Wardround 13i6

This week's reading was The midnight meal, Jerome Lowenstein. He sums up with “ The challenge is to identify and preserve, or recapture, the critical components of relationships in medicine – between colleagues and between physicians and patients – that we need to preserve. A good first step would be to devise some new equivalent of the midnight meal.” I agree with him. The question for us is how will we make it happen. More from Dr Lowenstein as the year goes on.

This week’s two minute tutorials were about GI bleeding (non-variceal). What can I say about this? A common problem, with an incidence of 100/100000 in the UK. The mortality is about 10% and has changed little in the last 40 years. This does not necessarily mean we are making no headway in treatment because the epidemiology is changing and the age of bleeders is increasing. The Rockall Score uses age, haemodynamic disturbance, comorbidity, OGD findings and diagnosis to predict mortality. See the link below to evidence based on call to read more about the scores. A simple way to convert the score into a ‘ball-park’ mortality figure is to square the score and add on half the square again. If you have a easier way let me know. This week's prize goes to Dr Kidder (excellent timing).

Resources:

Evidence based on-call

Non-variceal upper gastrointestinal haemorrhage:
Guidelines. British Society of Gastroenterology Endoscopy Committee
Gut 2002;51(Suppl IV):iv1–iv6

The reading for next week, and the theme for tutorials is:
Controversies in stable coronary artery disease, Opie LH, et al. The Lancet, 7 January 2006 Volume 367, Issue 9504, Pages 69-78

The themes for next week’s two minute tutorials are sections from the paper; two minutes please on:

Statins MJM SHO
β blockers GAJ SHO
ACE inhibitors FY1

You are free to choose an alternative topic from the paper, but I ask that topics are not duplicated.

Interesting topics this week:

Claudication presenting as hip pain.
The Illusion of Certainty. [Clinical Problem Solving]. Wolinsky AP. NEJM 1996; 335(1): 46-48 (DK has a copy and it is available from the elibrary)

Snake venom and ACE inhibitors (this appeared, partially formed, from the pit of my memory during the wardround. I will check the details and tell all in the next podcast)

MJM