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Poll archive

Posted in doc2doc feedback at Tue, 28 Oct 2014 00:07:05

AnneG

Posts: 544
Joined: 18 Mar 2014

I love the new poll feature, its a great way to see what everyone thinks on some of these issues. What do people think of creating a page with all the previous poll results on?

Should patients have the right to record consultations?

Posted in News & media at Fri, 31 Oct 2014 17:36:20

Carolin

Posts: 1100
Joined: 16 Aug 2012

Hello everyone 

I'm replacing Matthew Billingsley as moderator (I've introduced myself in the new members' bit of doc2doc). So, here's my first discussion thread...!

An observation in the BMJ focuses on a discussion thread on a consumer forum about a patient whose doctor would not allow her to record her consultation. http://www.bmj.com/content/348/bmj.g2078

Patients were supportive of the patient's point of view, saying it was a form of note taking and she did not need to ask her doctor's consent. Doctors were, unsurprisingly, more cautious, saying that it could lead to defensive medicine. 

What do you think? Is recording a consultation a right? Or does it harm the doctor-patient relationship?

what cough suppressant

Posted in General clinical at Wed, 29 Oct 2014 15:42:36

abbuus

Posts: 2
Joined: 29 Oct 2014

hi. im korean doctor 

it s getting colder, and more patients with "common cold" and "acute bronchitis" are comming to clinic. even though there are lack of  clear evidence, we use cough medicine frequently without restriction..now i feel the cough is not controlled with even combination of cough suppressant(codeine, dextromethorphan, sedating antihistamine/antidecongestant, new suppressant levodropropizine, corticosteroid, NSAIDS, honey,,and etc)..in some case i reassure patient it will be gone spontaneously sooner or later, but patient are frequently very distressed in daily life, especially when they need to talk much,..then they call for relieving medicine..

what do you in other world usually prescribe for this somtimes terrible thing?

 

"excuse for my poor eglish"

 

CV tips for cardiology job applications

Posted in Cardiology at Fri, 31 Oct 2014 15:59:10

Emz73

Posts: 1
Joined: 31 Oct 2014

This is the start of a series of career-related specialty specific threads. Please share your cardiology CV tips here. And if you are happy to do so, please feel free to paste parts of your own CV here to help others.

 

Tips from BMJ Careers article Learning opportunities in cardiology for junior doctors:

Attend conferences and theoretical and practical cardiology courses and complete online courses to boost your CV. You can also talk to the cardiology specialist registrars and consultants, show them your CV, and ask them to assess how you compare with colleagues applying for the same job.

 

Another BMJ Careers article that might help is: Preparing the perfect medical CV

The Ebola Frontline

Posted in Public health at Mon, 27 Oct 2014 21:53:43

sken

Posts: 789
Joined: 13 Oct 2009

This isn't from  MSF's Frontline Blogs page, but from the pages of the Observer, in the Sunday newspaper's magazine section, about the work at the centres run by the US charity, Samaritan's Purse  in Monrovia and by MSF in Sierra Leone .  You can read the whole report at:  http://www.theguardian.com/society/2014/aug/24/ebola-the-frontline-liberia-sierra-leone

It includes several interviews, with a doctor, a public health specialist, a nurse, one who has lost their entire family to Ebola and to a survivor, their first in Monrovia.   I'd like to copy here the last, becauue I think it encapsulates the predicament of so many in West Africa.    May I introduce you to Harrison Sakela?

 

The survivor

 

'I decided to treat her myself: I bought some medicine and a drip': Harrison Sakela, Liberia.

‘I decided to treat her myself: I bought some medicine and a drip’: Harrison Sakela, Liberia. Photograph: Carilla Doe

Harrison Sakela, Liberia
I kept hearing the word “Ebola” but I hadn’t seen what the illness could do to a human body until my mother got sick. She had travelled to a funeral in Sierra Leone and met someone who had it. I was teaching a class, like any normal day, when I was told that she was unwell, so I went to see her in Sierra Leone and it was obvious that something was very wrong.

I decided to treat her myself: I bought some medicine and a drip. I spent about three days trying to help her but she wasn’t responding. At the last stage, she wouldn’t look people in the face. She was toileting every two to three minutes. She refused to eat food. It took her two weeks to die.

