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BMJ. 2007 May 19; 334(7602): 1064.
PMCID: PMC1871778

Minerva

The characteristics of heart rate variability may be useful for predicting which patients with infections presenting to emergency departments are likely to develop septic shock. Twenty one of 81 patients enrolled in a study developed septic shock, and regression analysis identified the “root mean square successive difference” as the characteristic that best predicted this event (Academic Emergency Medicine 2007;14:392-7 doi: 10.1197/j.aem.2006.12.015). Before readers themselves go into shock, this characteristic can be automatically calculated by the machine that measures heart rate variability.

Does migraine affect cognitive function? A study in Neurology (2007;68;1417-24 doi: 10.1212/01.wnl.0000268250.10171.b3) suggests it does, but perhaps not as might be expected. Migraine sufferers, especially those who experience aura and those over 50, showed less decline on cognitive tasks over time than people who don't get migraine. They did score lower on tests of immediate and delayed memory at baseline, however.

Most studies of the impact of alcohol on health have focused on men. A study in Addiction (2007;102:730-9 doi: 10.1111/j.1360-0443.2007.01765.x) looks at alcohol use in women aged 35-69 who have had non-fatal heart attacks. The authors conclude that in this population of light to moderate drinkers, alcohol intake was associated with a reduced risk of myocardial infarction, compared with complete abstainers, although occasional binge drinking was related to a substantial increase in risk.

A direct comparison of continuous antiviral treatment for HIV infected people in India with structured interrupted antiviral treatment reports that the primary end point of maintaining a CD4 count of more than 200×106 cells/l at six and 12 months was achieved by both groups. The secondary end points were effective viral suppression, adverse events, and cost. One patient in the continuous therapy group and two in the interrupted group sustained a plasma viral load of more than 400×103 copies/l. No serious adverse events or deaths were reported, and a 50% reduction in costs was seen with interrupted therapy (AIDS Care 2007;19:507-13 doi: 10.1080/09540120701213849).

On a typical day in the United States, 75% of children watch television and 32% watch videos or DVDs. Not to be outdone, 27% of 5-6 year olds are now using a computer on a daily basis for nearly an hour, and more than a third of 3-6 year olds and a fifth of 0-2 year olds have a television in their bedroom. The reason commonly given is that this frees up television sets for other family members. The developmental impact from such media and digital obsession is not known (Pediatrics 2007; www.pediatrics.org/cgi/doi/10.1542/peds.2006-1804)

The Department of Health's standard application form designed to streamline applications to conduct multicentre research in the United Kingdom seems to have failed in its intention. Researchers applied to 316 primary care organisations in England and Wales. They could not establish contact with 4% of organisations; six months after submission only 82% of applications had been approved and the verdict was still awaited in 13%. A total of 318 staff hours were spent completing supplementary forms, providing extra information, and chasing up dormant applications (Journal of the Royal Society of Medicine 2007;100:234-8 www.jrsm.org/cgi/reprint/100/5/234).

Steroid sulfatase inhibitors are being developed as a potentially more potent treatment than aromatase inhibition for hormone dependent breast cancer in postmenopausal women. A novel tricyclic sulfamate ester has passed muster in the first trial of such treatment in postmenopausal women with oestrogen positive metastatic breast cancer. The drug almost completely blocked steroid sulfatase activity in peripheral blood lymphocytes and tumour tissue. In turn, this induced significant reductions in serum androstenediol and oestrogens. Disease was stable in five of the eight patients for up to seven months (Oncologist 2007;12:370-74 doi: 10.1634/theoncologist.12-4-370).

Minerva was not surprised to read in a study of 16 acute psychiatric wards that at any time of the day 84% of psychiatric inpatients were “socially disengaged” and mainly inactive. Just 4% of inpatients' time was spent in organised group activities, and many of the patients opted out of such activities altogether (Psychiatric Bulletin 2007;31:167-70 doi: 10.1192/pb.bp.105.009290).

The original Charnley hip joint has a follow-up history of more than 30 years. The Charnley Elite-Plus femoral stem is one of its younger offspring, thought to be particularly useful for younger patients. In a long term study, the survival of the femoral stem at 12 years was 99%, with revision as the end point. The prevalence of acetabular osteolysis was 10.8%. The use of a zirconia head and a modern cementing technique were crucial in preventing aseptic loosening of the femoral stem in these high risk patients (Journal of Bone and Joint Surgery (Br) 2007;89-B:449-54 doi: 10.1302/0301-620X.89B4.18665).

Same day discharge for patients having percutaneous coronary interventions such as stents and thrombolysis might be good when resources are tight, but is it safe? A randomised trial comparing same day discharge with overnight hospital stay found it to be safe and feasible in most (80%) patients selected, and there were no more complications with early discharge than in the overnight group (Circulation 2007;115:2299-306 doi: 10.1161/CIRCULATIONAHA.105.591495).


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