Baby P investigations - why did this child die in 2007 despite regular visits to professionals. Up until now social servies have largely taken the blame however now the focus has moved onto the doctors he had seen before he died. For example he was seen by a locum paediatrician 48 hours before he died who failed to see Baby P had a broken back. The development clinic he had attended was seriously understaffed and could not work effectively.
Health Stories of the Decade. Jeremy Laurence. BMJ 2009;339:b5281. December 2009
The story of the Noughties: Deadly Scares vs Miracle Cures. Pandemic flu according to one journalist is the story of the decade, starting with Avian flu, developing to SARS and Swine flu. Other stories in the top 10 were: MMR vaccine, Hospital Acquired Infections, the NHS, Obesity, Smoking, Cancer Drugs, IVF, Harold Shipman and Alcohol. Alot of it stems to public confidence in science and the mistrust that the public can have in politicians. The author says "The NHS has been transformed in the past decade" and that this is a credit to the labour government however the future of the NHS does look bleak due to the recession (cuts of billions over the next three years). How do we save money without compromising quality of care? Predictions are that alcohol and obesity will dominate the next decade. The BMA and Scottish parliament have backed minimum pricing for alcohol and it will be interesting to see if this comes into effect in the future.
The most internet hits was for a bizarre story in Canada where an obese patient was treated by brain stimulation and by chance scientists located and stimulated a memory center allowing the patient to recall memories he had long since forgotten - 'Scientists unlock the secrets of Memory'. There was also the story of the surgeon in the Democratic Republic of Congo who performed a successful arm amputation by texting his colleague in London.
Tuesday, 22 December 2009
BMJ Podcast 4th December 2009
This weeks news: Reaction to the Dr Foster review, an annual league table of performance of NHS trusts in the UK in terms of patient safety. Is this a productive and necessary task? Is this just for journalists? Many trusts are rated as excellent and the review does not take in improments. Also in the news a warning from the MDU about doctor's flirting on Facebook. Sounds like yet another attempt to reduce the freedom of speech and social lives of doctors.
Christmas Appeal: Medecins Sans Frontieres. In countries affected by war or recently recovering, MSF is often the main and only source of healthcare. The goal of the service is to provide medical care to those most in need. Often only the simplest of care can save lives and this highlights the real vulnerability people in these areas have to disease. A small health center can make huge improvements. People can help MSF by a) Volunteering (only 2 years experience are required plus experience of travel) and b) Lending support by spreading the word of what MSF does eg. campaigning for access to essential medicines and neglected diseases that may not be profitable to Western pharmaceutical countries and c) Financially (85% of funds are from the general public).
Link to the Christmas Appeal.
http://www.msf.org.uk/bmjappeal.aspx
I've just donated £6 today and I'd encourage anyone reading this to help the cause!
Christmas Appeal: Medecins Sans Frontieres. In countries affected by war or recently recovering, MSF is often the main and only source of healthcare. The goal of the service is to provide medical care to those most in need. Often only the simplest of care can save lives and this highlights the real vulnerability people in these areas have to disease. A small health center can make huge improvements. People can help MSF by a) Volunteering (only 2 years experience are required plus experience of travel) and b) Lending support by spreading the word of what MSF does eg. campaigning for access to essential medicines and neglected diseases that may not be profitable to Western pharmaceutical countries and c) Financially (85% of funds are from the general public).
Link to the Christmas Appeal.
http://www.msf.org.uk/bmjappeal.aspx
I've just donated £6 today and I'd encourage anyone reading this to help the cause!
BMJ Podcast 27th November 2009
BMJ Careers and Specialist training. This starts at the beginning of December each year but is widely considered a long and difficult application process. The BMJ and BMA offer info about choices. The BMJ offers careers advice for doctors entering the application process.
The King's Fund Annual Debate. In America privatised health has been present for many years and there have been lots of attempts to improve the way treatment and healthcare is provided. At the moment people pay for the services which they receive, however the new movement proposed is for patients to pay for the outcome of the treatment and management they receive eg. HBA1C levels in diabetics. More clinical outcomes need to be developed to offer a more appropriate level of improvement resulting from a treatment. In the UK, NICE could learn from this approach in its decision making on the funding of medicine provided by the NHS.
The King's Fund Annual Debate. In America privatised health has been present for many years and there have been lots of attempts to improve the way treatment and healthcare is provided. At the moment people pay for the services which they receive, however the new movement proposed is for patients to pay for the outcome of the treatment and management they receive eg. HBA1C levels in diabetics. More clinical outcomes need to be developed to offer a more appropriate level of improvement resulting from a treatment. In the UK, NICE could learn from this approach in its decision making on the funding of medicine provided by the NHS.
BMJ Podcast 20th November 2009
End of life care. The conversation between patients and the end of life decisions within the community is currently not as good as it could be. What happens when patient's ideas differ from those of their patients? Unbearable suffering may be interpreted differently. Euthanasia is legalised under strict conditions in the Netherlands. GPs are the most common to carry this out in patient's homes and the decision comes about after long discussion. Physicians who have objects are free to make these known and are able to refuse but should refer the patient to another doctor. The advantage in the Netherlands is more openness and discussion about the topic in the country. Still two thirds of requests are not accepted. Physicians may be more likely to focus on the physical perceptions of suffering whilst patients are more likely to focus on the psycho-social aspects. The law does not specify the definition. Society does find it difficult to approach this subject and equally doctors and nurses do not like to approach the topic. End of life care pathways are tools with stages of care to assist the process, having a role particularly in hospitals for doctos who may not have as much experience in end-of-life care. Audits of end-of-life care and research into the use of pathways will help to identify areas which are being dealt with effectively and places where care can be improved.
Concept of unbearable suffering in context of ungranted requests for euthanasia: qualitative interviews with patients and physicians. Published 16 November 2009, doi:10.1136/bmj.b4362
In 2003 the chlamydia national screening programme was set-up. Only 1 in 6 people take part in the screening process and levels need to be higher in the region of about 25% for the screening process to be successful. The disease is a huge public health problem and is vastly underdiagnosed.
Climate change - are population dynamics and family planning the keys to reducing greenhouse gas emmissions to help future generations? Perhaps this is an area which was discussed at the recent summit in Copenhagen.
Concept of unbearable suffering in context of ungranted requests for euthanasia: qualitative interviews with patients and physicians. Published 16 November 2009, doi:10.1136/bmj.b4362
Cite this as: BMJ 2009;339:b4362
In 2003 the chlamydia national screening programme was set-up. Only 1 in 6 people take part in the screening process and levels need to be higher in the region of about 25% for the screening process to be successful. The disease is a huge public health problem and is vastly underdiagnosed.
Climate change - are population dynamics and family planning the keys to reducing greenhouse gas emmissions to help future generations? Perhaps this is an area which was discussed at the recent summit in Copenhagen.
Thursday, 3 December 2009
Email to the Student BMJ
Dear Prizzi Zarsadias,
I was inspired by the article in the BMJ published on the 29th October 09, which was also discussed on the BMJ Podcast 'Analysing Aspirin', published on the 6th Novmeber 2009:
Edelman E, Eng C. A practical guide to interpretation and clinical application of personal genomic screening. BMJ 2009;339:b425
I am a fourth year medical student at Dundee university and have recently completed an intercalated BMSc in Human and Molecular Genetics. I was emailing to find out the interest in this area, and whether an article on this subject and looking at the exciting developments in genetics which the future holds would be of interest to the Student BMJ.
Historically, clinical geneticists have been involved in the treatment and management of single gene disorders (monogenic) with low frequency but high morbidity such as Duchenne's Muscular Dystrophy, and chromosomal abnormalities such as Trisomy 21 (Down's Syndrome). Most of the genes involved in monogenic disorders have now been identified and the research emphasis has shifted of late to the polygenic inheritance of complex, common conditions such as Diabetes Mellitus and Alzheimers Disease. Genome-wide association studies have become increasingly popular in the identification of inherited susceptibility markers which increase an individual's chance of inheriting common conditions, such as breast cancer.
Yours faithfully,
Gordon Hale
4th Year MBChB
I was inspired by the article in the BMJ published on the 29th October 09, which was also discussed on the BMJ Podcast 'Analysing Aspirin', published on the 6th Novmeber 2009:
Edelman E, Eng C. A practical guide to interpretation and clinical application of personal genomic screening. BMJ 2009;339:b425
I am a fourth year medical student at Dundee university and have recently completed an intercalated BMSc in Human and Molecular Genetics. I was emailing to find out the interest in this area, and whether an article on this subject and looking at the exciting developments in genetics which the future holds would be of interest to the Student BMJ.
Historically, clinical geneticists have been involved in the treatment and management of single gene disorders (monogenic) with low frequency but high morbidity such as Duchenne's Muscular Dystrophy, and chromosomal abnormalities such as Trisomy 21 (Down's Syndrome). Most of the genes involved in monogenic disorders have now been identified and the research emphasis has shifted of late to the polygenic inheritance of complex, common conditions such as Diabetes Mellitus and Alzheimers Disease. Genome-wide association studies have become increasingly popular in the identification of inherited susceptibility markers which increase an individual's chance of inheriting common conditions, such as breast cancer.
Thomas G, Jacobs KB et al. A multistage genome-wide association study in breast cancer identifies two new risk alleles at 1p11.2 and 14q24.1 (RAD51L1). Nat Genet. 2009 May;41(5):579-84.
Other topical issues which I would like to write about include the issue of personalised medicines, and the promises and pitfalls of 'gene therapy' medicines. During my intercalated degree I was personally involved in a research project which concerned the development of a gene-therapy for the rare inherited dermatological disorder, Pachyonychia Congenita (www.pachyonychia.org). The treatment has since been involved in clinical trials in the US and could potentially offer a cure patients affected by this debilitating disease.
