Generating energy from crematoriums, and other storiesBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1526 (Published 12 March 2013) Cite this as: BMJ 2013;346:f1526
The installation of 106 solar panels on the roof of a crematorium in Hereford, United Kingdom, is expected to generate over 15 000 units of electricity a year, saving more than 12 tonnes of carbon dioxide emissions and saving taxpayers nearly £5000 (€5800; $7540) per year. Solar panels are well suited to crematoriums, according to the local energy company, “because they are silent, and won’t disrupt the business of the site” (Pharos International Spring 2013;79:38).
Early laparoscopic cholecystectomy is encouraged for most people with acute cholecystitis. But what happens to those who are discharged on first admission without surgery? Using data from over 10 000 patients who did not undergo cholecystectomy on first admission, Canadian researchers found a 19% probability of a subsequent gallstone related event or hospital visit within 12 weeks of discharge. This risk increased in younger patients aged 18-34 years (Journal of Trauma and Acute Care Surgery 2013;74:26-31, doi:10.1097/TA.0b013e3182788e4d).
In a comparison study of 97 children with epilepsy and 69 healthy children, IQ was significantly lower in children with epilepsy than in controls. However, IQ did not differ significantly between the parents of both groups. Children with epilepsy had significantly lower IQ scores than their biological parents, which was not observed in the control group. The researchers suggest that the parent-child IQ difference is a marker of the effect of epilepsy, independent of familial IQ and of the type of epilepsy (Developmental Medicine and Child Neurology 2013;55:278-82, doi:10.1111/dmcn.12040).
The proportion of medical graduates in the United Kingdom who choose to specialise in psychiatry has remained at about 5% over the past 35 years. In a questionnaire study of nearly 34 000 respondents, the main reasons for choosing psychiatry included experience of the subject at medical school, self appraisal of skills, and inclinations even before applying to medical school. Of graduates who did not choose psychiatry, 72% gave “job content” as their reason for rejection, compared with 33% of those who considered but rejected other specialties (British Journal of Psychiatry 2013;202:228-34, doi:10.1192/bjp.bp.112.111153).
Minerva fondly remembers the adventures of Laura Ingalls in the Little House on the Prairie, and the tears she wept when Laura’s sister Mary went blind at the age of 14. Mary’s sight loss was blamed on scarlet fever in the novels, but in Laura Ingalls Wilder’s memoirs, she recalls Mary being “taken suddenly sick with a pain in her head” and then being “delirious with an awful fever,” with her face “drawn out of shape.” It was recorded as “spinal sickness” and “brain fever,” period terms for meningoencephalitis (Pediatrics 2013;131:404-6, doi:10.1542/peds.2012-1438).
Postdural puncture headaches (PDPH) occur in up to 40% of people who undergo lumbar puncture, typically starting within 15 min of sitting up, and resolving within 15 min of lying down again. In a prospective study of 160 people with migraine headaches and 53 matched healthy controls, risk factors for PDPH were identified as young age and low body mass index, but not having migraines (Neurology 2013;80:941-8, doi:10.1212/WNL.0b013e3182840bf6). Duration of PDPH was prolonged if multiple attempts at lumbar puncture were made, and if patients perceived their lumbar puncture experience as stressful.
Men with high risk prostate cancer who undergo robot assisted radical prostatectomy could have just as good oncological outcomes as those who undergo open surgery, according to a retrospective analysis of over 400 patients at one United States institution (British Journal of Urology International 2013, doi:10.1111/j.1464-410X.2012.11493.x). Recurrence free survival was similar in both groups at two years (open procedure 84% v robot assisted procedure 79%) and four years (68% v 66%). But robot assisted patients had less blood loss and underwent complete bilateral nerve sparing more often than patients with open surgery.
Preoperative magnetic resonance imaging (MRI) could underestimate the size of articular cartilage defects compared with what is actually found at arthroscopy. In one cohort study of 77 patients undergoing knee arthroscopy, MRI scans underestimated the defect area by an average of 70%; therefore, many patients were not well informed preoperatively about the best repair strategies on offer. The authors suggest that such discrepancies are predictable, and should be reflected in the treatment strategies discussed before surgery (American Journal of Sports Medicine 2013;41:590-5, doi:10.1177/0363546512472044).
PCV7—a seven valent, pneumococcal conjugate vaccine—was introduced in Australia in two phases, in 2001 and 2005. In the five years after its introduction, admission rates for all childhood pneumonias fell significantly; however, admissions for empyema rose more than expected, although this increase was significant only among children aged 1-4 years. There is a concern that empyema may have emerged as a “replacement disease,” produced by non-vaccine related serotypes of Streptococcus pneumoniae (Bulletin of the World Health Organization 2013;91:167-73, doi:10.2471/blt.12.109231).
Cite this as: BMJ 2013;346:f1526