BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7425.1236 (Published 20 November 2003) Cite this as: BMJ 2003;327:1236

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Minerva has had her knuckles gently rapped, once again. Commenting on her recent reporting of a study that found that the inexperience of junior doctors had little impact on patients' outcomes in intensive care, a reader says, “Surely she is aware that junior staff have minimal or non-existent influence in intensive care, at least in the UK. One could assume that over the pond, the US would also rely on more senior staff in ITU to make decisions, and hence be little influenced by changes in junior staff.” He says that the authors were probably looking in the wrong place.

Anal sphincter damage after childbirth is much more common than we think. A meta-analysis of 717 vaginal deliveries showed that 26.9% of primiparous women had anal sphincter defects and 8.5% of multiparous women had new sphincter defects. Fortunately, at least two thirds of defects caused no symptoms, although it's been calculated that the probability of faecal incontinence associated with an anal sphincter defect is about 80% (British Journal of Surgery 2003;90: 1333-7).

A longitudinal study comparing on-road driving performance in healthy older adults with that of people with very mild or mild early stage Alzheimer-type dementia provides good evidence that driving ability becomes poorer over time. The group with …

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