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Spraying fibrin into the operation site during total knee replacement is no better at reducing postoperative blood loss than giving a dose of intravenous tranexamic acid, according to a direct, placebo controlled comparison (Journal of Bone and Joint Surgery (Br) 2007;89-B:306-9, doi: 10.1302/0301-620X.89B3.17565). Both agents significantly reduced blood loss compared with giving nothing.
Wanted: ground breaking, accessible initiatives to be nominated for the 2007 Integrated Health Awards. Any organisation can apply if it takes an integrated health approach to help people achieve the best possible health and wellbeing. Integrated health emphasises prevention and education and takes a more holistic approach than conventional medicine, which, according to the Prince's Foundation for Integrated Health, which is offering the award, “tends to view the body as a machine made up of components that sometimes break down.” See www.fih.org.uk.
Although Jehovah's Witnesses usually refuse whole blood products, they can accept other components of blood. It all depends on the definition of “blood.” In 2000 and 2004 the official doctrine of the religion defined the “primary components” of blood as red blood cells, white blood cells, platelets, and plasma. But whether to accept fractionations of these primary components is up to individual believers. Immunoglobulins, albumin, and purified factors VIII and IX are all available to followers whose “conscience would permit” (Anesthesia and Analgesia 2007;104:753-4, doi: 10.1213/01.ane.0000255644.73211.f2).
Overall dietary patterns are now thought to be a better predictor of colorectal adenomas and cancers than specific dietary components. Cluster analysis shows that people with high vegetable and moderate meat intake and people with high meat intake were at significantly greater odds of developing an adenoma compared with people with high fruit and low meat intake (Journal of Nutrition 2007;137:999-1004, http://jn.nutrition.org/cgi/content/abstract/137/4/999). This dietary pattern seems more protective than diets containing more vegetables and meat.
A meta-analysis of the effects of soft drink consumption on nutrition and health found that studies funded by the food industry reported significantly smaller negative effects than studies not funded by the industry (American Journal of Public Health 2007;97:667-75, doi: 10.2105/AJPH.2005.083782). Overall, soft drinks are strongly associated with greater energy intake and body weight and lower intake of milk, calcium, and other nutrients as well as greater risk of medical disorders such as diabetes.
When a patient's name is spoken by a familiar voice even some patients in a persistent vegetative state produce a cerebral response, detectable by functional magnetic resonance imaging. Researchers describe seven cases of persistent vegetative state and four cases with minimally conscious states (Neurology 2007;68:895-9, www.neurology.org/cgi/content/abstract/68/12/895). Five of the patients with presumed persistent vegetative state had a cerebral response, and the two that showed the most widespread activation went on to improve to minimally conscious states within three months. Functional magnetic resonance imaging could be useful to distinguish between the two states.
Is there nothing statins can't do? A meta-analysis of randomised controlled trials claims that statins lower blood pressure to a small but statistically significant and clinically meaningful degree (Hypertension 2007;49:792-8, doi: 10.1161/01.HYP.0000259737.43916.42). The response was unrelated to age, serum cholesterol changes, or length of trial, but the effects were greater the higher the baseline blood pressure.
Canadian researchers have found a link between being diagnosed with ovarian cancer and not regularly visiting a doctor. Using case-control methods they found a greater risk of ovarian cancer among women who during the five year study period did not have a medical visit or pelvic examination or who had no regular healthcare provider (CMAJ 2007;176:941-7, doi: 10.1503/cmaj.060697). Postmenopausal women were at higher risk. There's no obvious explanation.
Weekends are good for lots of things—but not for having strokes. Statistics from the hospital morbidity database in Canada show that patients with stroke who are admitted at weekends have a higher risk adjusted mortality than patients admitted on weekdays (Stroke 2007;38:1211-15, doi: 10.1161/01.STR.0000259622.78616.ea). Rural and urban settings had similar patterns, and it made no difference whether the most responsible doctor was a general practitioner or a specialist.
Apart from being a smoker and having to take drugs twice or fewer times a day, the most important independent predictor of non-adherence to repeat prescriptions for heart failure drugs was a positive response to the question “have you changed your daily routine to accommodate your heart failure medication schedule” (British Journal of Clinical Pharmacology 2007;63:488-93, doi: 10.1111/j.1365-2125.2006.02800.x). Having a highly structured daily routine was a strong predictor of adherence.