MinervaBMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39360.521898.471 (Published 11 October 2007) Cite this as: BMJ 2007;335:780
Living near the surgery could get you a quicker cancer diagnosis. In northern England, patients with breast and colorectal cancer who lived further from their general practitioner's surgery were significantly more likely than those living nearby to present with late stage disease. The probability of detecting cancer at a late stage increased by about 1% for every minute of car travel time, according to a study in the European Journal of Cancer (published online 20 September 2007 doi: 10.1016/j.ejca.2007.07.028).
Magnets do not relieve pain, despite the claims of those marketing them. A systematic review and meta-analysis of 29 published and potentially relevant clinical trials found that the evidence does not support the use of magnets for pain relief (CMAJ 2007;177:736-42 doi: 10.1503/cmaj.061344). The analysis considered all randomised clinical trials of static magnets for treating pain from any cause.
Prudent management of women with a history of caesarean section is recommended by the authors of a Swedish study (British Journal of Obstetrics and Gynaecology 2007;114:1208-14 doi: 10.1111/j.1471-0528.2007.01484.x). Compared with women who delivered vaginally in their first birth, women who had a caesarean section were at greater risk of uterine rupture in subsequent vaginal deliveries. The risk is influenced by induction of labour, birth weight, gestational age, and maternal factors. Uterine rupture, although rare, is associated with a substantially increased risk of neonatal mortality (adjusted odds ratio 65.62, 95% confidence interval 32.6 to 132.08).
Horse riders face as much danger as rugby players. Researchers in Calgary report that, among experienced riders in southern Alberta, Canada, horseback riding is more dangerous than automobile racing, motorcycle riding, skiing, and American football, and as dangerous as rugby (American Journal of Surgery 2007;193:636-40 doi: 10.1016/j.amjsurg.2007.01.016). Chest and head injuries predominated; and 7% of those injured died. Only 9% of injured riders wore helmets.
The National Prescribing Centre has announced a free interactive information service that they say will be providing high quality, evidence based educational materials and resources relating to prescribing, therapeutics, and medicines management. An additional part of the service is a discussion forum to get peers talking to each other. The website, www.npci.org.uk, is a “virtual building” that “makes searching for content really intuitive.”
Cancer patients are at high risk of developing febrile neutropenia, which is often fatal. A study of 48 cancer patients with febrile neutropenia attending one US emergency department found that those who presented frequently had no identified source of infection. One third of the whole sample had positive blood cultures, and one fifth died or required intensive care within two weeks. The costs of managing them in the emergency department were similar to the cost of a single day of inpatient care (Oncologist 2007;12:1019-26 doi: 10.1634/theoncologist.12-8-1019).
Histone/protein deacetylase inhibitors (HDACi) have been approved by the Food and Drug Administration for cancer treatment. But new animal research shows that these drugs also inhibit the immune system (Nature Medicine published online 7 October 2007 doi: 10.1038/nm1652). One of the many functions of HDACi is to increase the production and suppressive function of regulatory T cells. These T cells suppress the rest of the immune system, and HDACi have been shown to decrease inflammatory bowel disease and prevent rejection of heart and pancreatic grafts in mice.
The general physician is a dying breed in the United Kingdom, but in the United States they're alive and kicking, and known as “hospitalists.” A hospitalist is usually defined as a general medical physician who, rather than referring patients to specialist teams, will manage patients from admission in the emergency department through to discharge and community based care. Patients treated by hospitalists tend to be discharged nearly one day earlier than those cared for by non-hospitalists, but the two groups had similar readmission rates and in-hospital and 30 day mortality (Archives of Internal Medicine 2007;167:1869-74 http://archinte.ama-assn.org/cgi/content/short/167/17/1869).
The ideas and beliefs that parents hold about their children's asthma drugs influence their children's adherence to asthma management plans (Pediatrics 2007;120:e521-6 doi: 10.1542/peds.2006-3023). Among parents in a sample of 622 children, 77% felt that their child's medication was necessary and 30% had strong concerns about the drugs. For 77%, necessity scores were higher than concern scores, but for 17%, concern exceeded necessity. Adherence to medication regimens increased as the difference between perceived necessity and concern scores increased.
Exposure to tobacco smoke in pregnancy may cause high blood pressure in the baby. Newborn infants of smokers had a systolic blood pressure 5.4 mm Hg higher than the babies of mothers not exposed to tobacco smoke in pregnancy. Diastolic pressures were not affected, and the association of smoking with heart rate was largely explained by confounding factors (Hypertension 2007;50:572-8 doi: 10.1161/HYPERTENSIONAHA.107.091462).
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