For every junior doctor post advertised in the UK there are 493 applicants, and one third of advertised jobs are non-training posts. In August, it'll become even more competitive as the number of UK graduates is estimated to rise by 20%. The royal colleges, the postgraduate deans, the General Medical Council, and the Department of Health have a message for international medical graduates thinking about coming to the UK, to avoid disappointment and unemployment, “don't come.”
Defining the musculoskeletal problems that pianists are prone to is surprisingly difficult. The prevalence of disorders related to playing is not just of interest to professional musicians, but to everyone who takes piano lessons or plays for fun. A systematic review painstakingly searched 38 databases and unearthed 482 citations, but there's still no consensus on definition or prevalence of musculoskeletal problems for pianists (Occupational Medicine 2006;56: 28-38).
An internet blog committed to investigating threats to the values of health care, especially those stemming from the concentration and abuse of power, makes interesting and entertaining reading (http://hcrenewal.blogspot.com/). A host of issues is covered, from ghost writing to the luxury lifestyle now enjoyed by Donna Shalala, the former secretary of health and human services in the Clinton administration and one of the principal advocates of Clinton's healthcare reform plan, which was meant to provide universal healthcare insurance.
Obesity exerts pressure on knee joints, predisposing to osteoarthritis, but what is its effect on knee joint replacements? A five year follow-up of 370 consecutive total knee replacements performed for osteoarthritis reports no significant differences in complication rates or clinical outcome measures between obese and non-obese patients (Journal of Bone and Joint Surgery [Br] 2006;88B: 335-40).
Another study that investigated the effects of obesity is a population study of migraine. Over 30 000 participants were divided into five categories of body mass index. Prevalence of migraine wasn't linked by body mass index—but the frequency of attacks, their severity, and other features of migraines, like photophobia and phonophobia, were (Neurology 2006;66: 545-50).
In sport, the combination of shoe surface on field surface can make the difference between winning and losing. A controlled laboratory study of grass and turf shoes on natural grass, Astroturf, Astroplay, and FieldTurf under a compression load of 333 N found that the highest peak torques (an indicator of injury potential) were developed by the grass shoe on FieldTurf and the turf shoe on Astroturf. Grass fields provided the lowest peak torques (American Journal of Sports Medicine 2006;34: 415-22).
Progress towards testing vaginal microbicides in humans is described in the Journal of Infectious Diseases (2006;193: 27-3516323128). The antiviral activity of PRO 2000 gel was assessed by applying it vaginally in women with HIV infection and then taking cervicovaginal lavage samples. These samples inhibited both HIV and herpes simplex virus infection by at least 1000-fold compared with samples taken before applying the microbicide gel, confirming the gel's bioavailability and its ability to retain antiviral activity after intravaginal application. The next step is to embark on large scale clinical trials.
J K Rowling, who invented Harry Potter, said that “fear of a name increases fear of the thing itself.” A competition to find the most acceptable name for a psychiatric service for elderly people in Dublin identified “age related psychiatry” as the most popular choice. “Geriatric psychiatry” and “psychogeriatrics” were the least popular. As names can become stigmatising over time, it would be interesting to repeat the exercise in 10 years to see if the new title has fallen out of favour (Psychiatric Bulletin 2006;30: 97-100).
Driving a car relies on “automaticity”—skilled action developed by repeated practice of the activity. But when it comes to patient safety, automaticity can be a threat rather than a benefit. For example, verbal checklist techniques (witnessing) when administering drugs to patients can induce the negative effect of automaticity, making an unsafe drug seem safe to give. A paper in Health Services Management (2006;18: 211-6) argues that patient safety depends on challenging the organisational systems that induce this phenomenon.
A quick dose of morphine given in the acute emergency setting is usually automatically accompanied by a swift shot of anti-emetic. But a randomised controlled trial of single doses of morphine plus anti-emetic shows a low overall incidence (2.7%) of nausea and vomiting, and there was no significant difference between the two groups (Emergency Medicine Journal 2006;23: 210-1316498159).
Doctors have limited time to read, and they shouldn't spend it all on getting to grips with one complicated study, says Richard Smith, former editor of the BMJ. Instead they should read synoptic, educational material, such as “throwaways”—papers that use journalists to summarise complex material, and which are free because they are funded by pharmaceutical advertising (Journal of the Royal Society of Medicine 2006;99: 115-9). This article is part of a serialisation of a book on medical journals that he wrote during a sabbatical from his BMJ editorship.
Figure 1.
A 15 year old girl presented with a slow growing, painful lesion under the nail of her great toe. It was initially treated as a wart, but she was referred on when topical salicylic acid did not improve the situation. A plain radiograph showed subungual exostosis, or osteochondroma, which is a bony spur caused by disordered bone growth at the epiphysis. It commonly presents in adolescents or young adults, and the treatment is complete excision. In this age group, radiographs are recommended to evaluate bony involvement before biopsy of any subungual mass.
Robert Winterton (wintertonris@hotmail.com), registrar, Jason Kelly, consultant department of plastic and reconstructive surgery, St James's Hospital, Leeds LS9 7TF
BMJ readers help us in many ways—by suggesting topics that we should cover, writing articles, and finding splendid quotations. The quotations we use as “endpieces” to fill the space at the end of pages (see p 604), and we are looking for more. So if you come across a striking phrase that has some bearing on health and medicine please send it (with details of its source and your name and address) to editor@bmj.com.
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