Dinner, bed and breakfast

New Zealand authors have reported their experience of a "hospital-avoidance scheme" — dubbed Dinner Bed and Breakfast (DBB), in which elderly patients with a self-limiting illness were cared for in a nursing home setting rather than being admitted to an acute care hospital. The DBB project was facilitated by a local surplus of nursing home capacity.

Initially, the scheme seemed to inadvertently facilitate the transfer of patients from their home to long-term nursing home care; but, over time, the program better met its intention of providing short-term care for patients who were usually independent and expected to recover over 3 to 5 days and return to their own home. However, the shift of care caused strain on specialist geriatric services, which was not planned or funded. On balance, the report’s authors viewed DBB as an acceptable interim solution while continuing to develop the ideal of enhanced care at home for appropriately selected patients.

www.nzma.org.nz/journal/118-1214/1439/

Lawnmower neuritis

A lawnmower has been implicated in a curious case of longstanding, intermittent thigh pain.

A 32-year-old gardener complained of a 2-year history of burning pain along the anterolateral aspect of his left thigh whenever he used a ride-on lawnmower, especially over uneven ground. Examination was consistent with compression of the lateral femoral cutaneous nerve of the thigh. It turned out that this gardener’s broad utility belt dug into his "sides", compressing the nerve, whenever he sat on the lawnmower.

A few months later he was symptom-free, after a change in job (to warden) and belt (to a thinner one) and some weight loss.

CMAJ 2005; 172: 1273

"Kavacaine"

Enterprising Fijian researchers have made a topical anaesthetic gel from an extract of the pepper plant Piper methysticum, more commonly known as kava.

Usually kava is made into an intoxicating drink by infusing the macerated root of the plant in water. These researchers used 96% ethanol to extract 100% of the kavalactones present in 50 g of finely cut, fresh kava roots. They then diluted the 2.9 g of crude extract obtained into a commercially available, water-based gel.

According to the researchers, empirical observations indicated that the created gel had a potent topical anaesthetic effect; they say clinical trials of this agent are warranted.

Fiji Med J 2005; 24(1): 8-9

Diabetes reversed

A single transplant of living-donor islet cells from the distal pancreas of a healthy mother has successfully reversed brittle diabetes in her 27-year-old daughter. In January 2005, the donor mother underwent a distal pancreatectomy. More than 400 000 islet equivalents were isolated from the pancreatic tail and immediately transplanted into the recipient daughter’s liver via access to the percutaneous portal vein under local anaesthesia. The daughter became insulin-independent from the 22nd day after transplantation. Because she did not have autoimmune type 1 diabetes, the transplanted islets did not need protection against autoimmune disease. The mother had no complications.

The procedure took place in Japan, where, because of cultural considerations, access to cadaveric organ donors is especially scarce.

Lancet 2005; 365: 1642-1644

Low-Fat Plus diet

Cholesterol-lowering diets may prove more effective if they focus attention on including certain foods rather than just reducing saturated fat and cholesterol.1

In a short, four-week randomised trial, conducted in 120 adults with moderately raised fasting plasma low-density lipoprotein (LDL) cholesterol levels, US researchers found that the Low-Fat Plus diet increased the total- and LDL-cholesterol-lowering effect of a typical low-fat diet by a further 0.18 mmol/L.

The Low-Fat Plus diet had identical levels of total fat (30% of energy), saturated fat (10% of energy) and cholesterol (< 300 mg/day) as that of a typical low-fat diet, but incorporated more vegetables, legumes and whole grains. It included soy, oats, wheatgerm, almonds, peanuts, flaxseed and garlic, all of which have been independently shown to reduce serum cholesterol levels.2

1. Ann Intern Med 2005; 142: 725-733
2. Ann Intern Med 2005; 142: 793-795

Dr Ann Gregory, MJA