Last Post of 2008

It is time to start thinking again.

No wardround meeting on Friday but for Tuesday we can have a paper to discuss: Culture shock - patient as Icon, Icon as Patient. A Verghese. NEJM 2008: 359(26); 2748–2751. Elibrary

Read and think.

MJM

Merry Christmas

The Christmas break in talks is upon us. Almost.

For Tuesday, come ready to tell us about a book or film (or other text) that has influenced you as a doctor.

Interesting Topics

Following on from our discusions about adverse drug reactions, you may want to have a look at Managing Drug-Drug Interaction Risks and Recognizing, Reporting, and Reducing Adverse Drug Reactions.

You are challenged to find at least one ADR from each of the groups A-F. Get to it.

MJM

Wardound 12xii8

If you are not in DGRI you will see a screen shot above. I hope it will give a clue how to get the article for Tuesday's discussion. So yet again get it, read it and think about it. In a stew. Michael A Lacombe. American Journal of Medicine. 1991;91:276-278. from the E-library. There is an accompanying editorial if you are up to it.

The two minute talks will be about adverse drug reactions:
Epidemiology R
Mechanisms E
Management Dr Pope
Prevention G

There are a number of excellent resources available about this subject..see what you can find. Remember, time the talk for two minutes, quote your sources and make a handoiut which will be useful.

Interesting topics this week
Progressive supranuclear palsy
Refeeding syndrome

MJM

We don't need no stinkin' help findin' book learnin'

I ridicule your pathetic excuses for failing to get the "In a Stew" article. I got the pdf at the weekend and again tonight without problems. 

Get it....it's a challenge... and we can then discuss it.

MJM

Wardround 5xii8

Sepsis bundle summary ↑ (you cannot see it at DGRI...images blocked)

The reading for Tuesday is In a stew. Michael A Lacombe. American Journal of Medicine. 1991;91:276-278. from the E-library. There is an accompanying editorial if you are up to it.

This week's talks were about antibiotics. This led to a discussion of the precipitants for MRSA such as antibiotic pressure and the ways we might try to limit this. Dr Jones outlined a method of deferring antibiotic use in non-urgent cases and stressed the need to identify specific about diagnoses. It should be clear to all that MJM and GAJ do not regard antibiotics as harmless, and MJM in particular decries the term "chest infection"....never use this in his hearing since it has the effect of decoupling frontal lobe function. Our hospital policy regarding IV antibiotics is a must read as is the antibiotic prescribing policy. Remember to look at the HPS site about C. difficile.

For next Friday the theme is decompensated liver disease:
Epidemiology G
Varices L
Ascites E
Encephalopathy R
Transplantation ?

Two minutes please. Be concise and precise. Quote your sources so others can read up more if inclined. Handouts can have more than bullet points again....but not mini-essays please. Think before you speak. Make the talk count. Don't tell us things we already know; there isn't time.

Interesting topics

Sepsis in Coeliac Disease (Dr Else's journal club talk about Gut 2008 Aug;57(8):1034-5).
Sepsis bundles

Remember we have some textbooks in the right hand Ward office

Wardround 28xi8

This week's talks were about common tests such as cholesterol, creatinine and glucose. It is useful to revise things which we come to regard as so common that our knowledge of them sinks into our subconscious. Knowledge in the subconscious can become corrupted or merely fade away. As an SHO I was given some advice by a consultant Dr Avinash Mithal. He suggested that when reading a journal article, editorial or review paper I should first write down what I know about the subject. IHD is common...how common, exactly? In doing this I am surprised how quickly "things_I_know" have become "things_I_think_I_know_but_don't". Next time you read a paper, try Mithal's method.

For Friday the two minute talks are about Antibiotics. This is a free for all. Decide which talk you want to do and stake your claim by posting in the comments section. The choices are:

Who needs IV antibiotics?

What are the precipitants of C. difficile?

What are the precipitants of MRSA?

