £25, eBay customers can bid to email him five questions on their chosen mental health topic. He also has other things for sale, and has sold about 400 items. No one has yet taken him up on his clinical skills (Guardian 19 July 2006).

A randomised controlled trial recently showed that male circumcision could reduce the sexual transmission of HIV from women to men by around 60%. Researchers have now used mathematical models to estimate the potential impact on health of circumcising all men in sub-Saharan Africa. The models predict that male circumcision could prevent two million new cases of HIV infection over the next decade and reduce deaths by 300 000. If extended for another 10 years, 3.7 million additional infections and 2.7 million deaths could be prevented. They argue that male circumcision is equivalent to an intervention that reduces transmission in both directions (between men and women) by 37% (PLoS Medicine 2006;3: e262).

Multitasking may be the only way to cope with the demands of the modern world, but a new functional magnetic resonance imaging study (Proceedings of the National Academy of Sciences U S A 2006;103: 11778-83[Abstract/Free Full Text]) shows that learning while performing a demanding secondary task can decrease the acquisition of knowledge and the capacity to recall memories flexibly. When multitasking, our brain uses an automatic habit-learning process involving the striatum that doesn't need effortful attention and activation of the medial temporal lobe, which is involved in declarative learning, decreases.

In young babies, suprapubic aspiration to obtain a urine sample causes more pain than urethral catheterisation (Pediatrics 2006;118: e51-6[Abstract/Free Full Text]). Fifty one babies under the age of 2 months completed the study, which showed that fewer samples were obtained with suprapubic aspiration. Aspiration also caused more pain as assessed by visual analogue pain scores and a video taken of the upper half of the babies (to blind the assessor to what procedure the baby had undergone).

Volunteers for HIV vaccine research may be at greater risk of HIV infection than the general population. Specifically, they are more likely not to use condoms and to have had a sexually transmitted disease. Phase III vaccine trials seek participants who are at high risk of HIV. However, phase I vaccine trials need healthy people who are at low risk, so the risk profile of participants should be taken into account when recruiting for such trials. Tighter inclusion criteria might be needed to avoid risk of infection (AIDS Care 2006;18: 569-73[CrossRef][Medline]).

Guidelines from the UK's Driver and Vehicle Licensing Agency came under scrutiny by several psychiatrists who specialise in old age. Although more than half (32 of 57) of the psychiatrists were satisfied with the eventual decision about whether people with dementia should be allowed to drive, they were critical of two of the existing factors taken into account in the assessment of driving ability. These were the mini mental state examination and the patients' own reports of their driving ability (Psychiatric Bulletin 2006;30: 265-8[Abstract/Free Full Text]).

Giving vitamin A supplements to mothers and babies in Zimbabwe to prevent anaemia proved fruitless even though vitamin A deficiency is a recognised cause of neonatal anaemia. A randomised controlled study of 1592 babies observed from 8 to 14 months of age showed that although HIV infection and low concentrations of iron at birth independently increased the risk of anaemia, vitamin A supplements made no difference to the haemoglobin count or anaemia (American Journal of Clinical Nutrition 2006; 84: 212-22[Abstract/Free Full Text]).

A recent study in Neurology (2006;67: 33-8[Abstract/Free Full Text]), comparing patients with Parkinson's disease with control patients with idiopathic adult onset dystonia, indicates that apathy might be a core feature of Parkinson's disease that occurs even in the absence of depression. Diagnostic criteria for apathy include patients' lack of concern about their problems, lack of interest in new experiences, flattened affect (decreased emotional range), and loss of effortful behaviour. These results show how important it is to separate patients with apathy and depression into separate treatment groups.

Just when there seemed to be hope of a drug treatment for chronic fatigue syndrome, the evidence falls flat. Previous research suggested that natural killer cell activity is reduced in patients with this syndrome. But a randomised, double blind, placebo controlled trial of BioBran MGN-3, a substance that enhances natural killer cell activity, taken for eight weeks, made no significant difference. Interestingly though, the fatigue measures of all 64 patients (whether taking placebo or BioBran MGN-3) improved over time (Quarterly Journal of Medicine 2006;99: 461-8[Abstract/Free Full Text]).

A 4 week old baby was referred to the general paediatric outpatients department. The problem was described as nappy rash, present for three weeks, which was not responding to treatment. The patient had already been seen by three doctors and had been prescribed seven different topical treatments (including some steroid based creams), but rather than improving the rash had developed an ulcerated area. Examination of the affected area showed a large capillary haemangioma. We were able to reassure the parents and prescribed a barrier cream for the ulcerated area, with regular follow-up. The parents were very relieved. It is important to note that such lesions can appear after birth. Simon Pirie, specialist registrar, department of paediatrics, Gloucester Royal Hospital, Gloucester GL1 3NN (Pirie_simon{at}hotmail.com)

Minerva was amused by a brave statement made in the Journal of Thoracic and Cardiovascular Surgery (2006;132: 5-7[Free Full Text]) that randomised controlled trials don't reflect reality and that more real world analyses are crucial for developing treatment guidelines. Are the academics finally leaving their ivory towers?

If you want to know what patients think, ask them. A qualitative study of patients' experiences found that even short consultations for psychological issues can be very effective, at least in the short term (British Journal of General Practice 2006;56: 496-503). Don't underestimate the power of providing a safe place where patients feel listened to and understood.

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

Rapid Responses:

Read all Rapid Responses

Intervention may be indicated in ulcerated infantile haemangiomas

Andrew Graeme Affleck
bmj.com, 7 Aug 2006 [Full text]

Perineal haemangiomas may have associated visceral malformations

Julia K Gass, et al.
bmj.com, 15 Aug 2006 [Full text]