The great mystery of the French paradox is how they come to eat animal fat in such delicious quantity and yet suffer so little cardiovascular disease. more…

A study of blood transfusion for very sick children in paediatric intensive care units inspires an editorial to ask “When Is More Really Less?

I’m constantly surprised how slowly epidemiological information about fetal outcomes continues to trickle out, despite the existence of huge databases covering several decades. This analysis shows that the risk of perinatal mortality in babies born to South Asian women is more closely linked to birth weight (below 2kg) whereas for the babies of white women, placental abruption is the greatest risk.

In an American study of a cohort of assisted-conception pregnancies, there is no significant difference between the outcome in fetuses who grew at varying rates in the first twelve weeks, except for a very few who showed a deficit of more than four days between the observed and expected size. By generalising this finding into an overall correlation, the authors seek to emphasise the significance of fetal growth in the first three months.

NHS walk-in centres are a typical Blair product. They were supposed to do all sorts of popular, headline-grabbing things, including reducing waiting times to see GPs. But of course they didn’t, for numerous entirely predictable reasons well summarised in the editorial from Warwick.

Delirium in ill elderly people can be very distressing and, if a recent experience of mine is anything to go by, inadequately managed in some NHS hospitals. My father-in-law at 81 was a man of strong clear intellect and you wouldn’t mess with him in an argument. But each time he was ill and admitted to hospital he became agitated and confused. On the last occasion he was heavily sedated, got pneumonia, and died. Here is an excellent review calling for better recognition, better prevention, and better guidelines for management.

During thirty years in general practice, various sorts of dubious dogma about asthma have come into fashion and then gone away. This is a condition which is seen and managed in primary care, and what may apply to other populations can be misleading when applied to the majority of our patients, who get intermittent symptoms and don’t want to be bothered with lengthy work-up. This eminently sensible little “Masterclass

The clinical updates which now follow the editorials in The Lancet provide very useful summaries of current knowledge: here is a concise Australian account of stroke management. more…

A big group of Canadians make a valiant attempt to determine which inhalers really benefit patients with chronic obstructive airways disease. The idea was to start with tiotropium and randomise to salmeterol or salmeterol-fluticasone or placebo. more…

The fritillaries are a wonderful group of bulbous plants, mostly of very discreet charm, quite unlike their blowsy cousins, the tulips. more…

Domhnall MacAuley attending the BMJ/IHI 12th International Forum on Quality and Safety in Health Care, Barcelona April 2007

Airports at 5am on a working day don’t have the same excitement as holiday travel. Suits, briefcases and determined frowns keeping the economy in the air. Nothing like the indignity of putting your toiletries in a clear plastic bag for the security check to make us all equal. Not much glamour. more…

There has been an outcry at the news that one briefing paper to the MTAS review group suggests doctors who can’t find a job in the UK should consider working for Voluntary Service Overseas (VSO) instead.

The BMA says the government’s failures in workforce planning have created this mess.

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Health secretary Patricia Hewitt has today issued an apology to those caught up in the Medical Training Application Service (MTAS) crisis, acknowledging that it had been a time of ‘great distress’ to them.

And she announced another review, this time of the whole of the Modernising Medical Careers policy, rather than just of MTAS. It would look into ways of strengthening the policy for next year, she said.

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When I said last week that the true scientist rejoices when her/his hypothesis is refuted, I wasn’t trying to restate Popperian orthodoxy but making the point that those who wish to see knowledge expand shouldn’t care whether it does so by proving them right or wrong – the main thing is that they’ve helped in the process. more…