Sword swallowing and folic acid

Running short of time to read the journals? Allow Dr Bryan Palmer to be your guide to the latest findings

Risks associated with sword swallowing

BMJ 2006; 333: 1,285 

The Christmas edition of the BMJ provides an annual light relief and long may it continue. One of the first out of its festive cracker is a study based in the UK on an unusual occupation, that of the sword swallower.

The study design was a letter sent to the Sword Swallowers International Association, based in the USA, asking for information on the practice and associated ill effects. Some 110 swallowers were contacted and a respectable 46 replied.

 Injuries were more likely when the swallower was distracted, or swallowed multiple or unusual swords or when previous injury was present. Perforations mainly involved the oesophagus and usually had a good prognosis. Sore throats were common.

Those without insurance stood to lose a lot, but the authors concluded that they had a better prognosis than those patients who had iatrogenic injuries.

Positioning patients for tracheal intubation

BMJ 2006; 333: 1,295–6 

This study comes from the direction of my old stomping ground as a student and from one of my former teachers.

The objective was to determine whether the phrase ‘sniffing the morning air’ is useful in positioning patients for tracheal intubation.

In this snapshot survey, 21 anaesthetists participated. The main outcome measures looked at the angles of necks and the line of sight from hip to shoulder as measured on a photograph.

This was done in an attempt to come to a conclusion on the suitability of the phrase ‘sniffing the morning air’.

The study concluded that it was not an ideal  phrase to use and that perhaps a more explicit description of the position of the head should be determined.

Medical expectations of athletes

Br J Sports Med 2007; 41: 41–4 

This study from Australia looks at expectations of athletes and their coaches with respect to fatigue of less than seven days’ duration and to blood tests. A single-questionnaire approach was implemented on 28 senior sports science or non-medically qualified sports medicine staff, 22 elite coaches and 62 elite athletes from the Australian Institute of Sport.

It found that 81 per cent of athletes and 91 per cent of coaches expected a blood test, mainly for reassurance.

The authors concluded that despite there being no science behind blood tests in this scenario, these expectations had to be taken into consideration when deciding on whether such testing has to be performed.

Folic acid supplementation in heart disease

JAMA 2006; 296: 2,720–6 

I wonder if 2007 will be the year of debunking popular myths. The first myth that might be out of the bag is the role that folic acid supplementation plays in the prevention of heart disease.

Taking folic acid and B vitamins if your homocysteine levels are high is a common practice in Australia, but is it worthwhile even measuring homocysteine?

Researchers from the US carried out a meta-analysis of 165 reports and 12 randomised controlled trials, and found that folic acid supplementation has not been shown to reduce cardiovascular disease or mortality in those with  a previous history.

However, there are several large studies currently looking at primary prevention.  

Dr Palmer is a former Hampshire GP currently working in Australia, and a member of our team who reviews the journals

The quick study

Swallowing swords is bad for your health, especially if you become distracted.

‘Sniffing the morning air’ is an unhelpful phrase for describing the correct position for patient intubation.

Athletes and coaches expect a blood test following fatigue of less than seven days’ duration.

Homocysteine lowering is unhelpful in patients with established heart disease.

Research of the week 

Attractive male surgeons

BMJ 2006; 333: 1,291–3  

This Spanish study used an unusual rating scale in its design as it tested the hypothesis that male surgeons are taller and better looking than male physicians, and it compared both sets of doctors with film stars who play doctors on screen.

I have not come across the ‘good looking score’, which is apparently based on a 1–7 system --- although any good builder will tell you what a 10 looks like. There might have been some bias because the independent committee was all female. The results suggested that male surgeons are taller and better looking than physicians, but film stars who play doctors on screen are better looking than both these groups of doctors.

The authors were unsure whether these phenotypic differences were genetic or environmental.

If they had used GPs there would have been no contest and would have designed the rating scale upwards.

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