Within a week of coming back from Sierra Leone, I began feeling very weak. My head was hurting, I had a fever. I was not even able to cross the road. A Samaritan’s Purse health facility worker saw me and asked me to come to the centre. I agreed straight away and tested positive for Ebola that day. I had severe diarrhoea and was very weak, but I never vomited blood like others had. A week later they tested my blood. It came back negative for Ebola and they discharged me. I came out and I am all right. Now I am the Ebola ambassador.

I have lost five family members to Ebola: my mother, father, sister, niece and my niece’s daughter. I have no one now, so I’ve decided to stay on at the treatment centre and work here as a security guard.

Most people in my community are ready to accept me again, although some people are saying that the Liberian government is giving me money to say that Ebola is real. Ebola is real. I have experienced it. The people of West Africa need to stop denying it exists

To support the work of Médecins Sans Frontières or Samaritan’s Purse, please visit: msf.org.uk and samaritans-purse.org.uk


 

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

Posted in General clinical at Thu, 30 Oct 2014 19:32:37

Liaqat

Posts: 6
Joined: 06 Oct 2014

The case below was published in the BMJ in 2011. I'll post the answer in a few days.

In early October 2010, a 64 year old man presented to our hospital in Switzerland with chest pain, fever, and night sweats, which had been present since his return from holiday three weeks earlier. He had been on holiday in Turkey from July to mid-September. On further questioning he reported an episode of diarrhoea and sickness associated with fever shortly after returning home to Switzerland. During his stay in Turkey he had eaten fresh food, including meat and dairy products. Furthermore, he had experienced a myocardial infarction and had undergone angiography and insertion of a bare metal stent on 4 September while in Turkey.

Previously he had been treated with a calcium channel blocker and an angiotensin II receptor antagonist because of high blood pressure. On admission, aspartate aminotransferase at 79 U/L (reference range 11-36), alanine aminotransferase at 86 U/L (10-37), γ glutamyltransferase at 192 U/L (11-66), alkaline phosphatase at 238 U/L (0-129), and C reactive protein (CRP) at 25.4 mg/L (0-10) were all slightly raised.

Stenosis of the right coronary artery was seen on angiography and another stent was inserted. Over the next seven days he developed recurrent fevers, which were accompanied by chills and temperatures as high as 39.5°C. Ten of 13 aerobic blood cultures taken at three to 10 days after presentation grew very small Gram negative rods two and a half to three days after incubation. Bloods taken during this time showed a normal white cell count and slightly decreased haemoglobin of 130 g/L (140-180).

An abdominal ultrasound showed an enlarged spleen and mild hepatosteatosis. Computed tomography of the chest and abdomen and transoesophageal echocardiography were performed to look for a source of infection, but all were uninformative.

what do you think of dabigatran?

Posted in Cardiology at Wed, 29 Oct 2014 22:18:33

KRIS

Posts: 5
Joined: 29 Oct 2014

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

http://www.bmj.com/content/349/bmj.g4670

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

sadian

Time Capsule

Posted in General at Thu, 30 Oct 2014 06:54:25

Mukhtar Ali

Posts: 858
Joined: 14 Nov 2010

The original work and concept of Time capsule is a very good idea and appreciable effort, but here I request every user to add your choice pic, documents etc. for building an imaginary time capsule that will in one or other way reflect our thinking process and feelings about the society we live in and the world around us.

The Wikipedia article about Time Capsule will help you to expand your idea about time capsule.

http://en.wikipedia.org/wiki/Time_capsule

Thanks a lot for your contributions.

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

Posted in Diabetes at Mon, 27 Oct 2014 17:05:22

diabetesMD

Posts: 695
Joined: 15 Apr 2011

All adults aged 45 or older should be screened for abnormal blood sugar concentrations, the US Preventive Services Task Force has said. 

The recommendations, which are open for public consultation, also state that those in high risk groups under the age of 45, such as the obese, should also be screened. 

Figures from the US Centers for Disease Control suggest that about eight million people in the US have undiagnosed diabetes. Although the task force did not find that measuring blood glucose alone led to improvement in mortality it found the screening and treating adults with high blood glucose had a moderate benefit in decreasing the risk of progression to diabetes.

