BMJ 2010: 341: 947 – 1002 (6th November)

If patients come to me concerned about their risk of future bowel cancer, I can now advise them on how to reduce it substantially by appropriate health behaviours. Five factors were all found to make a difference: avoiding smoking, avoiding excess alcohol, keeping waist circumference down, exercising regularly, and eating healthily (this last included eating more dietary fibre, more fruit and veg, less total fat, and less red and processed meat).

When I did my A&E stint back in my SHO days (yes, all right, I’m showing my age, it was back when those were SHO days), I used to wonder whether we should be referring all patients with ankle sprains to physio. The answer? Probably not. It’s helpful for athletes, soldiers, and severe sprains, as in those cases it gets people back to work and/or sports playing more quickly. However, there’s ‘limited evidence’ of it being helpful in other cases, so we can go ahead with dishing out the home exercise leaflets and general advice to wiggle their foot round in circles and send them home to do it themselves and save the physios’ time.

A really interesting addition to the available evidence on a very heated topic in parenting circles: The move towards low-tech childbirth may be misguided. In the Netherlands, infants of low-risk pregnant women under midwifery care actually had higher risks of dying while born than infants of high-risk pregnant women cared for by obstetricians. I look forward to seeing what debate transpires on this one. Hoo boy.

When should I suspect psoriatic arthritis? Well, if a patient with psoriasis has early morning stiffness >30 minutes; spinal stiffness improving with exercise; joint swelling or tenderness; or diffusely swollen ‘sausage’ digits, otherwise known as dactylitis.

I didn’t realise melatonin had been credited with possibly improving chronic migraine, but, alas, that hope now appears to be scuppered before coming to fruition. If any of my patients read about it on the Internet and come to ask me whether melatonin might help their migraines, I must now disappoint them by telling them of an RCT reported in Neurology that showed slow-release melatonin to be no better than placebo for this purpose. In other words, guys, save your money.

And, while it’s difficult to know what to do to help cancer patients who complain of fatigue, it now seems CBT is a good bet. In practice, this probably still means that it’s difficult to know what to do to help cancer patients who complain of fatigue, as I’m guessing it would prove somewhat difficult to persuade the MHT to provide CBT for that purpose, but at least it’s an idea to go on.


About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in BMJ, BMJ 2010, BMJ 341, Ligaments, Pregnancy and Childbirth. Bookmark the permalink.

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