MP3 File
Monday, February 27, 2006
Sunday, February 19, 2006
Saturday, February 18, 2006
Wardround 17ii6
This week’s reading and two minute tutorials were themed around epilepsy. The turn out was a little poor with only MJM (epidemiology), CC (investigations) and HG (classification) stepping up to face the music. So perhaps we can repeat this subject in a few weeks. I recommend the SIGN national clinical guideline No.70, Diagnosis and Management of epilepsy in Adults (from April 2003, updated 2005). The Quick guide is well worth a look for revision.
The reading for the week was The Falling Sickness, Jones J, Southern Medical Journal 2000;93(12):1169-1172, which I hope was enlightening. Though some of the views of epilepsy described may seem strange, if not outrageous, you should bear in mind that similar ideas may be held by patients with newly diagnosed epilepsy, or their relatives. It is important to educate patients about the reality of the disease. The aim of treating epilepsy is to render a patient able to live a normal life. Seizure control is but one aspect of this aim.
Next week’s theme is aortic stenosis:
Epidemiology (CT)
Clinical effects (BK)
Investigations (HG)
Treatment (CC)
Two minutes please, with sources quoted.
The reading for next week is The Company We Keep: Why Physicians Should Refuse to See Pharmaceutical Representatives. Howard Brody. Annals of Family Medicine 2005; 3:82-85.
Interesting cases this week:
Pulmonary eosinophilia
SIADH
Paroxysmal AF
Gout
I will be away next Friday so there will be no blog for 24ii6. I will leave it to Dr Jones to set the assignments. (How about fungal infections?).
MJM
The reading for the week was The Falling Sickness, Jones J, Southern Medical Journal 2000;93(12):1169-1172, which I hope was enlightening. Though some of the views of epilepsy described may seem strange, if not outrageous, you should bear in mind that similar ideas may be held by patients with newly diagnosed epilepsy, or their relatives. It is important to educate patients about the reality of the disease. The aim of treating epilepsy is to render a patient able to live a normal life. Seizure control is but one aspect of this aim.
Next week’s theme is aortic stenosis:
Epidemiology (CT)
Clinical effects (BK)
Investigations (HG)
Treatment (CC)
Two minutes please, with sources quoted.
The reading for next week is The Company We Keep: Why Physicians Should Refuse to See Pharmaceutical Representatives. Howard Brody. Annals of Family Medicine 2005; 3:82-85.
Interesting cases this week:
Pulmonary eosinophilia
SIADH
Paroxysmal AF
Gout
I will be away next Friday so there will be no blog for 24ii6. I will leave it to Dr Jones to set the assignments. (How about fungal infections?).
MJM
Sunday, February 12, 2006
Wardround 10ii6
The reading for this week was Does This Woman Have Osteoporosis? Green AD et al, JAMA 2004; 292: 2890 - 2900.
The paper reports that “no single maneuver is sufficient to rule in or rule out osteoporosis or spinal fracture without further testing. The following yielded the greatest positive likelihood ratios (LR+): weight less than 51 kg, LR+, 7.3 (95% confidence interval [CI], 5.0–10.8); tooth count less than 20, LR+, 3.4 (95% CI, 1.4–8.0); rib-pelvis distance less than 2 finger breadths, LR+, 3.8 (95% CI, 2.9–5.1); wall-occiput distance greater than 0 cm, LR+, 4.6 (95% CI, 2.9–7.3), and self-reported humped back, LR+, 3.0 (95% CI, 2.2–4.1). Conclusions: In patients who do not meet current bone mineral density screening recommendations, several convenient examination maneuvers, especially low weight, can significantly change the pretest probability of osteoporosis and suggest the need for earlier screening. Wall-occiput distance greater than 0 cm and rib-pelvis distance less than 2 finger breadths suggest the presence of occult spinal fracture.” I chose this paper because it described several clinical signs that are not routine for most of us in internal medicine (but perhaps less strange to rheumatologists).
The two minute tutorial theme was Dementia. My congratulations on the choice of subject. As I read/revised this, it became obvious to me that I have not given enough time to formally reviewing the subject. The talks were all well constructed and revised. Timing generally good. having said all that, my prize for this week goes to Dr Tuck.
Next week’s topic is Epilepsy...you have your assignments (I will include them later, but they are left the list at work).
