A couple of articles drew my attention this week as sent out in an email, released by the medical school.
Fighting Cervical Cancer in Under-Resourced Countries
David McGregor and Adeola Olaitan. the Obstetrician and Gynaecologist. Jan 2010.
Cervical cancer is not merely a condition prevalent in more economically developed countries. It is a condition which is preventable and in the UK a vaccine has now been produced which targets the human papilloma virus. However this may not be avaliable in many poorer countries. It is tragic that this preventable form of cancer still claims the lives of hundreds of thousands of women every year. 80% of cervical cancer deaths occur in under-resourced countries. In high resource countries such as the UK the number of deaths have been reduced now by 90% with the vaccine and cervical screening programmes in place. Low awareness of the condition is a major barrier in poorer countries. New methods of prevention are now emerging, such as the prospect of human papilloma virus DNA testing and visual inspection with acetic acid. Sreening and immunisation processes are only likely to succeed with sufficient patient education to go along side it.
The second article regards a review on how to manage women who decline blood products during pregnancy for religious reasons of for concerns regarding their safety.
Review: Management of women who decline blood and blood products in pregnancy.
Jane Currie, Matthew Hogg et al. The Obstetrician and Gynaecologist. Jan 2010.
Mortality rates are significantly increased amongst these women and antenatal councelling must involve a senior management team. Considerable efforts are required to optimise pre-delivery haemoglobin and identify risk factors for haemorrhage. Intra-partum techniques to avoid blood transfusion include cell salvage and early recourse to definitive surgical management in the event of a massive obstetric haemorrhage. Women's autonomy can be respected with accurate information and empathic councelling.
Friday, 29 January 2010
Sunday, 24 January 2010
The Wii Knee
The first entry today is a BMJ Case Report released in June 2009 regarding medial meniscal tear injury whilst playing on the Nintendo Wii.
Almedghiol SM, Shablahidis O, Rennie W, Ashford R. Wii knee revisited: meniscal injury from 10-pin bowling. BMJ Case Reports 2009; doi:10.1136/bcr.11.2008.1189
A 23 year old woman presented to the orthopaedic clinic with right knee pain, sustained whilst playing bowling on the Wii. Meniscus tear is one of the most common injuries of the knee, cuased by axial loading and rotational force. The knee became swollen immediately after the incident although the patient was able to go about her normal business in the aftermath. She presented three months later with pain and tenderness over the medial aspect of her knee. On examination there was a mild effusion of the right knee with tenderness along the joint line and a full range of motion maintained. What made this case un-usual was that usually meniscal tears are caused by contact sports injuries whislt this was an example of a 'non-contact' event. Investigation is MRI scan and treatment can be either medical, surgical or conservative. This case provides a worthy reminder that serious injuries can be caused by these games and people should take care!
Examination of the Knee: Revision
Inspect for muscle wasting, swelling, deformity, loss of full extension.
Feel for any effusion, patella and joint line.
Move to flexion and extension.
Function test collateral ligaments, and cruciate ligaments (anterior and posterior Drawer tes.
Further details on examination of the knee is in the ARC Musculoskeletal Assessment for Medical Students DVD.
The medical news making the headlines this week was regarding the postcode lottery for patients being given weight loss surgery.
Kmietowicz Z. Postcode lottery persists over weight loss surgery despite NICE guidance
22 January 2010, BMJ 2010;340:c427
Reports said that sometimes in the same hospitals patients with BMIs of greater than 60 were not being offered surgery whilst patients with a BMI of less than 40 from a different postcode were receiving bariatric surgery. The issue here does represent a somewhat ethical dilemma as to delivering equality of healthcare. Surgeons have reportedly said that there is no evidence to support the use of surgery in treating the most seriously ill, but it is cost-effective providing surgery, as consts of the operation will be re-couped within 3 years of the operation from money saved by obesity management. A quote: "In the UK an estimated 1 million people meet the NICE critria for obesity surgery and of this number around 240,000 have expressed interest in the surgery, yet only 4300 weight loss operations were carried out in 2009". The surgeons are calling for a long-term strategy that ensures all patients have equal access to equal access to treatment from appropriately equipped centres.
Almedghiol SM, Shablahidis O, Rennie W, Ashford R. Wii knee revisited: meniscal injury from 10-pin bowling. BMJ Case Reports 2009; doi:10.1136/bcr.11.2008.1189
A 23 year old woman presented to the orthopaedic clinic with right knee pain, sustained whilst playing bowling on the Wii. Meniscus tear is one of the most common injuries of the knee, cuased by axial loading and rotational force. The knee became swollen immediately after the incident although the patient was able to go about her normal business in the aftermath. She presented three months later with pain and tenderness over the medial aspect of her knee. On examination there was a mild effusion of the right knee with tenderness along the joint line and a full range of motion maintained. What made this case un-usual was that usually meniscal tears are caused by contact sports injuries whislt this was an example of a 'non-contact' event. Investigation is MRI scan and treatment can be either medical, surgical or conservative. This case provides a worthy reminder that serious injuries can be caused by these games and people should take care!
Examination of the Knee: Revision
Inspect for muscle wasting, swelling, deformity, loss of full extension.
Feel for any effusion, patella and joint line.
Move to flexion and extension.
Function test collateral ligaments, and cruciate ligaments (anterior and posterior Drawer tes.
Further details on examination of the knee is in the ARC Musculoskeletal Assessment for Medical Students DVD.
The medical news making the headlines this week was regarding the postcode lottery for patients being given weight loss surgery.
Kmietowicz Z. Postcode lottery persists over weight loss surgery despite NICE guidance
22 January 2010, BMJ 2010;340:c427
Reports said that sometimes in the same hospitals patients with BMIs of greater than 60 were not being offered surgery whilst patients with a BMI of less than 40 from a different postcode were receiving bariatric surgery. The issue here does represent a somewhat ethical dilemma as to delivering equality of healthcare. Surgeons have reportedly said that there is no evidence to support the use of surgery in treating the most seriously ill, but it is cost-effective providing surgery, as consts of the operation will be re-couped within 3 years of the operation from money saved by obesity management. A quote: "In the UK an estimated 1 million people meet the NICE critria for obesity surgery and of this number around 240,000 have expressed interest in the surgery, yet only 4300 weight loss operations were carried out in 2009". The surgeons are calling for a long-term strategy that ensures all patients have equal access to equal access to treatment from appropriately equipped centres.
Sunday, 17 January 2010
Haiti, Anthrax poisoning, Neurophobia and Racism
In the news this week was the devastating earthquake which hit Haiti, the poorest country in the Western Hemisphere. It seems now that between 50 and 100 thousand people have lost their lives and the photos show near 'apocalyptic' scenes. This made me think about the challenges to doctors and healthcare for people there. This week I've been in the A&E department or Ninewells. The centre is fully equipped to cope with all ranges of injury and the doctors have all of the resources they require at their disopsal. I think the biggest tragedy about Haiti is that a vast number of lives could probably have been saved with limited interventions eg. IV infusions, oxygen etc. There must be extremely limited resources and I wonder how the doctor's and aid workers in Haiti are coping at present. The loss of life in the whole incident is awful and the whole thing has been playing on my mind alot this week, thinking about the broader access to healthcare around the world. It just seems so unfair at times.
A few other things which took my attention this week from the BMJ.
Multiculturalism in the NHS - the experience of a not so foreign "foreign doctor". A Low.
A reminder by a doctor born in the UK but of Chinese origins that racism in the workplace is still common and that racial stereotyping does occur in clinical practice. He says that although he has lived in UK all his life, he frequently is asked questions such as 'How are you finding the climate over here then?'. It just reminded me about the multi-cultural nature of the UK at present and the benefits of having such an environment to live in.
Surgeons swear when operating: fact or myth? F Fausto Palazzo, Orlando J Warner
These guys did a study back in 1999 looking at the incidence of swearing in operating theatres and found that orthopaedic surgeons out of all specialities had on average the shortest time lapse between swearing. Thought it was a funny, light hearted article displaying a common truth!
A few other things which took my attention this week from the BMJ.
Multiculturalism in the NHS - the experience of a not so foreign "foreign doctor". A Low.
A reminder by a doctor born in the UK but of Chinese origins that racism in the workplace is still common and that racial stereotyping does occur in clinical practice. He says that although he has lived in UK all his life, he frequently is asked questions such as 'How are you finding the climate over here then?'. It just reminded me about the multi-cultural nature of the UK at present and the benefits of having such an environment to live in.
