With millions of journal articles published yearly, it is impossible to keep up. The team at Derby Children’s ED have got a special treat for our Christmas Wrap!
The Christmas edition of the BMJ is something of a cultural icon. Published in the last couple of weeks before Christmas, this edition has, for about 30 years, featured articles that would be considered “not traditional”, by any measure, for a scientific journal.
A study involving the half-life of teaspoons The case of the disappearing teaspoons: longitudinal cohort study of the displacement of teaspoons in an Australian research institute | The BMJ is a personal favourite. Who hasn’t used the lone butter knife or their folded-up patient list to measure out their coffee at work? The readership also clearly enjoyed an early systematic review of the efficacy of parachutes for preventing death in 2003 (Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials | The BMJ) because this was followed by a brilliantly executed randomised controlled trial, really demonstrating the importance of proper trial design in order to answer your question (Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial | The BMJ).
Those of us in paediatrics may be more interested in novel approaches to measuring testicular volume (An inexpensive and edible aid for the diagnosis of puberty in the male: multispecies evaluation of an alternative orchidometer | The BMJ) or the impact of Peppa Pig on medical consulting (Does Peppa Pig encourage inappropriate use of primary care resources?).
For this edition of Bubble Wrap, we planned to bring you the funniest and most appropriate “Christmas wrapping” papers from the BMJ. However, we’ve noticed that over the last couple of years or so that, whilst the papers are still not strictly what you’d necessarily find in the year-round editions, they have become less light-hearted or quirky. We feel, particularly at this time of year, we need a bit of humour and silliness to lift our spirits, so whilst we’ve got a couple of articles from the BMJ, we’ve broadened our gaze and looked at a couple of articles from other journals and brought one back from the BMJ archives. Laughter, after all, really might be the best medicine (https://pubmed.ncbi.nlm.nih.gov/37220157/).
Happy reading and Happy festive period!
If you or your team want to submit a review, please get in touch with Dr Vicki Currie at @DrVickiCurrie1 or vickijanecurrie@gmail.com.
Article 1: The impact of “the Q word” on hospital speciality activity levels
Ped S, Sefat O, Turner C, Tabner A, Johnson G. Narrative systematic review https://emj.bmj.com/content/42/12/824
What’s it about?
COI: One of the Bubble Wrap reviewers was an author on this paper, but he loves all Christmas papers equally!
This narrative systematic review examines whether saying the word “quiet” (which everyone in emergency medicine avoids like the plague!) actually affects hospital workload. Eight randomised controlled trials across multiple specialties, including emergency medicine, orthopaedics, acute medicine, ENT, and microbiology, were identified and synthesised. All studies evaluated objective workload measures, such as patient numbers, referrals, bleeps, or admissions following the deliberate use of the “Q word”.
Why does it matter?
The belief that saying “q****” tempts fate is widespread in healthcare, influencing how we communicate and reinforcing superstition over empirical evidence. Whilst there are only a small number of studies, this review finds that seven of eight trials showed no effect on workload. The single positive study reporting increased admissions had substantial methodological limitations and a high risk of bias. Importantly, some studies suggest that belief in the superstition may influence perceived workload, even when objective measures are unchanged, highlighting the role of cognitive bias rather than causation.
Clinically Relevant Bottom Line
The evidence does not support the idea that saying the word “quiet” makes shifts busier. This Christmas, clinicians can safely utter the word without fear (QUIET! There, we’ve said it again).
Article 2: Where medicine meets melody — Lullaby Hour brings harmony to the neonatal ICU
Caldwell A. BMJ 2025;391:r2587 https://www.bmj.com/content/391/bmj.r2587
What’s it about?
This BMJ Christmas feature explores Lullaby Hour, a programme run by the charity Music in Hospitals & Care, delivering live music sessions to neonatal intensive care units (NICUs) across the UK. Since 2017, and particularly during 2025, musicians have provided live, responsive music to critically ill neonates and their families, aiming to create moments of calm in medicalised environment of the NICU. The article interviews musicians, charity leaders, and neonatal clinicians, with discussion of the existing evidence on music therapy in preterm infants.
Why does it matter?
NICU environments can be noisy, stressful, and emotionally overwhelming for families. This article highlights how the role live music may play in supporting important moments such as parent-infant bonding, whilst promoting a sense of normality during prolonged admissions. Whilst the physiological benefits for babies, such as reduced heart rate and improved oxygenation, are described anecdotally, they are supported by prior studies. However, the authors acknowledge that systematic reviews report low-certainty evidence for clinical outcomes. Importantly, the piece reframes music not as an “extra” but as a potentially meaningful component of compassionate neonatal care.
Clinically Relevant Bottom Line
Live music in the NICU may meaningfully improve the emotional environment for babies, parents, and staff. While high-quality evidence for physiological benefit remains limited, programmes like Lullaby Hour remind us that humane, relationship-centred care matters, especially at Christmas.
Article 3: Nettle-induced Urticaria Treatment Study (NUTS): does dock leaf really work?
Raman R, Beddis T, Bonhomme P, et al. Emergency Medicine Journal 2024 https://emj.bmj.com/content/emermed/41/11/691.full.pdf
What’s it about?
The Nettle-induced Urticaria Treatment Study (NUTS) (brilliant name, Ed) tested a long-standing British folk remedy: rubbing a dock leaf on nettle stings. In a randomised, double-blind, active placebo-controlled trial, nine emergency clinicians deliberately stung both forearms with nettles, then treated one arm with dock leaf and the other with lettuce (chosen as a biologically inert but tactilely similar placebo). Participants rated discomfort using the bespoke ITCH score and visible wheals using the OUCH score over 20 minutes.
