BMJ 2006;333:762 (7 October), doi:10.1136/bmj.333.7571.762
Minerva
Minerva
Gently massaging a preterm baby's leg for two minutes before a heel stick to obtain blood samples is safe and helps reduce the pain response. Pain was assessed by the neonatal infant pain scale, heart rate, respiratory rate, and oxygen saturation and serum cortisol concentrations measured from the blood samples. Both the pain score and the heart rate after heel stick were higher among babies who were not massaged. The other outcome measures were unaffected (Journal of Paediatrics and Child Health 2006;42: 505-8[CrossRef][ISI][Medline]).
Minerva is looking forward to the Harveian oration by Sir Michael Marmot on "Health in an Unequal World." The gilt edged reminder bears eloquent testimony to current inequalities, stipulating a dress code of black tie and decorations with "carriages" at 10.45 pm.
Doctors' surgeries can participate in a scheme that recycles empty printer cartridges, each one generating £1 for the World Cancer Research Fund. At present only 10% of the 65 million cartridges bought in the United Kingdom each year are recycled, leaving the others gathering dust or filling up landfill sites, where they take up to 1000 years to decompose. Freepost cartridge recycling envelopes can be distributed in surgeries for use by patients too. To receive a supply of envelopes email wcrf{at}inkagain.co.uk.
Information about the type, density, and location of immune cells in human colorectal tumours may be more useful than an analysis of tumour type and spread when it comes to accurately predicting the clinical course of the disease (Science 2006;313: 1960-4
Symptomatic Clostridium difficile infection is associated with previous exposure to antibiotics, but it could also be linked to the use of proton pump inhibitors. Researchers compared 317 cases of disease associated with C difficile, identified by prescriptions issued in the community for oral vancomycin to treat the disease, with 3167 matched control cases. People who had taken a proton pump inhibitor in the 90 days before vancomycin was prescribed had an increased risk of C difficile disease (odds ratio 3.5), and 45% of all patients with C difficile had not received a prescription for an antibiotic in the previous 90 days (CMAJ 2006;175: 745-8
Is someone who first presents with multiple discrete seizures within 24 hours, rather than a single seizure, more likely to have a recurrence? The answer is apparently not. Multiple seizures within 24 hours should be regarded as a single event and managed in the same way as single seizures (Neurology 2006;67: 1047-9
A randomised single blind study comparing gargling with mineral water, dispersible aspirin, and benzydamine hydrochloride (a topical non-steroidal anti-inflammatory drug) five minutes before induction of anaesthesia found that benzydamine was best at reducing the incidence of postoperative sore throat. Benzydamine reduced the incidence for 24 hours whereas aspirin reduced it for four hours. Both drugs also reduced the intensity of the pain (Anesthesia and Analgesia 2006;103: 1001-3
Lutein and zeaxanthin accumulate in the macular pigment of the retina and may reduce the risk of developing age related macular degeneration. A rich source of both these oxygenated carotenoids is the yolk of chicken eggs. A study looking at the effect of eating an egg a day in people over the age of 60 found that after five weeks, serum concentrations of lutein and zeaxanthin had significantly risen but serum concentrations of total cholesterol, low and high density lipoproteins, and triglycerides were reassuringly unaffected (Journal of Nutrition 2006; 136: 2519-24
A Japanese study of self measured blood pressure, with an average follow-up of 11 years, shows that both morning and evening readings of blood pressure are useful in assessing the risk of stroke. Hypertension observed in the morning, however, is a particularly good predictor of stroke, especially among people taking antihypertensive drugs (Hypertension 2006;48: 737-43
On a similar theme, an Israeli team studied the effects of giving nocturnal melatonin to patients taking stable doses of antihypertensive drugs. The team found that, compared with placebo, melatonin significantly improved systolic blood pressure at night. The rationale for trying melatonin came from the observation that hypertensive patients whose blood pressure does not dip at night, and who are therefore at a greater risk of cardiovascular events, show a "blunted nocturnal surge" in excretion of melatonin (American Journal of Medicine 2006;119: 898-902[CrossRef][Medline]).
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Dancing is not only fun but is associated with better balance in later life. A group of 24 cognitively normal older social dancers were put through their paces and compared with 84 matched non-dancers. The groups had no differences when it came to participation in other cognitive and physical leisure activities, nor were there any differences in the number of falls or chronic illnesses. The dancers did, however, show better balance and more stable walking patterns (Journal of the American Geriatrics Society 2006;54: 1241-4[CrossRef][ISI][Medline]).
Practice makes perfect. A US study of endoscopic retrograde cholangiopancreatography reports that if you have the procedure done in a hospital that does more than 200 a year, you will have a shorter stay and a lower likelihood of procedural failure than if you have it done in a hospital that does fewer than 100 procedures a year (Gastrointestinal Endoscopy 2006;64: 338-47[ISI][Medline]).
Guidance at bmj.com/advice
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