Does this newly born infant require resuscitation? Is the baby crying or breathing? Is there good muscle tone? Is it a term gestation? If the answer to all these questions is yes, the infant does not require resuscitation. Instead, the baby should be dried, warmed and observed. The airway should be cleared if necessary. If the answer is no to all the questions, the recent American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care provide a useful algorithm. See Circulation 2010; 122:S909–S919.
Retirement as a health intervention: Anecdotally, many people say that they feel healthier after they retire. A recent study shows that retirement is indeed associated with a reduction in mental and physical fatigue and symptoms of depression. Over 11 000 men and almost 3000 women in France were followed up from seven years before retirement to seven years after retirement. Although the decrease in fatigue was more pronounced in those with chronic diseases, this study did not show any effect of retirement on the risk of major chronic diseases. Most of the improvement in fatigue occurred in a two-year period around retirement. See BMJ 2010:341: c6149 doi:10.1136/bmj.c6149.
Can patients with coronary artery disease and abnormal liver enzymes take statins? Treatment with statins appears to be safe in patients with coronary artery disease and mild-to-moderately abnormal results of liver tests. Fewer than 1% of patients receiving a statin discontinued treatment because of liver-related adverse effects. Although this post-hoc analysis of the GREACE study is limited by the small number of patients (n = 437) with possible nonalcoholic fatty liver disease, the results indicate that treatment with statins can improve the results of liver tests and reduce cardiovascular mortality in this group. See Lancet 2010; 376:1916–22.
Should asymptomatic women be screened for endometrial cancer? No, says the Society of Obstetricians and Gynaecologists of Canada. In a recently released clinical practice guideline, the authors state that good evidence exists to recommend against the use of transvaginal ultrasound and endometrial sampling to screen for endometrial cancer in asymptomatic postmenopausal women. If endometrial abnormalities are found incidentally in this group, the patient should be referred to a gynecologist. See J Obstet Gynaecol Can 2010;32:990–9.
Missed opportunity: In most emergency departments, emergency physicians do an initial review of radiographs, with a radiologist providing an interpretation at a later time. In one study of a large quality assurance database, the radiologist and emergency physician disagreed on the interpretation in 4605 (3%) of 151 000 radiographs. The most commonly missed findings were fractures, dislocations, air-space disease, pulmonary nodules and bowel obstruction. The good news? The rate of potential change in emergency management based solely on these discrepancies was only 0.056%. See Am J Emerg Med 2011;29:18–25.
All talk and no action? Although physicians spend much of their time counselling patients to exercise more and eat less, the results of all this talk seem to be limited. A systematic review on behavioural counselling to promote physical activity and healthful diets in adults was conducted for the US Preventive Services Task Force. The authors found that high-intensity dietary counselling, with or without physical activity counselling, resulted in small changes of −0.3 to −0.7 kg/m2 in body mass index, with similarly modest changes in blood pressure and cholesterol levels. Not surprisingly, the effects on self-reported dietary and physical activity changes were much larger. See Ann Intern Med 2010;153:736–50.
Is there a “surgical personality”? Probably not, but everybody thinks there is. A study in Switzerland asked nursing staff in a large tertiary hospital to rate the personality traits of internists and surgeons. At the same time, the internists and surgeons in the hospital were asked to complete the Freiberg Personality Inventory. The existence of a surgical stereotype was supported by the responses of the 334 nurses (62%) who participated. When the responses of the 253 doctors (89%) who completed the inventory were analyzed, the authors found that the internists were less aggressive and the surgeons more extroverted and achievement-oriented than the general population. However, no substantial differences emerged when the internists and surgeons were compared with each other. See Surgery 2010;148:901–7.