eMJA: In Other Journals, 2 November 2009

Music may soothe neonates in hospital and help to manage the pain associated with procedures such as heel prick test and circumcision, according to a Canadian systematic review. Nine randomised controlled trials were included in the study, which aimed to assess the usefulness of playing music in neonatal units to improve behavioural and physiological outcomes in babies. Outcomes included heart rate and respiratory rate, oxygen saturation, behavioural state and pain. The most common music type used was recorded lullabies. Although the authors set out to perform a meta-analysis, this was not possible due to the heterogeneity of the outcomes of the included trials. The methodological quality of the studies found was also generally poor, which added to the difficulty of analysing the data. The authors conclude that in general, music may be beneficial in terms of pain and behavioural states in neonates, particularly for less painful procedures, but that more methodologically rigorous trials are warranted.

Middle-aged spread

Women who are overweight in mid life are less likely to have healthy survival into old age, according to the results of the Nurses’ Health Study, United States. The research, involving over 17 000 women who survived until at least 70 years of age, gathered data on chronic disease, cognitive and physical function, and mental health. Participants were followed from a mean age of 50 years at baseline to at least 70 years. Healthy survival was designated as no major chronic diseases and no significant physical, mental, or cognitive limitations. Body mass index (BMI) was measured at baseline and correlated with the probability of healthy survival. Women with an increased BMI at baseline had significantly reduced odds of healthy survival compared to usual survival, with obese women having 79% lower odds of healthy survival than lean women. Those who gained weight from early adulthood to mid life also had a reduced probability of healthy survival. The authors conclude that adiposity in mid life is associated with a linearly decreased chance of healthy old age, and stress the importance of maintaining a healthy weight from early adulthood.

BMJ 2009; 339: b3796

Subdural haematoma — to drain or not to drain

Chronic subdural haematoma recurs after surgical evacuation in up to 30% of patients and is associated with significant mortality. The use of drains inserted into the subdural space after burr-hole evacuation had not been rigorously evaluated until a recent UK randomised controlled trial. The study included 269 patients with chronic subdural haematoma. Participants were assigned to receive either a drain or no drain after evacuation of a haematoma, with a primary endpoint of recurrence requiring redrainage. The use of a drain resulted in a marked reduction in recurrence and mortality at 6 months; the difference was so significant that the trial was stopped early. No increase in the frequency of medical or surgical complications was found with the use of drains, a concern that the authors comment was a reason previously cited by surgeons for not using them.

Lancet 2009; 374: 1067-1073

The (tired) young doctors

Medical residents are more likely to make major errors when fatigued and distressed, say US researchers. In a prospective longitudinal study of over 350 medical residents at the Mayo Clinic, there was an association of self-reported major medical errors with increasing sleepiness and fatigue, burnout, emotional exhaustion and a positive depression screen. Higher levels of fatigue and distress were found to be jointly and independently associated with medical errors, suggesting that they are distinct states. The authors comment that physician training schemes should identify and address these potentially hazardous problems.

JAMA 2009; 302: 1294-1300

Dr Tanya Grassi, MJA

mja.com.au | The Medical Journal of Australia

Username:
Password:

Password forgotten? Click here What is my username?