Minerva

By analysing the pharmaceutical waste produced by eight operating rooms, an anaesthetist in New York found that discarded or wasted propofol made up 45% of all the drug waste (Anesthesia and Analgesia 2012;114:1091-2, doi:10.1213/ANE.0b013e31824ea491). Future wastage was reduced by removing 50 mL and 100 mL vials of propofol from the pharmacy, and retaining only the smallest size—20 mL. This waste reduction matters—propofol does not degrade in nature, accumulates in body fat, and is toxic to aquatic life.

In patients with enlarged thoracic aneurysm the risk of sudden death due to aortic dissection (TAAD) is more than 10% annually. Diabetes is unexpectedly associated with a decreased risk of progression and rupture of abdominal aortic aneurysm and might even have a protective role in these aneurysms developing. In a case-control study in the United States, researchers reported that, after adjusting for demographic characteristics, the negative association between diabetes and TAAD remained highly significant. Furthermore, the more severe the diabetic complications, the lower the rate of hospital admissions with TAAD (Journal of the American Heart Association 2012;1:e000323, doi:10.1161/JAHA.111.000323).

Failure rates of rotator cuff repair are high, and failure often occurs during the early rehabilitation phase. Similar rates have emerged with reconstruction of the anterior cruciate ligament. A letter to The American Journal of Sports Medicine challenges all involved by suggesting that we are allowing patients to return to normal activities too soon, especially sports enthusiasts (2012;40, doi:10.1177/0363546512444847). Tissue healing takes time; and patients, relatives, coaches, and the media should stop putting pressure on surgeons to release their patients prematurely. Better understanding of the imaging of healing tissue and grafts would help.

Turnaround times between taking HIV blood tests from neonates and delivering the results back to the healthcare facility where the tests were taken were significantly shortened by use of automated text messaging in Zambia. Turnaround times were cut from 44 days with postal services to 27 days with text messaging. The mean time to notification of care givers fell significantly from 67 days to 35 days. Texted reports differed from original paper reports by 0.5% (Bulletin of the World Health Organization 2012;90:348-56, doi:10.2471/blt.11.100032).

Only three of 96 studies met rigorous basic criteria for a systematic review of homeopathy for treating eczema, and all had methodological limitations (British Journal of Dermatology, 2012, doi:10.1111/j.1365-2133.2012.10994). Concluding that no good evidence currently exists for the use of homeopathy, the author commented that some might argue that the absence of evidence is not evidence of an absence of effect. While this point is true, he said that it would be prudent to consider any treatment that is not supported by solid evidence as unproven and such treatments do not normally have a place in routine healthcare.

A Brazilian study of caffeine consumption and infant waking patterns at night has reported that where caffeine is commonly consumed during pregnancy and by breastfeeding mothers, heavy consumption (³300 mg/day) did not increase the number of times three month old babies woke up at night (Pediatrics 2012;129:860-8, doi: 10.1542/peds.2011-1773). The sample included 885 infants, and all but one of the mothers consumed caffeine while pregnant. Nearly 20% of mothers were heavy consumers of caffeine during pregnancy and 14% at three month post partum.

An updated Cochrane systematic review of Serenoa repens monotherapy for benign prostatic hyperplasia has reported that, compared with placebo, this phytotherapy does not improve lower urinary tract symptoms even at double or triple the usual dose. Treatment had to be continued for at least four weeks, and lasted for up to 72 weeks’ duration in one trial. The rate of withdrawal was about 10% in both groups, and side effects of both active agent and placebo were few and mild (British Journal of Urology International 2012, doi:10.1111/j.1464-410X.2012.11172.x).

The first time children are admitted into hospital with dilated cardiomyopathy marks a period of high risk for clinical decline, according to a retrospective review (Circulation Heart Failure 2012, doi:10.1161/circheartfailure.111.964510). Of 83 children admitted between 2004 and 2009, with a mean age of 7 years, most had moderate or severe left ventricular dysfunction and needed intravenous inotropes within seven days of admission. One year later, most of these children needed readmission, 15% died, and 38% received transplants.

An entire generation of psychiatrists now have little or no experience with first generation antipsychotic drugs, such as haloperidol. In a study of extrapyramidal motor side effects of first and second generation antipsychotic drugs, researchers did not observe the anticipated improvement in side effect profiles for patients randomised to second generation drugs (British Journal of Psychiatry 2012;200:387-92, doi:10.1192/bjp.bp.111.101485). The authors want a clearer definition of when first generation drugs can be used, potentially avoiding the life-shortening metabolic disturbances seen in some patients currently treated with second generation antipsychotic drugs.