BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e52 (Published 12 January 2012) Cite this as: BMJ 2012;344:e52

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The success of labour induction at term depends partly on the ripeness of the cervix (European Journal of Obstetrics and Gynecology and Reproductive Biology 2011;159:315-9, doi:10.1016/j.ejogrb.2011.09.010). A German randomised controlled trial of 122 women using oral misoprostol (off label) and mechanical cervical dilatation with a double balloon catheter for cervical ripening, compared with oral misoprostol alone, found the combined method group had a significantly lower rate of failure to induce labour than the controls (9% versus 21%, P=0.007). The median time for inducing labour was 15.3 hours in the active group and 20.8 hours in the control group (P=0.002).

Two distinct elements are required for medical students to feel “part of the team”: professional inclusivity and social exclusivity. Interviews with Australian undergraduate medical students showed they experience professional inclusivity when they engage in clinical placements where they feel they are treated as future doctors by lecturers, doctors, and patients. Social exclusivity arose when they felt socially separate from students in other disciplines (Medical Education 2011;45:1220-9, doi:10.1111/j.1365-2923.2011.04046.x).

Greying hair is actively growing hair, according to a Korean study in the British Journal of Dermatology (2011;165:1183-9, doi:10.1111/j.1365-2133.2011.10625.x). A morphological and genetic analysis of eyebrow and scalp hair found that keratin and keratin associated protein genes in white (non-pigmented) hair were upregulated at least two-fold in comparison with black (pigmented) hair. The research team also found increased immunoreactivity for keratin associated proteins in the follicle of white hair, compared with black hair.

It’s not just smoking that predisposes to lung cancer risk, but specifically the level of nicotine dependence. Compared with patients who smoke their first cigarette more than an hour after waking, those who need a cigarette within 30 minutes of waking are at a significantly higher risk of lung cancer. The risk estimates were similar whether smoking was estimated using total years, smoking status (current versus former), number of cigarettes smoked per day, or years since quitting. These observations may help identify high risk people who might benefit from targeted interventions (Cancer 2011;117:5370-6, doi:10.1002/cncr.26236).

Atrioventricular nodal ablation (AVNA) is becoming a common approach for people with refractory atrial fibrillation. A systematic review identified five randomised trials or prospective cohort studies that assessed efficacy and 11 studies that reviewed effectiveness, as well as 47 studies that looked at safety. Compared with drugs alone, AVNA is associated with improvements in symptoms and quality of life, with a low incidence of procedure morbidity and malignant arrhythmia. In those with reduced systolic function, AVNA also offers a small but significant improvement in echocardiographic outcomes relative to drugs alone (Circulation: Arrhythmia and Electrophysiology 2011, doi:10.1161/circep.111.967810).

Which men are likely to develop erectile dysfunction after radical prostatectomy for prostate cancer? For men who were potent before surgery, the main predictor of post-treatment erectile function is the type of surgery they’ve undergone. Potency rates for all ages (45-75 years) at 48 months were 49-74% for open surgery, 58-74% for laparoscopic surgery, and 60-100% for robotic prostatectomy. Men under the age of 60 are likely to regain erectile function (BJUI 2011, doi:10.1111/j.1464-410X.2011.10757).

Caesarean section deliveries bring intense postoperative pain, which can hinder recovery. A Portuguese team looked at the effectiveness of local anaesthetic wound infusion with ropivacaine for 48 hours, compared with epidural morphine analgesia, in 58 women undergoing elective caesarean deliveries. Local infusion was associated with better pain relief and a lower incidence of side effects such as nausea, vomiting, pruritus, and urinary retention. Nursing needs were also lower and length of stay shorter with local infusions (Anesthesia and Analgesia 2012:114:179-85, doi:10.1213/ANE.0b013e3182368e87).

Very small or preterm babies may be the first sign of cardiovascular susceptibility in women, according to a Swedish study. It linked preterm and small for date babies with the later hospitalisation or death of their mothers from heart disease. The model accounted for income, education, birth country, smoking, diabetes, hypertension, and pre-eclampsia. Maternal risk of heart disease increased with decreasing gestational age of the child, but the increased risk associated with smaller size was restricted to very small for gestational age babies (Circulation 2011;124:2839-46, doi:10.1161/circulationaha.111.034884).


Cite this as: BMJ 2012;344:e52

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