Wardround 1xii6

This week’s two minute talk theme was common investigations. We heard about:

Rheumatoid factor (MJM): present in many inflammatory and infectious illnesses, more useful as a prognostic marker than in diagnosis, and a possible cause of interfernce with immunoassays.
D-dimer (PL) the physician’s bain – thought of as a “rule-out DVT test” by many but actually more of a “profiling the risk of DVT test”, has little practical application in patients who already have high pre-test probability of DVT.

Bilirubin (TJ) measurement may be influenced by food intake.

Glucose (AB): remember that venous and capillary samples give different results by as much as 1 mmol/l. Always get a lab sample at the extremes of results or where hypoglycaemia is suspected in a non-diabetic patient.

Troponin (HG): Excellent talk Dr Gunn: useful prognostic marker in ACIS but must be interpreted with other clinical variables.remember that haemolysed samples will give a spuriously low result. Remember that diseases other than ACIS can cause elevations of troponin and that the timing of the sample with respect to chest pain is important.

CRP (DK): a substance in the serum of patients with acute inflammation that reacted with the C polysaccharide of pneumococcus. Useful to monitor inflammatory activity in view of its short half life. CRP is associated with increased cardiovascular risk. (CRP <1mg/l>3mg/l =high risk).

Urinalysis (SS): have a look at the paper below in interesting topics.



We have deferred the paper for reading until next week. So for next week think about Hope is the thing with feathers. A piece of my mind, Cripe, LD. JAMA 296(15):1815-1816, October 18, 2006. Access it via the elibrary.

For next week’s two minute talks we are addressing adverse drug reactions:
Epidemiology (PA)
Diagnosis (HG)
Important drug interaction I (FY2)
Important drug Interaction II (FY1)
Improving safety (TJ)
Non-drug interactions (SS)

Two minutes only please. Be concise yet precise and quote your sources (not much of that this week). For the Important drug interaction talks choose an important example.

The combined wardround has fallen by the wayside (and been covered with Autumn leaves). It is time to get it going again. The round is difficult when an SHO has to leave at lunchtime so we should begin again (providing GAJ agrees?) on the following Fridays: 15th December, 5th January. Format to be agreed beforehand.

Interesting topics this week: