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Re: New cardiology clinical champions

Posted in Cardiology at Thu, 23 Oct 2014 15:30:30

MBittencourt

Posts: 1
Joined: 04 Sep 2014

Thanks to Sadian for the trail this blog has had over the last years! 

I am glad to join the team working on the cardiology clinical champion team, hoping that the new team will be able to keep up with the high expectations.

I am looking forward to hearing what else other readers are keen to hear about, just like Odysseus mentioned above.

Mb

Re: The Ebola Frontline

Posted in Public health at Thu, 23 Oct 2014 15:22:27

John D

Posts: 3291
Joined: 01 Feb 2010

I think that cost  and availability of fuel is relevant - I find by a little Googling that about 500kgs of wood is needed to build a pyre that will consume a body.    Old tyres would do it, but rather disrespectful.    And what about material lifted into the air by the flames?

Cremation may not be part of local funeral tradition, or even against it.    The practice of bathing and touching a dead person has been hard to suppress.

And anyway, a virus can only survive in living cells, so it will soon decay, maybe faster than the body.  Hmmmmm. Check that.     'Live' vaccines are viable virus, but they must be kept in a fridge to maintain their effectiveness for longer than a month (CDC)   There are isolated reports of viable smallpox found in 'scabs' left in old books.  This review from CDC collected reports of such survival at "room temperature" for more than one year!  http://wwwnc.cdc.gov/eid/article/20/2/pdfs/13-1098.pdf

But Ebola is a different beast - I suppose that we just don't know.    Could we have areas of  West Africa  like Gruinard Island, on the West Coast of Scotland where WW2 BioWar experiments were carried out during WW2?    That was anthrax that readily forms spores, which remained infective until 1981, after which the whole island was sterilised with formaldehyde.

John

Re: Medical students asking intimate questions

Posted in Medical ethics at Thu, 23 Oct 2014 14:33:11

Maxim

Posts: 235
Joined: 14 Dec 2010

Don't be too sure that your questions won't benefit the patient.  Perhaps because you may have more time than other staff it's not unusual for students to uncover important items of information that are overlooked by others.  For this reason it's important that you don't allow any embarrassment on your part to prevent other essential staff knowing about your findings when debriefing.  Occasionally a patient might ask you not to share information but they will usually understand if you explain why it's to their advantage if you let just those essential doctors know.  It's too often the case that patients are repeatedly asked the same questions when perfectly reliable answers have already been obtained and shared or documented (and the notes read!)  The exception to this is the part of the history which crucially depends on the patient explaining symptoms in their own words and where interpretations by others  have been misleading or inadequate.

If the sensitive questions have already been asked and you know the answers then it's more difficult to justify asking again unless it's to clarify uncertain and relevant facts.   

Re: What's your diagnosis: a previously healthy and active man losing the ability to live independently

Posted in General clinical at Thu, 23 Oct 2014 12:36:14

AnneG

Posts: 531
Joined: 18 Mar 2014

The answer was Huntington's Disease. Go to the second page of posts and you will see the full answer. If you're a BMJ subscriber you can also see it here: http://www.bmj.com/content/343/bmj.d7463

In Response to Re: What's your diagnosis: a previously healthy and active man losing the ability to live independently:[QUOTE]

Ct Brain is essetial .What did it show?


Posted by Satti[/QUOTE]

 

Re: How stupid an people be?

Posted in General clinical at Thu, 23 Oct 2014 12:23:06

Maxim

Posts: 235
Joined: 14 Dec 2010

The answer has to be 'a lot more stupid than that.'  As others have said, you would need to check they they were warned ( even then they might have forgottten) before calling them stupid.  I'm not even sure how many transmissions from shared safety razor use have been well documented.

Perhaps more obstinately stupid are those doctors who persist in walking around with used IV needles instead of putting them in disposal bins at the exact site of use.

Re: Books

Posted in Medical education at Thu, 23 Oct 2014 09:43:47

sken

Posts: 784
Joined: 13 Oct 2009

How far do we buy books as opposed to just downloading to a device? I do both but still prefer books where I may need to flip back through the pages , highlight , make notes etc.... , but do not underestimate the convenience of a kindle (or similar). Nick Spencer's thoughtful book "Atheists ; the origin of the species" and John Butler's "Rock of Ages the changing faces of the Christian God" are about to be re-read. 

Gawande's "Being Mortal" and most of the above recommendations are about to be ordered along with the latest Karen Armstrong (remarkable woman) on trying to assess the relationship between violence and religion. Just finishing "Sapiens" by Yuval Harari. Interesting enough but very parson's egg.

New plan for the NHS

Posted in News & media at Thu, 23 Oct 2014 09:18:52

AnneG

Posts: 531
Joined: 18 Mar 2014

What do you think of the five-year plan for the NHS unveiled by six national bodies - NHS England, Public Health England, Monitor, the NHS Trust Development Authority, Care Quality Commission and Health Education England. 

The report calls for extra funding and changes to the way the NHS is run, such as hospitals employing GPs. You can see the review here: http://www.england.nhs.uk/2014/10/23/nhs-leaders-vision/

How do you think the NHS needs to change to meet the needs of 21st century healthcare?

 

 

Re: Should the NHS be liberated from political control?

Posted in News & media at Thu, 23 Oct 2014 09:00:08

Scheherazade

Posts: 77
Joined: 29 Jan 2009

It is bad enough when politicians meddle with the NHS on a whim, without heed to evidence of what works and what doesn't.  It is even worse when the NHS is used as political football. At the moment, the Conservatives are doing all they can to rubbish the Welsh NHS, purely because it is being run by Welsh Labour.  The Welsh NHS has problems undoubtedly, but they arise from underfunding, as is the case in the NHS in all home countries. Wales has an older, poorer, sicker population than England, and this is not taken into account by the Barnett formula, which gives the block grant from which Wales has to fund the NHS. So the 10% austerity cut in the funding across the four countries hits Wales hardest. Scotland in contrast gets 10% more than Wales does. 

It really upsets me to see politicians acting like children trying to find ways of scoring points when we are all trying so hard to do the best by our patients.

 

 

Whatever the results of any comparison between the two helath services, 

Re: Which medical innovation has changed your practice the most?

Posted in General clinical at Wed, 22 Oct 2014 21:45:35

sken

Posts: 784
Joined: 13 Oct 2009

Development of fibreoptic endoscopes. Anyone else out there remember using rigid instruments , for bronchoscopy or oesophagoscopy and without a GA ?

I am glad John D likes propofolol. Great stuff I've been given it more than once and tend to have the most vivid dreams in glorious colour afterwards . Not so much last time , so perhaps something has been taken out. but much better than flurothane ... Thanks too for highlighting the diazepam point - what was really surprising was the high doses of the original preparation used by many doctors who also clearly took no steps to avoid the thrombosis - but also continued to be told to use over the emusified version on cost grounds.

Re: Unfading Shadow of Ebola

Posted in Public health at Wed, 22 Oct 2014 19:54:07

John D

Posts: 3291
Joined: 01 Feb 2010

Oh, gosh, it would rude of me to name the other thread that this would appropriate for, as the link reports that "nearly 40 percent of Americans say they are concerned that someone in their family will get the deadly virus within a year" and will throng to A&E and GP surgeries when they get colds or flu.  This, in a nation where a 1991 poll found that 3.7 Americans (2%) had been abducted by aliens.  And it's not just Americans:

 http://www.mirror.co.uk/news/weird-news/alien-abduction-uks-first-support-3444674

John

 

Re: dementia

Posted in Neurology at Wed, 22 Oct 2014 19:45:25

Mukhtar Ali

Posts: 854
Joined: 14 Nov 2010

NHS dementia plan to give GPs cash for diagnoses

http://www.theguardian.com/society/2014/oct/22/nhs-dementia-diagnoses-gps-patients-criticised

Re: What's your diagnosis? Recurrent fever after a holiday in Turkey.