What is new in the antibiotic field?

What is antibiotic allergy, and what can be done about it?

Two minutes only. Be clear and concise. And here I am going to change the rules on the written handouts. You are allowed up to six bullet points only in text. Drawings or illustrations can be unlimited but must fit on one side of A4 and be large enough to be read without squinting or using a magnifying glass.

Our inability to read the paper on the last two Tuesdays I take as a message from the fates. Said paper will be cast to the furies. Though casting to the furries conjures more surreal images.

The reading for Tuesday will be Just how tainted has medicine become?  The Lancet 2002: 359 (9313), Page 1167, (6 April)

Interesting topics:

Tilt testing in syncope

Gout

MJM

Wardround 21xi8

Since we could not discuss the reading for last week, klet's carry it over to Tuesday.

Friday's talks are on everyday tests. You have free rein to choose the most useful aspect of each for your talks. Make them interesting, concise and illuminating.

MJM

Wardround 14xi8

The reading k for next week will be Measuring quality of life. Is there such a thing as a life not worth living? Bobbie Farsides, Robert J Dunlop BMJ 2001;322:1481-1483

Two minute talks for Friday: SEPSIS
Recognition O
Circulation R
Antibiotics S
Epidemiology J

www.survivingsepsis.org is a good place to start your background reading.

MJM

Wardround 7xi8

The reading for Tuesday is Comment: When not to write about autism, Ewen Calloway. New Scientist. Read it, think, and discuss.

The Two Minute talks for Friday will be about poisoning:
Paracetamol
Tricyclics
Carbon Monoxide
Ecstasy

Please plan your talk to last just two minutes. Be concise and precise, quote your sources and make a simple handout. A hundred words on the handout is too much. Don't waste time on the obvious. Let me help you out by saying I want facts specific to your topic. I will take it as read that Resuscitation/ABCDE etc are going to be done. The test you must pass is that those listening to the talk will be able to manage a case.

MJM

Wardround 24x8

The Two minute talks today were about arrythmias. Well researched and reasonably timed, but I would suggest more thought is given to the two minute limit. For next week : opportunistic infections with HIV: Pneumocystis pneumonia, atypical mycobacteria, toxoplasma, candida and cryptococcus. You have your assignments. If we have any extra people gatecrashing the talk they should choose another to do eg aspergillus, TB etc.

The paper for discussion on Tuesday will be The kindness of strangers. Eileen Palmer, BMJ 2008;337:a1993.



MJM

Wardround 10x8

The Reading for Tuesday is Trust, Anonymous, Bandolier. Read and think. Articles can be like lamps. Look at them carefully before choosing to use one for illumination. It could enlighten the subject matter, cast important issues into relative shadow, or even blind you to the whole subject.

The talks this week were excellent. Imported infections are not as uncommon as you might think, even in a place like D&G. The important thinks to know are where they have been, what they have been doing, who else has been involved. Use a resource such as travalax to find what is happening in the region and don't overlook the treatable (malaria, bacterial sepsis). I wondered about putting rabies in those parentheses, but perhaps that should be in the preventable category. I would suggest you read the local viral haemorrhagic fever protocol.

For next Friday the talks will be about the patient with an acute abdomen who finds themselves on a medical unit. No cop-outs here, I don't want a two second talk "refer to surgeons". The surgical team are all very busy in theatre. Only the surgical F1 is available and you are going to be forced to manage the patient initially.

Acute Pancreatitis F
Acute Vascular Events A
Perforated hollow Viscus O

Two minutes please. Keep it precise and concise.

Interesting Topics

Sepsis resuscitation bundle

How tired are you?


MJM

Wardround 3x8

The reading material for Tuesday is Commercial Features of Placebo and Therapeutic Efficacy, Rebecca L. Waber; Baba Shiv; Ziv Carmon; Dan Ariely, Journal of the American Medical Association, March 5, 2008; 299: 1016-1017. Get it via the elibrary, read and think.

