An interesting set of talks about nosocomial illness. I liked the Falls in Hospital handout: Simple, clear, no waffle. We have agreed that "have you had any falls" should be a routine question. I tend to put it in the neurology section of systems review.
It was good to see our local data for C. difficile. Always good to include local information in a talk. SS will read one of the C. Difficile ICP sheets.
Next Friday's topic is Electrolyte disturbance. Research, cogitate and give the group two minutes on one of the topics below. Clarity, practicality and memorability (for the right reasons) will be assessed.
Sodium
Potassium
Calcium
Magnesium
The reading for Tuesday is Mistakes. R Lesnewski. JAMA 2006: 296 (11); 1327-8
Monday's Audit: Have you fallen?
Interesting topics
Ecthyma Gangenosum
Staphylococcal infection
Amiodarone Lung
Campylobacter
MJM
Friday, August 19, 2011
Friday, August 12, 2011
Glucocorticoid adverse effects
Our topic today was adverse effects of glucocorticoids. These are commonly used drugs with significant adverse effects. If we wish to limit unwanted effects we need to know how common they are, harness patient's concerns to help us and have a plan for when we use steroids.
Your talks showed that you had put effort into researching the topic, but there needs to be a little more planning on the presentation side. The time allowed means that you have to be concise, and to make it sharp you must always be precise. Numbers (10%) not descriptors (quite common). List your sources on the handout so the audience can follow up if they want to.
Here are some useful papers. The links are to abstracts but the full versions are only a password away via ATHENS.
Monitoring adverse effects of low dose glucocorticoid therapy: EULAR recommendations for clinicalk trials and daily practice. MC van der Goes et al Ann Rheum Dis 2010;69:1913-1919
Epidemiology of glucocorticoid-assoiated adverse events. AK McDonough et al. Curr Opin Rheumatol 2008 Mar;20(2):131-7.
Patients’ and rheumatologists’ perspectives on glucocorticoids. MC van der Goes et al. Ann Rheum Dis 2010;69:1015-1021.
The acronym below which is an aide-memoire for reducing adverse drug effects in general. Apologies to its author, who I can't remember, but I first heard it at a meeting about 5 years ago.
S...Stratify: is the patient at higher risk of an ADR: comorbidities, drugs, age.
A...Assess: Hepatitis status, TB risk, vaccinations up to date?
F...Fend-off: vaccinate, optimise health (stop smoking etc).
E...Evaluate: check what ADRs might be expected, look for them.
T...Treat: nip it in the bud (UTI is easier to treat than septic multi-organ failure).
Y...Yearly: re-evaluate all of the above regularly. The frequency depends on the drug.
The topic for next Friday is Nosocomial illness:
Falls
C. Difficile
MRSA
Line infections
Two minutes please. Be concise yet precise. Tell us your sources. you are allowed an A4 (single side) handout.
Audit standard for next week. All casenote sheets have the patient's name and CHI.
MJM
Your talks showed that you had put effort into researching the topic, but there needs to be a little more planning on the presentation side. The time allowed means that you have to be concise, and to make it sharp you must always be precise. Numbers (10%) not descriptors (quite common). List your sources on the handout so the audience can follow up if they want to.
Here are some useful papers. The links are to abstracts but the full versions are only a password away via ATHENS.
Monitoring adverse effects of low dose glucocorticoid therapy: EULAR recommendations for clinicalk trials and daily practice. MC van der Goes et al Ann Rheum Dis 2010;69:1913-1919
Epidemiology of glucocorticoid-assoiated adverse events. AK McDonough et al. Curr Opin Rheumatol 2008 Mar;20(2):131-7.
Patients’ and rheumatologists’ perspectives on glucocorticoids. MC van der Goes et al. Ann Rheum Dis 2010;69:1015-1021.
The acronym below which is an aide-memoire for reducing adverse drug effects in general. Apologies to its author, who I can't remember, but I first heard it at a meeting about 5 years ago.
S...Stratify: is the patient at higher risk of an ADR: comorbidities, drugs, age.
