Intended for healthcare professionals


“Patientgate” and other stories . . .

BMJ 2014; 348 doi: (Published 02 April 2014) Cite this as: BMJ 2014;348:g2420

“Patientgate” was coined by Glyn Elwyn in a recent BMJ article (2014;348:g2078, doi:10.1136/bmj.g2078) that described a hypothetical case of a patient wishing to make an audio recording during a clinical consultation. The article drew lively comment, mostly supportive of such recordings. His Dartmouth team has carried out a scoping review of the literature, looking at 33 articles on the provision of recordings of consultations to patients. It shows that patients place a high value on receiving audio recordings of clinical consultations and most benefit from listening to consultation recordings (Patient Education and Counseling 2014, doi:10.1016/j.pec.2014.02.007). Minerva welcomes this as an inevitable part of the future but agrees that further investigation of the ethical, practical, and medicolegal implications of routinely providing recorded consultations is needed.

Autologous haematopoietic stem cell transplantation (HSCT) has been used as a treatment for multiple sclerosis since 1995. When it did not alter the course of progressive disease, it was written off by some as just another false dawn. However, new data from Sweden (Journal of Neurology, Neurosurgery & Psychiatry 2014, doi:10.1136/jnnp-2013-307207) suggest that for a subset of patients with aggressive, relapsing disease it can provide lasting remission. In a series of 48 patients given such transplants since 2004, relapse-free survival was reported as 87% and magnetic resonance imaging event-free survival as 85% at five years. But there has never been a randomised controlled trial of this treatment for multiple sclerosis.

Measuring blood pressure was once a matter of sitting people down in an office and watching a column of mercury go up and down. Today, blood pressure can be measured as often as the subject can bear it: in this study (American Journal of Hypertension 2014, doi:10.1093/ajh/hpu002), more than 10 measurements by day and more than five at night. The analysis was aimed at discovering the prognostic importance of “masked hypertension”—high levels detected by ambulatory monitoring but not by clinic readings. The authors examined individual participant data from 7826 people who were not treated with blood pressure lowering drugs. People found to have masked hypertension were at three times the risk of stroke compared with true normotension, but the authors cautiously note that “in the absence of any trial evidence, one can only speculate about the number of events that can be prevented by the early treatment of this condition.”

Two hundred years ago, Switzerland was a poor little country visited by a few poets and painters seeking the “sublime in nature.” Political refugees, rich consumptives, and mountain skiers followed later. Today, a visit to Switzerland can be associated with seeking help to die, although most assisted deaths in Switzerland are of Swiss citizens. A survey of 1093 cases between 2003 and 2008 (International Journal of Epidemiology 2014, doi:10.1093/ije/dyu010) shows that the most common reasons for assisted suicide in Switzerland were cancer and neurological disease, and that assisted suicide was associated with female sex, living alone or being divorced, and higher education and socioeconomic position.

Between 1 October 2009 and 31 March 2010, pandemic A/H1N1 (swine) influenza vaccine was given to about a million children across the UK. Years before, a swine flu vaccine programme in the US had been halted owing to a rise in cases of Guillain-Barré syndrome (GBS). But a survey of GBS cases in the UK in the two years after September 2009 has detected no increase (Archives of Disease in Childhood 2014, doi:10.1136/archdischild-2013-304475). Most children had identifiable infection in the weeks preceding onset and their outcomes were generally good.

Manual vaginal aspiration under local anaesthesia is a low cost method of first trimester abortion that has been used mainly in low resource settings. But recently it has been adopted by the Pregnancy Advisory Service in Gloucestershire, and according to a report in the Journal of Family Planning and Reproductive Health Care (2014, doi:10.1136/jfprhc-2013-100700), it has been highly successful and saved £60 000 (€72 200; $99 380) in the first year. The complication rate was 2% and the uptake of long acting reversible contraception was 80%, with 51% choosing an intrauterine system fitted at the time of aspiration.

China began leading the world in transport infrastructure around 2500 years ago, when it started building the Grand Canal. Now it has the world’s longest network of high speed trains, with more than a million people hurtling daily from city to distant city at speeds in excess of 300 km/h. May there be lessons here for the pusillanimous inhabitants of distant Britain? Well, it seems that we should not be deterred by considerations of noise pollution, judging by a study in which 80 Chinese students were exposed to the recorded noise of high speed trains and conventional trains travelling near their maximum speeds (Environmental Health 2014;13:12, doi:10.1186/1476-069X-13-12). The researchers found that both produced the same level of annoyance and activity disturbance.


Cite this as: BMJ 2014;348:g2420

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