Editor's Choice US editor's choice

What we know and what we do

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39148.366412.43 (Published 08 March 2007) Cite this as: BMJ 2007;334:0-a
  1. Douglas Kamerow, US editor
  1. dkamerow{at}bmj.com

    We all know that exercise benefits cardiac patients. It is universally included in rehabilitation plans for patients with heart disease. But what about exercise in cancer patients? Nanette Mutrie and colleagues conducted a randomized controlled trial of group exercise in 177 women with early stage breast cancer (doi: 10.1136/bmj.39094.648553.AE). Six months after the 12 week program, the intervention group had both psychological and physical benefits compared with the control group. In an accompanying editorial Julie Silver says that exercise is known to have important psychological effects but that the physical effects may also be important in cancer patients (doi: 10.1136/bmj.39134.625012.80). While this study has limitations (it did not analyse the patients by type of breast cancer, for example), it opens promising areas for further research and argues for the inclusion of physical therapy and training into rehabilitation programs after breast cancer treatment.

    We have known since at least the turn of the century that HIV-positive women can infect their babies through breast feeding. This led to recommendations that, where safe water supplies and commercial infant formulas are available, bottle feeding is preferred for these women. In an editorial, Nigel Rollins points out that the focus should be on what best promotes child survival, not solely on preventing HIV transmission (doi: 10.1136/bmj.39135.411563.80). Recent trials have shown that in many poor areas with high HIV prevalence, the diarrhea and malnutrition that result from improper use of baby formulas are a greater threat to newborns than HIV disease. Selective breast feeding for six months while the mother is taking antiretroviral drugs may lead to better infant survival than an arbitrary rule that HIV-positive mothers should not breast feed their babies.

    Neck pain is common and its treatment has not been well studied. Allan Binder reviews what we know about the epidemiology, diagnosis, and treatment of cervical spondylosis and neck pain (doi: 10.1136/bmj.39127.608299.80). The good news is that most acute neck pain resolves within days or weeks and does not require extensive or expensive testing. After a good history and physical examination, and absent “red flags” that suggest more serious conditions—such as systemic symptoms, lymphadenopathy, and neurological deficits—conservative therapy will most likely lead to improvement. The best treatments are exercise, manipulation, and mobilisation.

    Who hasn't had the experience, either as a patient or a doctor (or both) of wasted time or resources because of a missing patient record? I thought I knew that one of the virtues of having nationalised health care was a unified medical record system that eliminated such problems. Not so, says Tessa Richards in her column this week (doi: 10.1136/bmj.39146.615081.599). She actually cites large American health systems such as Kaiser Permanente as models of seamless access by patients, primary care doctors, and specialists to medical records. I didn't know we were leading the UK in anything health related except the number of coronary artery stents placed.

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