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Re: Corruption in Healthcare: Hospital Universitario del Valle (Cali, Colombia)

Posted in News & media at Tue, 31 May 2016 10:06:44


Posts: 1322
Joined: 13 Oct 2009

Many thanks for the update. Much appreciated. I have always thought doc2doc should help to foster communication about the challenges facing doctors in a variety of countries. Even though it seems we concentrate on our UK problems....

Re: Zika and the Rio Games

Posted in General clinical at Mon, 30 May 2016 09:20:05


Posts: 1322
Joined: 13 Oct 2009

I am not so sure that it is just human carriage - the influx of some of the related viruses into southern Europe for example has been thought to be airborne. 350 miles is a relatively little distance for high altitude winds. Of course human spread will exacerbate the problem but with a bit of global warming these problems may well hit Europe in the future anyway. Just look around at the puddles , stagnant water and garden rain tubs , pools etc... as mosquito breeding grounds and the UK too has the making of an epidemic. 

 So far have any athletes shown signs of backing out of competing ?

My impression is that public awareness is growing but still has a long way to go - haemorrhagic fevers in Africa have become much more of a personal threat in Europe over the last 30 years as the interest in Ebola showed and the interest each time bird flu problems arise. What I do not think the public has registered is how ill equipped we are to deal with a major epidemic - folk might even die... Cue : blame the government , failure to invest in the NHS etc... 

Re: Clinical question of the week: would you change this man’s anti-diabetic treatment?

Posted in Diabetes at Mon, 30 May 2016 03:29:18

Joey Rio

Posts: 1069
Joined: 13 Apr 2011

Dear Colleagues:

Dr. Richard Lehman is a senior GP from Oxford and writes in the BMJ, a prestigious Blog - a weekly review of what comes up in the major medical journals.

Interesting to take a quick look at what he writes and the reference he provides from the JAMA Internal Medicine - February 2016, Against Intensive Glycaemic Control for most type 2 diabetics 55 or above years old. Enjoy this new concept in type 2 diabetes care: 


Other comments are welcome.

All Best,


Re: ECG Question

Posted in General clinical at Mon, 30 May 2016 00:42:24


Posts: 840
Joined: 21 Feb 2012

In Response to Re: ECG Question:[QUOTE]

Correct  ansewr

The condition is Autosomal Dominent inhertance, mostly mutation in the gene encoding sodium channel in the cell membrane

Recently a mutation in the L-type calcium channel subunit has been identified

ECG can be normal in symptomless patients, but the ST segment changes can be elicited by adminstration of Ajmaline injection or quinidine

There is no treatment that reliably prevent ventiricular fibrillation which is the cause of sudden death in Brugada syndrome, hence ; insertion of ICD ( Implantable Cardiovecter Defibrillator ) is indicated to prevent the occurance of the fatal arrhythmia



Posted by alaminium[/QUOTE]


Thank you so much for further information



Newspapers can be unhealthy

Posted in General clinical at Sun, 29 May 2016 21:04:38


Posts: 1322
Joined: 13 Oct 2009

I continue with my grouse about otherwise responsible newspapers failing to recognise the major problems we have with obesity and alcohol. Following on from the Guardann journalist who admits to up to 180 units of alcohol in a week during her heavy drinking days (now said to be much reduced) we now have the same paper quoting an Italian GP who recommends 4 glasses of red wine daily to those who are pregnant. I remember in the past the general feeling expressed that those who did not reach at least the tipsy state were not worth bothering about socially. How far should papers lead in health programmes and how far deliver the opinions the public wants to hear?  The less authoratative papers do this with their regular features on medical "breakthroughs" but both activities seem to me a trifle irresponsible.

FY2 looking for career advice :)

Posted in Careers at Sun, 29 May 2016 18:47:44


Posts: 1
Joined: 29 May 2016

Hello :)

I am currently an FY2 in Scotland and will be taking a year (possibly 2) out of training to do some locum work and gain more clinical experience, as well as some post graduate education, with the ultimate aim of applying for radiology.

I don't intend on going abroad to work, but plan to do work in different healthboards and specialties. In terms of post graduate education, I thought about doing a part time distance PGCert in medical education and/or medical ethics, both areas of personal interest. 

I'm not intentionally putting off starting specialty training but I really am in no rush to start, as I've heard that once you are on the ladder it gets harder and harder to take time out.

