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Re: Fears of the Spread of a new Respiratory Virus

Posted in General at Wed, 23 Apr 2014 13:12:11

Mukhtar Ali

Posts: 775
Joined: 14 Nov 2010

Saudi health minister sacked as Middle East Respiratory Syndrome death toll rises

http://www.bbc.com/news/health-27108568

Re: Would you prescribe diamox(acetazolamide) for a patient planning a kilimanjaro trip?

Posted in Expedition and Mountain medicine at Wed, 23 Apr 2014 12:57:14

Dr.Chid

Posts: 491
Joined: 21 Feb 2012

In Response to Re: Would you prescribe diamox(acetazolamide) for a patient planning a kilimanjaro trip?:[QUOTE]One of the rare side effects, supposedly, of Acetazolamide while using in prevention of acute mountain sickness has been reported here:

http://www.samj.org.za/index.php/samj/article/view/4753

 
 

Posted by Matiram Pun[/QUOTE]

Dear Sir,

Thank you for the reference.

Dr.Chid

 

A case of drowning?

Posted in General clinical at Wed, 23 Apr 2014 10:54:06

John D

Posts: 2866
Joined: 01 Feb 2010
This question was posed by our new member Hemant, in another thread.  I've advised him that it should stand alone, and asked him to provide more clinical details. Welcome, Hemant, and over to you:
John as moderator
 

Hemant asked:

what is the definitive finding in antemortem drowning?

 

Re: what is the diagnosis?

Posted in General clinical at Wed, 23 Apr 2014 10:50:28

John D

Posts: 2866
Joined: 01 Feb 2010

In Response to Re: what is the diagnosis?:[QUOTE]

what is the definitive finding in antemortem drowning?

Posted by HEMANT[/QUOTE]

Hemant,

This isn't a general list where you might ask such a question.   Alaminium was posing this a single clinical quiz question.     I will post your Q in a new thread.    If this is a clinicial scenario, you should add more details there, as was given above with the X-ray.

See: http://doc2doc.bmj.com/forums/open-clinical_general-clinical_diagnosis-2#plckforumpage=ForumDiscussion&plckdiscussionid=Cat%3AOpenClinicalForum%3AGeneralClinicalDiscussion%3Af9b75f21-ee48-445d-9564-d67382c8510f

John (as moderator)

Re: Diagnosing an MI afterwards

Posted in Cardiology at Wed, 23 Apr 2014 10:28:14

John D

Posts: 2866
Joined: 01 Feb 2010

Sam, safia,

The marker for infarction you need to read up about is "troponin".  Perhaps also Natriuretic peptide as a marker of heart failure.

And of course an infarct will leave changes in the ECG, which  will themselves change with the physiology of the infarct as it heals, and whole books have been written on the subject

I'm no cardiologist and don't feel capable of teaching you, so I suggest you do the reading!

JOhn

Re: Poll archive

Posted in doc2doc feedback at Wed, 23 Apr 2014 09:59:48

AnneG

Posts: 64
Joined: 18 Mar 2014

Do doctors rely too much on ruling things out?

Yes - 67 votes (70.5%)

No - 28 votes (29.5%)

Does the NHS discriminate against foreign doctors?

Posted in General clinical at Wed, 23 Apr 2014 09:56:08

AnneG

Posts: 64
Joined: 18 Mar 2014

Recent articles on bmj.com have looked at the educational performance of international medical graduates compared with UK graduates. The subject has been debated since the 1980s when it emerged that international medical graduates and doctors from ethnic minorities had disproportionately high failure rates in membership exams compared with UK graduates.

Two new studies commissioned by the General Medical Council find that international graduates achieve less satisfactory outcomes than UK graduates at annual appraisals, and that they perform less well than UK graduates in postgraduate examinations in internal and family medicine.

Apologies for the UK-centric question but what is your view and experience of this - either as a foreign doctor working in the UK or as a doctor educated in the UK working with colleagues from overseas?

Should patients be able to access their medical records online?

