This week in the BMJ
Volume 333, Number 7560, Issue of 22 Jul 2006Women prefer speculum examinations without stirrups
Women prefer speculum examinations without stirrups
Women feel less vulnerable and experience less discomfort when speculum examinations (as part of routine gynaecological examination) are carried out without stirrups. Seehusen and colleagues (p 171) randomised 197 adult women from a US family medicine outpatient clinic who were undergoing routine gynaecological examination and cervical smear to examination with or without stirrups. When the women's perceived levels of physical discomfort were measured on 100 mm visual analogue scales, the level for those examined without stirrups was 17.2 compared with 30.4 in the stirrups group. Sense of vulnerability in the group of women examined without stirrups was reduced from 23.6 to 13.1, whereas sense of loss of control was the same in both groups.
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Consider whooping cough even if a child has been immunised
A substantial proportion of immunised children of school age who present to primary care with a persistent cough may have had a recent infection with Bordetella pertussis. Harnden and colleagues (p 174) recruited 179 children aged 5 to 16 years (from 18 UK general practices) who had been coughing for two weeks or more. Serological evidence of a recent Bordetella pertussis infection was found in 37% of the children, and 86% of these children had been fully immunised. Making a secure diagnosis of whooping cough may reassure the parents and prevent inappropriate investigations and treatment, conclude the authors.
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Both diabetes type 1 and type 2 are risky in pregnancy
Perinatal mortality and prevalence of congenital anomalies in babies of women with pre-gestational type 2 diabetes are as high as in babies of women with type 1 diabetes, say Macintosh and colleagues on page 177. They followed more than 2300 pregnancies and their outcomes in women with type 1 or type 2 diabetes. Perinatal mortality was similar in both groups (around 32/1000 births), and was nearly four times higher than that in the general maternity population. Prevalence of congenital anomalies was about 46/1000 births in both groups, which is more than double the number expected.
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How to manage pyoderma gangrenosum
Pyoderma gangrenosum presents in a variety of guises and is easy to misdiagnose, say Brooklyn and colleagues on page 181. Their article on the rare but serious ulcerating skin disease, which can present to a variety of health professionals, reviews its various forms of presentation and its differential diagnoses. The authors discuss who is at risk of pyoderma gangrenosum, and explore therapeutic options such as corticosteroids, ciclosporin, and anti-tumour necrosis factor 
agents.
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Maintaining public confidence in research
Researchers must balance the quest for better health for all against the need to respect the privacy of research participants. In this first article in a series on confidentiality and consent in medical research, Kalra and colleagues (p 196) look at what needs to be done to ensure best practice. Several areas of research practice need to be improved, and staff training and access policies are essential, but firstly the main contemporary public concerns must be recognised and understood, they say.
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