Wardround 19v6

A thing of beauty is a joy forever. Even my nemesis pictured here.

This week's two minute tutorials were a challenge; such broad subjects, inflammatory bowel disorders, so little time. Very interesting though. If you email your talks to me I will incorporate them in the blog.

The week's Reading had been The Iowa Car Crop by S E Landsberg. I had asked you why you thought I had chosen it and how it might be relevent to medicine. HmmmH.... I admit to being seduced by the first three lines: "A thing of beauty is a joy forever and there is nothing more beautiful than a succinct and flawless argument." The paper was chosen because any critical criteria I may use for choosing our reading were corrupted by the paper's rhetoric (or more correctly the author's rhetoric). The opening lines appealed to me and so the paper was chosen. The relevance to medicine is two fold. Firstly beware accepting or rejecting papers because of rhetoric rather than substance. the second part relates to the ships that disappear over the horizon and return later loaded with Toyotas. The author suggests that for an economist to analyse this phenomenon it is not necessary to understand the nature of Japan...it is adequate to imagine it a amagic box which convertts wheat into Toyotas. Diagnoses are similar. It is not always necessary to know everything about a patient's disease (indeed we never know everything) in order to produce a workable management plan. It is only important to know those things which are necessary to produce the plan. I do not know the cause of polymyalgia rheumatica, but I do know the prognosis, complications, treatment and differential diagnosis.

Next week's two minute tutorials are related to Hypertension:
Ace inhibitors (TS)
Beta-blockers (EB)
Calcium channel blockers (AJ)
Diuretics (CC)
Non-drug treatment (JCM)
Investigation of HT (MC)
Keep up the excellent standard. Quote your sources, keep it concise and precise.

The reading for the week is A mysterious death. David W Oldach, Robert E Richard, Eugene N Borza, R Michael Benitez. The New England Journal of Medicine. Jun 11, 1998.Vol.338, Iss. 24; pg. 1764, 6 pgs

I am away this week, see you next week. MJM

QUIZ

The houseman has searched in vain. Where to look?

Wardround 12v6

This week’s theme was Spirochaetal diseases, Syphilis, Yaws, Pinta, Leptospirosis and Lyme disease. I think this was quite a challenge, but the talks were excellent and a good stimulus for further reading on my part. I will try to get the fact sheets you made scanned and made available, but if you could email the files to me it would be easier.

Next week’s theme is inflammatory bowel diseases: UC, Crohn’s, Coeliac, C.difficile. You have your assignments. Two minute talks please, concise and precise.

This week’s reading was Clinical craft: a lesson from Liverpool. D M Gore Journal of Medical Ethics 27:74-75 (2001). "Surely now is a good time to revisit the concept of clinical craft. ... we also need a certain amount of pride to keep up our morale. By celebrating our craft we can identify with skilled workers anywhere." Pride in a job well done is a precious crop, full of nourisment for the spirit and vitamins for the soul. It is all too easy to tend the plant but allow the fruit to wither on the branch or fall to rot on the ground. My advice: Take some time each week to reflect on what you have achieved as an individual or as part of a team.

For next week I have chosen a different subject: The Iowa Car Crop, S E Landsburg, from The Armchair Economist (1995). I have left a copy on the ward. I would like you to read this and ponder two things: why I have chosen it and what relevance it has for medicine.

Interesting topics this week
SIRS (Systemic inflammatory response syndrome) with hypoxia, eosinophilia, myalgia and anti-MPO antibodies.
CSS
SIRS
Eosinophilia myalgia syndrome (as a fascinoma)

Ultrasound for pleural effusions

Staph. septicaemia. How to confirm SBE; do you know the Duke criteria? And if you do....Are they useful in clinical practice?

MJM

Wardround 5v6

The two minute tutorials this week were themed around common drugs: Furosemide, Coamoxiclav, Metformin, Citalopram, Omeprazole. It is always useful to focus on those things that would otherwise be part of the background. It was clear that there were important actions one can take when assessing a patient taking one of these agents.

Has it been effective? Is it still needed? Can it be withdrawn? should that be rapid or slow? Are there warnings for the patient? do those warnings change the patient's views about using the treatment.

What sticks in my mind? Do not stop citalopram abruptly, warn patients on PPIs about infection risks (and how to reduce them), warn patients to stop metformin if they become breathless or are vomiting, beware clavulanic acid (coamoxiclav) with liver disease.

The reading this week was Bandolier: What patients think. A comment on the Original paper: PN Trewby et al. Are preventative drugs preventive enough? A study of patients' expectation of benefits from preventive drugs. Clinical Medicine 2002 2: 527-533. There seems to be a gap between the risk/benefit thresholds exhibited by doctors and patients, at least in so far as this study shows.

The Bandolier comment includes "This is an interesting and imaginative paper that tells us what patients think. Half were happy to take a preventive drug if the hypothetical five year absolute risk reduction was 20%, or an NNT of 5. ..... There is a clear discrepancy. Few preventive medicines for preventing heart attacks would seem to meet patient expectation.... the power of the doctor to advise. If their doctor recommended it, more than twice as many subjects would take the medicine. This, though, imposes a significant burden on doctors properly to inform their patients. Much less attention has been paid to how patients think about their own versus population benefit, and especially how the information is presented. "

Interesting topics this week:

Trigeminal neuralgia and Lyme disease

Next week's two minute talks are themed around spirochaetes (I hope Dr Jones has handed out the assignments).

The reading for next week is: Clinical craft: a lesson from Liverpool. D M Gore Journal of Medical Ethics 27:74-75 (2001)

MJM

Connective Tissue Disorders

MP3 File

A brief introduction to diagnosis of CTDs

Common drugs

This week’s paper for discussion is not a real paper, but a comment. I did promise a brief paper for this week. You can of course read the original if it suits you to so do. The reading is from Bandolier: What patients think.

Original paper: PN Trewby et al. Are preventative drugs preventive enough? A study of patients' expectation of benefits from preventive drugs. Clinical Medicine 2002 2: 527-533.

The two minute tutorials are themed about common drugs: Furosemide, Metformin, Citalopram, Omeprazole, Coamoxiclav. Remember, two minutes only. Be concise and precise, quote sources and a handout please.

MJM