eMJA: In Other Journals, 5 January 2009

A change in surgeons may be necessary in very long operations, say UK researchers. Slack and colleagues studied the effect of operating time on surgeons’ muscular fatigue by collecting electromyographic signals from the deltoid (lateral head) and brachioradialis muscles in the dominant arms of eight surgeons while operating for a day. They found that the muscles fatigued during each operation, as well as over the course of the day; the longer the operation, the greater the fatigue. The researchers recommended that operations requiring high degrees of accuracy should be performed early in the day, that the more complex parts of each operation should be performed as early as possible, and that in the case of late complexity or very long operations, a change in surgeons may well be worth considering.

Forget ginkgo for dementia

Ginkgo biloba cannot be recommended for preventing dementia, according to US researchers. Following early indications of possible effectiveness, the Ginkgo Evaluation of Memory (GEM) Study Investigators conducted a randomised controlled trial comparing a twice-daily dose of 120 mg extract of G. biloba with placebo in 3069 community volunteers.1 All the volunteers were aged 75 years or older; most had normal cognition, 482 had mild cognitive impairment. After an average of 6 years of this intervention, G. biloba was not effective in reducing either overall incidence rate of dementia or Alzheimer’s disease. Further, an accompanying editorial drew attention to the potential adverse effects of the G. biloba extract as an illustration of why it is untenable to recommend a drug or nutraceutical in the absence of efficacy evidence simply because it could possibly help and initially appears harmless.2

1 JAMA 2008; 300: 2253-2262

2 JAMA 2008; 300: 2306-2308

Presidential genetics?

Would you vote for a prime ministerial (or presidential) candidate whose genetic information suggested an increased risk of cancer, Alzheimer’s disease or bipolar disorder? As voters, we may well have the right to know about a candidate’s risk of future disease as an indication of his or her fitness for office; however, US authors are concerned that genetic information is currently too easy to misinterpret and misrepresent. Further, it can simply be wrong by virtue of technical errors, low sequence coverage or low-complexity sequencing. As a result, Green and Annas say that we may be facing a future threat of “genetic McCarthyism”, whereby a candidate’s opponents may imply that his or her increased risk of disease is more substantial than it actually may be. To prevent such an era, they think future US presidential candidates should resist any calls to disclose their own genetic information.

N Engl J Med 2008; 359: 2192-2193

Rising up after a fall

Older people need training in strategies to get up from the floor after a fall, according to UK researchers. As part of the Cambridge City over-75s Cohort (CC75C) study, the researchers followed 110 participants — all aged over 90 years of age — for 1 year.1 They found that in a year, 60% of these generally frail nonagenarians had fallen at least once, and that among those who fell, 80% were unable to get up after at least one fall and 30% had lain on the floor for an hour or more. Nearly all of those who lay on the floor for a long time and had a call alarm system did not activate it. The CC75C researchers said preventive initiatives should include teaching older people how to get up if they fall.

An editorialist advised planning, instruction and practice getting up from the floor in the person’s own home.2 This program might be presented to the person involved as being similar to the training of the professional athlete who adopts a positive mental attitude and “visualises” the event in preparation.

1 BMJ 2008; 337: a2227

2 BMJ 2008; 337: a2320

Dr Ann Gregory, MJA

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