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Highlights from this issue
  1. The Triumvirate
  1. Correspondence to The Triumvirate ; alan.smyth{at}

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Line of duty…

The police procedural drama ‘Line of Duty’ stars Nottingham girl Vicky McClure, as Detective Sergeant Kate Fleming. It emphasises the responsibilities of police officers in discharging their duties in a fair and even handed fashion and the gruesome consequences if they fail to do so. The ‘line of duty’ for primary care doctors, evaluating infants with suspected acute bronchiolitis, involves: using a guideline; measuring oxygen saturations; providing written guidance; and not prescribing drugs that don’t work (such as antibiotics). In this month’s journal Carande and colleagues describe how adherence to each of these recommendations has improved since the NICE guidelines on bronchiolitis were published ( see page 674 ). Furthermore 35% of general practitioners had read the guideline and 25% changed their practice since guideline publication. DS Fleming would approve!

The chain of evidence…

The importance of an unbroken chain of evidence in forensic investigations is a recurring theme in the ‘Crime Scene Investigation (CSI)’ franchise. Prayle and colleagues take up this theme in this issue of Thorax ( see page 670 ). The ‘chain of evidence’ in this case stretches from clinical trial findings, through systematic review, and on to guideline recommendation and clinical practice. Their focus is on how consistently guidelines for managing chest disease in children use systematic reviews—specifically Cochrane reviews as these are of the highest quality. They find that, in 40% of guideline recommendations, some or all of the relevant Cochrane Reviews were not cited. In 26% of cases, the guideline recommendation did not fully agree with the Cochrane Review. It seems that the chain of evidence is straining, if not broken. Gil Grissom and his colleagues would not have been in the least surprised though they would have loved the technological innovation of the ‘Prayle plot’—see interactive online diagram.

The sweeney…

For non-UK readers ‘The Sweeney’ is cockney rhyming slang for ‘flying squad’ a British police unit specialising in violent crime. ‘The Sweeney’ TV series specialised in action sequences and the star (John Thaw) uttering his uncompromising ultimatum to villains: ‘you’re nicked mate!’ Such a robust interpretation of the rules might well be appropriate in enforcement of guidelines on the management of childhood asthma. In a comprehensive review of global asthma care in children, Lenney and colleagues remark that guidelines are increasingly evidence based but lament that ‘…their impact on improving outcomes has been negligible in many parts of the world, often due to lack of implementation’ ( see page 662 ). So once again the chain of evidence breaks at the implementation stage. In contrast to the uncompromising law enforcement characteristic of ‘The Sweeney’, Lenney favours an approach which assesses lay and professional educational needs and the accessibility and affordability of medication, particularly in low and middle-income countries.

Silent witness…

The creative genius of Nottingham is once again evident in ‘Silent Witness’ (created by Nottingham lad and ex-murder squad detective Nigel McCrery). In this long running pathology procedural, the (often glamorous) pathologist triumphs over professional rivalries by using the secrets of the ‘silent witness’ (the deceased victim) to bring the killer to justice. In this month’s Thorax, the dead reveal something about the cause of death, through an epidemiological study. Prescott and colleagues used data from the US Health and Retirement Study to determine the relative contributions to late death from acute hypoxic respiratory failure (AHRF) of ‘inciting events’ (such as pneumonia) and the AHRF itself ( see page 618 ). Late death in this study was at 31 days to 2 years after the index AHRF. So which of these is the guilty party? Well it seems that it is a joint criminal enterprise with over 70% of the increased risk associated with hospitalisation for an acute inciting event and 30% linked with AHRF itself.

Morse code…

John Thaw starred again as a detective in later life—this time as the curmudgeonly but cerebral ‘Inspector Morse’. Morse enjoyed choral music and The Times crossword puzzle and would unerringly get his villain through careful observation and deduction. From Morse code to the genetic code. In Thorax this month, de Vries and colleagues study the gene-expression signature for the ageing lung in chronic obstructive pulmonary disease (COPD) ( see page 609 ). They find that EDA2R stands accused as the villainous gene behind lung ageing. Morse would have admired their modus operandi!

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Is it a global weather map or an aeroplane wing in a wind tunnel? Play with the online version of this month’s featured image!


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