Posted in General clinical at Wed, 23 Apr 2014 09:45:51

AnneG

Posts: 64
Joined: 18 Mar 2014

Three million patients in the United States can now access their clinic notes online via the OpenNotes initiative,Tom Delbanco, professor of primary care at Harvard Medical School, told the BMJ's International Forum on Quality & Safety in Healthcare in Paris.

OpenNotes was set up in 2010 by three healthcare institutions and according to a study published in 2012 80% of patients felt more in control of their care, 80% reported understanding their conditions better, 80% reported remembering the plan for their care better and 70% said they were taking their medicines better.

Do you think online access to medical records is a good thing, leading to better dialogue between patients and clinicians, and giving patients more control of their data? Or do you think concerns about patient confidentiality or other issues make fraught with dangers? 

Re: authenticity in medicine

Posted in General clinical at Wed, 23 Apr 2014 08:55:09

Odysseus

Posts: 3817
Joined: 24 Feb 2009

We don't need words of more than one syllable.

We don't need authenticity or extreme rendition

or quantitative easing or mumbo jumbo.

We need 'real' and 'true' and 'love' and 'faith' and 'kind' and 'straight' and 'honest'. Not authenticity. Diabolical can be authentic as can murder and psychopathy and dishonesty and plagiarism.

in Australia the biggest compliment is to be called 'True blue' . It means real, dependable, faithful, strong, and good; the real deal, the verum corpus.

Odysseus

Re: Hello,Spring! You are welcome

Posted in General at Wed, 23 Apr 2014 08:47:03

Odysseus

Posts: 3817
Joined: 24 Feb 2009

Season of mists and mellow fruitfulness,

Close bosom friend to the maturing sun

and we have pumpkins maturing in the garden

and the figs have fruited twice

and now sleep

and some trees are shedding summer

and my chooks are laying fewer eggs

and the grape vine is casting off her exuberance 

and the shadows are lengthening and softer

the air cooler and the breezes softer.

Odysseus

Re: Do we need to end the culture of diagnostic rule-out?

Posted in General clinical at Tue, 22 Apr 2014 18:57:35

all

Posts: 4
Joined: 18 Apr 2014

How are you,hope fine? My name is Favour, I picked interest on you after going through your short profile. Can we be friends? I really want to have a good friendship with you. Beside i have something very vital to disclose to you, but I found it difficult to express  myself here, since it's a public site. Please i will like you to contact me through my private e-mail via: (favourmuar@hotmail.com) So we can get to know each other better,and for me to give you my pictures and also tell you more about myself OK.i believe we can move from here!  i am waiting for your mail to my e-mail  Address;(favourmuar@hotmail.com) Remember the distance or language or color does not matter but love and understanding matters a lot in life.
i am looking forward to hear from you soon.
Your friend,
Favour.



Hur är du, hoppas bra? Mitt namn är Favour, plockade jag ränta på dig efter att ha gått igenom din korta profilen. Kan vi vara vänner? Jag vill verkligen ha en bra vänskap med dig. Bredvid jag har något mycket viktigt att avslöja för dig, men jag hade svårt att uttrycka mig här, eftersom det är en offentlig plats. Vänligen jag kommer att vilja att ni kontakta mig genom min privata e-post via: (favourmuar@hotmail.com) Så vi kan lära känna varandra bättre, och för mig att ge er mina bilder och även berätta mer om mig själv OK. jag tror att vi kan flytta härifrån! Jag väntar på ditt mail till min e-postadress, (favourmuar@hotmail.com) Kom ihåg avståndet eller språk eller färg spelar ingen roll men kärlek och förståelse frågor mycket i livet.
Jag ser fram emot att höra från dig snart.
Din vän,
Favör.

Re: Fetal growth app for iPhone/iPad

Posted in General clinical at Tue, 22 Apr 2014 18:41:03

all

Posts: 4
Joined: 18 Apr 2014

How are you,hope fine? My name is Favour, I picked interest on you after going through your short profile. Can we be friends? I really want to have a good friendship with you. Beside i have something very vital to disclose to you, but I found it difficult to express  myself here, since it's a public site. Please i will like you to contact me through my private e-mail via: (favourmuar@hotmail.com) So we can get to know each other better,and for me to give you my pictures and also tell you more about myself OK.i believe we can move from here!  i am waiting for your mail to my e-mail  Address;(favourmuar@hotmail.com) Remember the distance or language or color does not matter but love and understanding matters a lot in life.
i am looking forward to hear from you soon.
Your friend,
Favour.
 