Yours faithfully,
Gordon Hale
4th Year MBChB
Tuesday, 1 December 2009
1st December 2009
First day of December - not loing till christmas. It's icy cold outside at the moment and I've got (almost) the whole day off today until doing specialist nurse shadowing at 4pm this afternoon.
The first thing which caught my attention today was this article:
The first thing which caught my attention today was this article:
Interventions for muscular dystrophy: molecular medicines entering the clinic.
Bushby K, Lochmüller H, Lynn S, Straub V. Lancet. 2009 Nov 28;374(9704):1849-56
Muscular dystrophy can be caused by mutations in more than 30 different genes however this condition may be one of the first to benefit from 'personalised genetic medicines'. These could be either gene-based or cell-based therapies. Personalised medicines would be able to target specific medicines and this reminded me of the work I had done for my dissertation in treatments for PC.
Spent alot of time this morning thinking about future plans. I don't think it would be possible to stay in Dundee forever because I feel as if I would be missing out on the bigger picture if that was the case, it would be better to gain experience somewhere else. Both Glasgow and Edinburgh seem to have top-class medical genetics research institutions which offer the academic foundation programme and clinical PhDs. If Amy and I moved to Glasgow, particularly somewhere on the south-west part of Glasgow eg. Motherwell then I could always apply to Glasgow and have Edinburgh as a back-up (it would be possible to live there and commute to either). We would also be near Amy's family and hopefully Mum and Dad will re-locate towards the central belt in the future aswell. What would be perfect would be if Heather came down aswell to Edinburgh uni or Glasgow, then everyone would be close-by!
So in the meantime:
Amy applys to Glasgow foundation schools 1st choice. I'll finish in Dundee, then apply to Glasgow for academic training, failing that I can apply to foundation schools in Glasgow. After that I'll have plenty of options for the future, PhDs etc, be it in Glasgow or Edinburgh, depending also on what Amy gets up to with her training. Meanwhile we settle down somewhere in SE Glasgow (as long as there's somewhere nice to live!).
Wednesday, 25 November 2009
Student BMJ November 2009
Quick round up of the most interesting things in the Student BMJ this month:
Apparently in the US, there is still a long way to go before Obama's healthcare reforms come into practice, with alot of comprimises being made which may end up leaving alot of people unhappy. An open letter from more than 400 doctors in the Us was written to the US government repudiating the outlandish claims made against the NHS.
A paper in the US journal of medical ethics asked the question about whether students should undergo 'doping tests' before undergoing exams to ensure that they are not taking drugs to boost their performance! The same way athletes are checked to be taking performance enhancing drugs, maybe students should too? Not sure what these performance boosting drugs are for students but I need to get my hands on them soon!
Studies have been released recently which confirm that the new working hours implemented by the EU have led to poor continuity of care and loss of teams in hospitals. Consultants were more likely than junior doctors to complain about the cut in hours and 64% thought quality of care had been reduced as a result of the changes.
There is a letter which emphasises the importance of 'traditional' CV writing and the problems created by the 'specific question' approach adopted by the foundation school application process. Things such as clinical audits, original scientific research, teaching and extra-curricular activities are important attributes. I quote 'Ensuring a breadth of good quality academic and non-clinical experiences during medical school leads to a solid basis for future applications'.
There is an article on 'medical professionalism' which states that most complaints made to the GMC are about a doctor's behaviour, and not their lack of knowledge. How can professionalism be assessed? Attendance? Voluntary participation? Completion of assessments on time? In the Us they found a link between negative student behaviour and later disciplinary action. On the other hand too much assessement of proefessionalism amongst medical students has been met with concern and anger. I think that professionalism amongst medical students is an important topic but I wouldn't want to think what my reaction would be if I was being taught it! I don't think teaching professionalism to all students is really necessary.
Apparently in the US, there is still a long way to go before Obama's healthcare reforms come into practice, with alot of comprimises being made which may end up leaving alot of people unhappy. An open letter from more than 400 doctors in the Us was written to the US government repudiating the outlandish claims made against the NHS.
A paper in the US journal of medical ethics asked the question about whether students should undergo 'doping tests' before undergoing exams to ensure that they are not taking drugs to boost their performance! The same way athletes are checked to be taking performance enhancing drugs, maybe students should too? Not sure what these performance boosting drugs are for students but I need to get my hands on them soon!
Studies have been released recently which confirm that the new working hours implemented by the EU have led to poor continuity of care and loss of teams in hospitals. Consultants were more likely than junior doctors to complain about the cut in hours and 64% thought quality of care had been reduced as a result of the changes.
There is a letter which emphasises the importance of 'traditional' CV writing and the problems created by the 'specific question' approach adopted by the foundation school application process. Things such as clinical audits, original scientific research, teaching and extra-curricular activities are important attributes. I quote 'Ensuring a breadth of good quality academic and non-clinical experiences during medical school leads to a solid basis for future applications'.
There is an article on 'medical professionalism' which states that most complaints made to the GMC are about a doctor's behaviour, and not their lack of knowledge. How can professionalism be assessed? Attendance? Voluntary participation? Completion of assessments on time? In the Us they found a link between negative student behaviour and later disciplinary action. On the other hand too much assessement of proefessionalism amongst medical students has been met with concern and anger. I think that professionalism amongst medical students is an important topic but I wouldn't want to think what my reaction would be if I was being taught it! I don't think teaching professionalism to all students is really necessary.
Sunday, 22 November 2009
Osteoporotic Fractures and Children In Need
The headline article on the BMJ website this week concerns a study carried out into predicting the risk of osteoporotic fractures in men and women in the UK.
Hippesly-Cox J etal. Predicting Risk of Osteoporotic Fracture in mena nd women in England and Wales: prospective derivation and validation of QFracture Scores. BMJ 2009;339:b4229
The study altogether covered a massive 24,350 diagnoses of osteoporotic fractures in women and there was a huge difference between frequency in men (only 7,934 in men).
The following factors led to a significant increased risk of fracture in women:
HRT use, age, BMI, smoking status, alcohol use, family history of osteoporosis, rheumatoid arthritis, cardiovascular disease, type II diabetes, asthma, tricyclic antidepressants, history of falls, menopausal symptoms, chronic liver disease and other endocrine disorders.
The results of the study suggest that using a simple algorithm can be more useful at predicting risk of fracture in primary care populations in the UK. The algorithm is known as the QFractureScore and could be used to predict patients at high risk of sustaining a fracture.
Doc2Doc, a website set up to encourage doctors to discuss topical matters, express points of view etc is a site I use sometimes for material. I saw this week that they had provided a handy 'round-up' of whats been in the news this week. Here's what it says:
The BBC have reported tamiflu-resistant H1N1 virus strains in Wales. There have already been five incidents in Cardiff of person to person transmission where this has been the case.
Researchers have shown in the journal 'Biological Psychiatry' that patients who are victims of child abuse actually show premature ageing. This is due to accelerated reduction of telomeres within cells.
Finally on a good note, the BBC's children in need event this year has raised more than 20 million pounds for charity.How good is that! Apparently Comic Relief raised 80 million pounds earlier in the year! Alot of the money goes towards important causes such as youth support services for victims of racism, support centres for visually impaired children, and play centres for children with terminal or life-threatening illnesses.
Hippesly-Cox J etal. Predicting Risk of Osteoporotic Fracture in mena nd women in England and Wales: prospective derivation and validation of QFracture Scores. BMJ 2009;339:b4229
The study altogether covered a massive 24,350 diagnoses of osteoporotic fractures in women and there was a huge difference between frequency in men (only 7,934 in men).
The following factors led to a significant increased risk of fracture in women:
HRT use, age, BMI, smoking status, alcohol use, family history of osteoporosis, rheumatoid arthritis, cardiovascular disease, type II diabetes, asthma, tricyclic antidepressants, history of falls, menopausal symptoms, chronic liver disease and other endocrine disorders.
The results of the study suggest that using a simple algorithm can be more useful at predicting risk of fracture in primary care populations in the UK. The algorithm is known as the QFractureScore and could be used to predict patients at high risk of sustaining a fracture.
Doc2Doc, a website set up to encourage doctors to discuss topical matters, express points of view etc is a site I use sometimes for material. I saw this week that they had provided a handy 'round-up' of whats been in the news this week. Here's what it says:
The BBC have reported tamiflu-resistant H1N1 virus strains in Wales. There have already been five incidents in Cardiff of person to person transmission where this has been the case.
Researchers have shown in the journal 'Biological Psychiatry' that patients who are victims of child abuse actually show premature ageing. This is due to accelerated reduction of telomeres within cells.
Finally on a good note, the BBC's children in need event this year has raised more than 20 million pounds for charity.How good is that! Apparently Comic Relief raised 80 million pounds earlier in the year! Alot of the money goes towards important causes such as youth support services for victims of racism, support centres for visually impaired children, and play centres for children with terminal or life-threatening illnesses.
Friday, 20 November 2009
DVT Assessment, Wheezy Children, Surfactant Replacement Therapy
Got loads to talk about this week.
Probably the most important was presenting my BMSc work at the ATRIUM conference last week and how it's really got me thinking about the possibility of a career in academic medicine. I know now that the first thing I need to do is to apply for the academic foundation posts. They're avaliable in Dundee, Glasgow, Edinburgh and Aberdeen. So far I've spoken to Dr Berg, Sam, Amy Martin and Tommy about these and had an email reply from Glasgow about what kind of things they're looking for from applicants. From what I can tell so far, I've got nothing to loose and it sounds like they don't mind doing telephone interviews if I'm on my elective. The TCGP open day with Amy gave me a good idea of the kind of things she's going to be starting to consider and tackling over the forthcoming years and also opened my eyes to the possibility of academic GP and teaching whilst stil maintaining clinical practice doing out-of-hours work etc.
