How “stataphobia” is preventing publication and other stories . . .BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f366 (Published 22 January 2013) Cite this as: BMJ 2013;346:f366
Stataphobia—an abnormal fear of research design and statistics—prevents publication, tenure, and scientific recognition. The Library of Alexandria Super Research Methods Help Desk in Egypt aims to help researchers in the developing world get published in major journals. A scientist in Russia will screen questions before inviting you to enter a “research door.” Once through, you will be given access to relevant lectures and materials, and 20 international experts from the research world will be on hand to answer questions. Expansion of the service may follow in other Arab countries and central Asia. For more information, contact Ron LaPorte at.
Does poor practice or a changing complaints culture explain the record number of complaints to the UK’s General Medical Council? Despite a sharp drop in the number of general practitioners being suspended for professional concerns, more patients are complaining—which is being put down to an emerging complaints culture (Casebook www.medicalprotection.org/uk/casebook-january-2013/complaints-culture). A similar picture is seen for surgeons. Patient expectations are climbing, medicine is becoming more complex, and the gap between expectations and what the NHS can deliver is widening.
In a study investigating links between parental smoking during pregnancy and high blood pressure in adult daughters, maternal and paternal smoking during pregnancy (>15 cigarettes per day) was associated with increased rates of hypertension. Adjusting for birth weight had little effect, but adjusting for body shape and weight up to age 18 years or for current body mass index did. The authors say that these links are largely explained by body weight throughout life rather than direct intrauterine mechanisms involving smoking (Hypertension 2013;61:494-500, doi:10.1161/HYPERTENSIONAHA.111.200907).
Current English guidelines suggest that colonoscopes should be withdrawn over a minimum of six minutes. A screening programme of over 31 000 colonoscopies by 147 colonoscopists identified four groups with withdrawal times ranging from under seven minutes to more than 11 minutes. The slowest group had a significantly higher adenoma detection rate than the fastest group (47.1% v 42.5%; P<0.001), and detected more right sided and smaller adenomata. The increase in detection beyond 10 minutes was minimal, and withdrawal times longer than six minutes did not detect more advanced adenomas (Endoscopy 2013;45:20-6, doi:10.1055/s-0032-1325803).
Minerva admits she has laboured under the misconception that adding sugar to tea and coffee does not influence the risk of type 2 diabetes. But a large American study conducted over 24 years proves her wrong; irrespective of the caffeine content in hot drinks, it is the sugar intake that counts. But coffee intake—whether caffeinated or decaffeinated—does lower the risk of type 2 diabetes. Minerva suspects that the doughnuts she consumes with these drinks may be more influential (American Journal of Clinical Nutrition 2013;97:155-66, doi:10.3945/ajcn.112.048603).
The level of postoperative pain experienced by children may have a genetic component (Anesthesia and Analgesia 2013;116:170-7, doi:10.1213/ANE.0b013e31826f0637). Researchers looked at 168 children undergoing orthopaedic or abdominal surgery, and receiving morphine as patient controlled analgesia. Children were genotyped with their parents for six polymorphisms of candidate genes implicated in pain receptors and opiate metabolism. The Faces Pain Scale was used to assess pain over the first 24 h after surgery. Two of the six genotypes were significantly linked to clinically meaningful pain variability.
Microscopic pyuria and leucocyte esterase should not be used as diagnostic surrogates for biological culture to detect infection in patients with lower urinary tract symptoms (British Journal of Urology International 2013, doi:10.1111/j.1464-410x.2012.11694.x). In a large prospective study of urine dipstick performance and direct microscopy, pyuria performed badly as a surrogate marker of infection. Refrigeration and preservation did not slow the loss of white cells; 40% of cells were still lost by 4 h. Neither centrifuging to reduce cell loss, nor staining to salvage and improve leucocyte detection conferred diagnostic advantage.
A common treatment for ovarian cancer appears to induce another type of cancer. Pegylated liposomal doxorubicin (PLD) is often given long term to women with ovarian malignancies. A chance finding of two women with new invasive, squamous cell cancers of the mouth prompted a search for more cases. Three other women were uncovered, none of them smokers. The authors say there is a balance to be struck between long term use of PLD to prevent recurrence of ovarian cancer, and the possible risk of a new secondary cancer (The Oncologist 2012;17:1541-6, doi:10.1634/theoncologist.2011-0216).
Preterm birth induces a switch from fetal to postnatal circulation before the left ventricle is fully developed. In animals, this results in an odd shaped left ventricle. To determine whether the same thing happens in humans, researchers used cardiovascular magnetic resonance to investigate 234 young adults, of whom about half had been born prematurely. Preterm adults had an increased mass and a unique, three dimensional geometry in the left ventricle, and significant reduction in systolic and diastolic function (Circulation 2013;127:197-206, doi:10.1161/circulationaha.112.126920/-/DC1).
In a Spanish randomised controlled trial, use of high dose vaginal progesterone in twin pregnancies was well tolerated, but failed to prevent preterm deliveries better than placebo. Nearly 300 women expecting twins inserted pessaries vaginally twice daily from 20 to 34 weeks of gestation. Pessaries contained placebo or progesterone (200 mg or 400 mg). There were no significant differences in the proportion of preterm or very preterm births, low birth weight, or perinatal morbidity and mortality between groups (BJOG 2013;120:50-7, doi:10.1111/j.1471-0528.2012.03448.x).
Cite this as: BMJ 2013;346:f366