Re: Civil Ceremony and Children

Posted in General at Tue, 22 Apr 2014 18:40:01

all

Posts: 4
Joined: 18 Apr 2014

How are you,hope fine? My name is Favour, I picked interest on you after going through your short profile. Can we be friends? I really want to have a good friendship with you. Beside i have something very vital to disclose to you, but I found it difficult to express  myself here, since it's a public site. Please i will like you to contact me through my private e-mail via: (favourmuar@hotmail.com) So we can get to know each other better,and for me to give you my pictures and also tell you more about myself OK.i believe we can move from here!  i am waiting for your mail to my e-mail  Address;(favourmuar@hotmail.com) Remember the distance or language or color does not matter but love and understanding matters a lot in life.
i am looking forward to hear from you soon.
Your friend,
Favour.

 

Re: What should a fourth year Medical student learn from a four week attachment to UK General Practice?

Posted in General clinical at Tue, 22 Apr 2014 18:02:02

all

Posts: 4
Joined: 18 Apr 2014

How are you,hope fine? My name is Favour, I picked interest on you after going through your short profile. Can we be friends? I really want to have a good friendship with you. Beside i have something very vital to disclose to you, but I found it difficult to express  myself here, since it's a public site. Please i will like you to contact me through my private e-mail via: (favourmuar@hotmail.com) So we can get to know each other better,and for me to give you my pictures and also tell you more about myself OK.i believe we can move from here!  i am waiting for your mail to my e-mail  Address;(favourmuar@hotmail.com) Remember the distance or language or color does not matter but love and understanding matters a lot in life.
i am looking forward to hear from you soon.
Your friend,
Favour.



Hur är du, hoppas bra? Mitt namn är Favour, plockade jag ränta på dig efter att ha gått igenom din korta profilen. Kan vi vara vänner? Jag vill verkligen ha en bra vänskap med dig. Bredvid jag har något mycket viktigt att avslöja för dig, men jag hade svårt att uttrycka mig här, eftersom det är en offentlig plats. Vänligen jag kommer att vilja att ni kontakta mig genom min privata e-post via: (favourmuar@hotmail.com) Så vi kan lära känna varandra bättre, och för mig att ge er mina bilder och även berätta mer om mig själv OK. jag tror att vi kan flytta härifrån! Jag väntar på ditt mail till min e-postadress, (favourmuar@hotmail.com) Kom ihåg avståndet eller språk eller färg spelar ingen roll men kärlek och förståelse frågor mycket i livet.
Jag ser fram emot att höra från dig snart.
Din vän,
Favör.
 

Re: Why not we screen pilots and young athletes for cardiac abnomalities?

Posted in General clinical at Tue, 22 Apr 2014 17:08:22

yoram chaiter

Posts: 2020
Joined: 03 Mar 2009

As it is , a lot of information is lacking in this area. There have been few really large studies.

The problem in our modern times that medicine becomes more and more dependent on monetary issue, hence peope tend to use cost effectiveness in a very broad sense.

Still, does ones' life can be subjected to such considerations?

I think some common sense is in order. We do know about pathologies that predispose to sudden death. We do know something about the forces acting on pilots and we do have some schemes for certain selected groups of athletes, troups etc.

Anamnesis and physical examination are important. Family history is important.

An ECG is a simple procedure and can sometimes catch a certain arrythmia, an echo can find various cardiac anomalies. Stress test can catch arrythmias and ischemic changes.

Saving one life from a few hundred screened means a lot.  Don't underestimate it. Yes, there will be false positives, but in this case sensitivity is more important. As to false negatives, yes, those can be encountered. but there is no single absolute test that will give us 100%  true positives and 0% true negatives. We are also in the era where genomics is becoming more and more available, but then we can sequence genes, but we still cannot say what each variation means. But that is something we will hwve to find out sooner or later. Perhaps then we will be able to increase the percentage of true positives and true negatives. Still , we are not God, and we will never achieve 100%.