This week I've been attached to the Neonatal unit (Ward 40) in Ninewells. One of the most interesting cases of the week was discussed in the unit MDT meeting about a woman pregnant with triplets currently in the Tayside area. She presents a real challenge to manage due to her vegan diet (she has insisted that all medications she is given are checked for correct ingredients), she has a metal phobia and she want's to have either a home birth or a water birth!
On the first day of the block we looked a paper which considers the definition of wheeze:
Cane RS, Ranganthan SC and McKenzie SA. What do parents of wheezy children understand by "wheeze"? Arch. Dis. Child. 2000; 82; 327-332
The aim was to find out what parents understand by wheeze and the results showed that understanding of the definition varied enourmously from what epidemiologists define as wheeze. There is also a label attached to wheeze that parents immediately understand as asthma. 23% of respondents said a wheeze was not something you hear. Of patients who doctors diagnosed as having wheeze, 39% of parents described their child's symptoms as having a different cause eg difficulty in breathing, or cough. The advice at the end is not to use the word 'wheeze' when talking parents but see if they volunteer it themselves. If they do, clarify what it means.
When I was researching my case presentation, I found out some interesting info about the use of surfactant in pre-term infants:
Engle WA. Surfactant-Replacement Therapy for Respiratory Distress in the Preterm and Term Neonate. American Academy of Pediatrics. 2008;121(2)
My case was a baby boy born at 28+4 weeks gestation. Presenting complaints were extreme re-maturity and respiratory distress syndrome. A premature infant is one born before 37 weeks gestation (approx 7% of all pregnancies). Incorrectly, I said in my talk that prematurity can be avoided by good antenatal care, however apparently the rates of pre-maturity have not decreased in recent years but have actually increased due to the increase in interventions people are having for their pregnancies. The study was a review of the current literature and concluded that in infants born before 30 weeks gestation, prophylactic surfactant administration has a better outcome than 'rescue' surfactant therapy.
Amy brought back a load of information from the GP conference she attended in Glasgow about genetics. I realised flicking through the info that alot of it was information aimed at GPs which I already knew about - I wonder if I could be taking more advantage of what I know by writing something, maybe an article in the Student BMJ?
At theme therapeutics this week (Case 12), the tutor highlighted a paper for us to look at considering the use of D-Dimers in diagnosis of a DVT.
Fancher TL, White RH and Kravitz RL. Combined use of rapid D-Dimer testing and estimation of clinical probabilityin the diagnosis of deep-vein-thrombosis: systematic review. BMJ. 2004; 1136
Well's probability tool is a useful assessment. Each positive response is one point, except if an alternative diagnosis is as likely as or greater than DVT, where 2 points are deducted. 0 or fewer points: low probability; 1-2 points: moderate probability; 3 or more points: high probability.
The criteria are as follows:
New album on the christmas wish list! Conditions - The Temper Trap
Probably the most important was presenting my BMSc work at the ATRIUM conference last week and how it's really got me thinking about the possibility of a career in academic medicine. I know now that the first thing I need to do is to apply for the academic foundation posts. They're avaliable in Dundee, Glasgow, Edinburgh and Aberdeen. So far I've spoken to Dr Berg, Sam, Amy Martin and Tommy about these and had an email reply from Glasgow about what kind of things they're looking for from applicants. From what I can tell so far, I've got nothing to loose and it sounds like they don't mind doing telephone interviews if I'm on my elective. The TCGP open day with Amy gave me a good idea of the kind of things she's going to be starting to consider and tackling over the forthcoming years and also opened my eyes to the possibility of academic GP and teaching whilst stil maintaining clinical practice doing out-of-hours work etc.
This week I've been attached to the Neonatal unit (Ward 40) in Ninewells. One of the most interesting cases of the week was discussed in the unit MDT meeting about a woman pregnant with triplets currently in the Tayside area. She presents a real challenge to manage due to her vegan diet (she has insisted that all medications she is given are checked for correct ingredients), she has a metal phobia and she want's to have either a home birth or a water birth!
On the first day of the block we looked a paper which considers the definition of wheeze:
Cane RS, Ranganthan SC and McKenzie SA. What do parents of wheezy children understand by "wheeze"? Arch. Dis. Child. 2000; 82; 327-332
The aim was to find out what parents understand by wheeze and the results showed that understanding of the definition varied enourmously from what epidemiologists define as wheeze. There is also a label attached to wheeze that parents immediately understand as asthma. 23% of respondents said a wheeze was not something you hear. Of patients who doctors diagnosed as having wheeze, 39% of parents described their child's symptoms as having a different cause eg difficulty in breathing, or cough. The advice at the end is not to use the word 'wheeze' when talking parents but see if they volunteer it themselves. If they do, clarify what it means.
When I was researching my case presentation, I found out some interesting info about the use of surfactant in pre-term infants:
Engle WA. Surfactant-Replacement Therapy for Respiratory Distress in the Preterm and Term Neonate. American Academy of Pediatrics. 2008;121(2)
My case was a baby boy born at 28+4 weeks gestation. Presenting complaints were extreme re-maturity and respiratory distress syndrome. A premature infant is one born before 37 weeks gestation (approx 7% of all pregnancies). Incorrectly, I said in my talk that prematurity can be avoided by good antenatal care, however apparently the rates of pre-maturity have not decreased in recent years but have actually increased due to the increase in interventions people are having for their pregnancies. The study was a review of the current literature and concluded that in infants born before 30 weeks gestation, prophylactic surfactant administration has a better outcome than 'rescue' surfactant therapy.
Amy brought back a load of information from the GP conference she attended in Glasgow about genetics. I realised flicking through the info that alot of it was information aimed at GPs which I already knew about - I wonder if I could be taking more advantage of what I know by writing something, maybe an article in the Student BMJ?
At theme therapeutics this week (Case 12), the tutor highlighted a paper for us to look at considering the use of D-Dimers in diagnosis of a DVT.
Fancher TL, White RH and Kravitz RL. Combined use of rapid D-Dimer testing and estimation of clinical probabilityin the diagnosis of deep-vein-thrombosis: systematic review. BMJ. 2004; 1136
Well's probability tool is a useful assessment. Each positive response is one point, except if an alternative diagnosis is as likely as or greater than DVT, where 2 points are deducted. 0 or fewer points: low probability; 1-2 points: moderate probability; 3 or more points: high probability.
The criteria are as follows:
- Active Cancer
- Paralysis or recent long period of immobilisation of lower limb
- Recently bedridden for more than 3 days or major surgery in the past four weeks or more.
- Localised tenderness
- Entire leg swollen
- Calf swelling greater than 3cm compared with asymptomatic leg.
- Pitting oedema
- Collateral superficial veins
- Alternative diagnosis as likely or greater than deep vein thrombosis.
New album on the christmas wish list! Conditions - The Temper Trap
Friday, 6 November 2009
Personal Genomic Screening
Common diseases and traits eg. tendency to balding can be investigated by genomic SNP (single-nucleotide-polymorphism) analysis of healthy people as well as people with diseases. Many associations are not valid and raise or reduce risk of conditions by very small amounts. Colon cancer, diabetes, cardiovascular disease are examples of polygenic conditions with SNPs which if present, correlate to higher patient risk . At the moment different screening companies seem to return different results eg. the same sample sent to 3 different labs may return different results. A family history is a much more powerful tool and genomic screening could be potentially damaging. The demand in the future for genetic councelling (or 'genomic' councelling) for patients could become huge in general practice in the future. One example of how SNP analysis could impact care is adjusted PSA based on presence of SNPs in the assessment of prostate cancer. Currently there is a grey-area between when and when not to send for a PSA test (PSA between 2 and 3.9) and watchful waiting is often the management outcome. However if a patient had a SNP profile showing increased risk of prostate cancer, it may be useful to do a biopsy at an earlier stage.
Information from the BMJ
Information from the BMJ
Published 29 October 2009, doi:10.1136/bmj.b4253
Cite this as: BMJ 2009;339:b4253
Clinical Review
A practical guide to interpretation and clinical application of personal genomic screening
Emily Edelman, project director1, Charis Eng, Sondra J and Stephen R Hardis chair of cancer genomic medicine, professor and chair2
David Nutt, Off-Duty Doctors and Aspirin Prescribing
Wanted to write something about the news of the dismissal of David Nutt, the chair of the government's Advsiory Council on the Misuse of Drugs. He was sacked by the home secretary, Alan Johnson, causing a rift between scientists and the government. It seems like there have been more than one case in recent years when advice to the government has been ignored if deemed an 'inconvenient truth'. I certainly don't agree that he should have lost his job over such an incident, it seems counter-productive to me. The reason he was sacked was due to comments he made about cannabis which contradicted current legislation, saying these didn't reflect clinical evidence. It's interesting that one of his points was that alcohol and tobacco are probably more dangerous than LSD and certain other illicit drugs. I think it's probably true that alcohol and tobacco bear a far greater public health burden than the illicit drugs but it would be dangerous for the public to have a perception that illegal drugs were infact more safe than previously thought. Article avaliable at http://news.bbc.co.uk/1/hi/health/8343004.stm
I read an interesting article about whether doctors off-duty should offer advice to strangers, the example given about an endocrologist telling a woman on a bus to go and have tests having spotted signs of acromegaly. In a clinical setting a patient sees a doctor consenting to be told information about their health, so is it un-ethical to confront someone like this? On the other hand as doctors with greater knowledge, do we have a moral responsibility to point out these things? What if the doctor was wrong? Intervention could cause un-necessary stress and anxiety to the patient. I thought this raised quite a lot of interesting ethical points.
http://www.guardian.co.uk/lifeandstyle/2009/nov/03/doctor-diagnosis-stranger
BMJ Blog 6th November 2009: Prescribing of aspirin - should it be prescribed as a primary preventative? A meta-analysis review of literature has concluded that use in people without cardiovascular disease should not be carried out, in any group of patients. Of course it has huge benefits for patients with cardiovascular disease, eg recently suffered a stroke. Some clinical practice guidelines do still recommend use of aspirin. Risks of taking aspirin largely offset the limited benefits. People who have been taking aspirin for many years need not suddenly stop taking aspirin but should have a discussion with their GP about their use of the drug.
