Wardround 25i7

The theme for this week’s two minute talks was Falls.. This fitted nicely with the week’s paper which was Will My Patient Fall? David A. Ganz; Yeran Bao; Paul G. Shekelle; Laurence Z. Rubenstein. JAMA 2007;297 77-86

Dr Gunn told us that falls are common with anannual incidence of 30-40% in the over 65s. Her number crunching paper also highlighted that 10-15% of falls result in a fracture and that one in four of the elderly who fracture a hip die within 6 months. Of the survivors of hip fracture 50% do not return to independent living.

Dr Richardson gave us a comprehensive list of cases of falls on his handout and suggested we use the mnemonic DIME to remember these: Disease, Impairment, Medication, Environment. Lets see who can recall the acronym next week. Thiamine all round to those who forget.

Dr Bayati outlined the investigations that could be employed in identifying patients at risk of falls and finding correctable aspects.

Dr Rymaczeska talked about reducing falls by multidisciplinary input (what’s that?). Important specific points were limiting the number of medications, modifying home hazards, education and exercise.

The JAMA paper concludes with Falls are a treatable geriatric syndrome. Screening for fall risk is as easy as asking, “Have you had any falls in the past year?” and then inquiring about gait or balance problems if the patient has not had a fall. Screening is the first step in preventing future falls and the major injuries that can result from falling. By performing a multifactorial fall assessment on a patient who screens positive and then treating the patient's risk factors for falling, falls can be reduced by 30% to 40%.

Next Week’s topic is the antibiotic treatment of chronic bacterial infection: so two minutes please on:
Brain Abscess (ZB)
Osteomyelitis (MRy’s successor)
Septic arthritis (MRi)
Endocarditis (HR)
Evidence for OPAT (HG)

The reading for next week is Paying Attention: from Zen and the art of motorcycle maintainence. Robert Pirsig. I have left a copy on the ward.

Interesting topics
Pulmonary embolus
Fractured rib
Cerebral Haemorrhage

MJM

Wardround 19i7

The two minute talks this week were themed about the resuscitation alphabet: A B C D E. All were well presented, and should be a good starting point to build your own methods. The ABC... is a framework, perhaps analogous to DNA, You have to translate it into something that works. The aim is to do those things that must be done while assigning each its appropriate priority. If you hold in your mind a line like “check the airway”, it must be attached to a list not of all the ways it can be done, but of things you would actually do.

Think it through. Draw a mind map if you like. Make sure, for example, that your system involves way of getting help. I you are an FY1Doc, make sure you take every opportunity to accompany those more senior when they attend resus.

From the discussion we moved on to mention neurological examination. You have each been asked to time your neuro exam. This is not a race, more of a baseline measurement. How about putting your times in the comments section?

We will take Falls as our theme for next week's two minute talks. Assignments will be:
Epidemiology (HG)
Aetiology (MRi)
Investigation (ZB)
Prevention (MRy)
Two minutes only, quote your sources, keep it concise and precise. Practical handouts?

The read and think is related this time:
Will My Patient Fall? David A. Ganz; Yeran Bao; Paul G. Shekelle; Laurence Z. Rubenstein. JAMA 2007;297 77-86


Interesting Topics
HSP
Atrial Flutter

MJM

Happy 2007

The read and think for this week is Protecting elderly people: flaws in ageist arguments. Michael M Rivlin. BMJ 1995;310:1179-1182 (6 May)

The two minute tutorials for Friday are on the resus/assessment alphabet....A(HG) B(CS) C(AC) D(AM) E(?)

Interesting Topics:
Non-ketotic hyperglycinaemia
Osteomyelitis

Obituary:
Following a long and productive relationship, MJM's elibrary/Athens account has unexpectedly expired. MJM and his Athens account did always get along. He could often be heard haranguing the account with unsavoury language when it failed to log him in efficiently, but those who knew them best recognised a warmth between them. In his grief, he wishes now that he had spent more time with the account. The time he spent reading actual books and journals now seems so tawdry, his infatuation with podcasts and audiobooks brings only shame. He asks that his account be re-incarnated so that he might do all those searches, read all those on-line articles that he sincerely wishes he had done before his account was so unexpectedly taken from him.

MJM