Skip to main content

'Tis the Season: The BMJ Christmas Edition

It's the most wonderful time of the year. No, not because those damn kids jingle belling and everyone telling you "be of good cheer". And not because of those holiday greetings and gay happy meetings when friends come to call. It's the hap-happiest season of all because I just got the BMJ christmas edition in my inbox! 

What, you were not so lucky?  Well, I guess someone is on someone else's not so nice list.  Don't worry though, I'll recap the three key lessons I learned after perusing the issue:


1) Never write "Stable Vitals" or "Observations Stable" in a Chart 

There are a lot of meaningless rituals that make it into physicians’ notes. One of the most common is using the term “stable” to refer to all aspects of patient care. The most common in the US is the term “stable vitals”. In the UK, “stable observations” takes "stable vitals" place. No matter which you choose, both convey little valuable information as demonstrated a retrospective study on the relevance of the expression “observation stable” in physicians notes.

The authors of the study reviewed physician notes of 46 inpatients in three teaching hospitals in the UK. For each physician note containing the phrase observations stable (or “obs stable”) the authors also recorded the nursing observations (ie temperature, blood pressure, heart rate, respiratory rate, and oxygen saturation) from the bedside chart during the preceding 24 hours.

The authors found that 78% of 46 inpatients reviewed had either either “obs stable” or “observations stable” written in the physicians notes. Nursing observations in the 24 hours preceding these entries included at least one abnormality in the vital signs in 71% of cases and a persistent abnormality in 19% (most commonly either tachypnea and hypotension). Nearly half (42%) of these physician notes came immediately after an abnormality was documented by nurses in the chart.


2. Health Care Providers and Policy Makers Need to Practice What We Preach 

A little piece of me dies every time I walk into our canteen after counseling a patient to cut down on the amount of salt he or she takes in.  The menu of items I have to choose from includes fries, pizza, hamburgers, deli sandwiches, and bags of chips.

Three researches from the Netherlands apparently had a similar reaction when going into the institutions of “salt policy makers”, so they assessed the salt content of hot meals served in 18 canteens.  The canteens in the study included that of the Department of Health, the Health Council, the Food and Consumer Product Safety Authority, university hospitals, and affiliated non-university hospitals.

Salt content of standard hot meals collected from these canteens on three random days revealed that they exceeded the total daily recommended salt intake of 6 g at all locations. As you may of guessed, the university hospital staff canteens were the worst in regards to salt intake. The authors conclusions sums it up nicely:

“It is impossible for salt policy makers to adhere to their guidelines for salt intake if they eat the hot lunch provided in their workplaces. The mean salt content of the meal alone exceeded the total daily allowance, translating into up to a 36% increase in mortality compared with adherence to the guideline.” 


3. Walk Faster than 3 miles an hour to Outrun the Grim Reaper 

I save the best for last.  A group of Australian researchers in this study were very concerned about determining the speed at which the Grim Reaper (aka Death) walks.  Using data from a population based prospective study of 1705 older community dwelling men living in Sydney, Australia, the authors compared walking speed and mortality.  They further used receiver operating characteristics curve analysis to determine the optimal walking speed to avoid contact with the Grim Reaper.

Long story made short, older men who walked faster than 0.82 m/s were 1.23 times less likely to die than those who walked slower. No one walking at least 1.36 m/s (3 miles or 5 km per hour) died. The authors thereby concluded:
“The Grim Reaper’s preferred walking speed is 0.82 m/s (2 miles (about 3 km) per hour) under working conditions. As none of the men in the study with walking speeds of 1.36 m/s (3 miles (about 5 km) per hour) or greater had contact with Death, this seems to be the Grim Reaper’s most likely maximum speed; for those wishing to avoid their allotted fate, this would be the advised walking speed.” 


Now I must get back to those parties for hosting,  marshmallows for toasting, and caroling out in the snow.  And those scary ghost stories, and tales of the glories of Christmases long, long ago.  

Happy holidays! 

Eric Widera


jrhalvor said…
Very... err, festive?

Of note, Mr.Reaper appears to be moving significantly faster that 2 mph in this video:

Happy Holidays!
This is nice post about our health and also i have many ideas for you just
click here "Michael Muskat" . I think you will inspire with me and also you can sugess me here i will also visit again here.
Thanks for posting...

"Michael Muskat"

Popular posts from this blog

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis.  This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis.  Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?).  This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here). 

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

Language Matters: Podcast with Brian Block and Anna DeForest

One of our first GeriPal posts was titled "Rant on Terminology," by Patrice Villars, NP.  In the spirit of looking back over our first 10 years, here is the opening paragraph to that post:

News Headlines read: Sen. Edward Kennedy loses battle with cancer. Really, he lost? I thought he died from a malignant brain tumor, an “aggressive” brain tumor. The median survival is less than a year for people for his particular tumor. Kennedy was diagnosed in May of 2008. He lived over 15 months after diagnosis. What a loser. He must not have fought hard enough. Huh? I thought he spent most of his life battling for social and health care reform in America. In this week's GeriPal podcast we take a deeper dive into this issue of language and medicine.  We are joined by guests Anna DeForest, MD, MFA, a resident in Neurology at Yale, and Brian Block, MD, a pulmonary critical care fellow at UCSF.  

Anna recently published a paper in the NEJM describing her reaction to hearing terms like, &…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …