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How can medical students best use their summer holidays?

Posted in Student BMJ at Sun, 27 Jul 2014 08:05:45


Posts: 3
Joined: 24 Jul 2014
Hello there, 

For the last two summers I have spent my time doing an 8 week student research project with a lab at the university here in belfast. Its been both interesting and empowering for me personally as it has encouraged me to undertake an intercalated degree next year in a research area I have developed an interest in. 

But aside from this option, what other suggestions does the community have for medical students making the most of their summers? 

The more raidcal/interesting the suggestion the better!!!

Thank you!

Can trainees be encouraged to take up unpopular specialties?

Posted in Careers at Tue, 29 Jul 2014 19:30:44


Posts: 3
Joined: 24 Jul 2014

We recently published a article in BMJ Careers about whether trainees could be encouraged to take up unpopular specialties such as psychiatry and emergency medicine.

Most of the doctors I spoke to were against financial incentives as a way of increasing trainees numbers, and instead talked about ensuring a good work/life balance.

What do you think?


Should trainee doctors be allowed to opt out of the European working time directive?

Posted in General clinical at Sun, 27 Jul 2014 06:22:22


Posts: 1
Joined: 07 Aug 2009

The government has said that it wants to encourage more junior doctors to opt out of the European working time directive which states that trainees can work for a maximum of 48 hours a week.

A taskforce reported in April that the directive had had an adverse effect on training in some specialties, particularly in acute medicine and surgery. It said that doctors were working unpaid to ensure that they had sufficient access to training. 

Mark Porter, chairman of BMA Council, said: "Having the right degree of flexibility in the system is important, but we must not create a culture in which doctors feel presured into opting out of the 48-hour weekly limit that protects patients."


final nice guidance on statins released

Posted in Cardiology at Sat, 26 Jul 2014 19:52:20

tjaard hoogenraad

Posts: 37
Joined: 05 Feb 2009

we have discussed the draft nice guidance on statins before that suggests reducing (potentially) the threshold for statin prescription to a 10% 10 year CV risk (currently 20% 10 year risk).

The final guideline is just published


and sticks with this threshold giving an estimated number needed to treat of 77 people to avoid one death/stroke/non-fatal MI after 3 years.

What do you think?



Should doctors become managers?

Posted in Careers at Tue, 29 Jul 2014 19:01:03


Posts: 3
Joined: 24 Jul 2014

A recent discussion at a UK conference highlighted the dearth of doctors in management positions. Una O'Brien, permanent secretary at the Department of Health in England, said that the UK was unusual in that very few doctors were in senior leadership positions but "interestingly in practically every other country in the world this is the norm."

One chief executive said that doctors might be put off becoming managers because pay and security is worse for managers than it is for doctors. Clinicians also tend to think that only by being involved in patient care can they "make a difference." 

However, Mark Newbold, chief executive of Heart of England NHS Foundation Trust, said: "You get to a point where there is only so many times you can sit around with other doctors, drinking coffee and criticising the way the place is being run without saying, 'Well actually maybe we should put our money where our mouth is and have a go at it.' And that's how I got into it."

Do you think the NHS would improve if more doctors were in senior managerial positions? What is the experience of overseas doctors?

Yes, Cheetos, Funnel Cake, and Domino's Are Approved School Lunch Items

Posted in Diabetes at Mon, 28 Jul 2014 03:42:36


Posts: 3987
Joined: 24 Feb 2009

Yes, Cheetos, Funnel Cake, and Domino's Are Approved School Lunch Items


I thought that I would post this to show what we are up against.

At exactly 10 a.m. on Monday, hundreds of school cafeteria professionals ran hooting and clapping down an escalator into an exhibition hall that looked like a cross between a mall food court and the set of Barney. Pharrell blared over loudspeakers. The Pillsbury Doughboy was on hand for photo ops, as was Chester the Cheetah (the Cheetos mascot) and a dancing corn dog on a stick. Attendees queued up to be contestants in a quiz show called "Do You Eat Smarter Than a Fifth-Grader?" and flocked toward trays groaning with every kind of kid food one could imagine: tater tots, PB&Js with crusts preremoved, toaster waffles with built-in syrup, and endless variations on the theme of breaded poultry: chicken tenders, chicken bites, chicken rings, chicken patties, and, of course, chicken nuggets.

The conference's sponsors include PepsiCo and Domino's.

I was at the annual conference of the School Nutrition Association (SNA), the professional group that represents the nation's 55,000 school food workers, and the biggest draw of the event—the exhibition hall—had just opened for business. More than 400 vendors vied for the attention of the conference's 6,500 attendees, who had descended on the Boston Convention and Exhibition Center with one main goal: to find new foods to serve at their schools.