However, Victor Montori of the Mayo Clinic who co-authored a paper on "pre-diabetes" said that the move risked turning healthy people into patients: "Given the percentage of people that qualify is so high, large amounts of resources will need to be dedicated to this programme, including the use of medications of unclear value in this population," he said. 

 

New cardiology clinical champions

Posted in Cardiology at Mon, 27 Oct 2014 13:50:58

John D

Posts: 3304
Joined: 01 Feb 2010
Doc2doc is sad to say goodbye to our cardiology clinical champion Sadian, who has decided to step down after providing sterling service on the message boards over the last few years. Hopefully Sadian will still visit doc2doc from time to time.
 
However, we're very excited to welcome four (yes four!) replacements who have a great breadth and range of experience.
 
I'm introducing them with their screen names so you know who they are online: 
  • Mbittencourt, a cardiologist based in Brazil who has particular interest in CT; 
  • Heart Matters, a trainee cardiologist from the West Midlands in the UK with interest in interventional cardiology; 
  • Heartfelt, a cardiologist in New York who is conducting research into bleeding-anemia-transfusions and thrombolytics;
  • Heart Doc, a consultant cardiologist from Essex, UK who has subspecialty interest in devices and heart failure.
 
They will begin posting clinical questions and contributing to the main messageboards over the next few weeks and I'm sure all the regular posters will make them feel welcome. I'm really excited to have such a dynamic and diverse team. 

Should smoking be banned in public parks?

Posted in Respiratory medicine at Wed, 29 Oct 2014 19:14:26

Eman Sobh

Posts: 170
Joined: 02 Jan 2014

The London health commission has launched a report looking at improving the health of the capital and one of its more eye-catching recommendations is that boroughs should increase the number of smoke-free public spaces, including parks, green spaces and Trafalgar Square. Policing such a ban would be tricky and it seems a bit draconian. I wouldn't often quote Forest (smokers' rights organisation) but one of its spokesman was quoted saying that if people don't like the smell of smoke they should just move - I would have to agree with this.

Other recommendations (out of 64) include:

  • It also says that London Transport should spend a fifth of its advertising budget on encouraging Londoners to to walk 10,000 steps, inlcuding walking up the stairs and escalators at Tube stations. 
  • Boroughs should be supported in attempts to introduce minimum pricing of alcohol of 50p a unit
  • Fast food outlets should be restricted to within 400m of schools
  • a £1bn, five-year programme of investment in GPs' premises

Advice Needed Please

Posted in General clinical at Mon, 27 Oct 2014 13:58:24

John D

Posts: 3304
Joined: 01 Feb 2010

As I'm sure you're all aware admission to medical school is arguably becoming more and more competitive with each year. So, I thought I'd try to take any opportunity possible to try and improve my application. I studied for a BSc Biomedical Science and unfortunately because of my father having a stroke and having to care for him as well as not applying myself as well as I should've I came out with a 2;2. So, I hope to undertake an MSc to improve my chances. At University I was involved in sports and societies, undertook a placement in outpatient Immunology and my thesis was included in a publication. In my "time out" whilst caring for my father I'm working as a healthcare assistant, I have completed "placements" in the Emergency Department and in Anaesthetics and I ran a voluntary research project in a lab at a local University. I also volunteered at a rehabilitation centre where my father attended post-stroke and I'm also involved in St Johns' Ambulance, I'm currently trying to gain voluntary teaching experience helping practical classes at the college I attended. I'm also a passionate saxophonist, although I don't play in a band and I'm involved in a variety of team sports. I plan to apply to re-start my studies next academic year so I essentially have a year to dedicate to my application and I can continue during my MSc, although there will obviously be time limitations. Do you have any advice or are there any glaringly obvious gaps in my application that I can improve?

 

 

 

 

 

Thanks, Arron.

 

 

Feeding Birds: A Humane Gesture

Posted in General at Thu, 30 Oct 2014 13:49:22

Mukhtar Ali

Posts: 858
Joined: 14 Nov 2010

Feeding birds is a humane  act  and an immemorial  popular custom of  every society. For many, it is a thing of joy, the joy of inner and soul.

Are you bird enthusiasts?

Thanks for your input.

Feeding the birds:

Of course my heart is open to the birds

whose song may lift my soul both night and day.