Our two minute tutorials for Friday are Imported diseases. You each have two minutes to enlighten us on the patient who is feverish and:

Fell in the water of Lake Malawai (H)
Was bitten by a dog at Giza (F)
Was bitten by a bug on the Amazon (A)
Has a nosebleed having returned from Wagadugu (Z)

MJM

WR 27ix8

The read and think for Tuesday is Orphan diseases: which ones do we adopt? T Richards, BMJ 2008;337:a1225.

The two minute talks for Friday are themed around Acute Hepatitis. Educate the yourself and the group.

Alcoholic (H)
Viral (A)
Autoimmune (F)
Toxic (Z)

MJM

Wardround 12ix8

The reading assignment for Tuesday is Titrating Guidance, Nathan Goldstein, Anthony Back, Sean Morrison. Arch Intern Med. 2008;168(16):1733-1739. 

Friday's two minute talks are the recognition and management of psychiatric disorders on medical wards: Delerium tremens, Depression, the aggressive patient.

MJM

Wardround 5ix8

The reading for next Tuesday will be Mistakes. Ruth Lesnewski. JAMA. 2006;296:1327-1328. get it with elibrary.

Read and think.

Friday's tutorial assignments will be Acute Colitis

Ischaemic

Infective

Inflammatory

Two minutes please, keep it precise and concise, quote your sources and illustrate with a handout.

Interesting Topics

Transverse Myelitis

MJM

Wardround 29viii8

Why was a rheumatologist asked to see this patient?

The reading this week about the methods magicians use to distract their audience led to some discussion of distraction, its benefits and pitfalls in medicine, the importance of not interrupting the 'rituals' of medicine that doctors use to keep on track and recognising when we ourselves have been distracted from the path.

For next week I would like you to read Why are medical journals so dull by Richard Asher. Originally published in the BMJ in 23 August 1958. Tempted as I am to leave you to get hold of the paper using your own initiative there is a link here if you do not feel like taking up the challenge. The link works for me but if you are unsuccessful I can give you a paper copy (folded in the shape of a dunce's hat!)

As ever the original responses to a paper can be illuminating. It is well worth getting used to reading the letters written to the editor about papers you read.

I was sorry to have been called away before the end of the Gram talks. It sounds obvious but the information Gram pos/negative cocci/bacilli should prompt immediate thoughts: does the patient have features of systemic sepsis syndrome? what do I need to check to further identify the type of organism and the likely spectrum of antibiotic sensitivity. Be sceptical about any comment from someone who has not assessed the patient that an organism could be a just a contaminant. How about clicking the comment button and writing in one sentence about something particularly interesting you found in your reading on the subject.

The talks for next week will be Epilepsy.
I was not able to assign these so it will be first come first served. Click the comment and claim the subject you will take. On offer are:
Epidemiology
Classification
Investigation
What to tell a patient after their first seizure
Treatment

Interesting topics

Lofgren's syndrome (what I was called away to see)


MJM

How weary, stale, flat and unprofitable, seem to me all the uses of this world
Fie on't ah fie! 'tis an unweeded garden, that grows to seed ...
That it should come to this.

Wardround 22viii8

The reading for next Tuesday will be Magician's Hand: How Humor And Misdirection Can Manipulate Levels Of Attention. You may also want to look at this related article.

Please read the articles and give them some thought. Is this relevant to medicine?

The two minute talks this week were the ECG. What is normal and what is not? What do you think was the most interesting or useful point in your talk. Click the comment button and type it in. I put together a little list a couple of years ago that you could revise from.

The two minute talks for next Friday will be mibrobiology 101: what should go through your mind when you get a call that your sick patient's blood cultures have grown:

Gram positive cooci HM
Gram negative cocci SV
Gram positive rods ZB
Gram negative rods HJ

Keep it precise (actual figures not general descriptions) and concise, educate your audience, quote sources, produce a handout and keep to two minutes.

