Unrecognised severe vitamin D deficiency

Vitamin D deficiency remains common and may mimic other musculoskeletal disorders or mental health problems, say John L Sievenpiper and colleagues from the Endocrine Unit at Royal Victoria Infirmary, Newcastle Upon Tyne, UK. The US, Canada, Sweden, and Finland already fortify milk with vitamin D. Europe should follow suit, says an accompanying editorial.

Measuring blood pressure in children

It is routine practice to measure blood pressure in adults in the emergency department, so why are we so bad at doing this in children, asks this editorial by Colin Michie and Chris Bird.

The emergence of Stenotrophomonas maltophilia

Headlines about S maltophilia, including "no antibiotics can stop it" and "rising death toll in hospitals" are unfounded, write Georgia Duckworth and Alan Johnson, from the Health Protection Agency's Centre for Infections in London. In fact, they say, S maltophilia infections are relatively rare compared to infections caused by bacteria such as meticillin resistant Staphylococcus aureus (MRSA).

A comprehensive service

In the third article of his six-part series on the NHS at 60, BMJ deputy editor Tony Delamothe looks at comprehensiveness and the difficulties of defining and meeting need.

Pay as you don’t go

Junior doctor Kinesh Patel is struck by the number of patients who don’t keep their appointments without even a telephone call. Should they be fined for not attending? Have your say on the BMJ poll

Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation

Early surgery relieved sciatica more effectively, but only in the first six months, and at two years 20% of all patients reported an unsatisfactory outcome, according to the two year results of a randomised controlled trial. A cost utility analysis of this RCT finds that early surgery provides better quality adjusted life years, and the greater healthcare costs are compensated for by earlier return to work. An accompanying editorial says this trial adds to the body of evidence supporting surgery eight weeks after onset of sciatica if symptoms persist. This research underwent fast track publication.

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