Cheering better with their song than words

Could ever bring  happiness into play.

In feeding the birds I hope to attract

the small ones that twitter and tweet in tune.

I'm hoping the kindness in this small act

may cause my little feathered friends to croon.

My plan worked as well as any plan does

the garden is now full of pretty birds

but also attracts some far larger crows

and from our neighbours  some rather harsh words.

Into my feeders I fit a large scoop

and clean the car daily, it takes off the poop.

 

Reducing Alcohol drink drive limit in Scotland

Posted in Medicolegal at Tue, 28 Oct 2014 12:56:38

sken

Posts: 789
Joined: 13 Oct 2009
 
The Scottish Justice Minister is proposing to reduce the Alcohol Drink Drive Limit from 80mcg/100mls to 50mcg/100mls. He wants to have this new limit in place for Christmas because that is the time when drink drive campaigns are reinforced.
 
Across Europe and throughout the world Alcohol Drink Drive Limits vary and some countries apply different rules to experienced and non experienced drivers. For example in the Netherlands the limit is 50 but for drivers who have less than five years since passing their driving test it is reduced to 20. In Italy the limit is 51 but is reduced to Zero for those with less than three years driving experience. 
 
Some countries have a drink drive tolerance of zero, for example:
 
Hungary, Estonia, Russia, Brazil, Romania, Georgia, Barbados, Nepal.
 
The European Parliament has put forward proposals to harmonise alcohol blood limit levels throughout Europe. They also propose a zero level for novice and professional drivers. 
 
Is it 'simplest' to just have a zero drink drive level? Is it realistic? Will it catch the persistent offenders who drink and drive or others with very small residual alcohol levels?
 
The following link gives Alcohol Drink Drive limits for pretty much every country (it certainly seems reputable):
 
 
kirked

Reflecting on failure in psychiatry exam

Posted in Psychiatry at Thu, 30 Oct 2014 20:33:53

Sidhom

Posts: 446
Joined: 23 Aug 2013

A recent blog post in the Royal College of Psychiatrists, discussed the journey of a trainee who could not make it in the final exam. It is reflection about the whole process. I wrote this blog post. So, I will be grateful to learn your opinion whether you would like to comment here or on the RCPsych website.

Medication-induced Dystonic reaction

Posted in General clinical at Thu, 30 Oct 2014 16:35:55

Dr.Chid

Posts: 644
Joined: 21 Feb 2012

Recently I had to treat a young girl who complained of stiffness of neck and back muscle, twisted neck and deviated gaze. These symptoms occurred immediately after she received IM dimenhydrinate. A diagnosis of medication-induced dystonic reaction was made. She recovered after receiving IV procyclidine and other supportive treatment. 

I wonder if my learned colleagues can help me  in finding an  antiemetic that does not cause dystonic reaction, especially in young patients. 

 

Colorado Amendment 67

Posted in Medicolegal at Fri, 31 Oct 2014 10:57:40

kirked

Posts: 1690
Joined: 08 Oct 2010
The Colorado Definition of Person and Child Initiative, Amendment 67 is on the November 4, 2014 ballot in the state of Colorado as an initiated constitutional amendment. If approved by voters, the measure would include unborn human beings under the definition of "person" and "child" in the Colorado criminal code. 
 
Personhood Colorado, the group behind the initiative, turned in over 140,000 signatures, surpassing the required threshold of 86,105 by a significant margin. On October 14, the Secretary of State's office confirmed that there were adequate valid signatures, securing a place for Amendment 67 on the 2014 ballot.
 
Personhood Colorado has said that the Amendment 67 is very different than their attempts in 2008 and 2010, which both failed with over 70 percent of voters rejecting them. Amendment 67 focuses on including foetuses in the Colorado Criminal Code and the Colorado Wrongful Death Act, while past attempts sought to simply change the definition of a person to include foetuses in all areas of law. Jennifer Mason, a spokeswoman for Personhood Colorado said, “This will be the first time that an amendment of this nature will be on the ballot in Colorado. This is a very different take on a sort of personhood amendment."
 
This time in Colorado, though, supporters have tied the measure to a tragic accident in July 2012. Heather Surovik was eight months pregnant and on her way back from a prenatal visit when her car was struck by a drunk driver. 
 