Interesting topics:

Hyperkalaemia...read the handbook
Atrial flutter
Korsakoff syndrome

MJM

Wardround 15viii8

The reading for next Tuesday will be The road to recovery. D Pisetsky. Please read the article and give it some thought.

The two minute talks this week were about common drugs: Furosemide, Coamoxiclav, Enoxaparin. The prize this week goes to HM. What do you think was the most interesting or useful point in your talk. Click the comment button and type it in.

The two minute talks for next Friday will be The ECG. What is normal and what is not? Let's have two minutes on:

P wave HJ
QRS complex
Axis
ST segment HM
T wave SG

Keep it precise (actual figures not general descriptions) and concise, educate your audience, quote sources, produce a handout and keep to two minutes.

The morbidity/mortality meeting is on Thursday 28th August. Time to start preparing now.

Interesting topics:

Fallot's tetralogy

Wernicke's encephalopathy

Dressler's Syndrome

MJM

Wardround 8viii8

On Friday I will talk to you about the training side of the ward work, so you are spared giving a talk until next week.


The reading for next Tuesday will be The minefield of medical morals. D Sokol.
Please read the article and give it some thought.


The two minute talks for next Friday will be common drugs. Let's have two minutes on:

Furosemide HM
Coamoxiclav HJ
Enoxaparin SG
Omeprazole RV
Prednisolone just in case

Remember, the aim of the aassignment is that both you and your audience increase your knowledge or understanding of the topic. Don't waste too much time telling us things we will already know. The time is limited to two minutes and you should practice your talk and timing before the big day. Don't give a five minute talk in two minutes, edit it down to time. Always quote your sources so others know where to go to check things out for themselves. You should produce a single side of A4 handout. This is to illustrate your talk, not to provide a textbook level detailed article. Hand drawn pictures with arrows and signs beat something that looks like a cv every time.

The usual advice is keep your talk precise and concise, educate your audience, quote sources, produce a handout and keep it to two minutes.

Interesting topics this week:

Where to look up complementary medicines
DGRI antibiotic guidelines (I can't make the link work so you will need to navigate to it so it's intranet only. Go to the DGRI homepage, at the top choose select a service, then prescribing support, then click go. The document is listed there).

MJM

Welcome to the new trainees, goodbye to the old.

The reading for thought on Tuesday will be Meeting the ethical needs of doctors. Daniel K Sokol. BMJ 2005;330:741-742.

Welcome to the new trainees. Could I ask you to look over to the right hand side of this page and click on the "Training" link please. There is a little about work on the ward there and a timetable for yourself and me.

There will not be any assigned two minute talks this Friday. What I would like each of you to do is tell us a little about yourself and what you wish to do this year, and after that. The usual Friday rules apply. Only two minutes please.

MJM

Holiday break

I am off to the land of large portions for a couple of weeks, there to stress my labyrinths and top up my vitamin D. The blog will resume on the 28th.

MJM

Wardround 4vii8

The reading for Tuesday will be Precision in diagnosis, John Todd, Lancet 1952: 260 (6748); 1235-37. It is available via the elibrary. You may be able to use this link after logging in to elibrary/Athens...but if the link fails you....you should still have enough information to find the pdf.


We will decide upon Friday's topics on Tuesday.


MJM

Wardround 20vi8

The reading for Tuesday will be The rational clinical examination. Does this patient have abnormal central venous pressure? Cook DJ, Simel DL. JAMA 1996; 275: 630-4.

The two minute talks for Friday will be slightly different. I would like you to look over a guideline of your choice (but related to adult general internal medicine, of course) and present 5 useful points from the document. As a warning example I would not find it useful to be told that nebulised beta agonists are useful in the management of acute exacerbations of COPD (I know that already), but I don't know how useful.

Not education except in its widest sense, but here are some pictures from the Summer Ball.

