What does 'Dermatologically Tested' Actually Mean?

At the finish!

Peripheral Venous Cannula

Marathon completed - 3 hours, 30 minutes and 37 seconds of pain (probably) never to be repeated. Still smiling at the end though!

Peripheral Venous Cannulas - A new study published in the Lancet this week looked at whether there was a difference in the incidence of phlebitis in patients who had their cannulas re-inserted after 3 days, compared to those where they were left alone. There was no greater incidence in phlebitis in either group. This could lead to an end of unnecessary replacement of IV cannulas on the wards. I think that the most important way to reduce risk of phlebitis and bloodstream infection is good, clean and sterile technique on insertion but I agree with the study conclusion that clinical judgement is the best way to decide if a cannula needs replaced.

'Gut Feeling' About Serious Infections in Children - This was an interesting study which asked whether 'gut feeling' had any merit in identifying acutely unwell children with normal parameters. The study researchers found that in children with a reassurring clinical assessment, serious illness was 25 times more likely in with gut feeling - parental concern was the feature most strongly associated with gut feeling. I expect that the 'gut feeling' principle could be extended to adults.

Is patient education the key to longevity? - As the competition rages for the election of the next US president, the observations column in the BMJ this week comes from America. Studies carried out across the pond have led to claims that education could actually be the fundamental cause of better health and longer life. According to the New York Times, poorly educated Americans die younger and life expectancy of those lacking a high school diploma is actually getting shorter. As doctors there may not be an awful lot that we can do to improve the education and economic status of a nation, however it may affect opinions when it comes to voting for future local and national elections.

Medicine and the Media - "Dermatologically Tested" - What does this phrase mean? I don't know, but I've seen it a lot on advertisements and skin products. Another doctor investigated further by getting in touch with several of the companies who promote their products in this way, such as Boots, Johnson and Johnson, Persil etc and found that they were reluctant to describe the testing processes which lead to these tags, quoting reasons such as 'commercial confidentiality' as the reasons for non-disclosure. It seems that there is not a common standard required to meet this label and that often it just means that there is an absence of proved harm, rather than evidence of benefit. There is a great deal of inconsistency in what these labels mean but currently a European Commision is working on a paper for creation of common criteria for claims made by cosmetic companies.

Long QT Interval - An interesting learning point. Long QT syndrome can lead to sudden cardiac arrest in previously asymptomatic individuals. It can either be genetic or caused by severe electrolyte imbablances and several drugs. A history of syncope or previous cardiac arrest are the strongest predictors of sudden cardiac death. A QT interval of greater than 450ms in males and 460ms in females is considered to be abnormal. The best ECG leads to measure the QT interval are II, V5 and V6.  In outpatients a beta-blocker should be prescribed and a pacemaker fitted with strenuous high intensity exercise avoided. First degree family members should undergo genetic screening for the condition.