BMJ Articles from July

Diabetic Ketoacidosis - For children and adolescents with type 1 diabetes this remains a major cause of morbidity and mortality. The most dangerous aspect of the condition is cerebral oedema but other life threatening aspects of the condition include hypokalaemia, pulmonary oedema and cerebral thrombosis. So what are the factors which can predict patients at risk? Younger age of onset of diabetes, missed diagnosis and certain ethnic groups are at higher risk. Protective factors include family history of diabetes and improved education levels. There has been a drive to increase doctors' abilities to recognise the signs of DKA and all hospitals should now have protocols in place which can be followed in the event of an emergency.

Malnutrition and Mortality in Africa - There hasn't been an awful lot of media coverage of the devastating droughts which have hit several countries in the Horn of Africa this year. Countries such as Ethiopia, Kenya and Somalia and in desperate need of aid. Acute malnutrition is a major health risk in these countries. The situation worst for the thousands of refugees who have been displaced from Somalia who are crossing into Ethiopia and Kenya. The WHO has set an emergency acute malnutrition threshold of 15% yet as many of 55% of children from arriving in refugee camps from Somalia are malnourished. Unicef have regional emergency health centres with experience in nutritional rehabilitation activities to try to tackle the ongoing problem.

What is the Evidence for Drinking Water? - Margaret McCartney, a GP from Glasgow, writes in the BMJ about the real evidence behing claims that we are not drinking enough water. It is recommended that adults drink 1.5 to 2 litres of water per day. But who is providing the evidence behind all of this? It's all backed by mineral water companies and food giant Danone. They all say that we are not drinking enough, however independent research has concluded that not only is there no scientific evidence that we need to drink that much, this recommendation could actually be harmful by precipitating hyponatraemia. Closely examining the evidence supported by Danone finds it to be weak and subject to selection bias. I think this is a good example of why it is important to see who is sponsoring research articles and to use critical appraisal when searching for information.

Pain Management to Treat Agitation in Dementia - Lastly, in this weeks BMJ is an article about treating agitation in patients with dementia. While neuropsychiatric symptoms are very common in dementia, it is often not managed well. New evidence published this month shows that treating underlying pain may be an effective method of intervention. The authors hypothesised that undertreated and underdiagnosed pain is associated with agitation in dementia. They carried out a randomised controlled trial and were able to show improved outcomes for patients given analgesics. This study opens up a new opportunity for improving the way we look after agitated patients with dementia.  

Graduation and Summer Holiday

Graduation (24th June 2011) Caird Hall, with Heather

Garden Party - Outside the Union

Graduation Ball (4th June 2011) Aviemore

A few things that have been going on since last month - Grad Ball in Aviemore, Rockness, T in the Park, Graduation in Dundee and the University Grad Ball, Northern Ireland for MacFest and Banchory. Here's a couple of photos.

Start my shadowing at the end of the month so enjoying a final week off and getting organised before it all kicks off!