MJM

Wardround 13vi8

The reading for next Tuesday will be The Midnight Meal and Other Essays about Doctors, Patients, and Medicine, Jerome Lowenstein. I have put a copy on the ward.

The two minute talks for next week will be your diagnosis of the Plague of Athens. You will find a description of the outbreak in 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.

You need to have an opinion on the diagnosis and be prepared to argue your corner. Make sure you revise the signs and symptoms of the disease you choose. I will post the discussion the following week and award a prize to the best argument/diagnosis.

The NPSA have issued guidance to improve the safety of chest drains.

MJM

Wardround 6vi8

The reading for Tuesday is Doctors, Lawyers and Wolves. George J Annas, Lancet 31 May 2008. Read and reflect please.

The two minute talks are neurologically themed. The specific assignments are no longer in my possession, but you have them and can forewarn the newcomers.

A short post I am afraid but as well as working this weekend I have been sorting out my email account at home which had been reporting "2,147,433,168 messages unread". 

MJM

Wardround 30v8

An interesting update on skin infections. What did you learn?

Cellulitis is a common condition in acute medicine. Always ask yourself if this is 'simple' or complicated. Is there immunosuppression, skin integrity, rapid progression, unexpected pain, recurrence, poor response to treatment?

You already have your asssignments for next week's talks and the discussion for Tuesday was posted last week.

The May M&M meeting when very well I felt.

Interesting topics

Unsuspected Pulmonary thromboembolism

MJM

Wardround 23v8

Endocrine emergencies. Well done. I had given YA 10/10 in my notebook for his talk on acute hypoadrenalism, so I was forced to give Thyrotoxic storm by EM a 10+. I think you have grasped what is needed.

Many of the emergencies discussed can be misdiagnosed as other common conditions and considering the possibility is just as important as knowing what to do.

I will share with you that my soul shudders each time someone recommends "routine bloods". I can cope with "x, y and z should be routine bloods in the investigation of...". Be specific.

For next Friday the assignments are based on skin infections:
Infection following animal bites
Lower leg cellulitis (A)
Cellulitis in the immunocompromised host. (S)
Necrotising fasciitis (Y)
Facial cellulitis (N)
Shingles

requirements: Concise, unrushed, precise, sources quoted, USEFUL.

For Tuesday you have been given a grey case to consider. By the way, what is a grey case and how should you deal with it? Prize 9virtual) to the best definition of a grey case.

The reading for a week on Tuesday will be The boards and executives of drug companies could catalyse action against the AIDS epidemic by immediately reducing the costs of HIV drugs in poor countries to zero. Donald Berwick BMJ 2002;324:214-218

Interesting topics

Pneumocystis pneumonia see uptodate

Adult onset Still's disease

Neurofibromatosis

MJM

Wardound 16v8

Our discussion paper last week was The reading for discussion on Tuesday will be DNR or PEACE. J Crampton. BMJ 2008;336:1015. An interesting discussion ensued. If you would like to read more on the subject could I suggest you take a look at Decisions relating to cardiopulmonary resuscitation A joint statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing from October 2007

For next Tuesday the reading will be Liz Wager: Training and the placebo effect.

Our talks this week were about poisoning, and overall I think they were well researched and presented as spoken mini-essays. I would like you, now, to think about these talks in a different way. The aim is to teach/train/educate your audience. This differs from writing an essay (or giving presentations, which are much the same thing) as you have done in the past. Those were to assess your ability to collect and critically appraise information. I want you to take that information and teach me and your colleagues. And by teach, I mean convert me from someone who could not do something into someone who can. Your handout is for that purpose as well.

Bear that in mind for this week's two minute talks on endocrine emergencies:

Hypoglycaemia A
Thyrotoxic Storm E
DKA N
Adrenal crisis Y
Phaeochromcytoma crisis S

Interesting topics

Antibiotics and seizures


MJM

Wardround 9v8

Our discussion this week, in the absence of a paper to read, was about improving practice by Morbidity and mortality meetings. We will now run an M&M meeting on the last Thursday of each month. There is an M&M folder in the Nurses office. All deaths for the month should be listed there. The GAJ team will review MJM patients and vice versa. The Necessary patients notes will need to be pulled the week before.

