Signs of sepsis in children . . . and other storiesBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3975 (Published 27 September 2018) Cite this as: BMJ 2018;362:k3975
Diagnosing sepsis in children
Most diagnostic aids for sepsis focus on clinical features that suggest that sepsis is present. A Delphi study in Archive of Diseases in Childhood took the opposite approach, asking experienced clinicians who routinely assessed ill children about features that ruled it out (Arch Dis Child doi:10.1136/archdischild-2017-314339). The answers, at least in retrospect, seem rather obvious. Most agreed that, if a child was talking, playing, smiling, eating, or interacting with others, sepsis was unlikely. There was no agreement, however, on how reassuring it was to see a child using an electronic device.
Diet and psoriasis
People with psoriasis often ask if they could improve their skin condition by making changes to their diet. If they are obese, weight loss is likely to help, since excess body weight is linked with both increased severity of disease and reduced response to treatment, perhaps as a result of the pro-inflammatory effects of body fat. Apart from that, a recent systematic review suggests that the answer is negative (JAMA Dermatol doi:10.1001/jamadermatol.2018.1412). This review found no convincing evidence that dietary supplementation with fish oils, selenium, vitamin D, or multivitamins made any difference.
Wearable activity sensors
Many people wear devices that provide a daily step count, but whether this results in a persistent increase in levels of activity is another matter. A study from the US provided 400 volunteers with a tracker worn on the wrist and followed them for five months (Br J Sports Med doi:10.1136/bjsports-2017-098512). More than half the participants believed that wearing the tracker had increased their physical activity. However, the data showed that on average, step counts had declined.
Guidelines are clear that benzodiazepines should be given only for short periods because of the risk of adverse effects and the potential to develop dependence. A survey in Pennsylvania that examined drug use in elderly people after a first prescription of a benzodiazepine finds that this recommendation is often ignored (JAMA Intern Med doi:10.1001/jamainternmed.2018.2413). More than a quarter of those prescribed one of these drugs were still using them a year later.
Time and motion
Cataract surgery is already the commonest operation in the UK and demand is rising. A time and motion study of cataract surgery in five hospitals finds a lot of variation in the way it is organised (Br J Ophthalmol doi:10.1136/bjophthalmol-2017-310452). Judged by the number of cases dealt with in a routine 4 hour theatre session, optimal patient flow occurred in hospitals where the surgeon was supported by other healthcare professionals. If the least efficient hospitals were able to improve to the level of the most efficient, productivity would double.
Seasonal changes in cognition
Three longitudinal studies of older adults in the United States, Canada, and France find that cognitive performance varies by season (PLoS Med doi:10.1371/journal.pmed.1002647). Test scores were higher in summer and autumn than they were in winter and spring. This was true both for people with dementia and for people without evidence of cognitive decline. Adjustment for depressive symptoms, sleep, physical activity, and thyroid status made little difference. One implication is that time of year may need to be considered when analysing data from therapeutic trials and observational studies in people with impaired cognitive function.