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Mobile phones in hospitalsMobile phones (cell phones) are a
source of irritation for some but undeniably useful for many, and over 50% of
the population of the United Kingdom possess one. Their use in hospitals,
however, is mostly banned as they are considered potentially hazardous in
medical environments. But the evidence for serious harm is flimsy, and the
hysteria that surrounds the use of mobile phones in hospitals is
unjustified.
So how dangerous are they? The evidence for harm is limited.
Anecdotal reports exist of interference with medical electrical equipment, which
led to a study by the Medical Devices Agency in the United Kingdom. In this
study, 4% of medical devices suffered from electromagnetic interference from
digital mobile phones at a distance of 1 metre. This compared with 41% from
emergency services’ handsets and 35% from porters’ handsets. Most of
the interference related to disturbance of the signal on monitors, such as
electrocardiographs, confirmed by data from the United States.
Other effects were on pacemakers, with inappropriate
inhibition or atrial oversensing – or misinterpretation of the mobile
phone signal as atrial activity with synchronous fast pacing of the ventricle
– which has been documented elsewhere in both permanent and temporary
systems. The effect on both devices is, however, transitory and can be avoided
completely by taking the mobile phone away from the monitor or pacemaker.
Moreover, the interference with the pacemaker occurred only with the mobile
phone at a distance of up to 10 cm.
BMJ
2003;326:460–1
Bananas in the fertility clinicHaving shunned sex for thousands of
years, bananas are in trouble. Those grown commercially are sterile mutants,
propagated by replanting the suckers that sprout from existing trees. Lacking
the genetic shuffling of sex, the single variety that dominates the export
market is susceptible to any pest that evolves to evade its defences against
disease.
In the late 1990s, the emergence in Southeast Asia of a new
strain of Panama disease, a wilt caused by the fungus
Fusarium oxysporum, devastated
commercial plantations. It has since spread to Australia and Africa, and if it
lands in Latin America, where most export bananas are grown, farmers will need a
new resistant variety.
Genetic manipulation seems the obvious answer – and
researchers at the Catholic University of Leuven in Belgium have already
produced several transgenic varieties that carry genes for antifungal proteins.
These will be field-tested for resistance to Panama disease over the next few
years.
But even if they pass these tests, there is no guarantee
that Europe’s suspicious consumers will warm to the idea of transgenic
bananas. So a conventional breeding effort it also under way. Breeders at the
Honduran Agricultural Research Foundation in San Pedro Sula have found that it
is just about possible to breed bananas, through careful hand pollination and
sieving hundreds of tonnes of banana pulp to collect the few resulting
seeds.
Nature
2003;421:569
Moulding the surgical mindWilliam Hunter, 18th-century
obstetrician and medical educator once described surgeons as ‘savages with
knives’. Ironically, one of these savages, his brother John, became one of
surgery’s icons. In their time, patients were pinned down, screaming and
squirming, by burly assistants, and the surgeon’s fame rested on his
dexterity, precision and speed. Then, surgeons were feared, surgery was limited
in frequency and scope, and plagued by deadly sepsis.
The arrivals of anaesthesia, antisepsis, and asepsis changed
all that. Now, surgeons are revered, surgery’s scope is virtually
unlimited, and waiting list numbers swell.
But what is the image of the modern surgeon? Surgery
continues to be a male-dominated fraternity of adherents of resolute action,
aggression, technology and defensive detachment in practice. Their expertise is
bound up in experience, and entry into their ranks is influenced by sex and an
‘intolerance of ambiguity, excessive reliance on high technology, a
negative orientation towards psychological problems and a
Machiavellianism...expressed as ‘the means justifies the end’ or
‘whatever it takes’.’
Something is missing in the moulding of surgical minds
– an emphasis on analysis, problem-solving, evaluation, discrimination and
judgement. In short, surgeons’ training is short on thinking, reasoning
and understanding.
Eminent US surgeon William J Mayo once observed that
‘Surgery is more a matter of mental grasp than it is of
handicraftsmanship.’
Stressing this mental grasp requires a seismic shift in
surgery’s culture.
MJA 2003;178:249
Influenza vaccination and reduction in hospitalisationSerious complications of influenza
among the elderly include pneumonia and exacerbations of coexisting conditions
that can result in hospitalisation or death. Vaccination against influenza has
consistently been associated with reductions in hospitalisations for pneumonia
and death from all causes in the elderly.
During influenza epidemics, hospitalisations for
cerebrovascular and cardiovascular causes increase, and acute infections,
including upper respiratory tract infections, may increase the risk of acute
cardiovascular and cerebrovascular events.
In this report, the authors studied two large cohorts during
the 1998–1999 and 1999–2000 influenza seasons to assess whether
influenza vaccination of community-dwelling elderly persons is associated with
reduced rates of hospitalisation for cardiac and cerebrovascular
disease.
Observational studies from the United States, Manitoba, and
the United Kingdom have reported that influenza vaccination is associated with
reductions in the risk of death from any cause of 30 to 50 per cent. In this
study, vaccination was associated with a reduction in risk of death from all
causes of 48 to 50 per cent. This reduction may be greater than might typically
be expected. Hospitalisation for pneumonia and exacerbations of underlying
medical conditions are well-recognised complications of influenza. The finding
that vaccination is associated with reductions in the risk of hospitalisation
for cardiac and cerebrovascular disease suggests additional effects of influenza
that contribute to the overall disease burden and may help to explain the
reduction in the risk of death associated with vaccination.
N Engl J Med
2003;348:1322–32
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