"When she woke up in the hospital, she was told that her baby had not survived," Amendment 67 backer Jennifer Mason said "But not only that, there would be no charges filed in relation to his death because under Colorado law, he was not considered a person." 
 
Heather Surovik said, "They can't tell me that's not a baby. He was eight pounds, two ounces. Brady was the second victim, and nobody recognized it." 
 
In response to public outcry, state lawmakers passed the Crimes Against Pregnant Women Act. The 2013 law created a new class of assault charges when a perpetrator unlawfully terminates a woman’s pregnancy. But it doesn’t describe the crime as homicide because Democrats were worried that could be a slippery slope toward granting rights to foetuses and embryos. They say if Amendment 67 becomes law, any medical procedure that ends a pregnancy or destroys a fertilised egg, would be considered homicide. Those procedures could include abortions and some forms of birth control.
 
It will be interesting to see what happens on November 4th.
 
Kirked

child removed from heart transplant list

Posted in General at Tue, 28 Oct 2014 10:42:11

John D

Posts: 3304
Joined: 01 Feb 2010

A while ago I posted a thread about a young boy from Turkey who was brought to Germany to be enlisted for a heart transplant, but was removed from the list  after it became clear that before leaving Istanbul he had suffered severe brain damage following resuscitation.

I promised to keep you updated. Unfortunately I cannot find that thread anymore ( nor any others : the search button is probably on leave...

 

Anne, could you possibly look into this ? and possibly join these threads ?)

 

This week, a German court has overruled the first court decision ( which said that the kid should get his htx and a suitable hospital should be found within a month ) and confirmed the doctors´decision that a transplantation would be far too risky here, with too unlikely a chance of success).

The case has several aspects : discrimination against disabled people ( which was the parents´main argument ), organ shortage and the fact that Turkey is not a member of Eurotransplant, and of course the extreme costs and the personal tragedy involved.

The 2yr old is still on LVAD and so far has not returned to Turkey because the parents say it would be too dangerous to move him.

Can we finally put to rest the canard that insuin use increases cardiovascular events?

Posted in Diabetes at Wed, 29 Oct 2014 20:21:28

Odysseus

Posts: 4362
Joined: 24 Feb 2009

N Engl J Med. 2012 Jul 26;367(4):319-28. doi: 10.1056/NEJMoa1203858. Epub 2012 Jun 11.

Basal insulin and cardiovascular and other outcomes in dysglycemia.

N Engl J Med. 2012 Jul 26;367(4):319-28. doi: 10.1056/NEJMoa1203858. Epub 2012 Jun 11.

Verbatim Abstract

BACKGROUND:

The provision of sufficient basal insulin to normalize fasting plasma glucose levels may reduce cardiovascular events, but such a possibility has not been formally tested.

METHODS:

We randomly assigned 12,537 people (mean age, 63.5 years) with cardiovascular risk factors plus impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes to receive insulin glargine (with a target fasting blood glucose level of ≤95 mg per deciliter [5.3 mmol per liter]) or standard care and to receive n-3 fatty acids or placebo with the use of a 2-by-2 factorial design. The results of the comparison between insulin glargine and standard care are reported here. The coprimary outcomes were nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes and these events plus revascularization or hospitalization for heart failure. Microvascular outcomes, incident diabetes, hypoglycemia, weight, and cancers were also compared between groups.

RESULTS:

The median follow-up was 6.2 years (interquartile range, 5.8 to 6.7). Rates of incident cardiovascular outcomes were similar in the insulin-glargine and standard-care groups: 2.94 and 2.85 per 100 person-years, respectively, for the first coprimary outcome (hazard ratio, 1.02; 95% confidence interval [CI], 0.94 to 1.11; P=0.63) and 5.52 and 5.28 per 100 person-years, respectively, for the second coprimary outcome (hazard ratio, 1.04; 95% CI, 0.97 to 1.11; P=0.27). New diabetes was diagnosed approximately 3 months after therapy was stopped among 30% versus 35% of 1456 participants without baseline diabetes (odds ratio, 0.80; 95% CI, 0.64 to 1.00; P=0.05). Rates of severe hypoglycemia were 1.00 versus 0.31 per 100 person-years. Median weight increased by 1.6 kg in the insulin-glargine group and fell by 0.5 kg in the standard-care group. There was no significant difference in cancers (hazard ratio, 1.00; 95% CI, 0.88 to 1.13; P=0.97).

