MinervaBMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.d8210 (Published 04 January 2012) Cite this as: BMJ 2012;344:d8210
The night time glow of lights picked up by satellite imaging from space predicts the spread of measles in west Africa (Science 2011;334:1424-7, doi:10.1126/science.1210554). In Niger, measles epidemics fluctuate dramatically from one season to the next. Suspecting that population density plays a part, as cities swell in numbers during the dry season and deflate when the rain starts, researchers used light sources from electric lights and fires at night as a measure of human occupancy. Measles transmission rates and population densities were highly correlated. These observations are important for tracking public health issues, for crisis management, and for improving intervention strategies.
Although anterior cruciate ligament reconstruction reduces knee ligament laxity, increases stability, and improves physical activity, osteoarthritis of the knee is still common after the operation. Among a cohort of 249 adults who had undergone single bundle anterior cruciate ligament reconstruction, 39% had developed radiographic osteoarthritis within seven years of surgery. The greatest predictors of arthritis were obesity and a high grade of chondrosis in the medial compartment (American Journal of Sports Medicine 2011;39:2595-603, doi:10.1177/0363546511424720).
Does the force required to remove a thoracic epidural catheter depend on the patient’s position? Eighty four patients who’d undergone open thoracotomy and were using patient controlled epidural analgesia were allocated to three positions for removal of their epidural catheters—prone, supine, and lateral. On the third post-operative day, researchers measured the peak tension recorded during epidural withdrawal. The patient’s position made no difference to the force required, suggesting that patients can choose the position they want to be in when the epidural is pulled out, as long as it’s clinically appropriate (Anaesthesia 2012;67:19-22, doi:10.1111/j.1365-2044.2011.06913.x).
Smokers have more advanced bladder cancers at the time they present, and have worse outcomes after radical cystectomy than non-smokers (British Journal Urology International 2011;109:70-6, doi:10.1111/j.1464-410X.2011.10371.x). But in a large study of almost 550 patients with bladder cancer, smoking was not an independent prognostic factor for survival, and women had a poorer survival rate than men, regardless of smoking status. The authors say that non-tumour factors such as presentation or treatment delay may explain the reported differences in survival.
Some medical students are destined never to become orthopaedic surgeons. Thirty three medical students were randomised to receive arthroscopic skills training or no training. They were then required to perform 30 attempts of two simulated arthroscopic tasks involving a shoulder and a knee. Competence was achieved when the learning curves stabilised. The “trained” cohort performed significantly better on the shoulder task but the two groups showed no significant differences for the knee task. Some couldn’t master the techniques involved regardless of focused training (Journal of Bone and Joint Surgery 2011;93-B:1586-91, doi:10.1302/0301-620X.93B12.27946).
A New Zealand study of young children admitted to hospital with pneumonia found that fewer than half of them had taken antibiotics before reaching hospital. For 21% of those who hadn’t received antibiotics there had been no opportunity to prescribe because the illness had evolved too rapidly. But missed opportunities were identified in the remaining untreated children. In some, the parents hadn’t obtained the medication; in others, the diagnosis had been missed despite the presence of obvious symptoms; and in some, pneumonia had been diagnosed but no antibiotic prescribed (Archives of Diseases in Childhood 2012;97:21-7, doi:10.1136/archdischild-2011-300604).
Patients with malignant melanoma who undergo lymph node exploration and excision often report persistent pain. A Danish study found that lymph node dissection is more commonly associated with altered sensation and pain (82% and 34%) than sentinel node biopsy (32% and 14%). The most important predictor of ongoing pain was sensory abnormalities. The authors conclude that nerve injury is the main underlying mechanism of persistent pain after lymph node excision (Pain 2011;152:2721-8, doi:10.1016/j.pain.2011.07.009).
Should hysteroscopic septoplasty be offered to everyone with a subseptate uterus? A Chinese study divided 138 women with subseptate uteruses into two groups—those with a history of recurrent spontaneous abortion and those without. Each group was then randomised to control and surgery subgroups. The rates of pregnancy and term delivery were significantly higher in those with a history of poor reproductive outcome who underwent surgery than in the control group. But for those without a poor reproductive history, surgery offered no benefit (International Journal of Gynecology and Obstetrics 2011;115:260-3, doi:10.1016/j.ijgo.2011.07.030).
Cite this as: BMJ 2012;344:d8210