This week’s two minute tutorials were themed around pneumonia:
There is an extended version of my talk about aspiration pneumonia on the podcast (see below). I will record the two minute version and publish that after the weekend. The prize for this week goes to Dr Kidder (for his excellent timing!). Would each person post one fact from their talk in the comments, please?
I have found the themed tutorials much better than random subject choices and we have decided to make the two minute tutorials themed each week. Perhaps we will have an occasional freestyle week? Dr Jones had suggested the theme for next week, keeping the ID flavour: hospital acquired infection. Here are the topics:
MRSA bacteraemia - NM
Hospital acquired pneumonia - DK
Pseudomonas Pneumonia (not CF) - Nawaz
C. Difficile - Bhasker
Catheter related UTI - SS
We would like an A4 sheet to highlight the important points. You can see my effort from this week in the aspiration pneumonia post (click on summary)
The reading for next week is:
A Necessary Inhumanity? Ruth Richardson. Journal of Medical Ethics 2000;26;104-106
You should be able to get the PDF using your Athens password.
We have decided in future to discuss the week’s paper at coffee on Tuesday rather than Friday, which is already quite busy, so I will write a little about the antibiotic timing paper (see WR 16ix05) next week.
Interesting topics this week:
Hypercalcaemia and bilateral hilar lymphadenopathy
Mycobacterium avium
Giardiasis
Indications for pacing in Heart block
Hypothalamic function
AIDS lipodystrophy
Don’t forget your two minute tutorials should be concise and precise.
If anyone out there would like to submit two minute tutorials for the podcast, just leave me a note in one of the comments.
Friday, September 23, 2005
Wednesday, September 21, 2005
Aspiration Pneumonia
A brief summary
MP3 File
Summary sheet
Aspiration pneumonitis and aspiration pneumonia. Paul E Marik. The New England Journal of Medicine. 2001 (Mar 1) 344 (9); 665-7
Aspiration Pneumonia: Recognizing and managing a potentially growing disorder. John L. Johnson, Christina S. Hirsch. VOL 113 / NO 3 / MARCH 2003 / POSTGRADUATE MEDICINE
MP3 File
Summary sheet
Aspiration pneumonitis and aspiration pneumonia. Paul E Marik. The New England Journal of Medicine. 2001 (Mar 1) 344 (9); 665-7
Aspiration Pneumonia: Recognizing and managing a potentially growing disorder. John L. Johnson, Christina S. Hirsch. VOL 113 / NO 3 / MARCH 2003 / POSTGRADUATE MEDICINE
Saturday, September 17, 2005
MJM wardround 16ix05
This week’s two minute tutorials were:
Dr Tuck: Colchicine overdose (6/8)
Dr Mohan: Glucocorticoids and the risk of heart disease (6/8)
Dr Queen: Using interpreters (6/8)
(would you each post the references/links in the comments, please)
Dr Jones has now given her considered opinion on last week’s emergency drug choices:
The prize is awarded to Dr Queen for emphasis on sanitation and oral rehydration therapy. I liked his idea to use mefloquine for prophylaxis and treatment. I would have chosen a broader spectrum penicillin in this setting (not on the ward) and a once daily cephalosporin for ease of administration. Vancomycin could be swapped for clindamycin for the penicillin allergic, for ease of treatment and broader cover including anaerobes and reducing the need for anti-tetanus. Dr Tuck had started with a slightly different approach, considering how to treat the most common conditions worldwide which perhaps influenced her choice more than the rest of us who focussed on survival in a disaster area. Dr Mohan produced a well balanced list with oxygen, fluids and I see has been persuaded to make antibiotic changes.
The week’s reading had been The case for an all-female crew to Mars. William J. Rowe. Journal of Men’s Health and Gender. 2004 Dec Vol 1 (No.4) 341-344
You will remember that I posed the questions: Is this for real or is it a spoof? How do you assess the credibility of a paper like this?
