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Bad news for shift workers
Sophia is sure that many readers of the journal will be interested in a paper published in the BMJ 2012;345:e4800). A systematic review and meta-analysis investigated some of the potential risks associated with shift work and discovered a rather worrying answer. Shift work is associated with myocardial infarction, coronary events and ischaemic stroke and although the relative risks are modest, the population attributable risks are not insignificant. It is possible that disruption of circadian rhythms may be responsible for predisposing shift workers to vascular events.
Out of hospital cardiac arrest
In 2005, the American Heart Association published their ‘chain of survival’ concept for resuscitation of patients with out of hospital cardiac arrest. The chain will be familiar to many practitioners, comprising four links: early access to emergency medical care, early cardiopulmonary resuscitation, early defibrillation and early advanced cardiac life support. A recent paper in Circulation (2012;126:589–97) recommends the implementation of a fifth link: transfer to a tertiary hospital where patients may receive intensive post-resuscitation care, appropriate circulatory and respiratory support, therapeutic hypothermia and percutaneous coronary intervention. Data suggests that implementation of the fifth link is associated with a significant improvement in neurological outcome after out of hospital cardiac arrest.
Injuries from bouncers
Lausanne is famous for its nightlife, with 30 000 night clubbers enjoying it on a typical weekend. However, there may be another side to the story. A study published in the Journal of Forensic and Legal Medicine (2012;19:341–4) describes injuries allegedly inflicted by nightclub security guards on 70 of their ‘clients’ in the city over a 3 year period. 18 of these clients sustained one or more fractures (all involving the face or head). Based upon their results, the authors raise concerns about the violent way that nightclub security guards interact.
Suicide
Evidence that the current economic recession in England may be responsible for increased rates of suicide is presented in the BMJ (2012;345:e5142). The data suggest that a significant proportion of the increase in the number of suicides may be attributed to rising unemployment. In what might be considered to be an equally depressing article in the same journal (BMJ 2012;345:e4972), a randomised controlled trial failed to show any significant effect for assertive outreach intervention after a failed suicide attempt.
Diagnosing appendicitis in children
Diagnosing appendicitis in the paediatric population is often challenging due to the lack of clear historical and physical examination findings. The use of CT scanning in suspected appendicitis has increased, but the importance of minimising radiation exposure has resulted in the development of clinical practice guidelines. The evaluation of one set of clinical guidelines was undertaken in a US Emergency Department. Researchers found that implementation of guidelines based on risk-stratification, staged imaging and early surgical intervention in high-risk cases resulted in lower rates of negative appendectomy and missed appendicitis. 58% of patients were managed without a CT scan (Academic Emergency Medicine 2012;19:886–93).
Poisoning in young children
In the 1950s most cases of childhood poisoning were due to ingestion of household products. However, today, an overwhelming majority of overdoses in children are due to ingestion of medication and pharmaceutical agents. Recent data reveals a 20% rise in ED visits of children aged less than 5 years presenting with medication overdose between 2005 and 2009. This may be due to the increasing availability of medicines in the home. An expert from the National Poisons Information Service argues that blister packs (which are excluded from standards set for child-resistant packaging) should also be adapted to protect children, along with further education of parents regarding storage of medicines. While child-resistant packaging has undoubtedly been a great advancement in the protection of children against accidental poisoning, it is clear that further action still needs to be taken (Arch Dis Child 2012;97:831–2).
Administration of medication in children
The potential for over-dosage and administration of sub-therapeutic dosage is much greater in children than in adults. This may partly reflect inconsistencies in the various devices used to measure oral medication, including metal tea spoons, calibrated spoons and oral syringes. A study from Cambridge found that although oral syringes produce the smallest variance in volume, parents are most accurate at administering medication with a calibrated spoon. The researchers conclude that in order to further improve dosing accuracy, parents should be educated on the correct use of oral syringes (Arch Dis Child 2012;97:838–41).
Treatment of bronchiolitis in children
The mainstay of treatment for bronchiolitis in children is supportive care with an emphasis on fluid replacement, gentle suctioning of nasal secretions, prone positioning, and respiratory support if needed. For a long time, pharmacological agents were not thought to be of any benefit in the treatment of this self-limiting viral respiratory tract infection. However, a review of recent literature published in Archives of Diseases in Childhood (2012; 97: 827–30) suggests that the combination of nebulised adrenaline with either oral dexamethasone or mixed with 3% nebulised hypertonic saline can be beneficial in treating the acute symptoms of bronchiolitis, as well as decreasing the length of hospital stay. Although both strategies appear to be safe and well tolerated, further research is needed to clarify their roles in clinical use.
Footnotes
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Competing interests None.
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Provenance and peer review Commissioned; internally peer reviewed.