Re: The state of medical education in India

Posted in BMJ India at Tue, 22 Apr 2014 09:31:53

Odysseus

Posts: 3817
Joined: 24 Feb 2009

In Response to The state of medical education in India:[QUOTE]

The old ones of doc2doc may have noticed that for the last 1 year I have been mostly absent from here and posted only sporadically. Now I can say that hopefully the exile is over. What was the reason of the exile you ask? Well I was participating in the great Indian carnival of postgraduate medical entrance exams to secure a specialty seat. It’s over for me and I have opted for general surgery at an institute of my choice.

 

Some background – about 40,000 MBBS graduates pass out each year all over India and the total annual postgraduate intake capacity is roughly around 15,000. There are two main ways of securing a postgraduate specialty – a centralized test called AIPG which has roughly 6000 seats distributed in colleges across India and rest are through entrance tests conducted by the individual states for which generally we eligible for one state only. The coveted clinical specialties are only around 8000. Apart from these, there are a handful of autonomous institutes but those are insignificant in the scheme of things.

 

This year more than 72,000 of us competed for those 6000 seats. In other words, the exam was so designed that 66,000 of us would be unsuccessful no matter how much knowledgeable we are. Most of us take a year break to study while negotiating with different hospitals for lenient workhours so that we get paid to meet our ends. The anesthesiologists were kind enough to grant me a 30 hours/week work. Many of us don’t get any specialty after 1 year of study. Then our whole life is put on hold, for a second year or for a third year or till the time we get a seat. One can find hostels full of doctors, all of different ages, all trying to secure a specialty.

 

And every year the cycle starts again.


Posted by Deb_D[/QUOTE]

Bravo!

Odysseus

 

Re: Should Government Provide Treatment to Illegal Drug Users?

Posted in General clinical at Tue, 22 Apr 2014 03:26:52

anonymous

Posts: 0
Joined: 23 Apr 2014

Also, I have seen many, many addicts get clean after rehab or shortly after.  Rehab can work and does work miracles in some cases, when appropriate follow up is done and the addict is willing and ready to change.

Re: Lancaster bans e-cig sales in local market!

Posted in Respiratory medicine at Mon, 21 Apr 2014 20:32:42

Sidhom

Posts: 336
Joined: 23 Aug 2013

I have not come across systematic data analysing its benefit as compared to NRTs, Bupropion, or Varenicline. The habit is still there, probably with much less side effects. I met with a couple of addiction counsellors from NIDA, LA. They stated that the branding with flavours may mean targeting younger population. There are no data regarding the sales of cigarettes, I wonder if they will ever show reduction which coincides with the rise of sales of e-cigs.

Re: why thrombolytics are contraindicated in NSTEMI & Unstable Angina?

Posted in Cardiology at Mon, 21 Apr 2014 19:35:18

sadian

Posts: 1091
Joined: 17 Jun 2011

and in addition to the above the RCT's testing thrombolytics in this context showed no benefit.

sadian

Re: Any single parent doctors out there?

Posted in Careers at Mon, 21 Apr 2014 16:51:29

DrPaed

Posts: 1
Joined: 21 Apr 2014

In Response to Any single parent doctors out there?:[QUOTE]

 

Hi Dr Tash,

I'm also working as a Consultant Paediatrician and am the single parent of a seven year old boy.

It's wonderful to hear that you are planning to adopt a child, which is something I have thought about, and still think about doing myself.

I separated from my husband two years ago, around the time I got my first consultant post, so I have found it tricky managing working long days/on-call commitments since being on my own. So although my circumstances are different to yours I'd like to offer my advice.

Do you have family around who are willing to commit to supporting you with childcare? Have you thought about a nanny or au pair? I know of other consultant paediatricians who are single parents who have au pairs and that has worked for them.

Is there any way you could negotiate reducing your on-call commitments with your colleagues? This won't take the problem away but may help?

