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Sophia already enjoys red wine for health reasons and is happy to justify a further pleasure in the form of dark chocolate, albeit in small portions. The addition of one piece of dark chocolate per day significantly improved both systolic and diastolic blood pressure in hypertensive patients compared with white chocolate. The effect is believed to be by increased nitric oxide production in the vascular endothelium. The effect was greater for those with higher blood pressures (JAMA 2007;298:49–60).
An article in JAMA (2007;298:289–98) reports disappointing results for those who believe that a diet high in fruit and vegetables has anticarcinogenic properties. Groups of women with early stage breast cancer who adopted a diet high in fruit, vegetables and fibre were compared with a similar group who followed a “five a day” regime. There was no difference in additional breast cancer events and mortality over a 7‐year period.
A controversial study from a US Level 1 Trauma Center warns against simple prehospital procedures for some patients. Prehospital procedures performed for penetrating trauma resulted in patients being more than two and a half times less likely to survive emergency department thoracotomy for each procedure performed! Procedures as straightforward as intravenous cannulation, tracheal intubation and application of a cervical collar adversely affected outcome (J Trauma 2007;63:113–20).
Triglycerides are routinely measured in the fasting state, but most of the time the majority of us are in the non‐fasting state. A study of more that 13000 individuals conducted in Copenhagen tested the hypothesis that non‐fasting triglycerides predict risk of myocardial infarction, ischaemic heart disease and death (JAMA 2007;298:299–308). Non‐fasting triglycerides were independently predictive of myocardial infarction and death in women and in men, with the predictive ability being greater in women.
Sensitivity of focused assessment with sonography for trauma (FAST) scanning for intraperitoneal haemorrhage appears to be low in patients with pelvic fractures and risk of haemorrhage (J Trauma 2007;63:97–102). Although only 146 patients were involved, sensitivity was only 26% in the group with 31 false negatives for intraperitoneal haemorrhage.
Sophia has always felt a little uneasy about the convention of using local anaesthetic gel for male catheterisation, but simple lubricating jelly for the same procedure in females. The argument goes that the female urethra is straighter and shorter than the male equivalent, so catheterisation should not be painful. However, an Australian trial showed that application of lidocaine gel to the catheter for females significantly reduced pain of catheterisation in females when compared with lubricating jelly (Emerg Med Australas 2007;19:315–9).
Prophylactic antibiotics do not decrease the rate of recurrent urinary tract infection (UTI) in children less than 6 years old, but do increase antibiotic resistance. The risks and benefits of prophylactic antibiotics need to be considered carefully, particularly in those with lower grades of reflux (JAMA 2007;298:179–86).
It is common practice in some hospitals that at least two sets of blood cultures are taken from different sites before commencing antibiotics for patients with community acquired pneumonia. However, a study from Pennsylvania (J Emerg Med 2007;33:1–8) casts doubt on the usefulness of these tests, arguing that they rarely influence treatment.
A systematic review concludes that educational interventions applied in the ED for asthma improve hospital admission rates, but not ED re‐presentations, days lost from school or work, and do not improve peak flow or quality of life. The data imply that patients are likely to present to the ED earlier in their exacerbation. Interestingly, education by a range of specialties and professions and given up to 1 week after presentation produced the same results (Cochrane Database Syst Rev 2007;3:CD003000).
An article in Evidence Based Medicine (2007;12:74–5) concludes that combining inhaled corticosteroids with beta 2 agonists leads to fewer hospital admissions and a higher discharge rate from the ED within the first 4 hours when compared with systemic corticosteroids or placebo with beta 2 agonists. Objective measures, such as peak expiratory flow, also improved.
The gut feeling that “something is wrong” has been used by generations of doctors in their assessment and management of unwell children. A study in the British Journal of General Practice (2007;57:538–46) indicates that such feelings can be a most useful predictor of infection.
A paper from Germany reports the experience of managing more than 300 cases of sudden infant death syndrome (J Forensic Leg Med 2007;14:343–7). The authors focus on the way that relatives are cared for.