Surgeons swear when operating: fact or myth? F Fausto Palazzo, Orlando J Warner
These guys did a study back in 1999 looking at the incidence of swearing in operating theatres and found that orthopaedic surgeons out of all specialities had on average the shortest time lapse between swearing. Thought it was a funny, light hearted article displaying a common truth!
House calls: The case of the entertaining case. R Thomas.
An investigation into the hypothesis that neurology cases are more frequently used as case reports than other specialties. Apparently there is a bias amongst medical students for case reports which involve neurology. The authors looked the US programme 'House' starring Hugh Laurie and found that 28% of cases included neurological diagnoses, with infectious diseases being the 2nd most common category with 16% of diagnoses. I can't believe that to carry out this study these guys must have watched every episode of House and listed the diagnoses! Nonetheless an entertaining article.
Another topical story this week in the news has been about the recent number of cases in Scotland of patients who have been getting Anthrax poisoning as a result of contamination of heroin supplies. Apparently the story has made it all the way to the New York Times although and I did see a couple of suspected cases during the week in A&E.
Sunday, 10 January 2010
Student BMJ January 2010
A few interesting articles of note in the Student BMJ this week. Alot of the articles seem to carry the theme of the ageing population and the impact that this will have on medicine. I was going to write 'burden' there but I think that comes across as quite a derogatory word and that infact we should be thinking about what we can do to help the elderly who may be dependent on us.
One article reads: 'Half of babies born today will live to celebrate their 100th birthday'. This came according to a study in the Lancet:
Christensen K, Doblhammer G et al. Ageing Populations: the challenges ahead. Lancet 2009;374:1196-208
According to report, to meet these challenges it will be necessary to delay disability. At the moment in the UK there are 29 pensioners to every 100 people of working age however it is predicted that by 2050 this ratio will be 60 to every 100. This is a significant demographic change which is made worse by current low birth rates in the UK and low immigration rates. Health care services in many parts are at present 'inherently ageist'' and that this must change. To improve quality of life for older people, there must be a narrowing of the gap between life expectancy and healthy life expectancy. The healthcare system must be more prepared for the changes which have been forecast with greater funding put into causes, prevention and treatment of the disabilities that become more common with old age.
Much of the credit for allowing me time to write this goes to my very understanding girlfriend who is very stressed about her ward simulation exercise, which I am not helping very much. Maybe if I'm going to be a doctor I should look after my patients more. My girlfriend would like to note that I always support her and that I make her feel much less stressed and worried about things, so I will likely make an excellent doctor.
One article reads: 'Half of babies born today will live to celebrate their 100th birthday'. This came according to a study in the Lancet:
Christensen K, Doblhammer G et al. Ageing Populations: the challenges ahead. Lancet 2009;374:1196-208
According to report, to meet these challenges it will be necessary to delay disability. At the moment in the UK there are 29 pensioners to every 100 people of working age however it is predicted that by 2050 this ratio will be 60 to every 100. This is a significant demographic change which is made worse by current low birth rates in the UK and low immigration rates. Health care services in many parts are at present 'inherently ageist'' and that this must change. To improve quality of life for older people, there must be a narrowing of the gap between life expectancy and healthy life expectancy. The healthcare system must be more prepared for the changes which have been forecast with greater funding put into causes, prevention and treatment of the disabilities that become more common with old age.
Much of the credit for allowing me time to write this goes to my very understanding girlfriend who is very stressed about her ward simulation exercise, which I am not helping very much. Maybe if I'm going to be a doctor I should look after my patients more. My girlfriend would like to note that I always support her and that I make her feel much less stressed and worried about things, so I will likely make an excellent doctor.
Abdominal Aortic Aneurysm Screening and Tube Feeding
This week I've been doning my anaesthetics attachment. One of the patients undergoing a general anaesthetic whom I followed was a 76 year old man who had presented with a massive abdominal aortic aneurysm. I read this article on the BMJ about screening for AAA. I had not known previously that this was done but it definitely gave me the impression that abdominal aortic aneurysms are much more common than perceived!
26th June 2009 - Screening prevents aneurysm deaths but questions remain over cost-effectiveness.