Aspirin for primary prevention of vascular disease in people with diabetes. Published 6 November 2009, BMJ 2009;339:b4596
I read an interesting article about whether doctors off-duty should offer advice to strangers, the example given about an endocrologist telling a woman on a bus to go and have tests having spotted signs of acromegaly. In a clinical setting a patient sees a doctor consenting to be told information about their health, so is it un-ethical to confront someone like this? On the other hand as doctors with greater knowledge, do we have a moral responsibility to point out these things? What if the doctor was wrong? Intervention could cause un-necessary stress and anxiety to the patient. I thought this raised quite a lot of interesting ethical points.
http://www.guardian.co.uk/lifeandstyle/2009/nov/03/doctor-diagnosis-stranger
BMJ Blog 6th November 2009: Prescribing of aspirin - should it be prescribed as a primary preventative? A meta-analysis review of literature has concluded that use in people without cardiovascular disease should not be carried out, in any group of patients. Of course it has huge benefits for patients with cardiovascular disease, eg recently suffered a stroke. Some clinical practice guidelines do still recommend use of aspirin. Risks of taking aspirin largely offset the limited benefits. People who have been taking aspirin for many years need not suddenly stop taking aspirin but should have a discussion with their GP about their use of the drug.
Aspirin for primary prevention of vascular disease in people with diabetes. Published 6 November 2009, BMJ 2009;339:b4596
Sunday, 1 November 2009
1st November 2009
Horrible weather outside for the first day of November, Dundee Utd v Rangers game was called off today due to flooding, Arsenal beat Spurs 3 - 0 yesterday!
I've submitted the abstract from my BMSc to two competitions now:
The ATRIUM (Academic TRaining In Undergraduate Medicine) Society at the University of Edinburgh, and the Royal Society of Medicine Pathology Abstract competition. Fingers crossed! Not sure what I'll do if they ask me for a poster though!!
Reading in the Lancet Student today, forensic psychiatry is a speciality which links between medicine and law and involves the care and management of offenders with mental health problems. In the UK there is a good setup for the management of such individuals however in many countries in the world forensic psychiatry isn't even recognised as a speciality with offenders being placed in public jails which lack the kinds of support services these people require. The article is titled: Forensic Psychiatry: Current Status and Future Impact on Global Mental Health.
We had an email last week from the medical school about avalaibility of the swine flu vaccine.Last year only 16.5% of healthcare workers took the seasonal flu vaccine, so why should this year be any different? Reasons for people not wanting the vaccine include concerns about its safety and the low percieved threat of a pandemic. Interestingly last time there was a swine flu vaccination (1976-7), 12 per million recipients developed Guillain-Barre syndrome. Healthcare staff at the moment are being urged to take up the vaccine to help protect themselves and their patients. Deaths in young adults have occurred, but the current strain (H1N1) is a mild illness for most people. I'm pretty un-decided at the moment.
The most interesting patient who I saw this week during the opthalmology attachment was a 75 year old male with a recently diagnosed Bell's palsy. A Bell's palsy in a unilateral, neuropathy affecting the facial nerve. Opthalmic complications commonly occur due to exposure of the eye as a result of an inability to close the eyelids for protection. This patient had a painful corneal ulceration and a red eye, he was admitted for an intensive course of prophylactic antibiotics, tarsorrhaphy (surgery to close the eyelids) and a botox injection to the upper eyelid to induce a temporary ptosis.
I've submitted the abstract from my BMSc to two competitions now:
The ATRIUM (Academic TRaining In Undergraduate Medicine) Society at the University of Edinburgh, and the Royal Society of Medicine Pathology Abstract competition. Fingers crossed! Not sure what I'll do if they ask me for a poster though!!
Reading in the Lancet Student today, forensic psychiatry is a speciality which links between medicine and law and involves the care and management of offenders with mental health problems. In the UK there is a good setup for the management of such individuals however in many countries in the world forensic psychiatry isn't even recognised as a speciality with offenders being placed in public jails which lack the kinds of support services these people require. The article is titled: Forensic Psychiatry: Current Status and Future Impact on Global Mental Health.
We had an email last week from the medical school about avalaibility of the swine flu vaccine.Last year only 16.5% of healthcare workers took the seasonal flu vaccine, so why should this year be any different? Reasons for people not wanting the vaccine include concerns about its safety and the low percieved threat of a pandemic. Interestingly last time there was a swine flu vaccination (1976-7), 12 per million recipients developed Guillain-Barre syndrome. Healthcare staff at the moment are being urged to take up the vaccine to help protect themselves and their patients. Deaths in young adults have occurred, but the current strain (H1N1) is a mild illness for most people. I'm pretty un-decided at the moment.
The most interesting patient who I saw this week during the opthalmology attachment was a 75 year old male with a recently diagnosed Bell's palsy. A Bell's palsy in a unilateral, neuropathy affecting the facial nerve. Opthalmic complications commonly occur due to exposure of the eye as a result of an inability to close the eyelids for protection. This patient had a painful corneal ulceration and a red eye, he was admitted for an intensive course of prophylactic antibiotics, tarsorrhaphy (surgery to close the eyelids) and a botox injection to the upper eyelid to induce a temporary ptosis.
Sunday, 25 October 2009
New Post 25th October
Admittedly I've been pretty slack on updating the blog recently, mainly because I've decided that I shouldn't use this space to talk about tutorials etc, rather use it to mention interesting articles I've read. Also because it seems that copying and pasting from Microsoft Word is a total nightmare! Not really worth the bother!
The following are some of the interesting things I picket up from listening to the BMJ podcast over the past few weeks:
Firstly, confidentiality rules have been changed with regards to disclosure of genetic information. Previously if a family member was given a risk of inheritance of eg. BRCA1 / 2 genes, if the information directly affected a family member it was at the patient's discretion whether or not to tell a relative. Sometimes eg. in the case of two sisters who no longer speak to each other, the information is not passed on, however now the clinical geneticist is allowed to disclose information to relatives if the information directly affects them, eg. their chance of inheriting the BRCA1 / 2 genes.
Secondly, a revent review suggests that one in four people are victims of domestic abuse. This is a remarkably high number and the article I listened to was discussing the importance of picking up the signs of domestic abuse. Sometimes patients will go at great lengths to hide abuse and doctors are often criticised for treating the acute problem and not recognising the underlying cause. Evidence shows that domestic abuse is predictable up to 3 years in advance.
Tumour markers are often not specific for certain cancers and can be raised in patients with benign tumours. As a result they should not be relied on and certainly not used to exclude presence of an underlying malignancy. For example in its early stages colorectal cancer will not have raised tumour markers. Tumour markers are most useful in monitoring patients with already diagnosed cancer who are undergoing treatment.
Finally, sudden infant death syndrome (SIDS) is the tragic sudden death of a child under the age of one where thorough investigation does not reveal the cause of death. The new campaign 'Back to Sleep' has helped reduce numbers of cot deaths but another message which also needs to be addressed is the dangers of drinking alcohol and sleeping in the same bed as baby. If it's not safe to drive, its not safe to share a bed with an infant. Sleeping on a sofa with a baby carries one of the highest risks of SIDS.
The following are some of the interesting things I picket up from listening to the BMJ podcast over the past few weeks:
Firstly, confidentiality rules have been changed with regards to disclosure of genetic information. Previously if a family member was given a risk of inheritance of eg. BRCA1 / 2 genes, if the information directly affected a family member it was at the patient's discretion whether or not to tell a relative. Sometimes eg. in the case of two sisters who no longer speak to each other, the information is not passed on, however now the clinical geneticist is allowed to disclose information to relatives if the information directly affects them, eg. their chance of inheriting the BRCA1 / 2 genes.
Secondly, a revent review suggests that one in four people are victims of domestic abuse. This is a remarkably high number and the article I listened to was discussing the importance of picking up the signs of domestic abuse. Sometimes patients will go at great lengths to hide abuse and doctors are often criticised for treating the acute problem and not recognising the underlying cause. Evidence shows that domestic abuse is predictable up to 3 years in advance.
Tumour markers are often not specific for certain cancers and can be raised in patients with benign tumours. As a result they should not be relied on and certainly not used to exclude presence of an underlying malignancy. For example in its early stages colorectal cancer will not have raised tumour markers. Tumour markers are most useful in monitoring patients with already diagnosed cancer who are undergoing treatment.
Finally, sudden infant death syndrome (SIDS) is the tragic sudden death of a child under the age of one where thorough investigation does not reveal the cause of death. The new campaign 'Back to Sleep' has helped reduce numbers of cot deaths but another message which also needs to be addressed is the dangers of drinking alcohol and sleeping in the same bed as baby. If it's not safe to drive, its not safe to share a bed with an infant. Sleeping on a sofa with a baby carries one of the highest risks of SIDS.
Saturday, 26 September 2009
Saturday 26th September
http://news.bbc.co.uk/1/hi/health/8261121.stm
An article caught my attention today on the BBC News website about Neurofibromatosis Type 1. It was particularly interesting because many of the family members affected by the condition weren't even aware that they had mild forms of the disease. The condition is caused by mutations on chromosome 17 and leads to growth of multiple tumours from nerve cells.
Medical Protection Society MPS Magazine.
Seems as though alot of the cases in the back of the magazine are to do with situations where doctors have failed to properly examine patients and have missed 'red flags' or signs as a result.
An article caught my attention today on the BBC News website about Neurofibromatosis Type 1. It was particularly interesting because many of the family members affected by the condition weren't even aware that they had mild forms of the disease. The condition is caused by mutations on chromosome 17 and leads to growth of multiple tumours from nerve cells.
Medical Protection Society MPS Magazine.