Many of the vendors were household names: Sara Lee, Kraft, Perdue, Uno, and Pizza Hut, to name a few. Among the corporate sponsors who collectively put up about $200,000 to help stage the affair were Domino's Pizza, PepsiCo, Tyson, General Mills, and AdvancePierre Foods, which bills itself as "the No. 1 provider of fully-cooked protein and assembled sandwiches to school systems across the country."

To be sure, you won't find most of the items on exhibit in supermarkets or restaurants. That's because they are specially made to conform to the new federal school nutrition standards, some of which took effect July 1. There are fruit and vegetable requirements; limits on calories, sodium, and saturated fats; and a mandate that all grain foods served at school must be at least 51 percent whole grain.*  The rules—which I'll cover in more detail in a subsequent post—are contentious, and the SNA opposes some of them. Politico's Helena Bottemiller Evich reported that after first lady Michelle Obama spoke out in favor of the rules, organizers told the White House that its senior adviser for nutrition policy, Sam Kass, would not be allowed to speak at the conference.

Politics aside, the vendors were armed with newly formulated products designed to conform to the rules. At the Kraft booth, a rep gushed about the virtues of the company's new flavored cream cheeses, available in milk chocolate, dark chocolate, and caramel, "with half the calories of Nutella." She told me they were designed as dips for fruits with the new produce rule in mind. "Nowadays, it's the only way to get kids to eat anything that's good for them," she said.

Indeed, the exhibitors' guiding principle seemed to be something like: "Whatever you do, don't tell them it's healthy." I watched as a Sara Lee rep promised a cafeteria director from Louisiana that her students wouldn't be able to detect the whole-grain flour in her company's chocolate muffin. The PepsiCo booth stocked a flyer (below) informing attendees that newly formulated Cheetos fit with the guidelines. When I sampled a vitamin-fortified, low-cal Slush Puppy, the rep asked me, "Doesn't that taste just as good as a regular slushy?" (It didn't.) A food service company rep promised me that his funnel cake was "plenty sweet," even though it fit within the calorie limits. (It was.)

While the exhibitors were eager to show off their products' nutritional stats, few offered actual ingredients lists. When I asked the rep at the Uno pizza booth why ingredients weren't included on his nutrition information sheet, he told me the list wouldn't fit on the page.

One ingredient in Domino's school lunch pizza was silicone dioxide, otherwise known as sand.

"Don't the school nutritionists ask you what's in this?" I asked. Nope, he said. Most of them just wanted to know whether the product met the legal guidelines. He offered to email me the list later. When he did, I learned that Uno's Whole Grain Low Sodium Sweet Potato Crust Pepperoni Pizza contained nearly 50 ingredients, including sodium nitrite, which has been linked to cancer. I also persuaded the Domino's rep to email me a list of ingredients in his company's specially formulated school pizza, SmartSlice. It was also nearly 50 items long, and included silicone dioxide, otherwise known as sand.

After wandering through most of the 180,000 square feet of exhibits, I came across an earnest gray-haired woman in the back of the cavernous room selling frozen "pulses"—mostly lentils and chickpeas—to stir into soups and sauces. I was the only one at her booth. Had she noticed that everyone seemed drawn to the big-name foods up front? She responded that she hoped attendees would consider fortifying their name-brand meals with some of her lentils. "If you add a pulse product to a potato salad, it steps up the nutrition," she offered hopefully.

But the attendees would have to find her first, and that would be a tall order: Corporations such as PepsiCo and General Mills had rented out multiple exhibit spaces ($2,400 to $2,600 a pop) in the high-traffic front and central aisles of the exhibit floor. Some big booths even had café-style seating areas where attendees chatted as they gobbled up samples. "You have to go in the far corners to find the more interesting stuff," says Steve Marinelli, who runs the food program for a rural Vermont school district and told me he was having trouble locating the wholesome foods he wanted. "Someone was selling this really cool hummus, but you really had to look hard to find it."

The lentil lady didn't stand a chance.


