Takayasu's arteritis

MP3 File

Wardround 25viii6

This week’s two minute talks were themed around hospital acquired infection:
HA UTI (DL) and HA Pneumonia (BW), both were well researched and almost to time. Could I ask that next week you begin to list your sources so that others can follow up on reading.

For next week the theme will be anti-viral treatments, with assignments as follows:
Hepatitis C (BW)
Hepatitis B (?GAJ)
Herpes viruses (MJM)
Influenza (CC)
SARS (LD)
Keep to time, be concise but precise, and quote your sources.

The paper for discussion had been: Changing the Paradigm for HIV Testing — The End of Exceptionalism. Ronald Bayer, Amy L. Fairchild. NEJM August 17 2006, Volume 355:647-649. Apologies to everyone for my rather abrupt and dogmatic devil’s advocacy. The paper, though ostensibly about a specific ethical issue, does offer food for thought about informed consent in general. A study has been done in D&G surveying patient's views about consent in lab testing, so perhaps we can bring that along for discussion sometime?

For next week’s reading I thought we might have something clinical rather than ethical. So let’s give some thought to syncope. Read Current evaluation and management of syncope. Kapoor WN. Circulation, Sept 24, 2002;106 (13):1606-1609.

Interesting topics this week
Periodic fever

Herpes Encephalitis
Tilt testing
uptodate also has a good introductory article on the subject.

MJM

Wardround 18viii6

The reading for this week and the two minute talks were themed around the Plague of Athens. All well thought out with logical approaches to diagnosis. The internet is full of sites discussing the possible diagnoses, but you might find this article useful:

The cause of the plague of Athens: plague, typhoid, typhus, smallpox, or measles? Burke A. Cunha, Infect Dis Clin N Am 18 (2004) 29–43.

Now I know DL had difficulty getting these out of the eLibrary but I have tried again today and could access the PDFs without difficulty (except having to enter my athens password twice). Go on take the challenge…access this journal on-line. I have left a copy on the ward if you are unsuccessful. This copy of Infect Dis Clin N Am has a historical theme and the other articles are worth a look. I particularly liked:

Osler on typhoid fever: differentiating typhoid from typhus and malaria. Cunha BA. Dis Clin North Am. 2004 Mar;18(1):111-25.

Next week’s two minute tutorials are on hospital acquired infection:
Dr Mohan will be leaving us but those left behind can fight on. Hosp. acquired UTI (Dr Lindsay), Hospital Acquired pneumonia (Dr Williams). Two minutes please keep it concise and precise.

The reading for next week is for once quite up to date. Changing the Paradigm for HIV Testing — The End of Exceptionalism. Ronald Bayer, Amy L. Fairchild. NEJM August 17 2006, Volume 355:647-649. Read and think


Interesting topics this week

Arteritis
Hypokalaemia
Ankylosing spondylitis
Typical/Atypical chest pain

MJM

Wardround 11viii6

The two minute tutorials this week were about diabetic retinopathy with Clinical features by NM and Management by VJ. Both were well prepared talks for such a broad subject. Dr Mohan gets this week’s prize (quoted his sources which included this which is worth a look. He has also posted more information at http://kmneo.blogspot.com/

This week’s reading was "Stepford doctors": an allegory. GM Sayers. Medical Humanities 2006;32:57-58. It seems more an analogy than allegory, and I am not sure that I agree completely with the article. Presumably it has been written to stimulate thought (and discussion) regarding the part doctors play in health care. It ends with this paragraph: This allegory cannot be concluded because it is ongoing. Some doctors refused to "reform" and transform into "Stepford doctors". They believed that their allegiance lay with their patients and not the masters. Those who did not leave the profession (as many did) remain part of the lineage from which they stemmed. They continue to defend the freedom to practise the sort of medicine their patients want. Only time will tell whether these doctors become extinct or manage to inspire their followers to reclaim their vocation. What do you think?

Next week’s reading is The plague of Athens. The link for reading is in last week’s post (see below). You must decide on a diagnosis and will have two minutes to make your case on the 18th August.

Interesting topics this week
Hyperkalaemia (beware Lo-salt preparations)
Septic shock
Atrial fibrillation
Toxic confusional states
Cannabis lung


MJM

Wardround 4viii6

This week’s two minute tutorials were about electrolytes:
Sodium Dr Mohan (excellent handout)
Creatinine Dr Joshi
Glucose
Calcium Dr Sykes
Magnesium MJM
This week’s prize goes to Dr Sykes. Would each of you post a sentence in the comments section about your subject please.

Next week's assignments are:
Clinical features of diabetic retinopathy (Dr Mohan)
Management of retinopathy (Dr Joshi)
Non-retinopathic eye disease in diabetes (up for grabs)
Two minutes please, keep it concise and precise and quote your sources.

The reading for this week was: Reassurance and the Warning on the Label. Jerome Lowenstein, from The Midnight Meal and other essays about Doctors, Patients, and Medicine (1997). In the essay Dr Lowenstein highlights the difference between advice and reassurance. We often attach warnings to advice given to patients along the lines of ..."we cannot predict whether it will work" or "we do not know what the effects will be". But reassurance must be free of such caveats since it is undermined by such additions. Do you agree?

The reading for Friday 11th will be "Stepford doctors": an allegory. GM Sayers. Medical Humanities 2006;32:57-58. Read and think.

The reading for Friday 18th is a description of the plague of Athens, written in 431BC by Thucydides in The History of the Peloponnesian War. If you click on the link it will take you to a copy of the piece. The web page begins with chapter VI, but you can skip down to chapter VII (unless you would like to read about the war). If you cannot find the right section, press ctrl-F and type in plague. The challenge is to make a diagnosis. You will have two minutes to make your case for the diagnosis of your choice. This will be in place of the usual two minute tutorials that week.

Interesting topics this week:
Hyponatraemia

MJM

magnesium

Magnesium


MP3 File

Wardround 1viii6

A warm welcome to the new clutch. I am afraid that this weblog will be the source of much work for you. Check it each week to confirm your assignments for the two minute tutorials and the paper for ‘reading and thinking’.

Since you will be finding your feet for the first few days, there will be only very simple two minute tutorials, but I will allocate them personally.

The reading for this week is: Reassurance and the Warning on the Label. Jerome Lowenstein, from The Midnight Meal and other essays about Doctors, Patients, and Medicine (1997). Read it, think about it, and we can discuss it over coffee on Friday.

Interesting cases this week:

Sick sinus syndrome.
Obstructive uropathy.

MJM