Are such qualifications useful for specialty application? And if I take the full 2 years out, will this be frowned upon when it comes to applications?

tl;dr - will it be frowned upon if I take 2 years out of training after FY2 to do locum work in the UK and post graduate studies?

Re: Body Integrity Identity Disorder (BIID)

Posted in Psychiatry at Fri, 27 May 2016 19:30:08

John D

Posts: 4049
Joined: 01 Feb 2010

Welcome to D2D, dinagross.  In fact, Wilcommen!

For all the deficiencies of us monglot anglophones, Google Translate is our friend, but I had to appeal elsewhere to get even a rough translatiion of your post:    Would this do?   "If I am alone, how can I be a mirror of my psyche?"    

Is this in relation to "Body Dysmorphic Disorder"?   




Re: Aphantasia: a real disorder or a fantasy?

Posted in Psychiatry at Fri, 27 May 2016 15:47:21

Mukhtar Ali

Posts: 1027
Joined: 14 Nov 2010

Aphantasia was first discovered in 1880, but has recently attracted much more attention thanks to a 2015 study by Adam Zeman at the University of Exeter and colleagues, who investigated the claims of 21 people who were unable to summon images to their mind’s eye.

Aphantasia ------------Some talk about the benefits of not having to relive trauma.


Re: 7T Sodium Cardiac MRI may be a game changer

Posted in Radiology at Fri, 27 May 2016 08:10:55


Posts: 1322
Joined: 13 Oct 2009

Again , many thanks but the thoughts of usefulness are optimistic. There seems little possibility that populations are prepared to modify their intake of excess food or sodium although individuals may do so. 

 Interesting experience on the train yesterday : 2 seats on either side of the of the carriage as "priority seats" for the frail  etc... Each pair of seats was taken by a truly enormously obese woman. One of them tried to take as little room as possible but still left nothing except for a cachexic person. The other truly flowed into the entire double space. This is where we are heading in the UK at least and as with so much else these are the folk who will dictate design of transport etc... in the future. So just be sure your new generation of scanners are big enough. The Caribbean island I visited recently had just bought a scanner for its population of 35,000 - but residents are often so overweight that they have to be exported to another island for an MRI.

Re: Prescribing Marjuana

Posted in General clinical at Thu, 26 May 2016 00:37:04


Posts: 840
Joined: 21 Feb 2012

In Response to Re: Prescribing Marjuana:[QUOTE]

Memdical Marjuana is prescribed in the form of :-

1/ Liquid Extract

2/ In the form of cookies or candy

3/ Vapor

4/ Smoke

It is mostly used to treat muscle spasm caused by diseases such as Multiple Sclerosis, nausia and vomiting due to Chemotherapy, poor appetite and weight loss caused by chronic diseases such as HIV, Seizures, chronic pain

Side effects mainly dizziness, fatigue, euphoria, risk of addiction



Posted by alaminium[/QUOTE]


Thank you.



Lessons from the rhubarb season

Posted in General at Wed, 25 May 2016 17:21:01


Posts: 1322
Joined: 13 Oct 2009

We are now well into the rhubarb season and those that indulge will be well aware of the potential effect on the gut. A visitor to the UK unused to this could well be classified as having traveller’s diaorrhoea (TD).  Many specialists like to give their special interest an all-inclusive nature. Think psychiatrists and depression or borderline personality disorders.

   By defining TD as 3 or more loose motions daily , we include many folk where this is their “normal” – but once they cross the Channel it becomes a disease. The effect I notice with goodly helpings of rhubarb I have when abroad after consuming many of the varied vegetables on offer – often soaked in copious amounts of oil. And that is apart from all those figs in season. BO 3 X daily : if only – and what about the night time as well… And of course any urgency is likely to affect social functioning so I automatically move to a more severe stage of TD by definition.  Co-incidentally , I may have a change in my gut flora , but that would not be  unexpected. 

  When challenged , those with a particular interest in TD can become incredibly defensive – reminiscent of the psychiatrist who will react with details of patients with severe or psychotic depression to suggestions that minor degrees of being “down-the-dumps” for a short time does not equate with psychiatric disease.


  Perhaps we need to change the definition of TD to one where the disturbance of bowel function is

A. 1. A disturbance beyond the normal bowel habit for the individual ;

2. Not corrected by a bland diet  ;

3. Associated with feeling unwell ;

4. Not responding to 2-6 mgs of loperamide daily ;

or B. . Persisting after return to the UK ,( but needing recognition that any TD may have precipitated the onset of IBS) when a wider differential diagnosis might be relevant.