Interesting ethical/legal case from Israel

Posted in Medicolegal at Tue, 29 Jul 2014 02:08:02

Dr Linda

Posts: 186
Joined: 20 May 2010
I missed this interesting ethical/legal case which occurred a couple of years ago. A 17 year old Israeli girl was very badly injured in a road traffic accident and subsequently sadly died. Her parents wanted Doctors to extract and freeze eggs from her for subsequent fertilisation and obviously ultimately a grandchild. The court agreed to eggs being harvested (a term I dislike intensely). Her parents also agreed to transplant of any viable organs.
I am not sure what my personal views are of this case. At 17 was there any evidence that the young girl wished to have children?; that she would ever have considered the circumstances where she would have a child/children after her death?; who would be chosen to fertilise the eggs? someone the putative grandparents approved of?; who would be the surrogate; how would such a surrogacy work?. These are just some questions that might be asked, doubtless there are many others.
The girls parents were in a dreadful situation where their daughter lost her life so young - were they in a position to make a thoughtful judgement?
I believe this was the first such decision in Israel and am fascinated that the courts allowed eggs to be taken and frozen.
Is it right to take gametes from a 'child' to create a child. Whilst sperm has been taken from men for posthumous use does that assist in assessing this case?
Any thoughts,

Can India build 5.2m toilets by the end of August?

Posted in BMJ India at Sat, 26 Jul 2014 23:06:00

John D

Posts: 3089
Joined: 01 Feb 2010

Earlier this month India's ministry of drinking water and sanitation said that it would build 5.2m public toilets by the end of August (yes, this August!) Some 60% of Indians practise open defecation (that's a polite way of saying that they c**p in the open) and a World Bank report said that stunting in Indian children was linked to malnourishment caused by open defecation.

It's an ambitious target but is it one that is likely to be met - and is building toilets alone enough to solve the problem of open defecation? 

How do you find medical blogging?

Posted in News & media at Sun, 27 Jul 2014 17:50:33


Posts: 403
Joined: 23 Aug 2013

A recent blog post on doc2doc medical bytes discusses the concept of medical blogging. It attempts to define  medical blogging and discusses medical blogging in the light of guidelines of BMJ to working with social media, and its emerging place as compared opposed to medical publication and as opposed to its miniature forms 'microblogging'.

I wonder what is your take on medblogging whether you find it helpful tool and a good medium for expression or an unreliable process that is not worthy of medical attention.

our mind inside the heart not the brain

Posted in Cardiology at Mon, 28 Jul 2014 17:45:41


Posts: 403
Joined: 23 Aug 2013

first .. all of us know the the heart has it's automaticity through A_S node , and can completely act and beat without any CNS connection for some period . 
that means that the initial impluse is generated form the heart itself  

second .. I think that when we recieve a very bad news  our response initiat from the heart not brain
like the spinal reflex .. when we touch a candle our muscle contracts by an order from the spinal cord not the brain .. then the brain realize that we touched a hot thing afterall .
so this is the heart .. we recieve a bad news .. our heart starts to response ( e.g. Tachycardia ) before sympathetic or adrenaline before everyting ... then the brain realize that we recieved a bad news . and the exact thing happen wit fear , love , rest ...etc 

If I ask you .. when the patient recieve a very bad news , he will be at risk of angina or MI not Strock in the brain .. even If he had a strock it would be a result of hypertension .. not of any change is the activity of the brain .. I mean that the heart is the first thing affected after an emotional stimuli not the brain . when I have a patient with Hypertension or MI I must advice him with meditation that provide the rest of his cardiac muscle 

so what is your opinion about this ? 
thank you for your support 

Mohammed Magdi Farrag 
Sohage University Faculty of medicine 

Diagnosing those who we dislike with 'personality disorder'

Posted in Psychiatry at Mon, 28 Jul 2014 20:36:08


Posts: 403
Joined: 23 Aug 2013

A blogpost by Dr Elana Miller, MD discusses in the concept of personality disoders (PDs). On one hand, she tackles the subjective nature of the diagnosis, and their potential for misuse. On the other hand, she dissects the diagnosis from transference-based psychodynamic therapy. Where by, a psychiatrist might diagnose those people whom s/he does not like as having personality disorders, or in more psychodynamic terms, that whenever countertransference exists it's projected rather than analysed. She further discusses major PDs that lend themselved prone to abuse.

I wonder whether from your clinical experience have you observed yourself or other professionals over-using personality disorders for disliked people.

Success at Consultant Interview

Posted in Careers at Mon, 28 Jul 2014 10:28:16

John D

Posts: 3089
Joined: 01 Feb 2010

The Medical Conference Group (MCG) will be holding a training session in Nottingham on 22nd November 2014 about Success at Consultant Interviews. Training is provided by experienced NHS Consultants who sit on the interview panels. Places go really quickly so definately check out the website at www.themcg.co.uk to find out more information. Many trainees have always felt a lot more confident after attending a training session with MCG. 

sulphonylureas and cardiovascular risk

Posted in Diabetes at Sun, 27 Jul 2014 18:02:33


Posts: 669
Joined: 15 Apr 2011

There is no evidence of sulphonylureas decreasing the  cardio vascularrisk  in diabetics.  There is even debate whether they increase cardio vascular risk.

should we be informing this to the patients who are receiving thease meds? should usage of sulphonylureas be discouraged? 

what do you think of dabigatran?

