MinervaBMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7249.1614 (Published 10 June 2000) Cite this as: BMJ 2000;320:1614
Roman soldiers used urtication, or external stinging, to relieve the pain of arthritis. Since then, many people have tried stinging their aching joints with nettles. The first randomised trial appeared this month in the Journal of the Royal Society of Medicine (2000;93:305-9). In a crossover trial of 27 patients, applying stinging nettle to an arthritic thumb or finger reduced pain scores and disability, although blinding was difficult because white deadnettle, the control treatment, has no sting.
The culture of blame that pervades the NHS is responsible for many of its recent problems. Errors are not reported, nothing is learned, so flawed systems remain flawed. In the United States, NASA has been called in to set up a blame free, anonymous reporting system that mimics its successful Aviation Reporting System for aviation errors (New York Times 31 May). Healthcare workers in 172 hospitals will report any mistakes they make or witness. Experts will then look for repeating patterns in the anonymous data and implement changes to stop the error happening again.
Working in the healthcare industry is one of the riskiest jobs in Canada, according to data released by the Workers' Compensation Board of British Columbia (www.cma.ca/cmaj/cmaj_today/05_30.htm). In 1998, 7% of full time healthcare workers were injured at work. Those working in nursing homes had even higher rates of injury—more than double the average rate for workers in the province. Over half the injuries were caused by “overexertion.”
Many people are not afraid of death; they are afraid of a bad death. A good death means freedom from pain and breathlessness, and clear communication with carers. It also means being able to contribute to the welfare of others, a new theme that emerged from qualitative research reported in Annals of Internal Medicine (2000;132:825-32). People who are dying are not helpless, and like everyone else they do not like to feel useless.
Doctors who feel they are wasting their breath giving lifestyle advice to patients should take heart. Research from the American city of St Louis suggests that face to face advice can prime patients to take notice of health promotion material that would otherwise be ignored or instantly forgotten (Archives of Family Medicine 2000;9:426-33). Reading advice sheets didn't necessarily make the study participants change their behaviour, but it's a start.
Non-invasive ventilation via a mask over the face or nose can help patients with an exacerbation of their chronic obstructive pulmonary disease escape intubation. Trials show that non-invasive ventilation saves lives on the intensive care unit, but can it work out on the wards for people with less severe disease? In the latest randomised trial (Lancet 2000;355:1931-5) non-invasive ventilation reduced death rates by half in a group of ward patients with mild to moderate acidosis, compared with controls who were given controlled oxygen treatment.
There's plenty of evidence linking serious mental illness to violent behaviour. The latest is a Danish cohort study of over 300 000 people (Archives of General Psychiatry 2000;57:494-500). It confirms an association between violent crime and schizophrenia in men and women regardless of their social class, personality, or use of illegal drugs. What does this mean for policymakers? Not much. Most people with schizophrenia are not violent, and most violent people are not mentally ill.
Minerva loves feature length cartoons and is grateful to JAMA (2000;283:2716-20) for printing a comprehensive list of all those released since 1937. She already owns videos of most of them. A content analysis describes all the films as violent to a greater or lesser extent, and parents wanting to limit their children's exposure should stick to Winnie the Pooh and Dumbo, which contain only one minute of violence each. The classic Bug's Life is the second most violent animated film ever released. No doubt grasshoppers account for most of it.
Journals and journalists depend on each other but hate to admit it. Charges of arrogance on the one hand and ignorance on the other litter both the specialist and the mass media. A paper in last week's New England Journal of Medicine, for example, looked closely at newspaper and television coverage of three popular drug treatments (2000;342:1645-50). Inevitably, the researchers found shortcomings in most of it. Non-disclosure of expert commentators' financial ties was one of the main problems.
A leading manufacturer of medical instruments has developed a variable stiffness colonoscope that combines the advantages of a flexible paediatric scope with those of a traditional rigid instrument (Gut 2000;46:801-5). The new instrument performed well in a randomised trial of 100 adults. The operators found it easier to insert than a standard instrument, and the patients found it less painful.
In the United Kingdom, it's a health visitor's job to support new parents, usually by visiting them at home. The value of this service is still uncertain. A systematic review of 34 studies on home visits included only four from Britain (Archives of Diseases in Childhood 2000;82:443-51). The evidence from elsewhere, however, suggests that for vulnerable parents at least, home visiting programmes are worth while.
Here's some timely advice from a Californian dermatologist for anyone planning to swim in jellyfish territory this summer (www.postgradmed.com/issues/2000/04_00/apr00.htm). If you get stung, remove any clinging tentacles with your fingers, or by scraping the skin with a credit card. Forget weird remedies such as hot sand, kerosene, or urine, and don't douse the sting with fresh water—it forces toxins further into the skin. Dilute vinegar is good first aid for box jellyfish and Portuguese man-of-war stings. Ice is best for the rest.
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