Intended for healthcare professionals

Minerva Minerva

Minerva

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7292.1004 (Published 21 April 2001) Cite this as: BMJ 2001;322:1004

When the medical authorities in Indiana issued police officers with automatic external defribrillators, they hoped survival would improve for people having cardiac arrests out of hospital. It didn't. A before and after study showed that if the police arrived before the paramedics, they carried out defibrillations flawlessly. Unfortunately they arrived first in only 6.7% of cases (Academic Emergency Medicine 2001;8:324-30). The rest of the time, the police were too busy or too far away to make it in time.

During dangerous floods in early 1997, the residents of Yuba County, California, were advised to evacuate their homes for higher ground. Four fifths of them left, but the remaining fifth stayed behind—often because they didn't want to abandon their pets (American Journal of Epidemiology 2001;153:659-65). A survey six months later found a dose-response relation between the number of pets in a household and the likelihood of their owners refusing to leave.

Earlier this month Alan Milburn, the UK's minister for health, endorsed a report by the NHS Confederation calling for a major restructuring of the health service and an end to hospital outpatient clinics (Health Services Journal 5 April). The plan to site specialist services in the community came about after suggestions that up to two thirds of the work done in outpatients is a waste of time for patients. Services were originally set up, it says, to accommodate the “British tradition of queuing.”

In the three years since Oregon's Death With Dignity Act legalised physician assisted suicide, only 70 people have taken advantage of it. The main reason is that few doctors are willing to write the lethal prescription, says a doctor from Portland (Medical Journal of Australia 2001;174:353-4). The federal government and three major health maintenance organisations in Oregon remain queasy about physician assisted suicide and transmit that feeling to many of the state's doctors, who fear antiabortion-style demonstrations if it becomes known that they are helping people to die.

Minerva did not know that the mouth guards worn by boxers, rugby players, and other competitors were meant to protect the wearer from concussion. This is a widely held belief, however, and an article in the British Journal of Sports Medicine considers the evidence (2001;35:81-2). It doesn't take long. Examination of the two studies behind the claim led the author to conclude that the protective properties of mouth guards are a myth supported only by bizarre anecdote. He adds that mouth guards may not even protect the teeth and lips; they have never been tested in a decent clinical trial.

Fighter pilots may have a risky job but they may also have stronger bones than regular pilots because the gravitational forces generated by high performance flying increase bone mineral density, particularly in the thoracic spine (Aviation, Space, and Environmental Medicine 2001;72:177-81). Bone mineral density of the thoracic spine increased by 11% in pilots on a 12 month training course at a base near Perth—but only in those who finished the course. Thirteen of the 23 original entrants dropped out.

A small randomised trial in obstetrics and gynaecology provides supporting evidence for the well accepted folklore that ginger reduces nausea and vomiting in early pregnancy (2001;97:577-82). Seventy Thai women took either a placebo or a specially made preparation containing about 1 g of ginger for four days. Nausea and vomiting decreased in women taking ginger. No improvements occurred in controls. Ginger cakes or ginger biscuits might work too, though they contain up to 30 times more ginger.

Minerva is particularly bad at walking in stilettos and usually resorts to wearing sensible wide-heeled shoes. Sadly, she has read that these may not be so sensible after all. Wide heels increase peak external knee flexor torque by 30% in comparison to going barefoot. Wide heels also increase peak varus knee torque—by about 26%, more than with narrow-heeled shoes (Lancet 2001;357:1097-8). So heels of any sort increase the risk of developing arthritic knees. The authors recommend shoes with low heels—or better still, none at all.

Some Montreal obstetricians find it hard to discharge their patients home early after an episode of preterm labour, even when contractions have stopped and all is well. Researchers conducting a clinical trial of home versus hospital care describe having to lean heavily on (“encourage”) participating obstetricians to stick to the research protocol. In the end all of them did and no harm was done. The women and their babies did just as well at home as controls did in hospital (Canadian Medical Association Journal 2001;164:985-91).

Figure1

A 23 year old veterinary nurse presented with a three month history of abdominal pain and diarrhoea. Diagnostic laparotomy revealed miliary, pinhead sized nodules coating the visceral and parietal peritoneum. The omentum was rolled up and stuck tightly to the anterior abdominal wall. Histopathology, cytology, and microbiology confirmed the diagnosis of intestinal tuberculosis. Her symptoms and signs resolved rapidly in response to antituberculosis treatment.

T Geyer, senior house officer, P Burgess, consultant, department of surgery, Princess Margaret Hospital, Swindon SN1 4JU

Feline spongiform encephalopathy—mad cat disease—was first noticed in Britain in 1990 during an epidemic of spongiform encephalopathy in cows. Since then there have been 87 cases in Britain, and others in Norway, Northern Ireland, and Liechtenstein (Veterinary Record 7 April). When vets from Bristol examined pathological specimens from 17 of the British cats, they found prion proteins in the central nervous system—as expected—and a smattering in lymphoid tissue. Unfortunately there was not enough to make lymphoid tissue such as tonsils useful for diagnosis.

In two Nintendo minigames—Tug of War and Pedal Power—players have to rotate a central joystick as fast they can for as long as they can. A study of three 8 year old boys in one British bedroom found central palmar blisters in 100% of players (Archives of Diseases in Childhood 2001;84:288). They were treated immediately with Mickey Mouse plasters and a dose of common sense from the attending adult. It didn't work. The boys continued the game until the plasters rubbed off and pain stopped play.

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