Posted in Cardiology at Sat, 26 Jul 2014 16:10:36


Posts: 1430
Joined: 09 Dec 2011

I have just been looking at the article on dabigatran in this weeks journal


personally I have not prescribed much dabigatran . Has anyone had enoguh experience to understand the bleeding risk?


A lower age limit in competitive sport?

Posted in Psychiatry at Mon, 28 Jul 2014 19:46:17


Posts: 639
Joined: 13 Oct 2009

At the Commonwealth Games , a 13 year old has just won a medal. Bearing in mind the training and stresses required as well as the various pressures , physical and psychological , that will be involved now and in the future, is this too young to compete on the adult stage? Of course it must be a bit of a threat to the older folk , but I am thinking of the youngster. One only has to think of some of the young gymnasts in previous Games whose lives were taken over from a very early stage for the pursuit of National ambitions.

PS Also interesting is the suggestion that winning swimmers tend to be young  not for physiological reasons but beacause the way of life no longer acceptable once mature enough to make their own decisions.

Ebola spreads: Doctor dying and ill with it

Posted in News & media at Mon, 28 Jul 2014 14:14:01


Posts: 1430
Joined: 09 Dec 2011

See: http://www.theguardian.com/world/2014/jul/27/liberia-ebola-first-doctor-dies-brisbane-virus-outbreak

The outbreak of Ebola in Liberia is spreading to other countries, and a leading Liberian doctor has died of the disease.

Dr.Samuel Brisbane was a consultant physisian at Monrovia's John F Kennedy Memorial Medical Centre.  One of the leading doctors of Sierra Leone is ill with Ebola,and  Dr.Kent Brantly and a second  American, Nancy Writebol are in isolation at a Monrovia hospitial.

An air passenger from Liberia flew into Lagos, Nigeria last Friday, fell ill on the aircraft and was taken to hospital where he died of Ebola.  Passengers who also flew on the plane and airport staff are being sought for observation, but there is so much fear of, and lack of public information about Ebola, that it is unlikely that people will come forward.   MsF, that has been in the epicentre of several Ebola outbreaks, (http://www.doctorswithoutborders.org/our-work/medical-issues/ebola ) say that they have had families remove infected patients by force, rather than allow them to be kept in isoloation under the best possible treatment.

This is getting scary.


Eid Greetings

Posted in General at Mon, 28 Jul 2014 05:33:43


Posts: 403
Joined: 23 Aug 2013


Wish you all a very      Happy------Glad------Grand-----Great ---- &  Blessed Eid.

Note---- Muslim community around the world celebrate Eid (Festival) on July28/29

43 year old male with daily fevers for 5 weeks. Your thoughts?

Posted in General clinical at Wed, 30 Jul 2014 01:25:35


Posts: 3987
Joined: 24 Feb 2009

   a43 year old healthy male with 5 weeks of daily fever. No medicaitons, No allergies. No pain. Mild cough but no other symptoms. No travel history. Nl CBC, no atypical lympshs, ALT 120, AST 150, rest of chemistry normal. CMV IgG pos, CMV IgM positvie. LDH 720. CRP 52. Creatinine 1.3. (Taking lots of ibuprofen for last month) Normal CXR and Chest CT normal. Q fever negative. Diagnosis currently is CMV but I cant find a paper that describes 5 weeks of fever except in transplant patients. Your thoughts?


Research, Presenting, Publications and CV building - Points = Prizes, What is the reality?

Posted in Careers at Tue, 29 Jul 2014 07:04:37


Posts: 1
Joined: 29 Jul 2014

Hi guys,

This is my first post, and I tried to pick the kind of title that would attract some attention.

Essentially I am an FY1 at Royal Preston Hospital in the UK and trying to find out about what counts and what does not.

I have spent years doing Audits and case reports and literature reviews for the sake of improving care and increasing my knowledge base. None of the stuff I did was geared towards presenting or publishing and so I have not been able to take it forward.

Now for the FY1 programme, presenting no longer gives any points, and although it made little difference it makes me wonder does it hold the same for CT and Reg jobs?

If presenting no longer counts then it would be a waste to spend lots of money and time, making posters and travelling to other countries etc.

