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What's new this month in BMJ Journals

BMJ 2005; 330 doi: (Published 10 February 2005) Cite this as: BMJ 2005;330:330
  1. Harvey Marcovitch, BMJ syndication editor (h.marcovitch{at}

Apomorphine may relieve restless legs

Nine patients with severe restless legs syndrome were pretreated with domperidone for three days to mitigate side effects of apomorphine, which was given as an intravenous infusion. All patients responded with fewer movements and subjective improvement. These findings could be used as a test for the condition, the authors say, and transdermal or subcutaneous apomorphine might eventually prove therapeutic.

J Neurol Neurosurg Psychiatry 2005;76: 181-5

Can worms treat Crohn's disease?

Twenty nine patients with longstanding Crohn's disease refractory to standard treatments were given repeated doses of the ova of Trichuris suis (pig whipworm), prepared from pathogen-free animals. At week 24 of the open label trial, 21 were in remission and another two were improved, much better than any expected placebo response. None had ill effects. The explanation may be that helminths blunt Th1 responses, which are known to be over-reactive in Crohn's. The authors call for a controlled trial.



Gut 2005;54: 87-90

Consent is needed for biological dressings

Representatives of 13 of Britain's major religious groups were asked their attitude towards the use of biological dressings or other products. Concerns included unwillingness to use products obtained by cruelty or deliberately killing animals (Methodists, Buddhists); a ban on pig products unless there was no other alternative (Muslim); and unacceptability of products derived from human prepuce (Quakers). All considered that fully informed consent was essential. None of 100 health professionals questioned knew the correct constituents of all the biological products. The authors call for manufacturers, regulatory authorities, and hospitals to make sure healthcare professionals are made aware of products' constituents and obtain properly informed consent from their patients.

J Med Ethics 2005;31: 2-6

Unbelted passengers endanger other car occupants

If an unbelted person is present in a vehicle involved in a collision, other belted occupants stand a 90% increased risk for injury, including death. Unbelted co-passengers are not at extra risk. These results from a US cohort of more than 150 000 car occupants during collisions are consistent with the hypothesis that unbelted car occupants become projectiles within a vehicle on collision. Belted occupants sustain an impact from the unbelted person next to them. This study adds to the arguments for all vehicle occupants to be belted at all times.

Injury Prevention 2004;10: 363-7

Watch the birdie

Five children developed erythema of the hands and itching, and three of them developed upper airway symptoms after attending the same local park. All five had bought bird feed while there. The feed turned out to contain peanuts; investigation confirmed that all had raised concentrations of specific peanut IgE. Nut allergy does not depend on ingestion, and doctors should suspect it in all cases of unexplained contact urticaria. The park authorities have changed the make up of their bird feed.

Arch Dis Child 2005;90: 108-9

Tasmanian smoke-free pubs see no fall in sales

Tasmanian restaurants and pubs (bars) experienced no fall in sales after the introduction of legislation banning smoking in enclosed public places, except in bars where meals were not served. Researchers computed 12 years of sales data to control for random fluctuations and tested three hypotheses: sudden permanent effects on sales, gradual permanent effects on sales, or an abrupt fall followed by return to normal. None of the hypotheses were supported by time series analysis of data from total retail turnover compared with that from restaurants and cafes as well as pubs. The authors conclude that legislators elsewhere can be more confident that smoke-free policies in hospitality venues will not have a negative effect on turnover.

Tobacco Control 2004;13: 454-5

Consent procedures are seen as a ritual

Patients may view consent to surgery, especially in an emergency, as part of a bureaucratic medicolegal ritual rather than an ethical imperative. Twenty five women were interviewed postoperatively. All had signed consent to surgery, but many still saw surgery as something which “had happened to them” either with their collusion or in the face of their scepticism or hostility. The investigators, from the University of Leicester, say that current procedures do not always enable partnership or promote autonomy but can even act oppressively.

Qual Safe Health Care 2004;13: 422-7


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