A questionnaire study from Norway draws attention to an underemphasised aspect of medical errors: the potentially devastating effect that they can have on the doctor responsible. One in three doctors admitted that they had been responsible for serious injury to a patient at least once. For a substantial proportion, the incident had had a negative impact on both their professional and private lives. Six per cent had sought professional help (Quality and Safety in Health Care 2005;14: 13-7).
General practitioners often groan when the latest health scare hits the headlines, anticipating a huge influx of worried patients. But the authors of a Danish study in the British Journal of General Practice ( 2005;55: 212-1715808037) report that although more than a third of untargeted health messages in the mass media were recalled by patients, they found no significant relation between health messages and contact with GPs. Campaigns and drug advertisements are another matter altogether.
Minerva hopes to be on holiday when anaesthetists finally comprehend the meaning of “physician led” anaesthesia, spelt out in the revised edition of The Anaesthesia Team (Association of Anaesthetists of Great Britain and Ireland, 2005). According to one anaesthetist, this “own goal” was not dreamt up by his own profession, although the current lack of anaesthetists certainly had been predicted in the early 1990s. Sadly, he says, the powers that be did not agree to allocate enough senior registrars—and by the time they did, it was too late: there was no funding.
Infection is implicated in endothelial dysfunction and atherogenesis, but the impact of childhood infections is unclear. Ultrasound data from the Avon longitudinal study of parents and children now show that even mild acute infections in childhood are associated with impaired endothelium-dependent vasodilation. The findings point to a potential role for extrinsic inflammatory stimuli in the pathogenesis of atherosclerosis from an early age (Circulation 2005;111: 1660-5).
Minerva developed palpitations just reading an article about how to approach clinical exams (Journal of the Royal Society of Medicine 2005;98: 174-7). Useful gems include “the day of the exam is not the time to take your first dose of beta blockers” and “do not rely on parking at the hospital.” Finally, “when the bell goes, stop talking and wait to be told to leave. Say `thank you' and leave quietly and promptly. Do not grimace, weep or look desperate.”
Steroid injections into arthritic hips offer questionable benefit, and by inducing immunosuppression they may actually put patients who later undergo total hip replacement at risk of infection. A retrospective matched cohort study of infections after arthroplasty in patients who had received a steroid injection and those who hadn't (40 in each group) showed that there had been five revisions in the injected group (four due to deep infection), but none in the matched group (Journal of Bone and Joint Surgery 2005;87B: 454-7).
Could Gulf war syndrome actually be chronic Lyme disease? The symptoms are similar, and Lyme disease is difficult to diagnose as the typical rash is often absent. It can also become apparent years after exposure to the causative organism. A writer in Medical Hypotheses ( 2005;64: 717-20) says that military personnel are at risk of tick bites while training in the field, and that those who later developed Gulf war syndrome may have entered the conflict with latent Lyme disease.
A study of patients with fibromyalgia who were randomised into a group writing about traumatic experiences, a control writing group, or a usual care control group, found that the trauma writing group experienced significant reductions in pain and fatigue and improvements in their psychological wellbeing at four months in comparison to the control groups. But by 10 months the benefits had disappeared. The idea for the study came from the observation that people with fibromyalgia report high rates of past trauma, and that writing targets cognitive and emotional processing (Psychosomatic Medicine 2005;67: 326-34).
People over the age of 18 in the UK who were conceived from sperm donations are now able to ask for information about their donor. Alongside this change of rules, the Give Life, Give Hope campaign is seeking to raise greater public awareness of the benefits of becoming a sperm donor, as well as trying to dispel the myth that donors are obliged to financially and emotionally support a child in 18 years' time. For more information go to the National Gamete Donation Trust at www.ngdt.co.uk
Smokers with mild asthma may be best advised to go straight for high dose steroid inhalers. A multicentre, randomised, double blind trial of low dose versus high dose inhaled steroids taken for 12 weeks reports that compared with non-smokers, smokers with mild asthma are insensitive to the therapeutic effects of low dose steroids. Daily peak flow readings were lower, and the number of exacerbations of asthma increased for smokers taking lose dose inhalers (Thorax 2005;60: 282-7).
Figure 1.
A 21 year old woman was referred to the ear, nose, and throat clinic by an immunologist who noted a white, swollen right tonsil. The patient had no symptoms, but when it was pointed out, the patient was able to remove the “tonsil” with her fingers. She produced a 1.5×1.5 cm tonsillolith. These usually present in adults with halitosis and episodes of recurrent inflammation. The appearance can provoke great concern. They can often be removed in the clinic, but tonsillectomy may be necessary. A unilateral giant tonsillolith is rare.
W Giridharan (giriw@tiscali.co.uk), specialist registrar, J Maclachlan, senior house officer, L C Knight, consultant, ear, nose, and throat department, Leeds General Infirmary, Leeds LS1 3EX
Guidance at bmj.com/advice
In addition to the conventional advice to rest, ice, compress, and elevate ankle sprains, a fifth piece of guidance may now be appropriate: slap on a patch. A randomised double blind placebo controlled study reported that applying a daily topical ketoprofen patch significantly reduced reported pain and swelling and improved the speed of overall recovery. The topical anti-inflammatory produced no evidence of systemic side effects (American Journal of Sports Medicine 2005;33: 515-23).
A 30 year follow-up of men enrolled in the Honolulu heart programme has found evidence for an association between the consumption of milk in midlife and the future risk of Parkinson's disease. The link can't yet be explained, and the intake of calcium (whether from milk or non-dairy products) was not connected to Parkinson's disease. One possibility is that the observed effects are mediated through neurotoxic contaminants in milk (Neurology 2005;64: 1047-51).