Wardround 24iii6

The two minute tutorials this week were themed around fungal infection. Amphotericin B (PS); New antifungals (GYD); Aspergillus (HG) *; Candida in catheters (KP); Cryptococcus (DK). The general quality of presentation was excellent this week and I was pleased to see the re-emergence of visual aids and citing of sources. Prize this week to Dr Gunn.

I found doctorfungus.org an interesting source for revision.

Next week we will stick with infectious disease but viruses this time. The assignments are related to Hepatitis B:
Treatment of chronic Hep B (DK)
Prevention/immunisation (KP)
Interpretation of serology (HG)
Clinical epidemiology (GYD)
Acute fulminant hepatitis (PS)

Be precise and concise, just two minutes. Cite your sources and let’s have visual aids.

This week’s reading had been Laments, and I would like to continue the discussion with Jerome Lowenstein’s essay “Can you teach compassion”. I presume he meant “Can one teach compassion” but, you never know, he may have meant it to be personal. It is not available on the internet but my copy will be available on the ward.

Rather a short post this week as my weekend has been spent away from internet access.

MJM

Neuropathy

MP3 File

Recommended reading: Clinical Evaluation and Investigation of neuropathy. Hugh J Willison and John B Winer. Journal of Neurology Neurosurgery and Psychiatry 2003;74:ii3

Wardround 17iii6

This week’s two minute tutorials were themed around transfusion (blood, platelets, FFP, cryoprecipitate, immunoglobulins and albumin). I was pleased to see that handouts have made a come back, but our original idea had been that visual aids would be brief revision notes rather than detailed notes. Have a look at mediglyphics.

The British Committee for Standards in Haematology (BCSH) have a collection of guidelines on transfusion that are well worth browsing.

The week’s reading had been Doctors and thin slicing. Interesting findings which none of the senior colleagues who read it found surprising. Certainly food for thought. I attended a course about communication last year and was told that communication was more important than what a doctor actually did with a patient. This strikes me as being unlikely. Worse though, if accepted as a correct premise it could undermine the practice of medicine. Is satisfaction a reasonable outcome measure when used alone? Is satisfaction now the same as satisfaction later? Richard Wakeford wrote a letter to the BMJ in 2003 (BMJ 2003;327:161 (19 July), doi:10.1136/bmj.327.7407.161) I quote a section of it here...

In its revalidation guidance documents for doctors the GMC says that one good professional comparison is with airline pilots. This comparison is helpful. Imagine two airlines, whose pilots' revalidation arrangements are on the following bases:
• Airline A—flight simulator skills tests, including rarely met but crucial challenges; a thorough medical examination
• Airline B—informal personal development plans, agreed privately with a colleague, maybe of their choice; cabin crew and passenger surveys of the gentleness of their landings and the clarity of their communications; a self declaration of sobriety, health, and honesty.

For the sake of argument, let us assume that one in every 15 pilots is shown by research to have at some point in their career an alcohol or other substance abuse problem. Which airline would you travel with?


Interesting topics this week
Tophaceous gout, which reminds me of this interesting paper regarding communication of information about gout treatment. Effective management of gout: an analogy. Wortmann R
Am J Med. 1998 Dec;105(6):513-4.

Chronic Q fever

The undiagnosable case (there is no such thing!....I’ll do a podcast on this sometime). We have certainly had some diagnostic challenges lately.

Next week’s reading for discussion continues the communication theme, The patient’s lament: hidden key to effective communication: how to recognise and transform. B Bub. Medical humanities 2004;30:63-69

The two minute tutorial topic for next week is Fungi. I will give more info on specific assignments when ID doc espeaks to me.

The team bids goodbye to Dr CT this week. No more dayglo stethoscopes.

MJM

ecthyma gangrenosum


MP3 File

Wardround 10iii6

The theme this week was everyday microbes with two minute talks on: S. aureus, Str. pneumoniae, E. coli, and P. aeruginosa. I was pleased that so much information was gathered, and if you would like to read a little more have a look at Medical Microbiology for some further basic information. If you would like a little more information on the military use of Serratia marcescans in San Francisco, have a look at the wikipedia entry.

Next week’s theme is blood transfusion products.
Blood
FFP & Cryo
Platelets
IVIg

Just to repeat the rules: two minutes on the subject, which should be a talk rather than a reading. Quote your sources and use handouts to illustrate points.

The reading for next week is Doctors and Thin Slicing from Blink, by Malcolm Gladwell.

Interesting cases this week
Myocardial infarction and diabetes
....and more at xxxxxxx

Trifascicular block

Bronchiolitis and macrolides

Mycobacterium avium complex

Cricoarytenoid arthritis (a patient with rheumatoid who could no longer play the trumpet!)

MJM

The unresponsive patient

Coma...initial management.


MP3 File

Wardround 3iii6

The two minute tutorials this week were about aortic stenosis. Epidemiology (CT), clinical features (BK), investigation (HG), and treatment (CC). There are plenty of brief summaries on the net but this is a subject worthy of more detailed understanding and knowledge for GIM trainees. Certainly the investigation, assessment and indications for surgery should roll off your tongue with ease. The prize for this week’s talk goes to Dr Tuck, for a concise summary with sources quoted. It is about time someone stepped up to the mark and knocked her off the top spot.

The discussion paper this week was The Company We Keep: Why Physicians Should Refuse to See Pharmaceutical Representatives. Howard Brody, Annals of Family Medicine 2005;3:82-85. I particularly like the ‘fanciful analogy’ in the paper’s introduction: read it for yourself. I will leave you to muse over one of the conclusions. Reps are not evil, but they are time-consuming and serve interests that often are at odds with those of our patients. To spend time with reps in a manner that preserves professional integrity would require both refusing to accept their gifts and spending a great deal of valuable time double-checking their information. I propose that the vast majority of physicians could spend their time in better ways. Do you feel this is true? Will you be putting your time to better use?

Next week’s reading continues the ethics theme and though the paper relates to research, you should decide if the ideas give any insights into medical practice. Can Mary Shelley’s Frankenstein be read as an early research ethics text? H Davies, Medical Humanities Jun 01, 2004 30: 32-35.

Next week’s theme is basic microbiology. Two minutes please on the following:
Staphylococcus aureus (CC)
Streptococcus pneumoniae (BK)
Escherichia coli (HG)
Pseudomonas aeruginosa (CT)

Interesting topics this week
Ecthyma Gangrenosum

Coma, look at the coma section of www.eboncall.org

Agranulocytosis

And review your knowledge of the normal ECG


MJM