A...Assess: Hepatitis status, TB risk, vaccinations up to date?
F...Fend-off: vaccinate, optimise health (stop smoking etc).
E...Evaluate: check what ADRs might be expected, look for them.
T...Treat: nip it in the bud (UTI is easier to treat than septic multi-organ failure).
Y...Yearly: re-evaluate all of the above regularly. The frequency depends on the drug.
The topic for next Friday is Nosocomial illness:
Falls
C. Difficile
MRSA
Line infections
Two minutes please. Be concise yet precise. Tell us your sources. you are allowed an A4 (single side) handout.
Audit standard for next week. All casenote sheets have the patient's name and CHI.
MJM
Thursday, August 11, 2011
11viii11
The two minute tutorials for Friday are focused on the adverse effects of corticosteroid therapy:
General overview
How to work up a patient prior to treatment
How to assess a patient on treatment
What are patient's views on steoid side effects
Tuesday's read and think will be A 76-Year-Old Man With Multiple Medical Problems and Limited Health Literacy. Amy Ship. JAMA August 10 2011.
Interesting topics
Illiteracy in rheumatoid arthritis patients as determined by the Rapid Estimate of Adult Literacy in Medicine (REALM) score. Gordon et al. Rheumatology (2002) 41 (7): 750-754
It's Good to Feel Better But It's Better To Feel Good and Even Better to Feel Good as Soon as Possible for as Long as Possible. Response Criteria and the Importance of Change at OMERACT 10. V Strand et al. J Rheumatol August 2011 38(8):1720-1727
MJM
Wednesday, August 03, 2011
It starts again: August 2011
Welcome to Ward 10. I hope you will both enjoy your stay with us and make the most of it. Learning does require a little effort but hopefully we can help each other by sharing the task.
The two minute tutorial topic for Friday is The Normal ECG. I would like you to choose amongst yourselves from: P wave, QRS complex, T wave, PR interval, Axis. The goal is for us to be able to recognise a normal ECG. You are limited to two minutes. Be precise yet concise and tell us your sources.
The paper to read, digest (intellectually) and then discuss on Tuesday is The Road to Recovery, by David Psetsky.
We usually have a weekly topic for audit, but we can choose our first topic on Friday.
There are at least two on-going audits of which you should be aware:
Antibiotic use is checked against local guidance (available on the intranet and due to be updated any day). It is important that the correct empirical antibiotic is chosen or the reason for chosing an alternative is clearly stated in the case notes or prescription kardex. The indication and expected duration of treatment or review date should be recorded.
We audit the recording of DNA-CPR and ceiling of care weekly (well you do).
Interesting papers:
Paracetamol, ibuprofen, or a combination of both drugs against knee pain: an excellent new randomised clinical trial answers old questions and suggests new therapeutic recommendations.
PS the links in the frame on the left are mostly inactive at present, awaiting my guiding hand.
MJM
The two minute tutorial topic for Friday is The Normal ECG. I would like you to choose amongst yourselves from: P wave, QRS complex, T wave, PR interval, Axis. The goal is for us to be able to recognise a normal ECG. You are limited to two minutes. Be precise yet concise and tell us your sources.
The paper to read, digest (intellectually) and then discuss on Tuesday is The Road to Recovery, by David Psetsky.
We usually have a weekly topic for audit, but we can choose our first topic on Friday.
There are at least two on-going audits of which you should be aware:
Antibiotic use is checked against local guidance (available on the intranet and due to be updated any day). It is important that the correct empirical antibiotic is chosen or the reason for chosing an alternative is clearly stated in the case notes or prescription kardex. The indication and expected duration of treatment or review date should be recorded.
We audit the recording of DNA-CPR and ceiling of care weekly (well you do).
Interesting papers:
Paracetamol, ibuprofen, or a combination of both drugs against knee pain: an excellent new randomised clinical trial answers old questions and suggests new therapeutic recommendations.
PS the links in the frame on the left are mostly inactive at present, awaiting my guiding hand.
MJM
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