Wardround 27iv7

Next week’s two minute tutorial theme will be psychiatric disease on the medical unit. So that we might might avoid unpleasant embarrassment we will limit this to psychiatric disorders manifest by patients rather than staff.

Drug associated psychiatric disorders SS
Delerium RP
Acute psychosis DK
Depression TJ
Schizophrenia CS
Alcohol RK

Remember two minutes only. The aim is to inform the group. Keep the talks concise yet precise, and quote your sources.

The read and think last week was White coats and fingerprints: diagnostic reasoning in medicine and investigative methods of fictional detectives. C Rapezzi, R Ferrari, A Branzi. BMJ 2005;331:1491-1494 (24 December), doi:10.1136/bmj.331.7531.1491. There is additional material on bmj.com.

I feel that the discussion was rather limited so we will have another go at the same paper this week.

Interesting topics
Brain tumours

Status Epilepticus: have alook at the topic at http://www.eboncall.org/

Interesting fact: if the stroke volume of the left heart becomes reduced by 1ml compared to the right ventricle, about a litre of extra blood will accumulate in the lungs within 15 minutes.

MJM

PS why the garden of earthly delights?

Wardround 20iv7

This week’s two minute tutorial theme was Neuropathy. SS gave us a strategy for investigation and will update/reorder it for next week. My own approach is in four steps: to classify the neuropathy as acute, sub-acute or chronic then as sensory, motor, autonomic or mixed, followed by an initial screen for the most common causes. What do you think that screen should comprise? Step four is NCS and everything else.

For next time we will review glomerulonephritis. The assignments will be:
Nephritic syndrome DK
Nephrotic syndrome LF
Classification CS (make it useful for MJM)
IgA nephropathy TJ
Membranous GN SS

Remember two minutes only. The aim is to inform, rather than hypnotise, the group so keep the talks concise yet precise, and quote your sources.

The reading for next week will be White coats and fingerprints: diagnostic reasoning in medicine and investigative methods of fictional detectives. C Rapezzi, R Ferrari, A Branzi. BMJ 2005;331:1491-1494 (24 December), doi:10.1136/bmj.331.7531.1491

Interesting topics
Trifascicular block (ECG and look it up in uptodate)
Non-epileptic attack disorder
Serratia Marcescans

MJM

Wardround 29iii7

What is this?

This week’s talks were about diarrhoea. If you want to read more, UpToDate has overviews or acute and chronic diarrhoea. For next week the two minute tutorials will be on Neuropathy:

Acute DK
Chronic CS
Investigation SS
Treatments FY1
Diabetic JT
Alcohol related Dr R

Two minutes please . Keep if concise yet precise. Make a one page handout and quote your sources.

The reading was Clinical decision-making: Coping with uncertainty. A F West; R R West. The paper 's conclusion is :Improving scientific knowledge is clearly a laudable objective, although it may reduce clinical uncertainty less than expected. Pretending that the clinical predicament can be reduced to a series of certainties by the recruitment of "evidence" will not work and unrealistic expectations of that stratagem may make the situation worse. Some degree of uncertainty was always here to stay and evidence, even of the highest quality, is only evidence. There will always be judgments to be made by responsible, informed, and compassionate people. They may not be able to perform these broader roles, in communication, holding anxieties and managing uncertainty, unless trained for and supported in them.

The reading for next week is Clinical diagnostic strategies. Sackett DL et al. Chapter 1 of Clinical Epidemiology. I have put a copy on the ward.

Interesting topics

Atrial fibrillation

MJM