Why does it matter?
This study demonstrates that even the most entrenched “everyone knows this works” remedies can and should be tested. While dock leaf showed a slightly greater early reduction in discomfort than lettuce, the difference was not statistically significant, and symptoms resolved quickly in both arms (we love that the different arms of the study were literal arms). Importantly, the paper is as much about how to do research as what it found: blinding, placebo choice, outcome measurement, and team-based research training are all highlighted.
Clinically Relevant Bottom Line
This study demonstrates that even the most entrenched “everyone knows this works” remedies can and should be tested. While dock leaf showed a slightly greater early reduction in discomfort than lettuce, the difference was not statistically significant, and symptoms resolved quickly in both arms (we love that the different arms of the study were literal arms). Importantly, the paper is as much about how to do research as what it found: blinding, placebo choice, outcome measurement, and team-based research training are all highlighted.
Article 4: Misogyny and manuscripts — a story of one woman’s fight against prejudice
McElhinney Z. BMJ 2025;391:r2600 https://www.bmj.com/content/391/bmj.r2600
Note: This is a commissioned fictional narrative, written in a historical style, rather than an empirical research study.
What’s it about?
This BMJ Christmas feature tells the story of Marianne Millwood, a young woman in the 19th century who documents the misogyny embedded in medical education and practice. Written in the style of a period novel (with explicit nods to Jane Austen), the piece follows Marianne’s attempts to collect women’s narratives about health, illness, menstruation, and childbirth and her repeated rejection by the medical publishing establishment solely based on her sex.
Why does it matter?
Although fictional, the article is rooted in the well-documented reality of the time. The exclusion of women from medical education, dismissal of women’s testimony as “hysterical”, and regarding the female body as a “pathological state”. The piece highlights tensions that remain uncomfortably familiar, drawing attention to issues about whose knowledge counts, who gets published, and how gendered assumptions continue to shape medical research, education, and clinical priorities. The story deliberately invites us to reflect on how much, or how little, has changed.
Clinically Relevant Bottom Line
Whilst this is not a research paper, it is a reminder that medicine’s evidence base has always been shaped by power, voice, and access. At Christmas, it’s worth a moment to pause and reflect about whose stories we still fail to hear, and what that omission costs our patients.
Article 5: Naughty or nice? Dispelling the Santa Claus myth
Park JJ, Coumbe BGT, Park EHG, et al. BMJ 2016;355:i6355 https://www.bmj.com/content/bmj/355/bmj.i6355.full.pdf
What’s it about?
This retrospective observational study set out to answer a question that has plagued parents, paediatricians, and ethicists for generations: what determines whether Santa Claus visits children in hospital on Christmas Day? The authors telephoned every UK hospital with a paediatric ward and asked staff whether Santa had visited at Christmas 2015. They then correlated Santa’s presence with proxies for “naughtiness” (school absenteeism and youth conviction rates), distance from the North Pole (measured “as the reindeer flies”), and socioeconomic deprivation.
Why does it matter?
Because evidence-based Christmas matters. The study found no association between Santa’s visits and child behaviour, criminality, or geographic distance. Instead, the only consistent factor linked to Santa not visiting was higher socioeconomic deprivation. So whilst Santa does not appear to discriminate based on niceness or naughtiness, structural societal inequality may still limit festive cheer. Along the way, the study also documented visits from a wide range of alternative superheroes, including elves, footballers, Elsa, and the occasional Stormtrooper.
Clinically Relevant Bottom Line
Santa does not necessarily reward solely good behaviour, but he may be constrained by social deprivation. This Christmas classic reminds us that even the most whimsical questions can uncover uncomfortable truths, but that if Santa can’t make it, local heroes still step in to spread some much-needed festive cheer. Distance to the north pole was not a barrier to present distribution, presumably because Santa is, like Christmas, very magical.
Summary:
The Christmas Wrapping Papers have taken us from lullabies in neonatal units, to employment practices of St Nick, via nettles, misogyny and myths. Along the way we’ve learned that music can soothe, stories matter, superstition rarely stands up to scrutiny, that emergency physicians will willingly sting themselves in the name of science (provided there is a decent study acronym) and that for Santa, being nice is not necessarily the be-all and end-all.
If there’s a message in all of this (and we like to think that there is one), it’s that curiosity is a wonderful thing and one of the reasons that we do what we do. Whether we’re asking big questions about care and equity, or small ones about folk remedies and forbidden words, curiosity and being a bit daft keeps us human. One paper from this year that we have not included so far laments the passing of the medical “revue” https://www.bmj.com/content/391/bmj.r2619 and calls for its return, citing the importance of levelling hierarchies, bringing people together from all over the hospital and the morale boosting effects that accompanied this. In a similar vein, whilst we have enjoyed the more serious contributions to the 2025 Christmas edition, we would love to see more of the silly, whimsical and irreverent papers of Christmas past. We look forward to the Christmas BMJ for exactly these reasons, keen to see the brilliant and absurd ideas that people across the world have conceived.
So, wherever you find yourself this festive season, at work or at home, and whether you find yourself busy or…not, we hope this Wrap brings a smile, a pause and, above all, the confidence to say QUIET out loud.
All reviews by the team at Derby Children’s ED (Graham Johnson and Shaarna Whitton)
A VERY Merry Christmas from the DFTB BubbleWrap team x
If we missed something useful or you think other articles are worth sharing, please add them in the comments!
That’s it for this month—many thanks to our reviewers for scouring the literature so you don’t have to.
Vicki Currie, DFTB Bubble Wrap Lead, reviewed all articles.