Timing of surgery for spinal injury . . . and other stories
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n675 (Published 18 March 2021) Cite this as: BMJ 2021;372:n675
Early surgery for acute cord injury
A pooled analysis of data from more than 1000 patients explores how the outcomes of acute spinal cord injury vary with the timing of surgery. Recovery of sensorimotor function, evaluated one year after injury, was greatest in patients who underwent surgical decompression within 24 hours of the injury. After the first 24-36 hours, motor recovery plateaus and the benefits of early decompressive surgery are lost (Lancet Neurol doi:10.1016/S1474-4422(20)30406-3).
Placebo effects
A review of functional neuroimaging studies of healthy participants compared brain responses to painful stimuli under placebo and control conditions. Placebos induced small reductions in activity in multiple areas including the insula, thalamus, habenula, mid-cingulate gyrus, and supplementary motor area. But the findings aren’t consistent and the authors end up with the rather non-specific conclusion that placebo analgesia is a multi-faceted phenomenon involving multiple cerebral mechanisms that differ across studies (Nat Commun doi:10.1038/s41467-021-21179-3).
Dark nudges and sludge
“Nudges” are small environmental changes that make it easier to choose wisely. Putting calorie counts on menus, for example, helps people eat less. Designing buildings with fewer lifts encourages taking the stairs. Dark nudges do the opposite and facilitate the choice of harmful options. Examples include the way that the alcohol and gambling industries use advertisements to make heavy drinking appear normal and gambling seem innocent. Sludge, as the name suggests, is the deliberate muddying of the waters to create confusion about the likelihood of harm (Milbank Q doi:10.1111/1468-0009.12475).
Five a day
The “five a day” promotion of fruit and vegetable consumption originated in California in the 1990s from a partnership between the state health department and the agricultural and supermarket industries (Am J Prev Med doi:10.1016/S0749-3797(18)30488-4). Five seems to have been chosen pragmatically as a realistic target rather than being based on nutritional evidence. But analyses of the Nurses’ Health Study and Health Professionals Follow-Up Study suggest that they got it right. During 30 years of follow-up, the greatest mortality benefit was seen for five servings a day, and eating more didn’t give greater risk reductions (Circulation doi:10.1161/CIRCULATIONAHA.120.048996).
Motor neurone disease
Ageing of the population is one reason for the increasing incidence of neurodegenerative diseases in many developed countries. However, an analysis from the Netherlands finds that it’s only a partial explanation for increasing rates of motor neurone disease (Neurology doi:10.1212/WNL.0000000000011467). After adjustment for changing demographics, mortality from motor neurone disease rose by 14% over the last 20 years. Mapping showed some geographical variation of risk but identified no areas where rates were especially high or low.
A smartphone app for knee osteoarthritis
A 6 week programme of daily exercises presented by a smartphone application reduced pain and improved function in people with knee osteoarthritis when compared with usual care (JAMA Netw Open doi:10.1001/jamanetworkopen.2021.0012). The intervention focused on strengthening and balance enhancement, using sit-to-stand and stair climbing exercises. Unfortunately, covid-19 hampered data collection and only around 70% of the people who were randomised contributed to the final analysis.
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