Minerva: June 2001
Minerva wonders if there is a conspiracy
afoot to phase out doctors altogether. Readers of the Postgraduate Medical Journal (2001;
77:3379) are reminded this month about
the chief nursing officer's 10 key roles for
nurses in the NHS Plan. It seems that in
future nurses will be required to order diagnostic tests, to make and receive referrals to
particular specialists, to admit and discharge
patients with specified conditions, and to
run clinics. Minerva wonders if the
PMJ will
be renamed the PNJ in future.
We hear and read a lot about violence
among children and teenagers in the United
States but far less about bullying. When
almost 16 000 children completed the
World Health Organization's health behaviour in school aged children survey in 1998
a shocking 30% admitted that they been
involved in moderate or frequent bullying
(JAMA 2001;285:2094100). A fifth described themselves as bullies, while 17%
claimed they had been the victims of
bullying. Not surprisingly, both perpetrating
and experiencing bullying was associated
with poor psychosocial adjustment.
The most common presenting complaint to
one English paediatric accident and emergency department in 19989 was trauma
(69% of cases). For "medical" cases (27%),
breathing difficulties, fevers, and diarrhoea
were the most common. Over three quarters
of all cases were seen by senior house officers. Paediatric consultants were involved in
just 1.4% of the cases (
Archives of Diseases in
Childhood 2001;84:3902). Sadly, much of
the audit data for the medical cases was
missing - perhaps because the senior house
officers managing these patients were too
busy to complete the paperwork.
"Do we need George Clooney?" asks this
month's
Emergency Medicine Journal (2001;
18:1578). Judging by the overworked
senior house officers above, getting the "Dr
Ross" character into accident and emergency might prove fruitful. Realistically,
though, a move to an accident and
emergency consultant who sees only children is unlikely to become common
practice in Britain. Ensuring that accident
and emergency trainees get more than the
current minimum of three months of
paediatric attachment may be a sensible
alternative.
As a child, Minerva was warned by her
mother about the dangers of reading in poor
light. Although this has long been dismissed
by eye care professionals, according to the
British Journal of Ophthalmology (2001;85:509
10) there is growing evidence that, in addition
to our genes' contribution, how we use our
eyes does influence eventual refractive status.
Investigations of night time exposure to light
commonly depend on retrospective data collection, and the commentator urges clinicians
to look ahead to confirmwhether mother was
right, as usual.
Minerva was relieved to read in Thorax
(2001;56:4124) that those who attended the
Millennium British Thoracic Society meeting displayed a high level of exercise
tolerance at the dinner and subsequent
party. The author of the conference report
seems mildly surprised at the ability of the
society members to work hard and yet still
find the energy to go out and enjoy
themselves. Minerva recalls that most doctors rapidly acquire these skills as soon as
they start medical school.
Schizophrenia is conventionally distinguished from the organic psychoses - dementia and delirium - by the absence of
intellectual compromise. A study of 128
patients with chronic schizophrenia now
reveals that the level of disorientation, poor
cognitive performance, and failure in daily
living skills suggest that, over and above the
effects of institutionalisation, an additional
diagnosis of dementia could be made
(
Journal of Neurology, Neurosurgery and Psychiatry 2001;70:58896). Postmortem and
imaging studies often fail to show the
characteristic abnormalities of any known
neurodegenerative disorder, leading to the
suspicion that a novel neuropathological
process may be at large.
Restenosis after coronary artery stenting is
clearly undesirable, and it seems to happen
more often to patients who are genetically
prone to having higher levels of circulating
angiotensinI converting enzyme (ACE). A
group of French doctors set about seeing if
they could use high dose ACE inhibitors to
reduce the risk of restenosis (Lancet 2001;
357:13214). Contrary to expectations,
they observed an exaggerated restenotic
process in patients given the ACE inhibitor
compared with those who had received
placebo.
A 68 year old man presented to his accident and
emergency department with a history of burning
pain across the left side of his face, first noticed after a
hot shower. His skin was erythematous, and a
diagnosis of superficial burn injury was made. Three
days later he returned with multiple crusty eruptions
within the distribution of the ophthalmic division of
the trigeminal nerve, typical of ophthalmic herpes
zoster.He was treated with aciclovir.
I Grant, specialist registrar,
A Pandya, specialist registrar,
M G Dickson, consultant surgeon, department of
plastic surgery, Lister Hospital, Stevenage SG1 4AB
Submissions for this page should include signed
consent to publication from the patient.
An 85 year old woman was admitted for treatment
of her urinary tract infection with demeclocycline.
Twelve days later she developed a rash on the left
side of her face. The ophthalmologist diagnosed
herpes zoster, and she was given aciclovir. The
dermatologist reviewing her noticed that she sat by
the ward window and made a diagnosis of
photoallergic dermatitis due to demeclocycline. It
cleared with 2.5% hydrocortisone ointment.
Demeclocycline is the most photosensitive of the
tetracyclines. It can also cause a phototoxic reaction,
in which case the patient presents with sunburn.
Prescribers should warn patients about this side
effect and offer appropriate protective advice.
C M QuarteyPapafio, locum consultant, dermatology
department, Pilgrim Hospital, Boston, Lincolnshire
PE21 9QS
Submissions for this page should include signed
consent to publication from the patient.
studentBMJ 2001;09:171-216 June ISSN 0966-6494