Seems as though alot of the cases in the back of the magazine are to do with situations where doctors have failed to properly examine patients and have missed 'red flags' or signs as a result.
Friday, 11 September 2009
Wanted to write about an interesting article which I read in the student BMJ, 'Shift Work and Cancer'. I had no idea before reading this that research has been published claiming to show a link between the two. Some of the underlying reasons cited include suppression of melatonin, sleep pattern disruption of the hypothalamic-pituitary axis and decreased vitamin D production.
Fritschi L. Shift Work and Cancer. BMJ. 2009 Jul 15;339:b2653. doi: 10.1136/bmj.b2653.
Fritschi L. Shift Work and Cancer. BMJ. 2009 Jul 15;339:b2653. doi: 10.1136/bmj.b2653.
Wednesday, 9 September 2009
Prolapse, Miscarriage and Ectopic Pregnancies
Yesterday was spent in the gynaecology out-patient department (Dr. Nicoll's teaching clinic) whilst today I was in the Early Pregnancy Assessment Clinic. I didn't realise until today that patients attending the teaching clinic are informed on their referral letter that they are coming to a teaching clinic and will be seen by students. I thought this was advantageous because it meant patients were willing to co-operate and I really appreciated the patients giving us their time and allowing us to observe with the examinations (bimanual, abdominal, speculum) and investigations (Pipelle biopsy).
I took a history from a 77 year old woman presenting with pelvic organ prolapse (dragging sensation), mixed incontinence and recurrent UTIs. It seems the cause of her problems may be bladder outlet obstruction as a result of failed TransVaginal Tape (TVT) surgery carried out in 2007 (a rare complication). Her prolapse was being managed presently with pessaries, however she was keen for surgery. Dr Nicoll councelled her against surgery (sacro-spinous fixation) due to her co-morbidites she had, and risk of the operation given her age. 2nd patient, interviewed by Jackie presented with prolapse after her partner told her after sex that it 'felt like the walls were caving in' (!). I learnt alot about pelvic organ prolapse (although maybe not quite enough to rival resident prolapse king Buchanan!), particularly the different ways in which prolapse can present ie.
anterior: urinary frequency, urgency, difficulty voiding, recurrent UTIs, stress incontinence. posterior: incomplete bowel emptying, digitation and other GI symptoms.
At the early pregnancy clinic 3 patients were seen; 1st was a very nervous, anxius woman and partner due to previous still birth (at term). Cannot even begin to imagine how awful that would be for the mother. In this unfortunate event, the woman is normally given an epidural and the fetus is delivered vaginally. 2nd patient was para 0+3 with bleeding at 11 weeks gestation but a viable (very bouncy) pregnancy was confirmed. The 3rd patient was para 0 + 2, very confused about dates of LMP and +ve pregnancy test. Based on the information, she would have been 10 weeks gestation, however on ultrasound scan there was only small gestational sac that would be more in keeping with approx 5 weeks. It is likely that this pregnancy had run into trouble and the patient was advised of this development. When the midwife left the room for a few minutes, I offered condolence and support to the patient and their partner but found this a difficult situation to manage. I think I coped quite well with the situation, and answered the couple's questions correctly.
Found out that numbers of ectopic pregnancies have shot up in recent years, ? due to chlamydia, gonorrhoea, increasing numbers of sexual partners and changes in contraceptive methods (less barrier).
Cervical screening tutorial offered alot of information this afternoon, such as aetiology, pathology, screening and treatment of CIN. Must remember that abnormal cells from a smear are NOT cancerous and patients must be councelled that it does not mean they have cancer. Hopefully what we covered today will be useful come visit to colposcopy on Friday.
England are going to South Africa 2010! Convincing 5-1 thrashing of Croatia, whilst Scotland are out, finishing third in the group and losing 0-1 on the night to the Netherlands. To top it off, the goal came 9 minutes from time on the 9th of the 9th, 2009. BlackBerry is on its way! Really looking forward to setting it up at the week - think I'm into a bit of a gadget fiend! Hopefully I'll be able to update this blog from my mobile - who knows!
I took a history from a 77 year old woman presenting with pelvic organ prolapse (dragging sensation), mixed incontinence and recurrent UTIs. It seems the cause of her problems may be bladder outlet obstruction as a result of failed TransVaginal Tape (TVT) surgery carried out in 2007 (a rare complication). Her prolapse was being managed presently with pessaries, however she was keen for surgery. Dr Nicoll councelled her against surgery (sacro-spinous fixation) due to her co-morbidites she had, and risk of the operation given her age. 2nd patient, interviewed by Jackie presented with prolapse after her partner told her after sex that it 'felt like the walls were caving in' (!). I learnt alot about pelvic organ prolapse (although maybe not quite enough to rival resident prolapse king Buchanan!), particularly the different ways in which prolapse can present ie.
anterior: urinary frequency, urgency, difficulty voiding, recurrent UTIs, stress incontinence. posterior: incomplete bowel emptying, digitation and other GI symptoms.
At the early pregnancy clinic 3 patients were seen; 1st was a very nervous, anxius woman and partner due to previous still birth (at term). Cannot even begin to imagine how awful that would be for the mother. In this unfortunate event, the woman is normally given an epidural and the fetus is delivered vaginally. 2nd patient was para 0+3 with bleeding at 11 weeks gestation but a viable (very bouncy) pregnancy was confirmed. The 3rd patient was para 0 + 2, very confused about dates of LMP and +ve pregnancy test. Based on the information, she would have been 10 weeks gestation, however on ultrasound scan there was only small gestational sac that would be more in keeping with approx 5 weeks. It is likely that this pregnancy had run into trouble and the patient was advised of this development. When the midwife left the room for a few minutes, I offered condolence and support to the patient and their partner but found this a difficult situation to manage. I think I coped quite well with the situation, and answered the couple's questions correctly.
Found out that numbers of ectopic pregnancies have shot up in recent years, ? due to chlamydia, gonorrhoea, increasing numbers of sexual partners and changes in contraceptive methods (less barrier).
Cervical screening tutorial offered alot of information this afternoon, such as aetiology, pathology, screening and treatment of CIN. Must remember that abnormal cells from a smear are NOT cancerous and patients must be councelled that it does not mean they have cancer. Hopefully what we covered today will be useful come visit to colposcopy on Friday.
England are going to South Africa 2010! Convincing 5-1 thrashing of Croatia, whilst Scotland are out, finishing third in the group and losing 0-1 on the night to the Netherlands. To top it off, the goal came 9 minutes from time on the 9th of the 9th, 2009. BlackBerry is on its way! Really looking forward to setting it up at the week - think I'm into a bit of a gadget fiend! Hopefully I'll be able to update this blog from my mobile - who knows!
Monday, 7 September 2009
An article in the BMA newsletter today says that 23% of the junior doctors in paediatrics in NHS Lothian are apparently on maternity leave at the same time. Same problem in Dundee's GUM clinic by the looks of things, yet another teaching session cancelled today, and it seems to be all of the important one's I'm missing too! Will need to catch up at a later date.
Sat in the gynaecology out-patient clinic today and saw three patients:
1) Investigations for ovarian cancer: CEA, Ca125. Follow up appointment, previous 'borderline' ovarian tumour. Found out that 15% of epithelial tumours are 'borderline', they show epithelial proliferation but no stromal invasion, tending to behave as a low grade malignancy. Removal of these tumours is ususally curative, as in this case.
2) Patient with a large anterior intramural fibroid in her uterus. Discussed with her and her partner the various surgical treatment options avalaible to her and talked about some of her concerns about having a hysterectomy. Found this really interesting and discussed it in greater detail in my RoCE.
3) 73 year old female patient complaining of faecal incontinence and bilateral leg oedema. This was a follow up appointment following wide local excision of a vulval carcinoma in '07. Unfortunately the patient was quite embarrassed by her problem, understandably so, and I felt quite awkward discussing it with her. Need to work on that because it probably doesn't leave a particularly good impression to the patient if the doctor finds talking about their problem awkward.
The registrar recommended a useful website to me, www.scan.scot.nhs.uk
It stands for the South-East Scotland Cancer Network and provides excellent guidelines in the management of not just gynae cancers but covers all specialities.... worth a look!
Sat in the gynaecology out-patient clinic today and saw three patients:
1) Investigations for ovarian cancer: CEA, Ca125. Follow up appointment, previous 'borderline' ovarian tumour. Found out that 15% of epithelial tumours are 'borderline', they show epithelial proliferation but no stromal invasion, tending to behave as a low grade malignancy. Removal of these tumours is ususally curative, as in this case.
2) Patient with a large anterior intramural fibroid in her uterus. Discussed with her and her partner the various surgical treatment options avalaible to her and talked about some of her concerns about having a hysterectomy. Found this really interesting and discussed it in greater detail in my RoCE.
3) 73 year old female patient complaining of faecal incontinence and bilateral leg oedema. This was a follow up appointment following wide local excision of a vulval carcinoma in '07. Unfortunately the patient was quite embarrassed by her problem, understandably so, and I felt quite awkward discussing it with her. Need to work on that because it probably doesn't leave a particularly good impression to the patient if the doctor finds talking about their problem awkward.
The registrar recommended a useful website to me, www.scan.scot.nhs.uk
It stands for the South-East Scotland Cancer Network and provides excellent guidelines in the management of not just gynae cancers but covers all specialities.... worth a look!