It was interesting to see that the first methods of addressing the credibility question were attempts to identify the character of the author and publication. Though this is a common way of approaching the problem of credibility, I would argue that these are not really valid ways to test the credibility of this paper’s content. In logic these are well enough recognised as fallacies to have been named: argumentum ad hominem (arguing against a person, rather than against what a person says) and arguing from authority (the prestige of the journal does not guarantee the paper’s truth). Returning to the content, the paper presents a hypothesis based on inductive reasoning. This is the method by which most scientific hypotheses are produced. The paper however, describes the hypothesis as if it is the result of a deductive argument. The difference is that a hypothesis (produced by inductive reasoning) would need to be further tested by experiment whereas deductive reasoning produces a ready proven answer. It is important to recognise and differentiate hypothesis (possibility) from deduction (certainty). A good hypothesis will come with suggestions as to the experiments needed to test it…remember that when you hypothesise a diagnosis.
Ok…checking the credibility of a hypothesis…Check that the propositions on which the reasoning is based are correct; check the reasoning is valid (logical); look for a clear exposition of the hypothesis and suggestions as to how it can be checked. Enough logic for now.
The reading for next week is:
Timing of Antibiotic Administration and Outcomes for Medicare Patients Hospitalized With Community-Acquired Pneumonia. Houck P, Bratzler D, Nsa W, Ma A, Bartlett G
Archives of Internal Medicine, 2004 (22 March);164(6):637–644
You should be able to get the PDF from NHSES elibrary using your Athens password.
Interesting topics this week:
RS3PE, pitting oedema of the hands
Exercise tolerance tests, tell me more
Vertebro-basilar insufficiency, how is it diagnosed?
Cellulitis, do you really know about it?
Alcohol associated collapse, alcohol effects
Clostridium perfringens, tell me more
LBBB, tell me more (use uptodate on the intranet)
Don’t forget your two minute tutorials…make them concise and precise.
The tutorial topics this time are not free choices: you are given a specific pneumonia to both speak about and produce an A4 size sheet highlighting important features and facts.
Sandip Mycoplasma
Naveen Pneumococcus
Dilshad Legionairres
Nawaz Chlamydia
Bhasker Q-fever
MJM Aspiration
GAJ Gp A Strep
If anyone out there would like to submit two minute tutorials for the podcast, just leave me a note in one of the comments.
MJM
Dr Tuck: Colchicine overdose (6/8)
Dr Mohan: Glucocorticoids and the risk of heart disease (6/8)
Dr Queen: Using interpreters (6/8)
(would you each post the references/links in the comments, please)
Dr Jones has now given her considered opinion on last week’s emergency drug choices:
The prize is awarded to Dr Queen for emphasis on sanitation and oral rehydration therapy. I liked his idea to use mefloquine for prophylaxis and treatment. I would have chosen a broader spectrum penicillin in this setting (not on the ward) and a once daily cephalosporin for ease of administration. Vancomycin could be swapped for clindamycin for the penicillin allergic, for ease of treatment and broader cover including anaerobes and reducing the need for anti-tetanus. Dr Tuck had started with a slightly different approach, considering how to treat the most common conditions worldwide which perhaps influenced her choice more than the rest of us who focussed on survival in a disaster area. Dr Mohan produced a well balanced list with oxygen, fluids and I see has been persuaded to make antibiotic changes.
The week’s reading had been The case for an all-female crew to Mars. William J. Rowe. Journal of Men’s Health and Gender. 2004 Dec Vol 1 (No.4) 341-344
You will remember that I posed the questions: Is this for real or is it a spoof? How do you assess the credibility of a paper like this?
It was interesting to see that the first methods of addressing the credibility question were attempts to identify the character of the author and publication. Though this is a common way of approaching the problem of credibility, I would argue that these are not really valid ways to test the credibility of this paper’s content. In logic these are well enough recognised as fallacies to have been named: argumentum ad hominem (arguing against a person, rather than against what a person says) and arguing from authority (the prestige of the journal does not guarantee the paper’s truth). Returning to the content, the paper presents a hypothesis based on inductive reasoning. This is the method by which most scientific hypotheses are produced. The paper however, describes the hypothesis as if it is the result of a deductive argument. The difference is that a hypothesis (produced by inductive reasoning) would need to be further tested by experiment whereas deductive reasoning produces a ready proven answer. It is important to recognise and differentiate hypothesis (possibility) from deduction (certainty). A good hypothesis will come with suggestions as to the experiments needed to test it…remember that when you hypothesise a diagnosis.