Our two minute talks were about the investigation of malignancy of unknown origin. A useful discussion I think. We heard about the more common cancers nad discussed how that should guide our history, examination and investigation. The use of tumour markers produced further discussion, which can I think be generalised to the use of many tests in medicine.

For next week:

The reading for discussion on Tuesday will be DNR or PEACE. J Crampton. BMJ 2008;336:1015

Read it, think, and share your thoughts.

The two minute talks for Friday will be about Poisoning:

Paracetamol (ST)

Carbon Monoxide (NV)

Methanol (EM)

Tricyclics (YA)

The usual advice. Keep it concise and precise, quote your sources and make a handout. Having heard your talk I should be able to manage a poisoned patient. The handout should be visual rather than textual. Example.

Interesting Topics

Group A streptococci

Do you know what streptococcal toxic shock is? UpToDate also has some good articles on the subject.

MJM

Wardround 25iv8

The discussion this Tuesday began with the paper The strange malady of Alessandro’s uncle, Neil A (Tony) Holtzman. I was prompted to choose the paper following the journal club discussion last week about the genetic markers for responses to warfarin. The paper describes the development of a new (genetic) investigation and treatment and its impact on the aforementioned uncle. Many interventions will appear better than they prove to be when evidence is limited.and the passage of time gives more accurate assessments.

The paper for discussion next week will be Screening for MRSA, M Wilcox, BMJ 2008;336:899-900

The two minute tutorials on diagnoses were well done but I would recommend adding an additional aliquot of thought to the planning stage. Ask yourself, “what do I want the listener to be able to do or know after this two minutes?” Detailed discussion of diagnostic criteria may contain all the necessary information but that alone does not complete the task. Keep the handout to one side of A4 and make it memorable. Ask yourself the questions MJM or GAJ might ask. Be honest with yourself about the handout. Would you read or keep somethiong that can be printed from a website in 10 seconds? What would be more useful?

Next week’s talks are about Colitits: epidemiology, investigation, treatment.

MJM

Wardround 18iv8

Back on-line.

The reading for Tuesday will be The strange malady of Alessandro’s uncle, Neil A (Tony) Holtzman. BMJ 2007;335:1306-1307, (doi:10.1136/bmj.39407.647014.80). Read it and think, then share your views.


The two minute talks for Friday will be Making a diagnosis: you can decide among yourselves who will make each presentation.

What constitutes Diabetes mellitus?
What constitutes COPD?
What constitutes Coronary artery disease?
What constitutes Delirium?

Two minutes please. practice it and make sure your timing is accurate. be concise and precise, quote your sources.

Interesting topics

Hypereosinophilic syndrome or look in uptodate which has an excellent article on the subject.

And here is an article worth a read, Blood Eosinophilia: A New Paradigm in Disease Classification, Diagnosis, and Treatment, A Tefferi, Mayo Clin Proc. 2005;80:75-83

MJM

Out of action at present

Wardround 7iii8

Last week's talks were about substance abuse: acute management and harm reduction. Good talks, full of useful information but the handouts were a little to bulky for my liking...try something that can be taken in with one or two glances rather than a page that requires reading. Have a look at this as an example. This would probably be the equivalent of all the talks at a Friday meeting.

What pearls have I taken away from these talks? (if I've missed a good one just add it to the comments section)

Myocardial sensitisation to catecholamines with solvent inhalation: aim for calm and quiet surroundings, monitor cardiac rhythm and use sedation if necessary. The acute effects should have worn off by 6 hours , and if not consider a complication such as myocarditis.

In acute alcohol withdrawal there is no one-size-fits-all regime. The benzodiazepine dosing must be titrated to control withdrawal but avoid over sedation. SIPS scoring is a good way to do this but if not in use you will have to use some common sense. (It's certainly better than using none.)