Epidemiology
Important clinical points in the history
Investigation
Social aspects
Treatment
The reading for next week is The Falling Sickness, Jones J, Southern Medical Journal 2000;93(12):1169-1172. (get it from the elibrary)
You may also wish to look over, Epilepsy: historical overview. WHO factsheet no. 168. February 2001
MJM
The paper reports that “no single maneuver is sufficient to rule in or rule out osteoporosis or spinal fracture without further testing. The following yielded the greatest positive likelihood ratios (LR+): weight less than 51 kg, LR+, 7.3 (95% confidence interval [CI], 5.0–10.8); tooth count less than 20, LR+, 3.4 (95% CI, 1.4–8.0); rib-pelvis distance less than 2 finger breadths, LR+, 3.8 (95% CI, 2.9–5.1); wall-occiput distance greater than 0 cm, LR+, 4.6 (95% CI, 2.9–7.3), and self-reported humped back, LR+, 3.0 (95% CI, 2.2–4.1). Conclusions: In patients who do not meet current bone mineral density screening recommendations, several convenient examination maneuvers, especially low weight, can significantly change the pretest probability of osteoporosis and suggest the need for earlier screening. Wall-occiput distance greater than 0 cm and rib-pelvis distance less than 2 finger breadths suggest the presence of occult spinal fracture.” I chose this paper because it described several clinical signs that are not routine for most of us in internal medicine (but perhaps less strange to rheumatologists).
The two minute tutorial theme was Dementia. My congratulations on the choice of subject. As I read/revised this, it became obvious to me that I have not given enough time to formally reviewing the subject. The talks were all well constructed and revised. Timing generally good. having said all that, my prize for this week goes to Dr Tuck.
Next week’s topic is Epilepsy...you have your assignments (I will include them later, but they are left the list at work).
Epidemiology
Important clinical points in the history
Investigation
Social aspects
Treatment
The reading for next week is The Falling Sickness, Jones J, Southern Medical Journal 2000;93(12):1169-1172. (get it from the elibrary)
You may also wish to look over, Epilepsy: historical overview. WHO factsheet no. 168. February 2001
MJM
Saturday, February 04, 2006
Wardround 3ii6
The reading for this week was Hedgehog zoonoses Riley PL, Chomel BB. Emerg Infect Dis. 2005 Jan. I suggested this as a catalyst to promote thought about zoonoses in general rather than intimating the specific importance of our prickly friends in human disease.
The talks were interesting and certainly stimulated discussion, particularly since we had one of our new microbiologists in attendance. Specifics included in discussion were Leptospirosis (icteric and anicteric), Lyme (remember the different clinical patterns in US and UK disease),
Rabies, and Toxoplasmosis.
Learning points: know the local zoonoses; take a history of animal contacts.
A second question was the definition of zoonosis. The World Health Organization defines a zoonosis as an infection or infectious disease transmissible from vertebrate animals to man. Merriam-Webster's Medical Dictionary suggests it is a disease communicable from animals to humans under natural conditions. I was slightly put out to find that my two volume shorter Oxford English dictionary does not list zoonois though it does list zoonosology as the study of the diseases of animals. I believe that the medical term zoonosis is in fact a contraction of the more precise anthropozoonosis, a zoonosis maintained in nature by animals and transmissible to humans. (The American Heritage Stedman's Medical Dictionary). Pedantry award to MJM. I lay down a challenge. Using this last definition find a non-infective anthropozoonosis.
Interesting cases this week:
Cryptococcal meningitis
I would also recommend the Uptodate article (available on the hospital intranet).
Next week’s reading is:
Does This Woman Have Osteoporosis? Green AD et al, JAMA 2004; 292: 2890 - 2900 (Get it from the elibrary)
The two minute tutorials next week are on Dementia: epidemiology, assessment, investigation and treatment. Talks precise and concise please, with some indication of your sources.
MJM
The talks were interesting and certainly stimulated discussion, particularly since we had one of our new microbiologists in attendance. Specifics included in discussion were Leptospirosis (icteric and anicteric), Lyme (remember the different clinical patterns in US and UK disease),
Rabies, and Toxoplasmosis.
Learning points: know the local zoonoses; take a history of animal contacts.
A second question was the definition of zoonosis. The World Health Organization defines a zoonosis as an infection or infectious disease transmissible from vertebrate animals to man. Merriam-Webster's Medical Dictionary suggests it is a disease communicable from animals to humans under natural conditions. I was slightly put out to find that my two volume shorter Oxford English dictionary does not list zoonois though it does list zoonosology as the study of the diseases of animals. I believe that the medical term zoonosis is in fact a contraction of the more precise anthropozoonosis, a zoonosis maintained in nature by animals and transmissible to humans. (The American Heritage Stedman's Medical Dictionary). Pedantry award to MJM. I lay down a challenge. Using this last definition find a non-infective anthropozoonosis.
Interesting cases this week:
Cryptococcal meningitis
I would also recommend the Uptodate article (available on the hospital intranet).
Next week’s reading is:
Does This Woman Have Osteoporosis? Green AD et al, JAMA 2004; 292: 2890 - 2900 (Get it from the elibrary)
The two minute tutorials next week are on Dementia: epidemiology, assessment, investigation and treatment. Talks precise and concise please, with some indication of your sources.
MJM
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