  C. Any significant features such as pyrexia , blood in the stools etc.. are red flag symptoms requiring a different approach and these travellers should not be dismissed as having a tummy upset and lumped together with those with milder symptoms. And as for the outbreaks of Norovirus on cruise ships , I would see that as something else altogether and remain thankful that I do not feel tempted anyway by embarking on one of those floating “townships” (by now not just floating hotels).

The aim of being more restrictive in our definition of TD is in part to discourage the overuse of antibiotics , prophylactic and recognise the true incidence of TD where these might be effective.


Re: Doctor needed for Liquid Biopsy

Posted in General at Tue, 24 May 2016 19:53:24

John D

Posts: 4049
Joined: 01 Feb 2010

I note that Googling for "Liquid Biopsy" reveals that those words are followed by a circled "R".  In other words,  this is a registered trade mark, and promoting it here may be advertising.

Please justify your post with more detail, VM950, without of course breaking patient confidance, as I'm minded to blank this thread.

JOhn, as moderator

Re: Book about how to treat sciatica and low back pain with Osteopathy

Posted in General at Tue, 24 May 2016 19:49:26

John D

Posts: 4049
Joined: 01 Feb 2010

Sadness peak,

I refer you to my previous answer on the quack nature of osteopathy, and osteopathists.


Re: What is your Biggest Issue in communications?

Posted in General clinical at Tue, 24 May 2016 14:40:46


Posts: 4
Joined: 23 May 2016

If anyone wants to demo sign up here: 


HIPAA-Compliant Messaging App - would you use?

Posted in Medicolegal at Mon, 23 May 2016 15:01:20


Posts: 4
Joined: 23 May 2016

We have a HIPAA-compliant messaging app made exclusively for use of doctor-patient, pharmacy, lab etc. communications. We've seen increases across the board for more patients seen, more prescriptions being filled, less time spent on the phone. It's pretty remarkable.

If you're curious, our app is free to use and I'd be happy to chat for 10 mins about setting it up for anyone interested: Just shoot me an email alexis.sheehy@klara.com.

Re: BMJ Open journal club: what impact does audit and feedback have on the role of the community pharmacist?

Posted in General clinical at Mon, 23 May 2016 14:52:47


Posts: 4
Joined: 23 May 2016

This is incredibly interesting based on my current line of work. I work on KLARA, a healthcare communications app created to increase the efficiency in healthcare communications, billing, etc. to yield a higher amount of patient adherence (also less annoyance for everyone involved). 


You can check out our website here: 


Re: In or Out?

Posted in Diabetes at Mon, 23 May 2016 09:58:39


Posts: 1971
Joined: 08 Oct 2010
I am unimpressed with the entire debacle. It seems a never ending attrition of claim and counter claim. If we stay in we are going to be subsumed into a federalist superstate crammed with beauracratic regulations, if we leave we are doomed into exile with no one to trade with and will listlessly perish while the rest of Europe flourishes.
Who is right? Heaven knows. 

Re: Wanting to leave and work abroad in Australia or USA.?

Posted in Careers at Mon, 23 May 2016 08:43:18


Posts: 1
Joined: 23 May 2016

GUYS! What about a Career in Botox and Fillers!!

Don't lose faith in the NHS just yet! OZ is great but the UK has a lot of potential. I am a GP and finished my GP training....I do 1 sesion a week if that now!! I chose a career in private medicine which has proved VERY successful and can also be done alongside any training!! 

If you are interested in Aesthetic medicine then go on a Botox and Dermal filler foundation training program and you can start work immediately. The money is great and the work life balance is there. Its a new profession and will soon be recognised by the GMC as a subspeciality. With the right training you can get on that ladder before the regulations change and it becomes harder. 

Recomended courses in London:

www.esthetiqueacademy.co.uk - caters for all F1, F2, SHO, Registrars and COnsultants. 



In Response to Wanting to leave and work abroad in Australia or USA.?:[QUOTE]


i went to the BMJ careers fair and the guys there made asutralia sound really good only porblem is that my degree was from europe though im a UK citizen,  which australia say you need to do the entrance exams first. Uk graduates dont have that problem. im stuck in a rut here, I want a new challenge and better lifestyle but its hard to choose whether to do the oz exam or suck it up and do all the USMLE  steps and head that way . its a crossroads decision i guess. im not terribly looking froward to doing CMT here at themoment!


anywone made the leap or thinking of it?