CONCLUSIONS:

When used to target normal fasting plasma glucose levels for more than 6 years, insulin glargine had a neutral effect on cardiovascular outcomes and cancers. Although it reduced new-onset diabetes, insulin glargine also increased hypoglycemia and modestly increased weight. (Funded by Sanofi; ORIGIN ClinicalTrials.gov number, NCT00069784.).

COMMENT:  More often than I fervently wish I hear from physicians and their patients the canard that insulin is atherogenic.  The syllogism goes something like people with type 2 diabetes have increased insulin and increased atherosclerosis, QED insulin causes atherosclerosis.  Frequently added by patients is their anecdotal experience with a family member who once starting on insulin deteriorated rapidly and died.  While I might be sympathetic to the patients and explain to them that the starting of insulin in patients with type 2 diabetes is a result of the continued reduction of the islets’ ability to secrete insulin and is not causally related to the development of complications.  I am not as sympathetic to the practitioners who all too often use this false syllogism to delay the onset of insulin treatment or use less than adequate doses of insulin.  The ORIGIN and now the ORIGINALE studies have done much to disprove that insulin treatment is related to an increase in cardiovascular events.  We now have over six years of data on over 12,000 patients without any evidence of adverse cardiovascular effects of insulin.  We should put this canard to rest.

 

The Taxi cab is your professional counsellor

Posted in Psychiatry at Wed, 29 Oct 2014 13:20:18

AnneG

Posts: 544
Joined: 18 Mar 2014

The RT news report Taxi Stockholm Therapy Project were the Tax cab driver works as a therapist. Would you accept to have the therapist/driver to treat/drive you back home.

Definition of health

Posted in General clinical at Fri, 31 Oct 2014 13:59:47

KRIS

Posts: 5
Joined: 29 Oct 2014
Can you define health in one sentence? If you don't know, ask WHO, they will babble something.

high-intensity statin therapy promotes atheroma regression in patients with diabetes.

Posted in Diabetes at Tue, 28 Oct 2014 20:22:01

diabetesMD

Posts: 695
Joined: 15 Apr 2011

High-Intensity Statin Therapy Alters the Natural History of Diabetic Coronary Atherosclerosis: Insights From SATURN

Diabetes Care Online Ahead of Print September 4, 2014

Abstract

OBJECTIVE Although statins can induce coronary atheroma regression, this benefit has yet to be demonstrated in diabetic individuals. We examined the benefit of high-intensity statin therapy in promoting coronary atheroma regression in patients with diabetes.

RESEARCH DESIGN AND METHODS The Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) used serial intravascular ultrasound measures of coronary atheroma volume in patients treated with rosuvastatin 40 mg or atorvastatin 80 mg for 24 months. This analysis compared changes in biochemistry and coronary percent atheroma volume (PAV) in patients with (n = 159) and without (n = 880) diabetes.

RESULTS At baseline, patients with diabetes had lower LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels but higher triglyceride and CRP levels compared with patients without diabetes. At follow-up, diabetic patients had lower levels of LDL-C (61.0 ± 20.5 vs. 66.4 ± 22.9 mg/dL, P = 0.01) and HDL-C (46.3 ± 10.6 vs. 49.9 ± 12.0 mg/dL, P < 0.001) but higher levels of triglycerides (127.6 [98.8, 163.0] vs. 113.0 mg/dL [87.6, 151.9], P = 0.001) and CRP (1.4 [0.7, 3.3] vs. 1.0 [0.5, 2.1] mg/L, P = 0.001). Both patients with and without diabetes demonstrated regression of coronary atheroma as measured by change in PAV (−0.83 ± 0.13 vs. −1.15 ± 0.13%, P = 0.08). PAV regression was less in diabetic compared with nondiabetic patients when on-treatment LDL-C levels were >70 mg/dL (−0.31 ± 0.23 vs. −1.01 ± 0.21%, P = 0.03) but similar when LDL-C levels were ≤70 mg/dL (−1.09 ± 0.16 vs. −1.24 ± 0.16%, P = 0.50).

