Minerva

Minerva

BMJ 2002; 324 doi: http://dx.doi.org/10.1136/bmj.324.7329.122 (Published 12 January 2002) Cite this as: BMJ 2002;324:122

Patients undergoing surgery for broken hips are at risk of developing thromboses. Using thrombelastography (which records the changes in viscosity and elasticity of a sample of whole blood) surgeons found appreciable hypercoagulability in 250 patients, starting immediately after surgery and persisting at the six week review, even though heparin prophylaxis was used (Injury 2001;32:765-70). Since many patients go home well before six weeks, much longer lasting chemical antiplatelet therapy may be warranted.

Polygraph lie detectors rely on simultaneous blood pressure measurements, rates of breathing, and sweating. High definition thermal imaging of “concealed blushing” seems to work just as well (it picks up 75% of people guilty of lying and 90% of those innocent) and is easier and quicker to perform. Liars seem to give off a rapid thermal signature of warming around the eyes that can be detected without physical contact and analysed without expertise. The technology might be usefully incorporated at airport check-in desks (Nature 2002;415:35).

Patients sometimes get more than they bargained for when they're admitted to hospital. It's been suggested that on entering hospital each patient should be automatically warned about the 10% risk of nosocomial infections, because the consequences of not providing a warning might result in legal action on the issue of consent to treatment. But such warnings could result in a massive loss of confidence because hospital treatment is designed to cure or alleviate dangerous conditions, not make things worse (Clinical Risk 2001;7:242).

Having recently needed an inhaler and discovered for herself just how tricky they can be to use, Minerva was worried to discover that the ability to learn inhaler technique is related to cognitive function and dyspraxia. Elderly patients who had problems with inhalers were subsequently found to score poorly on mini-mental tests and dyspraxia tests (Postgraduate Medical Journal 2002;78:37-9). Minerva wonders if poor inhaler technique could be considered another screening test for early cognitive impairment.

Seeing blood in the toilet bowl is always shocking, but are we any good at assessing how much is actually there? Thirty subjects took part in this volume assessment exercise and showed that most people (including doctors and nurses) overestimate the amount of blood seen in the pan. More worrying—from a clinical point of view—is that larger volumes tended to be considerably underestimated (ANZ Journal of Surgery 2001;71:650-1).

It's not just physical injuries that arise from unintended encounters with motor vehicles. Of over 1100 people who attended one accident and emergency department, almost a third reported psychiatric consequences a year later. Those who reported being “very frightened” immediately after the incident had appreciably worse psychiatric outcomes at follow up. Compensation seekers were significantly worse off at one year, but they were also the ones who had had the more severe injuries (British Journal of Psychiatry 2001;179:528-34).

Minerva is all for home remedies, but she is often frustrated by the lack of evidence behind them. This season zinc has featured highly. Previous studies of oral zinc failed to find an effect, but a trial in Clinical Infectious Diseases (2001;33:1865-70) shows that even sticking zinc gel up your nose fails to prevent or reduce rhinovirus infections. As the authors themselves suggest, surely it's time to test specific hypotheses for a proposed mechanism of action, rather than just use more of the same substance.

Fast tracking possible cases of cancer doesn't always lead to a better prognosis. A study of 84 patients with throat cancer shows that delays in getting a diagnosis from professionals made little difference to life expectancy. If patients presented earlier, survival rates might improve substantially, but it's difficult to know how to influence this because symptoms occur late in the disease and longer delays don't seem to be associated with any particular patient characteristics (Cancer 2001;92:2885-91).

Figure1

Schönlein-Henoch purpura is said to affect dependent parts, most typically the lower legs and buttocks. A 57 year old man with Schönlein-Henoch purpura and renal failure had a left hemisphere ischaemic stroke associated with severe hypertension. Note the arteriovenous fistula on his right arm—before the stroke his purpuric rash had been restricted to a typical distribution. After the stroke the purpura also affected his now paralysed and dependent right hand, providing evidence for the effect of gravity on the rash.

Martin Dennis, reader in stroke medicine, Western General Hospital, Edinburgh EH4 2XU

The latest post-11 September campaign to be launched in the United States is particularly pertinent to the medical profession. The Association of Medical Publication's print campaign aims to help doctors and nurses recognise the difference between common illnesses and those caused by bioterrorism. The advertisements, which are appearing in donated space in more than 30 medical publications, cover topics such as anthrax, botulism, pneumonic plague, and smallpox (New York Times 27 December 2001).

Unmet health needs of humans and dogs are explored in the latest issue of the Medical Journal of Australia (2001;175:632-4). Less than half of all dog owners in New South Wales actually walk their dogs, and they are generally less likely than non-owners to meet the recommended levels of physical activity sufficient for health benefits. The authors calculate that if half the dog owners increased their dog walking to 150 minutes a week, the resulting savings in healthcare costs, divided by costs of dog bites, gives a very favourable cost-benefit:bites ratio.

Congratulations to Dr Kieran Moriarty, who was awarded the CBE in this year's New Year honours list for his services and research into liver disease caused by alcohol abuse. That the appalling strain alcohol abuse puts on the family, society, and economy is being recognised is good news, says one writer in the Daily Telegraph (1 January 2002). Ironic, then, that next on the list is Hugh Morrison, chief executive of the Scotch Whisky Association.

A leading provider of clinical software is teaming up with the publishers of Clinical Evidence to help doctors make treatment decisions. This company intends to produce a support system that will not only mimic the processes doctors naturally use to make clinical decisions but also incorporate information already known about each individual patient, in addition to providing up to date clinical evidence. Such a system could be just the ticket when all those general practitioners who are threatening to retire early, do so.

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