Posted by rohachy[/QUOTE]


Medical School Scholarship Fundraiser-https://www.gofundme.com/24gkdx8

Posted in General at Sun, 22 May 2016 20:57:22


Posts: 2
Joined: 22 May 2016

Raising money from donors to donate the funds to various university medical school scholarship funds within the U.S.A.

Medical School Scholarship Fundraiser-https://www.gofundme.com/24gkdx8

Posted in General at Sun, 22 May 2016 20:54:20


Posts: 2
Joined: 22 May 2016

Raising money from donors to donate the funds to various university medical school scholarship funds within the U.S.A.

Re: Plantar fasciitis vs metatarsalgia vs other?

Posted in Sport and exercise medicine at Sun, 22 May 2016 13:05:30


Posts: 2
Joined: 19 Aug 2014

Thank you all for the comments! And yes, I have been feeling incredibly low these last few months, running was my main stress release - you've hit the nail on the head with CBT! I've been swimming but only out of necessity, I don't enjoy it nearly as much. There aren't very many sports medicine specialists in the area but I will try to look further afield.

Re: Time to abandon three-phase trials?

Posted in BMJ at Sun, 22 May 2016 05:56:21

Jorge Ramirez

Posts: 70
Joined: 09 Jan 2015

The answer is yes, it is about time to abandon phase 3 clinical trials.

It is perhaps also a good time to abandon pharmaceutical marketing campaigns disguised as phase 4 clinical trials.

Randomized clinical trials are the best source of high quality evidence according to the foundations of evidence based medicine (EBM). However, the pyramid of EBM is not supported by evidence (i.e., data) and opinion polls are not evidence anyway (the earth was the center of the universe 500 years ago).


Ramirez, Jorge H (2015): Evidence Live 2015: Hierarchical levels of evidence based medicine are incorrect.. figshare. https://dx.doi.org/10.6084/m9.figshare.1286767.v1

Ramirez, Jorge H (2014): Clinical trials, observational studies and meta-analysis: PubMed Trends. figshare. https://dx.doi.org/10.6084/m9.figshare.1122534.v1



How to waste £2.4 bn

Posted in BMJ at Sat, 21 May 2016 22:05:58


Posts: 57
Joined: 04 May 2015

Article in BMJ of 30th April 2016 by Dr Margaret McCarney on the NHS England 56 page  document 'General Practice Forward View.

She makes several salient points.

Spending money on non-evidence based interventions leads to harms: it wastes time and energy. 

Two elephant sized omissions

Lack of cost effectiveness of the Care Quality Commission and the urgent needs to stop doing things that don't work, What about ditching the Health and Social Care Act an stopping unnecessary screening?

I recomend the article

How to misspend £2.4 bn

Posted in BMJ at Sat, 21 May 2016 21:52:51


Posts: 57
Joined: 04 May 2015

NHS England have produced a 56 page article 'General Practice Forward View'. There is comment on this by Dr Margaret McCartney in the BMJ of 30th April 2016. She makes several salient points.

Spending money on non-evidence based interventions leads to multiple harms: it wastes time and energy and disrupts the NHS.

£30 m on acceleration towards a paper free environment, where is he evidence of benefit ?

£45 on increasing online consultations, where is the evidence of benefit ?

... and two elephant sided holes , lack of cost effectiveness of Care Quality Commission.

and the urgent need to stop doing things that don't work, Health and Social Care Act, unnecessary and un proven screening and unnecessary targets.

I only do a few out of hours sessions now. I do worry about General Practice. The almost universal reason that I see patients in OOH is that they could not get a timely appointment with their GP. GP are so busy chasing targets that there is little time left to see ill patients. Prevention may be better than cure . But some times a cure is good and we are all mortal.

Re: Antibiotics proscribing not the answer to over-prescribing.

Posted in Radiology at Sat, 21 May 2016 19:21:09


Posts: 206
Joined: 21 Aug 2011

The point for patient responsibility reflects the mostly sad failure for rational prescribing by doctors

The CDC suggests that up to one in two antibiotics given in the US was not appropriate in 2015. Let us hope that re-examining the data will bring this down to one in three..