Our two minute talks last week were based on the investigation of abnormal LFTs but we got sidetracked into the interpretation of hepatitis B serology. This was I hope a useful time both for the specifics of understanding HepB serology and the general point of structuring your knowledge in a way which is useful for practical use. When learning a new topic, or revising an old one remember that the way it is structured in the textbook may need translating to make it easier to remember or apply.
Test yourself…which tests are useful for:
Assessing response to Hep B immunisation?
Checking for previous contact with Hep B?
Acute hepB?
Chronic Hep B?
Next is Opportunistic infection (in HIV)
Pneumocystis SYC
Cytomegalovierus AA
Atypical Mycobacteria AA
Kaposi’s MR
Two minutes please. Keep it precise and concise, quote your sources and educate your colleagues.
Last week’s discussion was about waste and how we might address the problem. This week we will discuss Measuring quality of life. Is there such a thing as a life not worth living? B. Farsides, RJ Dunlop BMJ 2001;322:1481-1483.
Next week the Tuesday discussion will be replaced with (by?) a quiz.
Interesting topics
PEG tubes
Aortic stenosis: indications for valve replacement in adults (uptodate)
MJM
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
MJM
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.
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.
MJM
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:
Aspiration Pneumonia, good article on Uptodate
Farewell to the old guard and welcome to the new batch. Get ready to gorge yourself on fruit from the tree of knowledge.
The difference between a good physician and a bad one is certainly very great; but the difference between a good physician and no physician at all, in many cases, is very little.
If during the course of the common epidemic diseases which occur in this island every spring and autumn, two hundred patients were taken promiscuously, and one half delivered to the care of the faculty to be treated according to the art; that is, as private patients by whom they are fee'd every time they prescribe, and the other half delivered to the care of nurses, instructed to give them no physic whatever, but merely cooling drinks, and such light and simple foods as the patients' appetites might lead them to, I am convinced the world would be a good deal surprised at the result of the experiment.
J Moore, Medical Sketches. London: A Strahan and T Cadell, 1786
Jeremy Hugh Baron, honorary professorial lecturer, Mount Sinai School of Medicine, New York
Remember that a short read means more time for reflection.
The two minute talks this week were stimulated by a recent case of tetanus. We heard about the toxin effects of Tetanus (J Wallace); C. diff (G Bell); Botulism (N Mohan); Staph Toxin (L Frame). Very interesting topics. I was not aware of the neuromuscular effects of aminoglycosides. My prize goes to NM. You can find out more trivia about botulism at Naveen’s blog.
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
