Minerva: April 2000
The United Kingdom's dead citizens charter was established last
year to improve end of life experiences and promote better funeral
practices. It identifies 30 areas that need an overhaul, including
the availability of information for relatives organising a funeral.
Institutions such as hospitals, hospices, and nursing homes need
funeral advisers, say the National Funerals College, to guide relatives
rationally through a choice of funeral directors and disposal options.
A pilot study is planned.
Many general practitioners dream of paperless surgeries, where
piles of patient records, BMJs, and guidelines no longer
litter the carpet tiles. For now, however, 96% of practices are
stuck with paper, according to a recent British survey (British
Journal of General Practice 2000;50:46.7). Most respondents
blamed high costs for slow progress with computerisation. Others
were worried about the legal status of purely electronic records.
The NHS Executive's plans to convert all practices to electronic
records by 2005 are beginning to look overoptimistic.
Seasonal mood changes are common in western Europe, and they tend
to occur over winter. Chinese medical students, however, go gloomy
in the summer (American Journal of Psychiatry 2000;157:133.5).
Researchers suggest that a lack of air conditioning might make the
summer months in mainland China oppressive and depressing. Social
upheaval during the long summer vacations is a more plausible explanation.
Contraceptive pills have comparable effects to hormone replacement
therapy in healthy postmenopausal women, according to a small randomised
trial from Thailand (Obstetrics and Gynaecology 2000;95:87.94).
Both treatments increased bone mineral density and improved serum
lipid profiles in 80 women over one year. There was little to choose
between them, although oral contraceptives suppressed bone turnover
more than hormone replacement therapy. This may or may not translate
into fewer fractures.
The 1994 ceasefire in Northern Ireland brought an uneasy peace
to civilians but did not diminish the number or violence of punishments
handed out by paramilitary leaders to wayward members (Injury
2000; 31:41.5). Ironically, the injuries got worse as severe beatings
replaced gunshots to the limbs as the preferred method of punishment.
Shootings were abandoned, say doctors at the Royal Victoria Hospital
in Belfast, because paramilitary groups considered use of firearms
a breach of the peace process.
Embryos placed in the uterus after in vitro fertilisation tend
to implant where the operator chooses to put them (Fertility
and Sterility 2000;73:123.5). Embryos are too small to see with
ultrasound but Japanese researchers tracked their whereabouts by
labelling the embryos with air. Once a pregnancy was established,
they used transvaginal ultrasound to locate the gestational sac.
80% of the "successful" embryos had stayed put in the fundus.
Stigma against mentally ill people is widespread and pervasive,
and although we have recognised descriptions for some prejudicial
beliefs, such as racism and homophobia, there is no word to describe
prejudice against people with mental illness. One psychiatrist suggests
the term "psychophobia" (Advances in Psychiatric Treatment
2000;6:65.72). This doesn't sound quite right to Minerva, who suspects
that people will be offended by the stem "psycho."
Scientific fraud is as old as science, and usu. ally goes undetected
despite the best efforts of peer reviewers and monitoring committees.
There are, however, statistical techniques available for detecting
weird or suspicious patterns in a dataset, writes an international
team of statisticians (Statistics in Medicine 1999;18:3435.51).
They argue that it is very difficult to make up or cook data so
that it behaves plausibly when analysed. Detecting fraud this way
would be cheaper, and possibly more effective, than ever more extensive
trial monitoring.
The excesses of the American food industry reached new heights
with the recent launch of Mrs Fields' new "Stokabunga" cookie. Each
one contains more calories than an average meal - and an unprecedented
48 grams of fat, 16 of them saturated. Less of a snack than a survival
aid for Arctic explorers on unsupported expeditions to the pole.
Normal Americans are advised to avoid them (Nutrition Action
Health Letter 1999; 26:16).
Stimulation of the enteric nervous system is probably to blame
for the potentially lethal diarrhoea triggered by rotavirus infection
in children, report Swedish scientists (Science 2000;287:491.5).
Cholera and Escherichia coli are known to cause diarrhoea
this way, but it's a new and important finding about the rotavirus,
which kills thousands of infants each year. Effective drugs are
still a long way off, however, not least because investing in treatments
for children in the developing world is financially unrewarding
for drug manufacturers.
Why do patients with atrial fibrillation not receive warfarin,
asks a review in Archives of Internal Medicine (2000;160:41.6).
Partly because doctors find it difficult to weigh up the risks and
benefits in individual patients. Personal experience with patients
taking warfarin skews the risk benefit ratio established by clinical
trials, say the authors. The human element is understandable; far
worse is the conflicting advice given by clinical guidelines.
A 76
year old man came to the eye clinic after his optician found
some macular abnormalities. He had discrete pigmented scars
at both maculae consistent with solar burns. Visual acuity was
6/9 right and 6/6 left. The patient said that as a young man
he had used the Bates method for improving defective vision.
Bates was an American doctor who, in the early part of the 20th
century, advised patients to stare at the sun with a magnifying
glass to improve their vision. Our patient was a timely reminder
of the effects of direct sunlight on the retina. He presented
on August 10-the day before the total eclipse.
Marianne Shiew, senior house officer,
Michael Spolton, consultant, department of ophthalmology, East Surrey Healthcare NHS Trust, RedhillRH1 5RH
Submissions for this
page should include signed consent to publication from the patient
studentBMJ 2000;08:89-130 April ISSN 0966-6494
