Minerva Minerva


BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7208.526 (Published 21 August 1999) Cite this as: BMJ 1999;319:526

Good clinical reasoning does not come naturally, and although it can be taught, it rarely is (Medical Education 1999;33:480-3). Fourth year students given a two hour session on the biases that can derail the diagnostic process—such as overestimating the likelihood of dramatic or exotic diseases—improved their reasoning skills to the level expected of experienced housemen. How long the effect lasts, however, remains to be seen.

The American College of Pathologists wants every sexually active American woman to have a cervical smear every year—and to make sure they do, the college is offering to send them an email reminder. It has set up a website (www.papsmear.org) urging responsible Americans to sign up for “an email that could save your life.” One obvious flaw in the strategy is that the kind of women who are likely to access this site are probably those least in need of a spam reminder to go for a smear test.

Young health services researchers who need a break could apply for a new fellowship launched by the UK's Nuffield Trust. The successful applicant will be given £8000 to enter a different realm for a month—the theatre or civil aviation, for example—and to draft a lecture on what different organisations can learn from each other. The best bit is that the placement can be anywhere in the world. For more information contact James Durance (jdurance{at}cbarker.co.uk or Kate Hodge (khodge{at}cbarker.co.uk).

A newspaper cutting landed on Minerva's desk last week reporting soaring rates of plastic surgery among American teenagers (Detroit Free Press 1999 August 7:1A, 8A). Most are having nose jobs or corrective surgery for bat ears, but teenagers as young as 14 are demanding liposuction and breast implants in increasing numbers. Last year more than 24 000 US teenagers had plastic surgery, an increase of 85% since 1992. To add to the lunacy, parents are even offering to pay for new breasts as a graduation present.

Canadians who came originally from Europe or South Asia have substantially higher rates of ischaemic heart disease than Canadians with Chinese ancestry (Canadian Medical Association Journal 1999;161:132-8). Europeans also have the highest rate of death from cancer of these ethnic groups, the three largest in Canada. Are these comparisons useful, asks one commentator, who concludes that researchers should move on from observing crude ethnic groupings and look more carefully into the factors that make anyone more or less susceptible to disease.

Misoprostol has yet to prove itself in the third stage of labour, but a small randomised trial against placebo suggests it can reduce postpartum blood loss when given by mouth just after cord clamping (Obstetrics and Gynaecology 1999;94:255-8). If bigger trials confirm these findings, misoprostol could be a valuable drug in poor rural areas where intramuscular injection of oxytocic drugs is impractical: it's cheap, and it can be given rectally as well as orally.

People who stalk other people are usually lonely, distressed, socially incompetent, and need treatment as well as the force of law to make them stop, says a group of Australian psychiatrists (American Journal of Psychiatry 1999;156:1244-9). A descriptive study of 145 stalkers referred for treatment in Victoria found that about a quarter stalked their doctors—usually a psychiatrist. The rest stalked ex-partners, work colleagues, or casual acquaintances. More important data on how they were managed and whether or not it worked are to follow


A 67 year old man with an exacerbation of chronic obstructive airways disease developed a dilated unreactive right pupil within half an hour of intubation and ventilation. Urgent computed tomography of his brain showed nothing acute, and the pupil returned to normal over the next few hours. He had been given nebulised ipratropium bromide while lying on his right side, just before intubation. This antimuscarinic agent must have tracked up the face mask into his right eye and dilated the pupil

P N Board, specialist registrar, S Chay, staff grade, P G Lawler, consultant, department of intensive care services, South Cleveland Hospital, Middlesbrough TS4 3BW

Submissions for this page should include signed consent to publication from the patient.

Plasmodium falciparum, the organism responsible for the most dangerous form of malaria, has 14 chromosomes. Scientists have already sequenced chromosome 2 and a team from Oxford unveiled chromosome 3 in last week's Nature (1999;400:532-8) Painstaking sequencing work should yield new drugs and vaccines, they say, but with 12 more chromosomes to go it's unclear how long we will have to wait.

In the meantime, malaria has emerged as the second biggest killer of pregnant women in Zambia, where rates of maternal death are now eight times higher than they were 20 years ago (International Journal of Tuberculosis and Lung Disease 1999;3:675-80). Tuberculosis associated with AIDS has also contributed substantially to the worsening death toll, which now stands at 921 deaths per 100 000 live births; the worst rate in Africa

The antismoking lobby has a new and powerful weapon in the fight to ban smoking in public places: reliable data linking environmental tobacco smoke with stroke (Tobacco Control 1999;8:156-60). In this big case-control study from New Zealand, working or living with smokers nearly doubled non-smokers' risk of having a stroke. The effect was most marked in men.

Plasmodium vivax kills fewer pregnant women than Plasmodium falciparum but can still cause anaemia and low birth weight in vulnerable populations (Lancet 1999;354:546-9). A cohort study of nearly 10 000 women living in open camps on the north- western border of Thailand found that women having their first baby were the worst affected; they were more likely than multigravidas to have P vivax malaria, and their anaemia was more severe.

To curb doctors' instinct for exotic complication and flannel in their writing, informatics experts have developed a limited vocabulary for drafting clear and concise problem lists (Annals of Internal Medicine 1999;131:117-26). Ironically, the paper is so peppered with informatics jargon that Minerva was unable to tell how they did it, or whether anyone found it useful.

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