Ok…checking the credibility of a hypothesis…Check that the propositions on which the reasoning is based are correct; check the reasoning is valid (logical); look for a clear exposition of the hypothesis and suggestions as to how it can be checked. Enough logic for now.
The reading for next week is:
Timing of Antibiotic Administration and Outcomes for Medicare Patients Hospitalized With Community-Acquired Pneumonia. Houck P, Bratzler D, Nsa W, Ma A, Bartlett G
Archives of Internal Medicine, 2004 (22 March);164(6):637–644
You should be able to get the PDF from NHSES elibrary using your Athens password.
Interesting topics this week:
RS3PE, pitting oedema of the hands
Exercise tolerance tests, tell me more
Vertebro-basilar insufficiency, how is it diagnosed?
Cellulitis, do you really know about it?
Alcohol associated collapse, alcohol effects
Clostridium perfringens, tell me more
LBBB, tell me more (use uptodate on the intranet)
Don’t forget your two minute tutorials…make them concise and precise.
The tutorial topics this time are not free choices: you are given a specific pneumonia to both speak about and produce an A4 size sheet highlighting important features and facts.
Sandip Mycoplasma
Naveen Pneumococcus
Dilshad Legionairres
Nawaz Chlamydia
Bhasker Q-fever
MJM Aspiration
GAJ Gp A Strep
If anyone out there would like to submit two minute tutorials for the podcast, just leave me a note in one of the comments.
MJM
Thursday, September 15, 2005
Sunday, September 11, 2005
Free Speech
Oh No!! I see we have an alternative chronicle of the ward round...(click on the title "free speech" to see it)...but who should we believe? I must sort this out...where did I put my Machiavelli?
Saturday, September 10, 2005
MJM Wardrounds - Lister
This week’s two minute tutorials were in support of a choice of antibiotics/drugs for an emergency…including our first input from a pharmacist. I need to speak to Dr Jones, to get the marks, before announcing the winner. The various drug choices are listed in the comments for last week’s wardround post, except Dr Tuck’s which is in the trichotillomania comments. (Bad aim Claire, have you been posting comments half asleep?).
I enjoyed the exercise of choosing the 5 antibiotics and five other drugs. It was interesting that several of us ran into the same problem: finding that only 4 non-antibiotics were needed. That 10th drug proved to be a problem, I think, not because it was not needed but because it opened up so many possible disorders for consideration. Hopefully you found the exercise useful.
The choices were backed up by sound argument and support from sources such as the Red Cross. There did seem to be, perhaps unsurprisingly, many broad areas of agreement: antiseptics, cover for tetanus (be it with anti-tetanus Ig or clindamycin), antibiotics to provide broad cover for G+, G-, anaerobes, protozoa etc. Most of you chose to take rehydration fluids (oral or IV), opiate analgesics and oxygen. I had not thought of activated charcoal but on reflection I quite like the idea. I will look at the Red Cross site again (Thank you to Naveen Mohan for pointing it out to me.)
I suggested a tree of woes exercise for each of you. For my part I would now ditch Anti-tetanus Ig and diclofenac for clindamycin and activated charcoal.
This week’s reading was On the antiseptic principle in the Practice of surgery. Joseph Lister. Lancet 1867, Sept 21, 90 (2299) 353-356
This is a landmark paper without any doubt, describing what must be one of the most important advances in the practice of medicine. The effects of the work are shown in Lister’s last paragraph….
"There is, however, one point more that I cannot but advert to-namely, the influence of this mode of treatment upon the general healthiness of an hospital. Previously to its introduction, the two large wards in which most of my cases of accident and of operation are treated were amongst the unhealthiest in the whole surgical division of the Glasgow Royal Infirmary… But since the antiseptic treatment has been brought into full operation, and wounds and abscesses no longer poison the atmosphere with putrid exhalations, my wards, though in other respects under precisely the same circumstances as before, have completely changed their character; so that during the last nine months not a single instance of pyaemia, hospital gangrene, or erysipelas has occurred in them. As there appears to be no doubt regarding the cause of this change, the importance of the fact can hardly be exaggerated."