Posted in General clinical at Wed, 22 Oct 2014 16:13:25

Maxim

Posts: 235
Joined: 14 Dec 2010

Carolyn

It's helpful to be reminded by someone a little closer geographically that malaria persists in some parts of Turkey.

Doctors are to be recruited on the basis of values as well as skills

Posted in Careers at Wed, 22 Oct 2014 15:00:57

AnneG

Posts: 531
Joined: 18 Mar 2014

A story on the BMJ Careers site reports that doctors should be recruited on their values, as well as their skills. 

From next autum students enrolling on healthcare courses at universities in England will have to demonstrate values such as respect and dignity, commitment ot quality of care, compassion and everyone counts. Health Education England has said that trusts should recruit staff on the same basis, although it will not be mandatory. 

How doctors would demonstrate such values is a moot point...! 

 

Re: Is paying UK GPs 55 £ for diagnosing dementia a good idea?

Posted in Neurology at Wed, 22 Oct 2014 10:03:28

AnneG

Posts: 531
Joined: 18 Mar 2014

Sken - if it's okay by you I'll delete your post and keep this thread going. If you want to repost your original words of wisdom onto this thread that would be good. 

AnneG

Re: Reflecting on failure in psychiatry exam

Posted in Psychiatry at Wed, 22 Oct 2014 08:56:14

sken

Posts: 784
Joined: 13 Oct 2009

I thought the blog very good. It is a problem in most specialties and I suspect many of those passing may have passed by a very small margin. Of course there should be continuing job opportunities and counselling etc... , but it is all too easy to overlook what goes on in the mind of the individual . Many , many years ago I remember looking at the DPM and what was involved - a formidable set of exams. I suspect other specialties still have a relatively easy time of it - but that may change as reaccreditation and specialty exams are introduced.

A related problem can be those who complete their training but cannot find an appropriate post - or those where a research degree becomes a necessary part of qualification even for supremely clinical positions. At times I feel the medical hierarchy loses sight of the basic questions about service needs and what makes an adequately competent doctor. The entire system can be so difficult for those coming from overseas.

I

Re: Feeding Birds: A Humane Gesture

Posted in General at Wed, 22 Oct 2014 02:50:37

Odysseus

Posts: 4351
Joined: 24 Feb 2009

In Response to Re: Feeding Birds: A Humane Gesture:[QUOTE]


Posted by Mukhtar Ali[/QUOTE]

This is a gallah (pronounced in Oz as g'laar). We call foolish people gallahs. A "cockatoo" was the name for the lookout in an illegal gambing game of "two up" where two pennies were tossed in the air and with betting based on heads or tails. "Two-up" is played on ANZAC Day by some as a sentimental relic of the past. The two pennies are placed on a wooden bat about two inches wide and six inches long and tossed up into the air.

Odysseus

Re: What constitutes poetry when in blank verse; lineated prose or real art?

Posted in General at Tue, 21 Oct 2014 20:35:07

Odysseus

Posts: 4351
Joined: 24 Feb 2009

Homer's vocabulary is so rich and unique, I have a Homeric dictionary.  He and Shakespeare are the bedrock of English and Western intellectual and literary endeavour. 

Ben Johnston said Shakespeare was a man for all time. So was Homer. They were literary Time Lords; intellectual master craftsmen.

One can only read Homer in small pieces are there is so much to digest, so many annotations. It is like drinking OP whisky neat. It needs to be diluted with time and explanation.

Odysseus

PS Greek boys in the time of Pericles were taught to recite large chunks of Homer who epitomised the virtues,    Athenian nationalism and the notion of heroism and valour. Modern education has led to few children being able to recite more than a line of Shakespeare. When I was at school, we could recite extracts from various Shakespearian plays and sonnets but learning something by heart was not disparaged as now. We also used slide rules and log tables.