Single parent adoption is certainly possible for people in our speciality. I know of a former colleague who has recently adopted twins as a single parent. She's currently on adoption leave, but I'll try and get in touch with her and see if she could write to you.

Hope this helps and good luck

DrPaed.

 

Hi,

 

I am planning to adopt as a single parent and work as a consultant paediatrician. I wondered if anyone has any top tips for childcare for overnight on calls. The adoption agencies want some concrete plans in place.

 

Thanks


Posted by DrTash[/QUOTE]

 

3D Printing in Medical Industry: Questionnaire for Doctors

Posted in General at Mon, 21 Apr 2014 10:07:37

researcherinme

Posts: 1
Joined: 21 Apr 2014

Hey All,

I am doing this research on market potential of 3D Printing/Additive Manufacturing in Medical Industry as to how it can revolutionize the healthcare industry.

I would need your response regarding the same through a small questionnaire:

https://qtrial2014.az1.qualtrics.com/SE/?SID=SV_1G2VW2LyB8GyC3j

Requesting you to please fill and also circulate the questionnaire with your doctor friends to fill this survey.

Regards

Guneet

 

Re: Happy Easter To All

Posted in General at Mon, 21 Apr 2014 06:49:10

Carolin

Posts: 960
Joined: 16 Aug 2012

I hope you all had a happy Easter !!! Sorry I didn´t have time to say that before, with all my family obligations.

I went to the service at Strasbourg cathedral and was really touched that although it was a French service of course, they had a German reading from the scriptures in it.

Re: Share your memories of "black Wednesday"

Posted in General clinical at Mon, 21 Apr 2014 03:45:33

Odysseus

Posts: 3817
Joined: 24 Feb 2009

I find it curious how you call the Foundation doctors rather than interns or Junior RMO. I assume they were foundation garments but can't see why they start in Woden's Day when most of us started on Moon Day and in Oz at the beginning of the year (we have moved off the Julian calendar) but still call it Moon Day and Thor's Day. Why doesn't the NHS start them on Good Friday, or Pancake Day to put a good spin on it as the spin doctors love spin. Why don't you call it Ash Wednesday and annoint Foundation Docs with oil and ashes? 

I am unaware of any cataclysmic day or the Wrath of Oden (not to be confused with the Wraith of Oden) on January 1 in Greater Oz. Perhaps the heavens fell  in and we just didn'ttalk about it. Perhaps we are just more used to natural disasters as the foundation of our society.

When I started as an intern we just slid down the greased slipway of medicine into the great river of humanitas and interminable working hours in big wards.  It all was a non-event. Just hard work. 

Odysseus

Any single parent doctors out there?

Posted in Medical mums at Sun, 20 Apr 2014 17:54:27

DrTash

Posts: 2
Joined: 20 Apr 2014

I am planning on adopting as a single Mum and am a consultant paediatrician. Does anyone have any tips on childcare for nights on call? The adoption services want some concrete plans in place.

Thanks

Re: Can trainees be encouraged to take up unpopular specialties?

Posted in Careers at Sun, 20 Apr 2014 11:46:22

Maxim

Posts: 45
Joined: 14 Dec 2010

I'd be interested in the reference to the specific RCPsych campaign to which Sidhom refers.  That College's journal published a paper last year on the low popularity of careers in psychiatry and there were a whole range of reasons cited by students and junior doctors.  Many of the reasons were rooted in anecdote with little evidence but this chimes with my experience over many years of career counselling for students and junior doctors.

The most common reasons for unpopularity (and often popularity) in the early stages of training seem to be linked to poor understanding of what that career involves for its practitioners (as opposed to students) and, even more importantly, a failure to consider how things might be in the future.

My purely personal opinion (I was not a psychiatrist), is that the specialty has created many problems for itself by allowing and even causing psychiaty to be separated from the rest of medical practice in many areas.  This is relevant because Psychiatry could be said to lack its own unifying theory to guide practice so it is vital to remain linked to the rest of Medicine to avoid being seen as an arcane discipline and to be 'stigmatised'.