Editor's choices

Small changes in things we do often can have as much or more impact than the latest “breakthrough.” So we were delighted to find a better way to vaccinate. Diggleet al had previously published work showing that long wide needles (needle [i] in photo) gave fewer local reactions than using the standard short needle. But there were residual concerns about the possibility that the immunogenicity might be less. So the authors have repeated the study but they showed that the needles (see figure) did not differ for average immune response. So as the commentator suggests, it’s time to change the guidelines and perhaps “The drug companies should also think of supplying long needles rather than short thin ones along with the vaccine doses.”

The other simple thing that unfortunately doesn’t seem to work so well according to Nasseret al is determining the presentation of a fetus nearing term. In particular, it would be nice to detect all the potential breech deliveries so that external cephalic version could be used. The article did make me feel a little better about my own non-skills as a medical student, but it would be great if there was a simple alternative to doing an ultrasound on all fetuses at 37 weeks.