Wardround 24viii7

Thank you for your ideas about the cause of the plague in Athens. If you want to read more there is much to be found on the internet. If you would like to see a published discussion about the plague of Athens have a look at 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.

The two minute talks for this week will be about instruments in medicine:

Ophthalmoscope GAJ
Stethoscope AG
Saturation meter MJM
Auroscope AW
Sphygmomanometer AA

Two minutes please. Keep it precise and concise, and quote sources.

The reading for next week (4ix7) will be Metaphorical Medicine: using metaphors to enhance communication with patients who have pulmonary disease. Arroliga AC et al. Ann Intern Med. 2002 Sep 3;137(5 Part 1):376-9

For this week the reading is What patients want to know about adverse events. Bandolier 153 November 2006

MJM

Wardround 17viii7

The Roth Spot is a white-centered hemorrhage. It is a cotton wool spot surrounded by hemorrhage. The cotton wool comes from ischemic bursting of axons; the small hemorrhage comes from ischemic bursting of a pre-capillary arteriole. It is not specific to bacterial endocarditis.

I will scan in this week's handouts on HSVE and JE. The prize for best talk this week goes to Dr Anderson for a novel way of presenting the information about Japanese encephalitis.

Herpes simplex encephalitis
Japanese encephalitis

The talks this week are your diagnostic choices for the plague of Athens. Read the article and come up with a diagnosis. You have two minutes to convince the group you are correct.

The History of the Peloponnesian War written by Thucydides in 431 B.C. 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.

Don't forget to read Does this patient have abnormal central venous pressure? Cook, Deborah J; Simel, David L JAMA; Feb 28, 1996; vol 275 (8): 630-634, for Tuesday.

Interesting topics

Endocarditis

Intravascular Catheter–Related Infections.

Klebsiella.

MJM

Wardround 10viii7

This week’s talks were about common drugs.. Coamoxiclav, Loop diuretics, LMWH and aspirin. You will become aware over time that I tend to be impressed by talks with a practical bent to them. So I may not care that furosemide is protein bound, but I am very interested that its effectiveness may be impaired in nephrotic syndrome due to the drug remaining bound to protein in the tubular lumen, since I need to give higher doses. It was good to see sources quoted. The week’s prize to Dr Reidy: good handout, sources quoted and an interesting slant on aspirin.

The reading last week had been A Necessary Inhumanity? Ruth Richardson. Journal of Medical Ethics 2000;26;104-106. The inhumanity discussed is apparently developed by doctors, for our own protection and to allow us to provide better care. We call it clinical detachment. I have no douibt that some doctors are inhumane, as her examples illustrate, but are we all? I do not think that I am inhumane when I remain calm (detached from the expected emotional response) in the face of severe illness in my patient. What do you think?

The talks for the coming week are related to encephalitis:

Herpes simplex encephalitis Dr Reidy
West Nile Virus Encephalitis Dr Waters
Japanese encephalitis Dr Anderson
Cerebral lupus Dr Ghanbari

The reading for next week is Does this patient have abnormal central venous pressure? Cook, Deborah J; Simel, David L JAMA; Feb 28, 1996; vol 275 (8): 630-634

Interesting topics

Staphylococcal septicaemia, excellent articles in uptodate.

DIC

MJM

Wardround 3viii7

The new session begins and with next to no warning the new batch came up with two minute talks on the normal ECG. We heard about the p wave from Dr Ghanbari, PR interval from Dr Waters, QRS from MJM, ST from Dr Reidy, T wave from Dr Anderson and Axis from Dr Cameron. You can see a brief resume of a normal ecg here. The prize for best talk goes to Dr Cameron for making a difficult topic so simple that a big brother halfwit would understand it.

Now that you have all had a chance to see how the talks are done I can give the assignments for next week and be a bit more insistent about the rules. Next week’s two minute tutorials will be on common drugs:

Low molecular weight heparin (Dr Waters)
Aspirin (Dr Reidy)
Co-amoxiclav (Dr Anderson)
Loop diuretic (or was it PPI?) (Dr Ghanbari)

Keep it concise yet precise. Practical rather than theoretical. Heretical if you must. Produce a handout and quote your sources. This is helpful for your colleagues. If they find it interesting they can go and read it themselves.

Next Tuesday’s reading you already have. For the Tuesday after we will read The homeless man on morning rounds, from The midnight meal and other essays about doctors, patients and medicine. By Jerome Lowenstein. I will put a copy on the ward next week.

Interesting topics arising this week:

Encephalitis

West Nile Virus

Aspiration Pneumonia, good article on Uptodate

MJM