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BMJ. 2007 April 14; 334(7597): 806.
PMCID: PMC1852001

Minerva

Referral for NHS dental implant treatment is reserved for people who have lost teeth through trauma or were born with too few. It's expensive, and demand vastly outweighs resources. An audit of referral and selection in six months in one London hospital found that only 80% of referrals were in the approved categories (Annals of the Royal College of England 2007;89:247-51, doi: 10.1308/003588407X155464). As many as a quarter of patients had untreated caries or periodontitis, which are both contraindications for NHS implant treatment. The proportion of patients with caries was more than double among patients referred by general dental practitioners than among patients referred from hospitals.

In the aftermath of the Modernising Medical Careers debacle, a letter writer in the Journal of the Royal Society of Medicine (2007;100:164, www.jrsm.org/cgi/content/full/100/4/164-a) points out that there's value in holding interviews for both employers and future employees. Junior doctors should regard the process as much for them to have the opportunity to find out more about their potential employers, and to decline a job if the red flags start waving, as it is for consultants to choose their juniors.

The Netherlands recently introduced a standardised medicinal cannabis product. Because it was anticipated that this would probably be taken with anticancer drugs, researchers did a drug interaction study (Oncologist 2007;12:291-300, doi: 10.1634/theoncologist.12-3-291). They looked at the effect of medicinal cannabis on irinotecan and docetaxel, which are both metabolised by cytochrome P-450 isozyme 3A. The cannabis product was given as a herbal tea to patients with cancer being treated with these drugs. The researchers found that the plasma pharmacokinetics were not significantly altered by the cannabis, leaving the required chemotherapy doses unchanged.

A prospective randomised trial of oral betamethasone versus intramuscular dexamethasone for treating mild to moderate viral croup found no difference between them (Academic Emergency Medicine 2007;14:e76, www.aemj.org/cgi/reprint/14/4/e76). The study was presented as an abstract at the first inter-American conference on emergency medicine. The oral steroid is clearly palatable and doesn't require a nurse to give it, say the authors, making it a good alternative for ambulatory management.

The consumer correspondent for the Journal of Family Planning and Reproductive HealthCare had the arguably enviable job of writing about sex products, much to her friends' amazement (2007;33:129-30, doi: 10.1783/147118907780254015). Apparently they were shocked that such a “highbrow periodical should have commissioned a piece about what can be viewed as such a lowbrow industry.” The correspondent's biggest warning is that even the better informed outlets promote costly sex products that are useless or even harmful. Health professionals “may giggle but it may cause our more innocent clients to reach unadvisedly for the credit card.”

The first ever conference on blogging in health care took place last year. Typically blogs—from “web logs”—are defined as “personal journals posted on the internet,” with entries in reverse chronological order and an invitation for readers to contribute, turning the diary entries into conversations. Medical blogs are sprouting up everywhere and are becoming seen more as tools for communication of complex science—albeit without peer review—and not just for entertainment (European Science Editing 2007;33:13-4).

Alone neither neck support pillows nor exercises help chronic neck pain, but after three months a combination of the two interventions brought about a significant reduction in pain (Journal of Rheumatology 2007;34:151-8, www.jrheum.com/abstracts/abstracts07/151.html). But commenting on the trial in Journal Watch (2007;27:43, http://general-medicine.jwatch.org/cgi/content/full/2007/206/3) a reviewer points out that the original neck pain was relatively mild and the benefit modest. And the pillow had been designed by one of the authors, who holds the trademark for the brand, which is a potential conflict of interest.

The health secretary, Patricia Hewitt, clearly belongs to the “no pain, no gain” school of theory. Interviewed in the Health Service Journal, she said the “pain has been worth it” (29 Mar, p 12-3, www.hsj.co.uk/healthservicejournal/pages/na/p12/070329). The pain she's referring to is the pressure placed on chief executives to balance the books in the past year. So much pressure, said some, that they were forced to make short term savings that affected patients' care.

A meta-analysis in the Journal of Bone and Joint Surgery(Am) reports that releasing tourniquets early to obtain haemostasis after knee arthroplasty increases the blood loss (2007;89:699-705, doi: 10.2106/JBJS.F.00497). And releasing a tourniquet after wound closure can increase the risk of early postoperative complications, with the need for further surgery. What's not known is what happens with the late release of a tourniquet and whether this is also associated with early postoperative complications.

The placebo response is important in the treatment of depression. But how much is contributed by different factors remains hazy. Double blind, placebo controlled trials of antidepressants show that follow-up assessments incur a significant therapeutic effect for patients taking placebo, which represents 40% of the placebo response (British Journal of Psychiatry 2007;190:287-92, doi: 10.1192/bjp.bp.106.028555). Two additional visits were associated with twice the reduction in depression score than one visit, making them cumulative.


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