The reading for next week is:
The case for an all-female crew to Mars. William J. Rowe. Journal of Men’s Health and Gender. 2004 Dec Vol 1 (No.4) 341-344
If you prefer it as a PDF, click here and you should be able to get the file with your Athens password. Is this for real or is it a spoof? How do you assess the credibility of a paper like this? And what can you learn from it?
Interesting problems this week:
Small joint inflammatory arthritis in polymyalgia rheumatica, tell me more
Miller-Fisher syndrome. What is anti GQ1B?
Stent thrombosis, tell me more
Tarsal tunnel syndrome, what are the symptoms?
Dressler’s syndrome after pacemaker insertion, tell me more
Hypomagnesaemia, tell me more
Pacemaker Syndrome, what’s that?
Don’t forget your two minute tutorials…make them concise and precise.
If anyone would like to submit two minute tutorials for the podcast, or make a suggestion for future topics, just leave me a note in one of the comments.
MJM
I enjoyed the exercise of choosing the 5 antibiotics and five other drugs. It was interesting that several of us ran into the same problem: finding that only 4 non-antibiotics were needed. That 10th drug proved to be a problem, I think, not because it was not needed but because it opened up so many possible disorders for consideration. Hopefully you found the exercise useful.
The choices were backed up by sound argument and support from sources such as the Red Cross. There did seem to be, perhaps unsurprisingly, many broad areas of agreement: antiseptics, cover for tetanus (be it with anti-tetanus Ig or clindamycin), antibiotics to provide broad cover for G+, G-, anaerobes, protozoa etc. Most of you chose to take rehydration fluids (oral or IV), opiate analgesics and oxygen. I had not thought of activated charcoal but on reflection I quite like the idea. I will look at the Red Cross site again (Thank you to Naveen Mohan for pointing it out to me.)
I suggested a tree of woes exercise for each of you. For my part I would now ditch Anti-tetanus Ig and diclofenac for clindamycin and activated charcoal.
This week’s reading was On the antiseptic principle in the Practice of surgery. Joseph Lister. Lancet 1867, Sept 21, 90 (2299) 353-356
This is a landmark paper without any doubt, describing what must be one of the most important advances in the practice of medicine. The effects of the work are shown in Lister’s last paragraph….
"There is, however, one point more that I cannot but advert to-namely, the influence of this mode of treatment upon the general healthiness of an hospital. Previously to its introduction, the two large wards in which most of my cases of accident and of operation are treated were amongst the unhealthiest in the whole surgical division of the Glasgow Royal Infirmary… But since the antiseptic treatment has been brought into full operation, and wounds and abscesses no longer poison the atmosphere with putrid exhalations, my wards, though in other respects under precisely the same circumstances as before, have completely changed their character; so that during the last nine months not a single instance of pyaemia, hospital gangrene, or erysipelas has occurred in them. As there appears to be no doubt regarding the cause of this change, the importance of the fact can hardly be exaggerated."
The reading for next week is:
The case for an all-female crew to Mars. William J. Rowe. Journal of Men’s Health and Gender. 2004 Dec Vol 1 (No.4) 341-344
If you prefer it as a PDF, click here and you should be able to get the file with your Athens password. Is this for real or is it a spoof? How do you assess the credibility of a paper like this? And what can you learn from it?
Interesting problems this week:
Small joint inflammatory arthritis in polymyalgia rheumatica, tell me more
Miller-Fisher syndrome. What is anti GQ1B?
Stent thrombosis, tell me more
Tarsal tunnel syndrome, what are the symptoms?
Dressler’s syndrome after pacemaker insertion, tell me more
Hypomagnesaemia, tell me more
Pacemaker Syndrome, what’s that?
Don’t forget your two minute tutorials…make them concise and precise.
If anyone would like to submit two minute tutorials for the podcast, or make a suggestion for future topics, just leave me a note in one of the comments.
MJM
Wednesday, September 07, 2005
Preventing trichotillomania in secretaries
How to use a dictophone
MP3 File
Physician Dictation Guide
An excellent brief guide...anyone who uses a dictation machine should read this at least once.
A history of the machine
Find out the difference between a dictaphone and a dictophone.