Screening is an interesting public health topic and one that we quite often grapple with one the medical course. Of course it is only useful screening for diseases if they are treatable. It is clearly now thought in the UK that a National Screening programme for this for over 65s will prevent about half of all aneurysm deaths (approx 6,000 men die from a ruptured AAA every year). In order to calculate cost-effectiveness, one study used QALY - a combined measure of quantity and quality of life). They found that infact the cost-effectiveness of the screening was not as true as the reporters had suggested.
Another interesting article which I read this week was on the BBC News website. They compiled a news report that in the UK there was widespread inappropriate tube feeding of patients.
6th January 2010. 'Jane Dreaper. Inappropriate tube feeding of patients 'widespread'. BBC News.
The Royal College of Physicians maintained that every effort needs to made to ensure that feeding is by mouth for as long as possible, but that with increasining numbers of patients with dementia, feeding difficulties were becoming a 'growing problem'. It was re-iterated once again that the patient must come first in these circumstances. It is perceived that in some places 'tube feeding' is carried out because it is possibly 'easier'. This is a suggestion which The Alzheimers Society repute and say is unacceptable. As doctors I think that it is important that we put the patient first, considering their needs, and advocate oral feeding for as long as possible in caring for patients with dementia.
And just on another note - this week the elective flights have been booked!
I'm flying Virgin Atlantic, Glasgow to Barbados, Grenada on Saturday 10th July.
Returning from Havana to London on Monday 6th September. Something to definitely look forward to over the next 6 months!
26th June 2009 - Screening prevents aneurysm deaths but questions remain over cost-effectiveness.
Screening is an interesting public health topic and one that we quite often grapple with one the medical course. Of course it is only useful screening for diseases if they are treatable. It is clearly now thought in the UK that a National Screening programme for this for over 65s will prevent about half of all aneurysm deaths (approx 6,000 men die from a ruptured AAA every year). In order to calculate cost-effectiveness, one study used QALY - a combined measure of quantity and quality of life). They found that infact the cost-effectiveness of the screening was not as true as the reporters had suggested.
Another interesting article which I read this week was on the BBC News website. They compiled a news report that in the UK there was widespread inappropriate tube feeding of patients.
6th January 2010. 'Jane Dreaper. Inappropriate tube feeding of patients 'widespread'. BBC News.
The Royal College of Physicians maintained that every effort needs to made to ensure that feeding is by mouth for as long as possible, but that with increasining numbers of patients with dementia, feeding difficulties were becoming a 'growing problem'. It was re-iterated once again that the patient must come first in these circumstances. It is perceived that in some places 'tube feeding' is carried out because it is possibly 'easier'. This is a suggestion which The Alzheimers Society repute and say is unacceptable. As doctors I think that it is important that we put the patient first, considering their needs, and advocate oral feeding for as long as possible in caring for patients with dementia.
And just on another note - this week the elective flights have been booked!
I'm flying Virgin Atlantic, Glasgow to Barbados, Grenada on Saturday 10th July.
Returning from Havana to London on Monday 6th September. Something to definitely look forward to over the next 6 months!
Friday, 1 January 2010
Happy New Year 2010
Happy new year!
I went down to Stonehaven last night for the Hogmanay celebrations and watched as 48 locals swung the traditional 'fireballs' to bring in the new year down the historic high street. The snow and full moon made for a really special atmosphere last night and it was great event. The programme guide to the evening provided me with some interesting insights into Hogmanay in Scotland which I had never known before!
For many centuries in Scotland, Christmas was not the major celebration and it was only in the 1950s that Christmas became popular. Christmas was virtually banned for a time before this after a Protestant Reformation as the Kirk portrayed christmas as a Catholic feast.
'Redding the house' is one popular tradition in which the home is given a thorough clean on Hogmanay, particularly the fireplace, in prepration for the new year. Another tradition is 'first-footing' in which the first person to enter the house after midnight brings gifts such as salt, coal, shortbread, whisky or a black bun to bring luck to the householder. A tall, dark, hansome young man is said to bring the best luck whilst women and vicars are unlucky. A blonde or red-head is unlucky because they are assumed to be unwelcome Norsemen.
The idea of the Stonehaven fireballs is to 'burn off the bad spirits left from the old year so that the spirits of the New Year can enter, clean and fresh. The ceremony goes back for over 150 years and unlike the Glasgow / Edinburgh street parties has apparently never been cancelled! To be eligible to be a fireball swinger you have to be either from Stonehaven or have family from the area, and have to volunteer to help at the event for atleast two years beforehand.
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