Identifying alcohol misuse in patients presenting with other conditions is important. A reported alcohol intake less than the recommended level does not exclude abuse. Be aware, ask more detailed questions (eg CAGE) if you are suspicious.

Further reading

Alcohol - problem drinking
Opiod dependence

Next week's two minute talks will be about Parkinson's disease:

Diagnosis
Management
Problems with treatment

This time try to have visual rather than written handouts. If you want to give out lists, just tell us where to find them e.g. more information at www.listsofcauses.com.

The discussion for Tuesday will be "Should doctor's who see prisoners insist hand-cuffs are removed?" You may want to read Restraint of detainees in NHS facilities.

MJM

Wardround 29ii8

The talks this week were about interstitial lung diseases. You are getting the hang of it now; Information targeted at clinical practice and delivered so as to be memorable. The best talk/handout this week was Extrinsic allergic alveolitis (Dr NNT). Remember to ask about activities up to 6 hours before the onset of acute dyspnoea. Always consider infective causes. (I have a feeling that I need to take care not to evolve into an Infectious Diseases evangelist.)

For next week the assignments are based on substance misuse:

Glue (MR)
Alcohol (NNT)
Cocaine (KL)
Crystal Meth (R)

Two minutes please on the management of acute toxicity and harm reduction.

The reading last week was Doctors’ education: the invisible influence of drug company sponsorship. Ray Moynihan. BMJ 2008;336:416-417. You may want to have a look at Who pays for the pizza? by the same author.

For next Tuesday I would like you to read and think about Junior doctors' shifts and sleep deprivation. Carol Black et al, BMJ 2005;330:1404.

You may want to test your own level of tiredness with this online psychometric test

Interesting topics

Alternative causes for elevated cardiac troponin levels.
Ann Intern Med 2005;142:786-791

Clozapine myocarditis

Marfan's Syndrome

MJM

Wardround 22ii8

The reading for Tuesday will be, Doctors’ education: the invisible influence of drug company sponsorship. Ray Moynihan. BMJ 2008;336:416-417 (23 February).

There is an extended podcast on rheumatoid arthritis, with slides available (60 minutes duration) at the training site.

MJM

Wardround 15ii8

A good attempt (first/second stabs) at the two minute talks on Friday. Much effort for so little gain. But this is the point of training...getting better. Next week we have Neuropathy as our topics, split into acute, subacute and chronic. Ask yourself "what do I want to learn?" "what do I want my colleagues to remember?" " how can I get he message accross so they remember?"

Then prune it to two minutes, keep it concise and yet precise and quote your sources. make a handout to get the message accross. And be realistic; no one will read a 400 word A4 handout but they will glance at pictures. And another piece of advice. Have the handouts ready before the wardround starts.

Here is my old podcast on Neuropathy



It won't be visible inside DGRI but it is also available here.

The reading for Tuesday is The Interpreter of Facts, HW Horowitz. JAMA 2008; 299: 497-498.
Get it from the elibrary, or be old-fashioned and caress the journal in your own hands. Read and think.

Interesting Topics

Status Epilepticus

MJM

Wardround 8ii8

The reading for Tuesday is Clinical craft: a lesson from Liverpool. D M Gore. Journal of Medical Ethics 27:74-75 (2001). Read and think.

The talks this week were about rheumatological presentations to admissions units. Well done to Dr Lewin for a well presented (and acutely timed) talk on the red eye, diarrhoea, sore joints syndrome, and with little warning. It is worth having a looke at the recently produced guidelines for the hot swollen joint. By the way (SZ) it wasn't that difficult to find, being the second hit when I googled it. You might want to see my summary sheet. In dealing with the various scenarios, I would recommend differentiating joint/muscle symptoms with or without objective signs and with or without involvement of other organ systems. SIRS is sepsis until you know otherwise.