Thursday, 3 September 2009
Lung Transplantaiton, Spina Bifida, Oesophageal Cancer and Drive-Thru Medicine
Cystic fibrosis is the most prevalent serious genetically inherited disorder in Scotland, and it was really interesting tonight listening to the experiences of a Glasgow medical student with the condition who received a lung transplant one year ago. Having finished medical school against the recommendation of her doctors her condition worsened to the extent that she could not work. After waiting on the transplant list (for up to 2 years) she had the transplant and has made a remarkable return to health. The report on the Student BMJ podcast also talked about how half of the people on the waiting list never receive a transplant, and that the UK has significantly lower levels than, say, Spain which has the highest transplant rates in the world. The first organ transplant was successfully carried out in Boston in 1954. Sounds like the GMC are doing something about this:
GMC is to instruct all GPs to talk to dying patients about organ donation. BMJ 2009;339:b3578 2nd September 09
Found out today that the UK now has its first 'private' medical school, at the University of Buckingham. Hope this isn't just another step in the privatisation of health care, NHS doctors vs private trained doctors in a few years time maybe? Watched a really captivating programme on BBC iPlayer tonight about living with Alzheimers disease, good to re-visit these things from time to time.
Patients who I saw today in gynaecology: a woman in theatre for laparoscopic sterilisation, a second pateint with menorrhagia in theatre for endometrial biopsy, and a 76 y.o. woman with late-presentation of ovarian cancer. Ovarian cancer often presents with obscure symptoms, and often goes un-diagnosed. Some research is now being carried out to identify and refer patients with suspected ovarian cancer quicker from primary care.
Apparently one state in the US (Kentucky I think) has come up with an efficient way of vaccinating large volumes of people against flu in a short space of time: the drive-thru vaccination clinic! Not a bad idea but not quite sure about the safety! They tell people waiting in the queue, 'roll up your sleeves and roll down your windows!'.
Apparently the medical school has been issuing new dress code measures, and students should 'dress in a manner which inspires public confidence'. I'll try! Have recently found a couple of new tools for helping pass 4th year: Patient information leaflets, OnExamination.com and YouTube!
Amy gets back tomorrow!!!! Hope she brings back the Australian sun with her....
New music I need to download at some point: Fielding and The GoStation. Think the news about Chelsea's transfer ban is absolutely hilarious, puts Eduardo's two match ban (which will hopefully be overturned but doubt it will) into perspective!
Finally, saw an interesting research article on the BMJ today:
Now, for more Late Night Love courtesy of Wave 102........................or maybe another episode of The Office on BBC iPlayer, absolute comedy genius!!
GMC is to instruct all GPs to talk to dying patients about organ donation. BMJ 2009;339:b3578 2nd September 09
Found out today that the UK now has its first 'private' medical school, at the University of Buckingham. Hope this isn't just another step in the privatisation of health care, NHS doctors vs private trained doctors in a few years time maybe? Watched a really captivating programme on BBC iPlayer tonight about living with Alzheimers disease, good to re-visit these things from time to time.Patients who I saw today in gynaecology: a woman in theatre for laparoscopic sterilisation, a second pateint with menorrhagia in theatre for endometrial biopsy, and a 76 y.o. woman with late-presentation of ovarian cancer. Ovarian cancer often presents with obscure symptoms, and often goes un-diagnosed. Some research is now being carried out to identify and refer patients with suspected ovarian cancer quicker from primary care.
Risk of ovarian cancer in women with symptoms in primary care: population based case-control study. BMJ 2009;339:b2998. 25th August 09
In the news yesterday Scotland has the highest rates of spina bifida in the UK. Although the number of pregnancies affected by the condition are roughly equal, women in Scotland are less likely to terminate the pregnancy than their English counterparts. However this was hardly the impression I got having spent the afternoon in the Nairn clinic and hearing that Dundee has the highest rates of terminations of pregnancy in the UK. It was a real day of contrasts yesterday, with the morning spent on the infertility ward, and the afternoon the direct opposite. I wonder what the women on the infertility ward would feel about what goes on down in the basement of level 6... Spina bifida can be prevented by regular folic acid supplements, and can be detected on fetal ultrasound scanning by identifying the classic 'lemon and banana signs'.Apparently one state in the US (Kentucky I think) has come up with an efficient way of vaccinating large volumes of people against flu in a short space of time: the drive-thru vaccination clinic! Not a bad idea but not quite sure about the safety! They tell people waiting in the queue, 'roll up your sleeves and roll down your windows!'.
Apparently the medical school has been issuing new dress code measures, and students should 'dress in a manner which inspires public confidence'. I'll try! Have recently found a couple of new tools for helping pass 4th year: Patient information leaflets, OnExamination.com and YouTube!
Amy gets back tomorrow!!!! Hope she brings back the Australian sun with her....
New music I need to download at some point: Fielding and The GoStation. Think the news about Chelsea's transfer ban is absolutely hilarious, puts Eduardo's two match ban (which will hopefully be overturned but doubt it will) into perspective!
Finally, saw an interesting research article on the BMJ today:
Tea drinking habits and oesophageal cancer in a high risk area in northern Iran: population based case-control study. BMJ 2009;338:b929. 26th March 09
brought to my attention on the BMJ podcast this week.Now, for more Late Night Love courtesy of Wave 102........................or maybe another episode of The Office on BBC iPlayer, absolute comedy genius!!
Wednesday, 2 September 2009
Spent the morning today in Ward 35, ACU with Dr Kay and Dr Eid, witnessing two egg retrieval procedures and embryo transfer for IVF infertility treatment. The first patient was a self funding para 1 + 1 woman with previous failed cycle of IVF. Chance of success is increased with the following criteria: parous woman, young, absence of pelvic disease. 12 follicles approximately were drained, 3/4 of which contain eggs. 8 - 12 eggs are collected and approx 50% will become fertilised. The best two embryos are selected and re-implanted. The balance has to be weighed up between the risk of multiple pregnancy and the chance of a pregnancy occurring. Risks associated with IVF egg retrieval include infection, perforation of the bowel and haemorrhage although these complications are rare.
The second patient was Hep B +ve. I knew that due to her +ve status, it would be advisable to wear protective masks during the egg collection procedure however the theatre team had not done this. Therefore I went into the preparation room and collected masks to give to each of the members of staff. This should have been avoided with everyone wearing masks before entering the room with the patient. ICSI had been used for this patient, indicated due to severe male factor infertility. The long term results of ICSI are currently unavaliable. We discussed that patients wishing to have pre-implantation genetic diagnosis carried out can be referred to the regional centre in Edinburgh. I also discussed with the doctors some of the ethical implications of sperm donation, which has suffered a serious decline in numbers since new anonymity laws recently came into place.
The afternoon involved tutorials on Antepartum Haemorrhage (focusing particularly on placenta praevia & placental abruption), and Amenorrhoea, as well as a visit to the Nairn Suite to find out about councelling for termination of pregnancy. All in all an eventful day!
The second patient was Hep B +ve. I knew that due to her +ve status, it would be advisable to wear protective masks during the egg collection procedure however the theatre team had not done this. Therefore I went into the preparation room and collected masks to give to each of the members of staff. This should have been avoided with everyone wearing masks before entering the room with the patient. ICSI had been used for this patient, indicated due to severe male factor infertility. The long term results of ICSI are currently unavaliable. We discussed that patients wishing to have pre-implantation genetic diagnosis carried out can be referred to the regional centre in Edinburgh. I also discussed with the doctors some of the ethical implications of sperm donation, which has suffered a serious decline in numbers since new anonymity laws recently came into place.
The afternoon involved tutorials on Antepartum Haemorrhage (focusing particularly on placenta praevia & placental abruption), and Amenorrhoea, as well as a visit to the Nairn Suite to find out about councelling for termination of pregnancy. All in all an eventful day!
Tuesday, 1 September 2009
Arctic Monkeys Headline Set Reading 09
- 1.My Propeller *
- 2.Red Right Hand (Nick Cave and The Bad Seeds cover)
- 3.Crying Lightning *
- 4.Brianstorm *
- 5.Still Take You Home
- 6.I Bet You Look Good On The Dancefloor *
- 7.Potion Approaching
- 8.Pretty Visitors
- 9.House Is A Circus
- 10.If You Were There, Beware
- 11.When The Sun Goes Down
- 12.Dangerous Animals
- 13.View From The Afternoon
- 14.Cornerstone *
- 15.Only Ones Who Know
- 16.Do Me A Favour
- 17.Fluorescent Adolescent *
- 18.Secret Door *
- 19.505
Looking at the BMA newsletter today I noticed an article about one particularly concerned doctor who was upset that junior doctors and medical students were missing out on interesting cases as they were being 'cherry-picked' by private institutions. I thought this was a good point, until I realised he was specifically referring to 'scrotal' cases, with the average medical student spending only 2 sessions in NHS urology clinics and possibly not seeing a single circumcision. Pity. http://web2.bma.org.uk/nrezine.nsf/wd/BSKN-7VBC85?OpenDocument&Login
The new Irish pub on Perth Road seems like one of the few places you can go out in Dundee, and feel like you're somewhere completely different! One of the highlights of the weekend has to have been Dominoes on Friday, particularly when theres 50% off courtesy of Andrew! Spent alot of time watching the highlights from Reading and Leeds festival, some bands I'm liking at the moment: The Gaslight Anthem, You Me at Six and Radiohead. Especially thought the performance by the latter, headlining the festival was astonishing, really need to get my hands on some Radiohead albums in the next few weeks.
I'm very disappointed Zane Lowe isn't coming to Dundee this year for Freshers Week! Vernon Kay is hardly a worthwhile substitution, he's not a DJ, he's just a celebrity face! Another night of top 40 hits then I'd imagine. Really looking forward to the next couple of weekends, Amy gets home on Friday so excited about seeing her again, then the following weekend; Fat Sams Live, Kirsten's leaving do and the tail end of Freshers week.
Interesting cases in the gynae theatre today. Particularly a woman who presented with bilateral peripheral oedema who was originally referred to a cardiologist on suspicion of a DVT (she had elevated D-dimers). However on abdominal examination she was found to have a raised pelvic mass, raising suspicions of a large abdominal tumour. CT scans revealed a large, complex abdominal cyst, highly suspicious of malignancy, compressing on the IVC and decreasing venous return. In theatre (Dr Mackenzie), laparoscopy confirmed these suspicions. Debulking of the tumour was carried out to remove some pressure on the IVC, however this patient will require chemotherapy and follow-up as metastases were seen on the abdominal wall.