CONCLUSIONS High-intensity statin therapy alters the progressive nature of diabetic coronary atherosclerosis, yielding regression of disease in diabetic and non-diabetic patients.

COMMENT:  Most studies that have examined the benefit of anti-hyperlipidemic therapy have concluded that the benefit in persons with diabetes is equal or superior to those without the disease.  This study yields similar results.  Whether the intravascular ultrasound reduction in coronary atheroma will translate into clinical benefits awaits longer-term studies.

 

Psychoanalysing Macbeth

Posted in Psychiatry at Fri, 31 Oct 2014 18:17:52

Sidhom

Posts: 446
Joined: 23 Aug 2013

A recent BMJ JNNP blogpost discussed the understanding of the evolution of the symptoms of Macbeth from a psychoanalytic point of view. Psychiatric syndromes rely on a clusters of symptoms. Many psychoanalysts, psychologists and psychiatrists excelled at forming important clusters. However, authors and novelists seem to picture characters in quite a deep perspective. Many literary characters made their way to psychiatric nosology e.g. Odipus complex (Hamlet would have been a better example) Electra's complex, Othello's syndrome (morbid jealousy) etc.

The relationship between fictional characters and psychiatry took a twist where some psychoanalysts started analysing fictional characters and diagnosing them. I wonder to what extent is that useful in psychiatry. I would like to hear your say about utilising fictional characters in diagnosis, and analysing them as well.

Is there a place for discussing family size with patients in the consultation room?

Posted in General clinical at Fri, 31 Oct 2014 12:11:01

JamesChan

Posts: 3
Joined: 16 Jan 2012

The Guardian recently published an article with the title and tagline:

How to save the planet? Stop having children

Doctors should be encouraging people to have smaller families for the sake of the environment, says GP
 

Do we as doctors have a responsibility for the wider population, both geographically and temporally distant? The ecological impact of a large population is vast, and with the population of the world already over 7 billion, do we as citizens have a responsibility to consider this when planning our families?

The majority of the growth is occurring in sub-Saharan Africa and Asia, not here. But the largest impact per capita is in Europe, North America and Australasia. I don't see this as a moral belief issue, but one of economics and ecology, those distant determinants of the health and survival of our species.

Is there a role for these discussions in the consultation room? We already talk to our patients about contraception and family planning. Do we take on these roles as technical advisers 'doing our job'? Or do we have a wider professional responsibility, and have a conversation with our patients when appropriate? Is this something for sex and reproductive education? Does that confine it the issue to a teenage classroom?

This developed into quite a Facebook discussion recently, and I decided to bring it here to open it to a wider audience.

Expert evidence/forensic evidence: Primers for juries

Posted in Medicolegal at Fri, 31 Oct 2014 11:26:07

kirked

Posts: 1690
Joined: 08 Oct 2010
In March 2011 the government’s law commission  recommended legislation to deal with concerns that scientific evidence was being admitted too readily and with too little scrutiny. Law commissioners called for a new reliability-based admissibility test for expert evidence in criminal proceedings.The test was designed to reduce the risk that juries would reach their conclusions on unreliable evidence. Experts would be questioned in court about their methods and experience, enhancing public confidence and leading – it was hoped – to fewer miscarriages of justice.
 
The Lord Chief Justice has now suggested that juries be given 'primers' on specific matters of science which would help them understand the issues to assess before them. Is this a good idea?
 
I have mentioned here on doc2doc before my concern (and that of many legal colleagues) that forensic evidence has precious little independent backing than most people would think is the case. Ballistics and fibre comparison has virtually no unbiased support from disinterested parties. Likewise fingerprint comparison although being around for a century is lacking independent validation and yet can be used every day to imprison people. It really is of great concern.
 
When all said and done all twelve jurors in a case are rarely scientists and there is also a perception that such forensic evidence is automatically sound because that is they way things are.
 
In support of its recommendations, the Law Commission gave the example of a case in which a prosecution expert told a jury he was “absolutely convinced” that an earprint found on a window had been left by a man accused of murder. Mark Dallagher spent seven years in prison before DNA evidence established that the print could not have come from his ear. If the Law Commission’s test had been applied, the expert’s evidence would never have been admitted.
 
How confident are you in Forensic and expert evidence (I recognise there are several areas under this one question).
 

 

kirked