This week in the BMJ
Volume 333, Number 7579, Issue of 2 Dec 2006Google is a good diagnostician
This week in the BMJ
Google is a good diagnostician
Using signs and symptoms as search terms on Google finds the correct diagnosis 57.7% of the time (95% confidence interval 38.3% to 77.1%) say Tang and Ng (doi: 10.1136/bmj.39003.640567.AE). The authors identified 26 case reports published in a single journal and selected three to five specific symptoms and signs from each to be used as Google search terms. They compared Google results with the original diagnoses. Google searching is less helpful in identifying complex diseases with non-specific symptoms than in diagnosing illnesses with unique symptoms.
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This week in the BMJ
Should statins be used perioperatively?
Using statins may prevent perioperative cardiovascular events, suggest Kapoor and colleagues (doi: 10.1136/bmj.38993.731725.BE) in their systematic review of 18 controlled studies. Perioperative death or acute coronary syndrome were seen 30-42% less often in statin users than in patients not taking statins at the time of surgery. The authors conclude, however, that the current evidence base is inadequate to justify the routine use of statins to reduce perioperative cardiovascular morbidity. A large randomised controlled trial is needed to provide a definitive answer to this question.
This week in the BMJ
Acute rheumatic fever is still a clinical challenge
Acute rheumatic fever, now rare in high income populations, remains highly prevalent in developing countries where access to health care is poor, says Cilliers (doi: 10.1136/bmj.39031.420637.BE) in her clinical review. Although it is known to be caused by humoral and cell mediated immune responses to group A beta haemolytic streptococcus antigens, the syndrome of carditis, polyarthritis, and skin or neurological changes is still not completely understood. Only 0.3-3% of patients with acute streptococcal pharyngitis develop rheumatic fever and a genetic predisposition is certain.
This week in the BMJ
Practice based commissioning shares fundholding's flaws
Labour's policy of practice based commissioning seems to have similar problems to the GP fundholding scheme that was abolished in the 1990s, according to Greener and Mannion in their analysis and comment article (doi: 10.1136/bmj.39022.486921.94). Under both schemes, purchasing secondary care out of a primary care budget increased GPs' awareness of resource economics. But patients' satisfaction seems to have been reduced in line with increased managerial responsibilities of GPs. The authors suggest that the high administrative costs of practice based commissioning would make collaboration between practices a cost effective solution.
This week in the BMJ
Don't miss acute angle closure glaucoma
Angle closure glaucoma is a rapidly progressing ophthalmic emergency that can lead to blindness. Unusual presentation may mean that the diagnosis is missed or treatment is delayed. In their lesson of the week, Gordon-Bennett and colleagues (doi: 10.1136/bmj.39024.570313.AE) discuss three cases of angle closure glaucoma that were initially misdiagnosed. The authors call for a high index of suspicion of this condition when patients present with blurred vision, headache, and a red eye, especially if they are taking drugs that could alter intraocular fluid dynamics.
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