The new Irish pub on Perth Road seems like one of the few places you can go out in Dundee, and feel like you're somewhere completely different! One of the highlights of the weekend has to have been Dominoes on Friday, particularly when theres 50% off courtesy of Andrew! Spent alot of time watching the highlights from Reading and Leeds festival, some bands I'm liking at the moment: The Gaslight Anthem, You Me at Six and Radiohead. Especially thought the performance by the latter, headlining the festival was astonishing, really need to get my hands on some Radiohead albums in the next few weeks.
I'm very disappointed Zane Lowe isn't coming to Dundee this year for Freshers Week! Vernon Kay is hardly a worthwhile substitution, he's not a DJ, he's just a celebrity face! Another night of top 40 hits then I'd imagine. Really looking forward to the next couple of weekends, Amy gets home on Friday so excited about seeing her again, then the following weekend; Fat Sams Live, Kirsten's leaving do and the tail end of Freshers week.
Interesting cases in the gynae theatre today. Particularly a woman who presented with bilateral peripheral oedema who was originally referred to a cardiologist on suspicion of a DVT (she had elevated D-dimers). However on abdominal examination she was found to have a raised pelvic mass, raising suspicions of a large abdominal tumour. CT scans revealed a large, complex abdominal cyst, highly suspicious of malignancy, compressing on the IVC and decreasing venous return. In theatre (Dr Mackenzie), laparoscopy confirmed these suspicions. Debulking of the tumour was carried out to remove some pressure on the IVC, however this patient will require chemotherapy and follow-up as metastases were seen on the abdominal wall.
Thursday, 27 August 2009
Found out today that all magazines and toys have been removed from waiting rooms for clinics at Ryehill health centre on Perth Road. Mother attending the clinic says its a nightmare bringing two kids along because there's nothing for them to do. Managed to ask the midwife at the clinic (Linda) lots of antenatal health questions and she was really helpful. Performed several abdominal palpations and got to play with the hand held Doppler.
Read the following article about H1N1 virus today on the BMJ website:
'Two swine flu call centres in England will close on Sunday with the loss of 1200 jobs reports The Guardian. Demand for Tamiflu has plummeted: it peaked on 27 July with nearly 39,000 authorisations for the use of Tamiflu while on 16 August there were only 3396. According to the HPA there were only 11,000 new cases of swine flu last week and the GP consultation rates have dropped from a peak of 35 consultations per 100,000 of the population to under 5 (similar to the rate in January this year for seasonal flu). 59 people in the UK are reported to have died from the virus so far.
Read the following article about H1N1 virus today on the BMJ website:
'Two swine flu call centres in England will close on Sunday with the loss of 1200 jobs reports The Guardian. Demand for Tamiflu has plummeted: it peaked on 27 July with nearly 39,000 authorisations for the use of Tamiflu while on 16 August there were only 3396. According to the HPA there were only 11,000 new cases of swine flu last week and the GP consultation rates have dropped from a peak of 35 consultations per 100,000 of the population to under 5 (similar to the rate in January this year for seasonal flu). 59 people in the UK are reported to have died from the virus so far.
Time for a break?
With everything seemingly back to normal it’s tempting to forget all about swine flu. But we shouldn’t get too comfortable, as the RCGP mentioned in its weekly flu update: this quiet time should be used to prepare for the next wave of flu. But what more can be done? We’ve already had a dress rehearsal this summer and clinicians’ knowledge, skills and organisation regarding swine flu are now fine-tuned. Perhaps the best thing people can do is take a hard earned break to recharge the batteries for the winter ahead."
Wonder whether it will be a problem when the winter comes around and what I'll be able to do to help treat patients with flu like symptoms in hospital.
Wednesday, 26 August 2009
Came across a patient today with Ehlers-Danlos syndrome at the high risk antenatal clinic, Ninewells Hospital. Its an autosomally dominant inherited disorder caused by a defect in collagen synthesis and comes on 4 major clinical sub-types - type I to IV. This patient had Type III, also known as 'Hypermobility EDS'. It affects between 1 in 10,000 and 1 in 15,000 people. A serious complication of type 4 EHD is coarctation of the aorta and this patient did have a positive family history of coarctation of the aorta. It was recommended that due to this risk in the patient, the second stage of labour should be as short as possible to minimise risk.
Discussing with the doctor afterwards I learnt that the most important thing about aortic dissection in labour is recognising it by picking up key clinical signs such as marked hypotension, severe chest pain and shock. This severe complication had caused a fatality on the ward in the past year.
On a slightly lighter note, at the pathology MDT meeting the medical stereotypes were out in force, consultant gynaecologist 'surgeons are pretty thick anyway' and my favourite from the pathologist when discussing the patient's tumour 'we could just dissect it on autopsy'. Seriously?
Discussing with the doctor afterwards I learnt that the most important thing about aortic dissection in labour is recognising it by picking up key clinical signs such as marked hypotension, severe chest pain and shock. This severe complication had caused a fatality on the ward in the past year.
On a slightly lighter note, at the pathology MDT meeting the medical stereotypes were out in force, consultant gynaecologist 'surgeons are pretty thick anyway' and my favourite from the pathologist when discussing the patient's tumour 'we could just dissect it on autopsy'. Seriously?
Tuesday, 25 August 2009
Symptoms of early pregnancy include: nausea, vomiting, dry skin, weight gain, mood changes, chest pain, constipation, heartburn, pelvic pressure / joint pain, carpal tunnel syndrome, vaginal discharge and fatigue. Many of these symptoms disappear after approximately 16 weeks gestation although there's no 'magic cut-off'. Meanwhile UTIs are very common in pregnancy and must be treated as they may cause pre-term labour.
I cannot make up my mind on where I stand regarding the release of Abdelbaset Ali al-Megrahi on compassionate grounds. Ethically if the man was soon to die from terminal cancer, I would support his release to be with his family. However, he is guilty of a crime for which he was given a life-sentence and I can understand why many people are particularly upset by his release. I don't know what's true about the economic discussions taking place between Scotland and Libya and the rumours that his release were part of a trade deal although I sincerely hope they are not true. If they do turn out to be true, it would pose serious questions about the members of the Scottish parliament who warranted his release.
From now on I will take something to do in clinics between patients not turning up, tutors being absent, patients not wanting students present etc instead of wasting hours like this afternoon!
I cannot make up my mind on where I stand regarding the release of Abdelbaset Ali al-Megrahi on compassionate grounds. Ethically if the man was soon to die from terminal cancer, I would support his release to be with his family. However, he is guilty of a crime for which he was given a life-sentence and I can understand why many people are particularly upset by his release. I don't know what's true about the economic discussions taking place between Scotland and Libya and the rumours that his release were part of a trade deal although I sincerely hope they are not true. If they do turn out to be true, it would pose serious questions about the members of the Scottish parliament who warranted his release.
From now on I will take something to do in clinics between patients not turning up, tutors being absent, patients not wanting students present etc instead of wasting hours like this afternoon!
Monday, 24 August 2009
Clinical features:
Hydatidiform Mole: vaginal bleeding, large for dates uterus, passage of vesicles, hyperemesis, early onset pre-eclampsia and hyperthyroidism.
Ruptured Ectopic Pregnancy: Shock, peritonism, haemorrhage, cervical excitation, uterus small for dates.
Tubal Miscarriage: Abdominal pain / peritonism, PV bleeding, uterus small for dates, cervix closed, shoulder pain.
Hydatidiform Mole: vaginal bleeding, large for dates uterus, passage of vesicles, hyperemesis, early onset pre-eclampsia and hyperthyroidism.
Ruptured Ectopic Pregnancy: Shock, peritonism, haemorrhage, cervical excitation, uterus small for dates.
Tubal Miscarriage: Abdominal pain / peritonism, PV bleeding, uterus small for dates, cervix closed, shoulder pain.
Sunday, 23 August 2009
Exciting times, delivered my first baby last night on the labour ward at about 3AM on Sunday morning! After a normal labour (patient brought to labour ward 2 weeks post-dates) para 1 + 0 woman I was able to assist in the delivery of the baby and the placenta with two midwives present in the room. The midwives are all fantastic, all of them have been really welcoming over the past week which has really helped. There was some post-partum haemorrhage, probably caused by trauma to the vagina during the delivery. Blood pressure and haemoglobin levels were closely monitored and the patient made a full recovery. Carried out checks on the placenta for completeness, presence of both the amnion and chorion, and also presence of three blood vessels in the umbilicus. Also was present in theatre earlier in the evening for to witness a forceps delivery.
Saturday, 22 August 2009
Been very busy on the labour ward this week, an interesting case from last night:
28 y.o. para 0 + 0 woman presentation breech, admitted to the labour ward from DMU for emergency caesarian section, fetal presentation was confirmed by ultrasound scan. On delivery the baby was seen immediately by the on-call paediatrician with some concerns over baby's breathing. Grunting sounds were heard, heart rate greater than 100. Discussed with the on-call consultant the importance of using accuracy when describing fetal position, lie, and presentation. Learnt that whilst it is possible to have a SVD with a breech fetus, recent evidence has shown that caesarian section has a higher chance of positive outcome.
28 y.o. para 0 + 0 woman presentation breech, admitted to the labour ward from DMU for emergency caesarian section, fetal presentation was confirmed by ultrasound scan. On delivery the baby was seen immediately by the on-call paediatrician with some concerns over baby's breathing. Grunting sounds were heard, heart rate greater than 100. Discussed with the on-call consultant the importance of using accuracy when describing fetal position, lie, and presentation. Learnt that whilst it is possible to have a SVD with a breech fetus, recent evidence has shown that caesarian section has a higher chance of positive outcome.
