The Week That Wasn't: Burst Esophagus, Clinical Superstition, Vaccination Record

Ellie Kincaid


December 27, 2019

You may have recently seen articles about an ultramarathoner whose esophagus ruptured during a race, whether predicting that a workday will be a "quiet" one influences clinical workload, and a vaccination record that could be embedded into the skin. Here's why you didn't see them on Medscape Medical News.

Runner's Ruptured Esophagus

A 37-year-old man was running in his first 100-mile race when he began vomiting and felt such severe chest pain he thought he might have broken a rib. He was taken to an emergency department and was eventually diagnosed with Boerhaave syndrome, or spontaneous esophageal rupture. After surgery and after spending 41 days in three hospitals and 3 more months recuperating, he was able to run again. "The whole experience gave me a new perspective on life and the importance of health," he wrote in a paragraph accompanying the published case report.

This case is dramatic and fascinating, in part because Boerhaave syndrome is rare. The authors of the case report cite research from Iceland in which the yearly incidence of esophageal perforation was calculated to be 3.1/1,000,000; 24% of the cases that occurred during the study period occurred spontaneously. It's highly unlikely most clinicians will see such a case in their career, so we didn't consider it "must-know" information for our readers, and didn't cover it.

Does Saying a Workday Will Be "Quiet" Jinx It?

Self-experimentation is a long and continuing tradition in medicine. Determined to test the superstition that saying the word "quiet" increases a clinician's workload on their shift, a medical microbiology team in the United Kingdom ran a randomized controlled trial on themselves. Each morning for 2 months, team members opened an opaque envelope and followed the instructions inside. The instructions were either to say the phrase, "Today will be a quiet day" or to refrain from saying the word "quiet" in any context. The researchers analyzed their clinical workload during the study period and reported the results in the BMJ's annual Christmas issue. They found no effect.

"Clearly this study is somewhat tongue-in-cheek, but it highlights an important problem," the researchers write — ie, staff shortages and work-related stress for clinicians in the UK's National Health Service. If avoiding saying the word "quiet" is a coping mechanism for clinicians, as the authors propose, they need a more effective one. We cover clinician burnout thoroughly on Medscape Medical News, so we didn't cover this particular study that is only somewhat germane to the topic and that makes a point that our readers are already aware of, we hope: Superstitions are not reality.

In-Skin Vaccination Record

It sounds like science fiction: A microneedle patch that both delivers a vaccine and leaves a record of the vaccine in the skin, which healthcare workers can later read with a modified smartphone. Scientist and serial biotech engineer Robert Langer, ScD, and members of his lab at the Massachusetts Institute of Technology built such a patch and described its performance in Science Translational Medicine earlier this month. The scientists write that the technology could be helpful in locales where there are few resources and where accurate medical record keeping is difficult.

Although this research is interesting and potentially useful (some of the authors have applied for a patent on their invention), the experiments described in the article were to prove the concept in vitro and in rats. There's not yet a product for clinicians to use or recommend. Because Medscape Medical News is a clinical news site and this technology isn't yet ready for the clinic, we didn't cover this research.

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