Re: Antipsychotics for ADHD

Posted in Psychiatry at Tue, 21 Oct 2014 14:13:17

cassandra

Posts: 23
Joined: 24 Apr 2012

I feel it unfair that Dr Gold's thoughtful blog has been misquoted into a tabloid headline.

 

She says " ... when medication is so effective at controlling behavior, the motivation for investing time and effort in relationship-based interventions may be lost. Prescribing medication takes much less time. With atypical antipsychotics the results are often immediate, and can be dramatic.

If risperidone is found to significantly alter the brain’s capacity for emotional regulation, then it might have a role to play. But if it does not, and we have well-established methods of intervention that do, then the possibility exists that by prescribing this medication to children, particularly in the absence of relationship-based interventions, we are actively interfering in their development."
 
Fair enough?

Re: Where was WHO in Ebola outbreak?

Posted in General at Mon, 20 Oct 2014 18:53:32

Mukhtar Ali

Posts: 854
Joined: 14 Nov 2010

Ebola: WHO under fire over response to epidemic

http://www.bbc.com/news/world-europe-29691044

Vitamin D Might Help Kids With Eczema

Posted in Cardiology at Mon, 20 Oct 2014 18:23:58

Mukhtar Ali

Posts: 854
Joined: 14 Nov 2010

Daily vitamin D supplements might help children with eczema that gets worse in the winter, a new study suggests.


http://www.nlm.nih.gov/medlineplus/news/fullstory_148978.html

Help with ABFM national boards

Posted in Medical education at Mon, 20 Oct 2014 13:53:55

alecsdad

Posts: 1
Joined: 20 Oct 2014

I let my Family Medicine boards expire in 2004.  I want to prep to take them but don't know where to start.  Any advice is appreciated.  Thanks.

Re: Poll archive - 13/10/14 - 20/10/14

Posted in doc2doc feedback at Mon, 20 Oct 2014 08:49:15

AnneG

Posts: 531
Joined: 18 Mar 2014

Should all adults over the age of 45 be screnned for abnormal glucose?

Yes - 102 votes (73.9%)

No - 33 votes (23.9%)

Don't know - 3 votes (2.2%)

Re: help me...dnt knw what to do:(

Posted in Student BMJ at Sun, 19 Oct 2014 10:36:47

Maxim

Posts: 235
Joined: 14 Dec 2010

Anneshah

Thank you for sending additional information about the location of your Medical School.  You’re right that your system is very different to that in UK Medical Schools but the advice I would offer is what should apply to academic study anywhere.  For obvious reasons I am unable to give you more personal advice and I restrict all my correspondence to this group forum.

The impression from all your posts is of chaos in your studies and it’s not possible for anyone here  to understand exactly why you’re in such difficulties.  For these reasons, the best plan (as would be the case in the UK) has to be for you to spend enough time there with a personal tutor who can analyse the problems, discuss study habits and to consider if your health is suffering to an extent that interferes with your studies and whether you need a break.

Going without sleep to cram in more study time always makes things worse.

Whilst the supervision there is probably different to the UK, I have to believe that any institution calling itself a credible Medical School has to have some system of personal academic supervision and support for its students.  Others using this forum may have more information about your country but if what I describe doesn’t exist, the problem is not yours alone.

Perhaps you could tell us, via this forum, what happens.

 

Re: Should smoking be banned in public parks?

Posted in Respiratory medicine at Sat, 18 Oct 2014 21:57:55

dod2doc

Posts: 11
Joined: 28 Aug 2013

Yes it should be immediately 

passive smoking is worst than smokingsmoking

Re: Imposing Tax On Sugar To Curb Obesity?

Posted in General at Sat, 18 Oct 2014 18:08:33

Mukhtar Ali

Posts: 854
Joined: 14 Nov 2010

Sugary drinks warning signs change habits of US teens

http://www.bbc.com/news/health-29645062