JAMA 18 Oct 2006

Coronary artery bypass grafting has become the commonest major surgical procedure in the developed world. But since it tends to be needed most in people who are old, have smoked, got fat, and/or become diabetic, there is a sizeable risk of post-operative pulmonary complications. A team from Utrecht sensibly wondered if these might be reduced by training the least fit to breathe properly by the use of preoperative intensive inspiratory muscle training. They demonstrate that this intervention cuts post-operative pneumonia by more than half, and the average hospital stay by a day. Maybe some hospital trusts will decide it is cost-effective, unless they have already sacked all their respiratory physiotherapists.

You can’t do medicine without poisoning people, though you can try to reduce the risk of adverse drug events (ADEs), or adverse drug reactions (ADRs) as we tend to call them over here. This survey looks at 21 298 ADEs presenting to US emergency departments and gives an excellent general overview of the classes of drug and the kinds of reaction. Insulin and warfarin provide the biggest problems, as you’d expect.

Like childhood cancer, dilated cardiomyopathy in children strikes randomly, and a proportion of it may be caused by viruses. A predisposing condition can only be identified in a third of cases, and of these, half have myocarditis. Overall, 31% die within a year (or, rarely, get transplanted); at five years, the figure is 46%. (Commercial plug: for a discussion of the issues around the care of children and young people dying from heart failure, see the excellent chapter by Hayley Pryse-Hawkins in Heart Failure and Palliative Care eds. Johnson and Lehman, Radcliffe 2006).

Should we eat fish? You betcha. Especially with large quantities of dairy-based sauces, in case people suspect you of being a health freak. Dover sole with béarnaise; skate in black butter; turbot with cream and sorrel; trout with buttered cèpes; Matjesfilets of salted raw herring with heaps of sour cream: the list is as wide as the ocean. Warning: may contain traces of methylmercury. This rather dour clinical review (“evaluating the risks and the benefits