From my understanding courses, awards and publications are how you rack up points and get jobs (besides impressing at interview). 

I have 3 main questions:

1) Case reports are looking difficult to publish, with many journals not accepting them. Should you just  submit them as letters to editors in big journals or be happy with an actual case report in low "impact factor" smaller journals?

2) What counts as a proper publication these days?

I have replied to articles on BMJ, but it seems unless your article is an original under e.g. "Clinical Review" or "Views and Opinions" and gets printed it does not count? Does a reply they accept count towards publication even if not printed inn BMJ? I ask because I do not understand how it would be referenced.

3) Could someone help to rank the order of publications in how they are viewed when it comes to specialty training?

I understand it to be something like

1) Publication in a journal

2) Clinical review/ systematic review in journal 

3) Letter to Editor/Opinion piece

4) Abstract in journal

5) Case report in journal

6) Oral Presentation at National/International Conference

7) Poster Presentation at National/International Conference

8) Presentations at Local/Regional meetings


Please advise regarding what ever you can :)

Tips for new doctors?

Posted in General clinical at Tue, 29 Jul 2014 10:58:24

Abi R

Posts: 13
Joined: 18 Nov 2013

I've written a story about the tips for new doctors that people have been sharing on Twitter via #tipsfornewdocs. 

I was wondering what advice doc2doc members would give to a newly qualified doctor about to start their first shift in a hospital. 

I would also love to hear about your experiences - what went well, what went not so well, what would you never do again?



Are you Ageist? I am!

Posted in Psychiatry at Tue, 29 Jul 2014 14:15:28


Posts: 639
Joined: 13 Oct 2009

I have been reading a bit on the subject of late :

Do you speak a little more loudly/clearly to old people or try to hold conversations when the back ground noise is less?

Do you start by using simpler language when discussing “high-tech” ?

Do you use shorter sentences ?

Do you value the life of your child more than that of your grandmother ?

Do you feel older people are more likely to have impairment of organ function?

Does it cross your mind that an old person statistically may live a shorter time than a younger one?

Would you offer to help an old person cross the road or give up your seat on a train/bus?

Would you offer to do the shopping or visit an old person who lives alone?

Do you disagree that Society has to accept that the needs of the elderly are as important as those of newborn or disabled children? (Interesting that the author elsewhere objects to the term elderly then uses it).

Would you prefer your airline pilot to be under 75 ?

Then  you are being patronising and ageist as well. Perhaps we should have begin to fight back to restore common sense.

DOI  One of what  used to be called elderly

45 years presented with breathlessness

Posted in General clinical at Tue, 29 Jul 2014 10:59:19


Posts: 382
Joined: 29 Jul 2010

This is the ECG of 45 years old man presented with breathlessness and palpitation

what is the clinical diagnosis ?



Florida’s physician “gun gag” law upheld.

Posted in General clinical at Tue, 29 Jul 2014 16:37:47


Posts: 669
Joined: 15 Apr 2011

Just when you thought that the US’ obsession with guns had gone about as far as it could go by promoting “stand your ground” laws and preventing the CDC and other government agencies from doing research on gun violence, along comes a law that is an extreme example of the reductio ad absurdum mentality of the gun lobby.  Their logic is that if doctors know about guns in the home they might urge their patients to take actions that might reduce the availability of guns.  So Florida passed a “gun gag” law in 2011 prohibiting physicians from inquiring about guns in their patient’s homes.  The law was initially invalidated as being an unconstitutional limitation of physicians’ free speech, but yesterday an appeals court validated the law stating:

"The act simply codifies that good medical care does not require inquiry or record-keeping regarding firearms when unnecessary to a patient's care," the majority opinion stated. "Any burden the act places on physician speech is...entirely incidental."  So if you keep a loaded gun in your night stand easily available to your three-year-old, your Pediatrician has no business asking about this or advising you about gun safety. 



Posted in General clinical at Wed, 30 Jul 2014 03:46:16


Posts: 1
Joined: 30 Jul 2014


I'm a 30 yr old male. Few weeks ago I felt a lump located  on the right hand side of my neck, just above the hairline. At first it was sore to touch and it got larger, this all occurred  during a 10 day time frame.

However since then the lump has got smaller, it's somewhat pea sized, and there's no pain when  touched. On the other hand  when I gently pull the hair on the lump it more or less comes of without any effort or pain, unlike the usual irritation caused when pulling ones hair.  Is there something I should be worried about?

I would appreciate your help!

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Posted in General at Wed, 30 Jul 2014 04:17:20


Posts: 1
Joined: 30 Jul 2014

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