The talks for next week are about stroke. Thrombolysis (NN), anti-platelet treatment (MR) and surgical treatments (KL). Two minutes please, keep it precise and concise, quote your sources and give a handout you would be proud to be shown in twenty years....yes I am that cruel.

Interesting topic

Pulmonary Embolism
Hereditary Thrombophilia


MJM

Wardround 1ii8

The Reading for next Tuesday is Waste in the NHS, Andrew Moore, Bandolier Extra, February 2002. Give yourself time to read it, then let's hear what you think.

The two minute talks this week were about Gram stained rods and cocci. You should now be able to target appropriate antibiotics a little better. Don't ever think "I'll use a broad spectrum antibiotic".....plan the spectrum to cover the clinical situation.

The talks for next week will be about rheumatological emergencies.
The single hot joint SZ
Generalised myalgia/arthralgia CG
Red eye, diarrhoea, and sore joints PM

A two minute talk please, keep it concise and precise, quote your sources and provide a one sheet handout.

Interesting topics

Helicobacter


MJM

Wardround 25i8

Our discussion this week was about ethics. The use of jokes which might offend, open-ness with patients, harrassment, ethics committees, politics and medicine all had their moment. It can be helpful to think out loud. For next week the discussion will be about the ethics of offering or declining transplantation to a patient with several co-morbid conditions and difficulty adhering to established models of care.

You will have an opinion (that’s an order). But why do you have that opinion? Can you see why others may have a different opinion? Who is right? How can you best structure the problem for analysis? Would an ethics committee help? How? How can you recognise whether you are virtuous (in your decision) or lacking both virtue and insight?

The two minute talks this week were about urinary tract infections. I hope you have learnt about the subject and your methods of research. Did you ask ‘why?’ when you should have done?

Next week is microbiology. You get a phone call from bacteriology. The blood culture is positive for: G+R (MG), G-R (NS), G+C (SZ), G-C (CG). You have been given a little background to work on. So what do you want to know? Each result should ring some bells of recognition and some alarms. Give the group two minutes on your case.

Interesting topics

Pernicious anaemia

Behcet’s and thalidomide


MJM

Wardround 18i8

The ethical dilemmas to read for Tuesday are to be found here and then An ethical dilemma, BMJ 2001;322: 1236-1240.

Tutorials for Friday (Urinary infections)

Interesting Topics

PICC lines (This is I think the original poster and can be read without visual aids )

MJM

Wardround 11i8

The discussion for Tuesday is this video by students. You may need to view it outside DGRI, I think youtube access will be blocked in the hospital network.



The two minute tutorial theme this week (and next week) is immunisation. We heard about Pneumococcus (NS), HiB (SZ), meningococcus (MG) and influenza (CG). A little more tweaking is needed to get the essential information into two minutes. For next week we will hear about: BCG, smallpox, polio and Hep B. Any audits spring to mind?

Two minutes please. Identify what you think is the essential information to get across, and remember that diluting that with waffle/unimportant points will impair meme transfer.

Interesting topics.

Pancreatitis

Trimethoprim and creatinine


MJM

Wardround 4i8

Happy new year for 2008. May your knowledge expand, ignorance regress and wisdom blossom.

The reading for Tuesday 8 january will be The practice of clinical medicine as an art and as a science , John Saunders, Journal of Medical Ethics 26:18-22 (2000).

The two minute tutorial theme for friday is immunisation: there is a medscape CME session which covers five main areas (a page each). Your task is to read the page allocated to you and translate it into UK guidance for the rest of us.

There is a 'Green book' issued in the UK with guidance on immunisation so you could look into that for inspiration. You can find an on-line version here.

Pneumococcus NS
HiB SZ
meningococcus MG
influenza CG
polio SS

Two minutes maximum, keep it concise and precise with an A4 size handout to make it clearer. Don't put all the info on the handout, just the essentials.

Interesting topics

candida glabrata


colchicine for gout


MJM