MP3 File
Physician Dictation Guide
An excellent brief guide...anyone who uses a dictation machine should read this at least once.
A history of the machine
Find out the difference between a dictaphone and a dictophone.
Saturday, September 03, 2005
MJM Wardrounds
This week’s two minute tutorials were:
Dr Mohan -Obesity as a risk factor for AF (8/8)
Dr Tuck - Mobile phone safety in hospitals (6/8)
Dr Queen – Diagnosis of Churg-Strauss (3/8)
I have asked Dr Mohan to post the reference of the paper in the comments section and I see he has done so in the comments section of 'palindromic rheumatism'.
For next Friday you are challenged to choose the ten drugs you would take in your ‘doctor’s bag’ to a disaster area. You must choose five antibiotics and five others. Please post your choices in the comments before next Friday. If you are not on the wardround please feel free to post your choices as well. As ever, a prize of kudos for the best.
For those on the wardround next week, your two minute tutorial will be your chance to support your choice. I am still waiting for info on clavulanic acid (next week, Dr Queen, please), and glycopeptide antibiotics (Dr Mohan)
The reading for next week is:
On the antiseptic principle in the Practice of surgery.
Joseph Lister. Lancet 1867, Sept 21, 90 (2299) 353-356
You should be able to get the PDF using your Athens password.
doi:10.1016/S0140-6736(02)51827-4 (don’t know what a DOI is?....better find out, you will come across them again)
Interesting cases this week (I’ve cheated a bit by listing some things seen earlier in the week but not on the actual round).
Nephrogenic fibrosing dermopathy (one of the pseudosclerodermas)
Hypercalcaemia (how is it treated) 2
Acute renal failure with normal urea but high creatinine (how does that happen?)
Pancytopenia with myocrisin (Is that bad news?)
Hickman lines and infection (should it stay or should it go?) ...also
Stridor in Wegener’s Granulomatosis
Unilateral wheeze (what could that be?)
Acute Arterial occlusion (tell me more)
Rash and fever after returning from rural Nicaragua (what could that be?...have you tried travax?)
Don’t forget your two minute tutorials…defend your choice of drugs...be precise and concise
If anyone out there would like to submit a two minute tutorial for the podcast just leave me a note in one of the comments.
MJM
Dr Mohan -Obesity as a risk factor for AF (8/8)
Dr Tuck - Mobile phone safety in hospitals (6/8)
Dr Queen – Diagnosis of Churg-Strauss (3/8)
I have asked Dr Mohan to post the reference of the paper in the comments section and I see he has done so in the comments section of 'palindromic rheumatism'.
For next Friday you are challenged to choose the ten drugs you would take in your ‘doctor’s bag’ to a disaster area. You must choose five antibiotics and five others. Please post your choices in the comments before next Friday. If you are not on the wardround please feel free to post your choices as well. As ever, a prize of kudos for the best.
For those on the wardround next week, your two minute tutorial will be your chance to support your choice. I am still waiting for info on clavulanic acid (next week, Dr Queen, please), and glycopeptide antibiotics (Dr Mohan)
The reading for next week is:
On the antiseptic principle in the Practice of surgery.
Joseph Lister. Lancet 1867, Sept 21, 90 (2299) 353-356
You should be able to get the PDF using your Athens password.
doi:10.1016/S0140-6736(02)51827-4 (don’t know what a DOI is?....better find out, you will come across them again)
Interesting cases this week (I’ve cheated a bit by listing some things seen earlier in the week but not on the actual round).
Nephrogenic fibrosing dermopathy (one of the pseudosclerodermas)
Hypercalcaemia (how is it treated) 2
Acute renal failure with normal urea but high creatinine (how does that happen?)
Pancytopenia with myocrisin (Is that bad news?)
Hickman lines and infection (should it stay or should it go?) ...also
Stridor in Wegener’s Granulomatosis
Unilateral wheeze (what could that be?)
Acute Arterial occlusion (tell me more)
Rash and fever after returning from rural Nicaragua (what could that be?...have you tried travax?)
Don’t forget your two minute tutorials…defend your choice of drugs...be precise and concise
If anyone out there would like to submit a two minute tutorial for the podcast just leave me a note in one of the comments.
MJM
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