Volume 193 - Issue 10
In Other Journals
Author: Alison Williams
Med J Aust 2010; 193 (10): 618. || doi: 10.5694/j.1326-5377.2010.tb04077.x
Published online: 15 November 2010
Published online: 15 November 2010
Surgical safety checks
According to a US study, routine adoption of safety practices used by aircrew may help reduce surgical mortality. In 2006, a training program focusing on checklists and team-work was implemented at 74 surgical facilities in the Veterans Health Administration. Theatre staff (anaesthetists, nurses, technicians and surgeons) all attended the training together, which included strategies such as routine preoperative briefings and postoperative debriefings, challenging each other when identifying safety risks, recognising red flags and stepping back to reassess a situation. The training also facilitated more open communication in theatre and encouraged all team members to speak up if they had a safety concern. Facilities participating in the program experienced an 18% reduction in annual patient mortality (RR, 0.82; 95% CI, 0.76-0.91; P = 0.01) compared with a 7% decrease among the 34 facilities that had not yet undergone training (RR, 0.93; 95% CI, 0.80-1.06; P = 0.59).
JAMA 2010; 304: 1693-1700
Say cheese
Is it possible to tell the difference between a fake smile and one that comes from the heart? A 72-year-old man with acute cerebral ischaemia and left facial hemiparesis was unable to fully smile on command, but during emotional encounters he was able to overcome the facial paralysis. This is believed to be because the nerve tracts affecting voluntary facial movement originate from the motor cortex, while those affecting involuntary movement during emotion probably arise from a medial brain region with input from the limbic system.
N Engl J Med 2010; 363: e25
Dental bugs and cardiovascular events
Bacteria associated with chronic periodontal disease have been implicated as contributing to cardiovascular disease, but can their release during invasive dental procedures actually trigger a cardiovascular event? After analysing Medicaid data for 32 000 cases of myocardial infarction or stroke, UK researchers have shown a small but significant increase in these events within a month after invasive dental procedures such as tooth extractions (incidence ratio, 1.50; 95% CI, 1.09-2.06). Fortunately, no events occurred on the actual day of the procedure and the risk was found to gradually subside to baseline after about 6 months. The authors state that these “short-lived adverse effects are . . . likely to be outweighed by long-term benefits of invasive dental treatment to vascular health”.
Ann Intern Med 2010; 153: 499-506
Is smaller better?
Results of a WA study have challenged concerns that medical students posted to small remote locations (with populations < 20 000) may be disadvantaged in their learning opportunities. After a year-long rural clerkship, students returning from small communities had significantly higher end-of-year grades compared with their city counterparts and reported greater levels of satisfaction with their learning experience. The potential disadvantages of smaller populations, such as smaller case loads and fewer or no specialists available for teaching, appeared to be outweighed by benefits such as lack of competition for cases, continuity of care, and an increased sense of belonging to the health care community.
Rural Remote Health [internet] 2010; 10: 1470
Fish oil supplements and postnatal depression
Women taking fish oil supplements during pregnancy do not reduce their risk of postnatal depression, nor are they more likely to have smarter children, according to a large Australian study. The trial randomly assigned 2399 pregnant women (with or without a history of depression) to take either docosahexaenoic acid (DHA)-rich fish oil capsules or matched vegetable oil capsules. At 6 weeks and 6 months postpartum, depressive symptoms did not differ significantly between the two groups (9.67% v 11.19%, P = 0.09), nor did the mean cognitive composite scores of their children at 18 months of age. However, taking the fish oil supplement was associated with half the risk of preterm birth, confirming findings of previous studies.
JAMA 2010; 304: 1675-1683 doi: 10.1001/jama.2010.1507