Thursday, 20 August 2009
Thistlegorm
Found this video of YouTube of the Thistlegorm and thought it was definitely worth posting.
http://www.youtube.com/watch?v=UzkVLGi8dMc&feature=related
http://www.youtube.com/watch?v=UzkVLGi8dMc&feature=related
Wednesday, 19 August 2009
Labour Ward
Its been an exciting few days, really enjoying the week. So far 2 days, 3 caesarians and 3 healthy babies although still no 'normal spontaneous deliveries' of note. Watching the doctor get consent yesterday was interesting, it seemed to involve about 3 different people explaining all of the details of the op, anaesthetic and risks to both mother and baby.
In theatre today I found out why in women with a high BMI the table has to be tilted. Also saw one of the midwives 'attempt' to catheterise the patient on the table but unfortunately get the wrong hole, oops. Managed to help Dad who looked like he was about to pass out at one point and help him through to the prep room to sit down.
Best things about labour ward: tea and toast in abundance, all of the staff being incredibly friendly and seeing alot of things in my first week. Worst part there's so many people and codes that it's becoming a memory game trying to remember everything! Looking forward to night shifts at the weekend and meeting my supervisor tomorrow. Managed ok in the pre-assessment for the block but definitely need to brush up on my gynae pathology.
In theatre today I found out why in women with a high BMI the table has to be tilted. Also saw one of the midwives 'attempt' to catheterise the patient on the table but unfortunately get the wrong hole, oops. Managed to help Dad who looked like he was about to pass out at one point and help him through to the prep room to sit down.
Best things about labour ward: tea and toast in abundance, all of the staff being incredibly friendly and seeing alot of things in my first week. Worst part there's so many people and codes that it's becoming a memory game trying to remember everything! Looking forward to night shifts at the weekend and meeting my supervisor tomorrow. Managed ok in the pre-assessment for the block but definitely need to brush up on my gynae pathology.
Monday, 17 August 2009
Night Shift
A first night
On my first night on call as a surgical junior doctor I was called to a patient on the second day after major bowel surgery. He was agitated, tachycardic, and mildly hypotensive, and the nurses assured me that he had passed only 10 ml of urine in the past four hours. I ran from the opposite corner of the hospital to find a clearly sick and possibly septic patient. His ABCs (airway, breathing, circulation) were good (except for his tachycardia), and he was experiencing abdominal pain but was too agitated to tell me more than that. On examination he was guarding around his lower abdomen; it was very tense, but he still had bowel sounds. His fluid balance chart (not fully completed by the nurses) showed only one litre in over the past 24 hours, and only about 500 ml out (all day from his catheter). Culprit found: “He’s hypovolaemic,” I thought. So we gave him a 500 ml bolus of succinylated gelatin solution for intravenous infusion and followed that up with a six hour bag of Hartmann’s solution. Over the next hour his agitation worsened.
I called the surgical senior house officer, who shouted at me for having woken him, promised to come anyway, and asked if we had given the patient a bladder scan. I had to sheepishly say we hadn’t thought of that. By the time he got there we’d done a bladder scan, which showed more than 900 ml. The catheter clearly needed changing because it was completely blocked. We set up the trolley, ready for me to pass a new catheter, disconnected the catheter bag, and deflated the balloon. I was promptly soaked by the 900 ml of urine before I’d even withdrawn the catheter. The patient breathed a sigh of relief and thanked me, and the senior house officer walked in to find me covered in urine.
My tips for anyone approaching their first set of surgical nights are:
* If a patient has poor urine output flush the catheter and bladder scan them before panicking about fluid challenges
* The senior house officer may be asleep, but the trust is paying them to work, so don’t feel guilty about waking them up if you’re unsure about something
* Always have a spare change of clothes or know the code to the theatre changing room so if you get covered in blood, vomit, or urine you can get changed.
Sarah Jones, F1, Nottingham
Looking forward to my first night shift (sort of) on Friday!
On my first night on call as a surgical junior doctor I was called to a patient on the second day after major bowel surgery. He was agitated, tachycardic, and mildly hypotensive, and the nurses assured me that he had passed only 10 ml of urine in the past four hours. I ran from the opposite corner of the hospital to find a clearly sick and possibly septic patient. His ABCs (airway, breathing, circulation) were good (except for his tachycardia), and he was experiencing abdominal pain but was too agitated to tell me more than that. On examination he was guarding around his lower abdomen; it was very tense, but he still had bowel sounds. His fluid balance chart (not fully completed by the nurses) showed only one litre in over the past 24 hours, and only about 500 ml out (all day from his catheter). Culprit found: “He’s hypovolaemic,” I thought. So we gave him a 500 ml bolus of succinylated gelatin solution for intravenous infusion and followed that up with a six hour bag of Hartmann’s solution. Over the next hour his agitation worsened.
I called the surgical senior house officer, who shouted at me for having woken him, promised to come anyway, and asked if we had given the patient a bladder scan. I had to sheepishly say we hadn’t thought of that. By the time he got there we’d done a bladder scan, which showed more than 900 ml. The catheter clearly needed changing because it was completely blocked. We set up the trolley, ready for me to pass a new catheter, disconnected the catheter bag, and deflated the balloon. I was promptly soaked by the 900 ml of urine before I’d even withdrawn the catheter. The patient breathed a sigh of relief and thanked me, and the senior house officer walked in to find me covered in urine.
My tips for anyone approaching their first set of surgical nights are:
* If a patient has poor urine output flush the catheter and bladder scan them before panicking about fluid challenges
* The senior house officer may be asleep, but the trust is paying them to work, so don’t feel guilty about waking them up if you’re unsure about something
* Always have a spare change of clothes or know the code to the theatre changing room so if you get covered in blood, vomit, or urine you can get changed.
Sarah Jones, F1, Nottingham
Looking forward to my first night shift (sort of) on Friday!
Saturday, 15 August 2009
Posted by Susan Kersley at 6/7/2009 7:28 AM BST on bmj.com
Are most doctors perfectionists? Do you agree? Are you driven by wanting to be perfect or a fear of litigation?
Rather than perfect Is it OK to be 'good enough' rather than perfect?
What is the distinction between being 'good enough' and being 'perfect' ?
It just isn't possible, however careful you are, to be 100% perfect all of the time.
In Medicine you may not be certain of the way things will turn out. You can only consider probabilities. A surgeon will warn a patient of the all the possible complications of an operation. As a doctor you may not be able to predict precisely what will happen to the patient you can only talk of likelihood and possibility. You have to be clear about the outcome the patient and you want and address these issues. This applies to life in general : you cannot be 100% certain of the outcome of a certain action, you can ony look at what might happen and then make a decision based on: evidence, your gut feelings, what people tell you and what you see happening to others in similar circumstances. So be clear about what you want and 'just do it' - you don't have to be perfect!
Rather than perfect Is it OK to be 'good enough' rather than perfect?
What is the distinction between being 'good enough' and being 'perfect' ?
It just isn't possible, however careful you are, to be 100% perfect all of the time.
Dr. A might not make a decision without consulting a superior, whereas Dr. B doesn't consider all the possible outcomes of his actions and does something without weighing up the possible outcome.
Friday, 14 August 2009
Wednesday, 12 August 2009
Looking back at Scotland's 4 - 0 defeat to Norway tonight, i'm finding it more and more difficult to see the tartan army qualifying for the World Cup Finals in South Africa. I thought that Gary Caldwell's sending off was harsh, and totally changed the game. It should have been 5 - 0 had it not been for some suspicious linesman decisions. At least things are looking better for England, and I really hope Northern Ireland qualify purely so I can watch the games in the finals with the Dundee Uni N. Ireland supporters club!
I now know that the first week of the Obs & Gynae block I'm going to be on the labour ward, including 2 night shifts next weekend! I really think its going to be a case of being thrown in at the weekend and it'll probably be a steep learning curve but I'm looking forward to it. Some tips from Amy are to revise how to write a partogram, different delivery methods and how to scrub in. Maybe I'll look over some things in the next few days before starting but we'll see how that goes! Even just sorting through all the info on Blackboard today it seems like ALOT of info to digest but I think as long as I'm well organised i'll manage the workload.
Meanwhile I just bought the Ricky Gervais podcast with Karl Pilkington which I'm really hoping lives up to the hype!
I now know that the first week of the Obs & Gynae block I'm going to be on the labour ward, including 2 night shifts next weekend! I really think its going to be a case of being thrown in at the weekend and it'll probably be a steep learning curve but I'm looking forward to it. Some tips from Amy are to revise how to write a partogram, different delivery methods and how to scrub in. Maybe I'll look over some things in the next few days before starting but we'll see how that goes! Even just sorting through all the info on Blackboard today it seems like ALOT of info to digest but I think as long as I'm well organised i'll manage the workload.
Meanwhile I just bought the Ricky Gervais podcast with Karl Pilkington which I'm really hoping lives up to the hype!
Monday, 10 August 2009
10th August 2009
I guess my reason for starting the blog is to keep other people (and myself) up to date on what's going on this next year. Hopefully if I can actually get on here regularly enough it'll be a good place to write down my experiences and remember them when it the time comes around.
Right now, I'm just back from Borneo, having been away for 6 weeks on the D.A.R.E. project. Although I'm thinking maybe we should call it the D.A.V.E. or R.A.V.E. society next year! 4th year starts in one week, I tried to do one hour of studying tonight and that lasted all of 10 minutes... Think it's going to be a steep learning curve next week starting on the Obs & Gynae block!
Right now, I'm just back from Borneo, having been away for 6 weeks on the D.A.R.E. project. Although I'm thinking maybe we should call it the D.A.V.E. or R.A.V.E. society next year! 4th year starts in one week, I tried to do one hour of studying tonight and that lasted all of 10 minutes... Think it's going to be a steep learning curve next week starting on the Obs & Gynae block!
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