MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'MJM Wardrounds' source. Mon, 17 Nov 2008 22:51:05 +0100 http://wardround.blogspot.com/2008/11/wardround-7xi8.html The reading for Tuesday is Comment: When not to write about autism, Ewen Calloway. New Scientist. Read it, think, and discuss.More to comeMJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1945218 Sat, 08 Nov 2008 14:17:00 +0100 1945218 http://wardround.blogspot.com/2008/10/wardround-24x8.html The Two minute talks today were about arrythmias. Well researched and reasonably timed, but I would suggest more thought is given to the two minute limit. For next week : opportunistic infections with HIV: Pneumocystis pneumonia, atypical mycobacteria, toxoplasma, candida and cryptococcus. You have your assignments. If we have any extra people gatecrashing the talk they should choose another to do eg aspergillus, TB etc.The paper for discussion on Tuesday will be The kindness of strangers. Eileen Palmer, BMJ 2008;337:a1993.MJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1905872 Fri, 24 Oct 2008 14:27:00 +0100 1905872 http://wardround.blogspot.com/2008/10/wardround-10x8.html The Reading for Tuesday is Trust, Anonymous, Bandolier. Read and think. Articles can be like lamps. Look at them carefully before choosing to use one for illumination. It could enlighten the subject matter, cast important issues into relative shadow, or even blind you to the whole subject.The talks this week were excellent. Imported infections are not as uncommon as you might think, even in a place like D&G. The important thinks to know are where they have been, what they have been doing, who else has been involved. Use a resource such as travalax to find what is happening in the region and don't overlook the treatable (malaria, bacterial sepsis). I wondered about putting rabies in those parentheses, but perhaps that should be in the preventable category. I would suggest you read the l... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1870693 Mon, 13 Oct 2008 09:35:00 +0100 1870693 http://wardround.blogspot.com/2008/10/wardround-3x8.html The reading material for Tuesday is Commercial Features of Placebo and Therapeutic Efficacy, Rebecca L. Waber; Baba Shiv; Ziv Carmon; Dan Ariely, Journal of the American Medical Association, March 5, 2008; 299: 1016-1017. Get it via the elibrary, read and think.Our two minute tutorials for Friday are Imported diseases. You each have two minutes to enlighten us on the patient who is feverish and:Fell in the water of Lake Malawai (H)Was bitten by a dog at Giza (F)Was bitten by a bug on the Amazon (A)Has a nosebleed having returned from Wagadugu (Z)MJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1853593 Mon, 06 Oct 2008 09:35:00 +0100 1853593 http://wardround.blogspot.com/2008/09/wr-27ix8.html The read and think for Tuesday is Orphan diseases: which ones do we adopt? T Richards, BMJ 2008;337:a1225. The two minute talks for Friday are themed around Acute Hepatitis. Educate the yourself and the group.Alcoholic (H)Viral (A)Autoimmune (F)Toxic (Z)MJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1837186 Sun, 28 Sep 2008 20:02:00 +0100 1837186 http://wardround.blogspot.com/2008/09/wardround-12ix8.html The reading assignment for Tuesday is Titrating Guidance, Nathan Goldstein, Anthony Back, Sean Morrison. Arch Intern Med. 2008;168(16):1733-1739. Friday's two minute talks are the recognition and management of psychiatric disorders on medical wards: Delerium tremens, Depression, the aggressive patient.MJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1791610 Sun, 14 Sep 2008 20:36:00 +0100 1791610 http://wardround.blogspot.com/2008/09/wardround-5ix8.html The reading for next Tuesday will be Mistakes. Ruth Lesnewski. JAMA. 2006;296:1327-1328. get it with elibrary.Read and think.Friday's tutorial assignments will be Acute ColitisIschaemicInfectiveInflammatoryTwo minutes please, keep it precise and concise, quote your sources and illustrate with a handout.Interesting TopicsTransverse MyelitisMJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1773204 Sun, 07 Sep 2008 17:14:00 +0100 1773204 http://wardround.blogspot.com/2008/08/wardround-29viii8.html Why was a rheumatologist asked to see this patient?The reading this week about the methods magicians use to distract their audience led to some discussion of distraction, its benefits and pitfalls in medicine, the importance of not interrupting the 'rituals' of medicine that doctors use to keep on track and recognising when we ourselves have been distracted from the path.For next week I would like you to read Why are medical journals so dull by Richard Asher. Originally published in the BMJ in 23 August 1958. Tempted as I am to leave you to get hold of the paper using your own initiative there is a link here if you do not feel like taking up the challenge. The link works for me but if you are unsuccessful I can give you a paper copy (folded in the shape of a dunce's hat!)As ever the origin... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1742740 Fri, 29 Aug 2008 20:20:00 +0100 1742740 http://wardround.blogspot.com/2008/08/wardround-22viii8.html The reading for next Tuesday will be Magician's Hand: How Humor And Misdirection Can Manipulate Levels Of Attention. You may also want to look at this related article.Please read the articles and give them some thought. Is this relevant to medicine? The two minute talks this week were the ECG. What is normal and what is not? What do you think was the most interesting or useful point in your talk. Click the comment button and type it in. I put together a little list a couple of years ago that you could revise from. The two minute talks for next Friday will be mibrobiology 101: what should go through your mind when you get a call that your sick patient's blood cultures have grown: Gram positive cooci HMGram negative cocci SVGram positive rods ZBGram negative rods HJ Keep it precise (actual f... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1726354 Fri, 22 Aug 2008 11:42:00 +0100 1726354 http://wardround.blogspot.com/2008/08/wardround-15viii8.html The reading for next Tuesday will be The road to recovery. D Pisetsky. Please read the article and give it some thought. The two minute talks this week were about common drugs: Furosemide, Coamoxiclav, Enoxaparin. The prize this week goes to HM. What do you think was the most interesting or useful point in your talk. Click the comment button and type it in. The two minute talks for next Friday will be The ECG. What is normal and what is not? Let's have two minutes on: P wave HJQRS complexAxisST segment HMT wave SG Keep it precise (actual figures not general descriptions) and concise, educate your audience, quote sources, produce a handout and keep to two minutes.The morbidity/mortality meeting is on Thursday 28th August. Time to start preparing now. Interesting topics: Fallot's tetralogyWe... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1709097 Fri, 15 Aug 2008 13:01:00 +0100 1709097 http://wardround.blogspot.com/2008/08/wardround-8viii8.html On Friday I will talk to you about the training side of the ward work, so you are spared giving a talk until next week.The reading for next Tuesday will be The minefield of medical morals. D Sokol.Please read the article and give it some thought.The two minute talks for next Friday will be common drugs. Let's have two minutes on:Furosemide HMCoamoxiclav HJEnoxaparin SGOmeprazole RVPrednisolone just in caseRemember, the aim of the aassignment is that both you and your audience increase your knowledge or understanding of the topic. Don't waste too much time telling us things we will already know. The time is limited to two minutes and you should practice your talk and timing before the big day. Don't give a five minute talk in two minutes, edit it down to time. Always quote yo... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1686220 Wed, 06 Aug 2008 15:17:00 +0100 1686220 http://wardround.blogspot.com/2008/08/welcome-to-new-trainees-goodbye-to-old.html The reading for thought on Tuesday will be Meeting the ethical needs of doctors. Daniel K Sokol. BMJ 2005;330:741-742.Welcome to the new trainees. Could I ask you to look over to the right hand side of this page and click on the "Training" link please. There is a little about work on the ward there and a timetable for yourself and me.There will not be any assigned two minute talks this Friday. What I would like each of you to do is tell us a little about yourself and what you wish to do this year, and after that. The usual Friday rules apply. Only two minutes please.MJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1677002 Sun, 03 Aug 2008 22:45:00 +0100 1677002 http://wardround.blogspot.com/2008/07/holiday-break.html I am off to the land of large portions for a couple of weeks, there to stress my labyrinths and top up my vitamin D. The blog will resume on the 28th.MJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1603037 Wed, 09 Jul 2008 19:33:00 +0100 1603037 http://wardround.blogspot.com/2008/07/wardround-4vii8.html The reading for Tuesday will be Precision in diagnosis, John Todd, Lancet 1952: 260 (6748); 1235-37. It is available via the elibrary. You may be able to use this link after logging in to elibrary/Athens...but if the link fails you....you should still have enough information to find the pdf.We will decide upon Friday's topics on Tuesday.MJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1582938 Sun, 06 Jul 2008 21:46:00 +0100 1582938 http://wardround.blogspot.com/2008/06/wardround-20vi8.html The reading for Tuesday will be The rational clinical examination. Does this patient have abnormal central venous pressure? Cook DJ, Simel DL. JAMA 1996; 275: 630-4.The two minute talks for Friday will be slightly different. I would like you to look over a guideline of your choice (but related to adult general internal medicine, of course) and present 5 useful points from the document. As a warning example I would not find it useful to be told that nebulised beta agonists are useful in the management of acute exacerbations of COPD (I know that already), but I don't know how useful.Not education except in its widest sense, but here are some pictures from the Summer Ball.MJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1537921 Mon, 23 Jun 2008 08:30:00 +0100 1537921 http://wardround.blogspot.com/2008/06/wardround-13vi8.html The reading for next Tuesday will be The Midnight Meal and Other Essays about Doctors, Patients, and Medicine, Jerome Lowenstein. I have put a copy on the ward.The two minute talks for next week will be your diagnosis of the Plague of Athens. You will find a description of the outbreak in The History of the Peloponnesian War written by Thucydides in 431 B.C. If you click on the link it will take you to a copy of the piece. The web page begins with chapter VI, but you can skip down to chapter VII (unless you would like to read about the war). If you cannot find the right section, press ctrl-F and type in plague.You need to have an opinion on the diagnosis and be prepared to argue your corner. Make sure you revise the signs and symptoms of the disease you choose. I will post the discussion t... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1516507 Fri, 13 Jun 2008 15:26:00 +0100 1516507 http://wardround.blogspot.com/2008/06/wardround-6vi8.html The reading for Tuesday is Doctors, Lawyers and Wolves. George J Annas, Lancet 31 May 2008. Read and reflect please.The two minute talks are neurologically themed. The specific assignments are no longer in my possession, but you have them and can forewarn the newcomers.A short post I am afraid but as well as working this weekend I have been sorting out my email account at home which had been reporting "2,147,433,168 messages unread". MJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1502552 Sun, 08 Jun 2008 22:02:00 +0100 1502552 http://wardround.blogspot.com/2008/06/wardround-30v8.html An interesting update on skin infections. What did you learn?Cellulitis is a common condition in acute medicine. Always ask yourself if this is 'simple' or complicated. Is there immunosuppression, skin integrity, rapid progression, unexpected pain, recurrence, poor response to treatment?You already have your asssignments for next week's talks and the discussion for Tuesday was posted last week.The May M&M meeting when very well I felt.Interesting topicsUnsuspected Pulmonary thromboembolismMJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1481842 Sun, 01 Jun 2008 13:21:00 +0100 1481842 http://wardround.blogspot.com/2008/05/wardround-23v8.html Endocrine emergencies. Well done. I had given YA 10/10 in my notebook for his talk on acute hypoadrenalism, so I was forced to give Thyrotoxic storm by EM a 10+. I think you have grasped what is needed.Many of the emergencies discussed can be misdiagnosed as other common conditions and considering the possibility is just as important as knowing what to do.I will share with you that my soul shudders each time someone recommends "routine bloods". I can cope with "x, y and z should be routine bloods in the investigation of...". Be specific.For next Friday the assignments are based on skin infections:Infection following animal bitesLower leg cellulitis (A)Cellulitis in the immunocompromised host. (S)Necrotising fasciitis (Y)Facial cellulitis (N)Shinglesrequirements: Concise, unrushed, precise,... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1467845 Sun, 25 May 2008 22:31:00 +0100 1467845 http://wardround.blogspot.com/2008/05/wardound-16v8.html Our discussion paper last week was The reading for discussion on Tuesday will be DNR or PEACE. J Crampton. BMJ 2008;336:1015. An interesting discussion ensued. If you would like to read more on the subject could I suggest you take a look at Decisions relating to cardiopulmonary resuscitation A joint statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing from October 2007For next Tuesday the reading will be Liz Wager: Training and the placebo effect.Our talks this week were about poisoning, and overall I think they were well researched and presented as spoken mini-essays. I would like you, now, to think about these talks in a different way. The aim is to teach/train/educate your audience. This differs from writing an essay (or giving ... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1450258 Sun, 18 May 2008 14:45:00 +0100 1450258 http://wardround.blogspot.com/2008/05/wardround-9v8.html Our discussion this week, in the absence of a paper to read, was about improving practice by Morbidity and mortality meetings. We will now run an M&M meeting on the last Thursday of each month. There is an M&M folder in the Nurses office. All deaths for the month should be listed there. The GAJ team will review MJM patients and vice versa. The Necessary patients notes will need to be pulled the week before. Our two minute talks were about the investigation of malignancy of unknown origin. A useful discussion I think. We heard about the more common cancers nad discussed how that should guide our history, examination and investigation. The use of tumour markers produced further discussion, which can I think be generalised to the use of many tests in medicine. For next week: The read... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1432450 Fri, 09 May 2008 16:05:00 +0100 1432450 http://wardround.blogspot.com/2008/04/wardround-25iv8.html The discussion this Tuesday began with the paper The strange malady of Alessandro’s uncle, Neil A (Tony) Holtzman. I was prompted to choose the paper following the journal club discussion last week about the genetic markers for responses to warfarin. The paper describes the development of a new (genetic) investigation and treatment and its impact on the aforementioned uncle. Many interventions will appear better than they prove to be when evidence is limited.and the passage of time gives more accurate assessments.The paper for discussion next week will be Screening for MRSA, M Wilcox, BMJ 2008;336:899-900The two minute tutorials on diagnoses were well done but I would recommend adding an additional aliquot of thought to the planning stage. Ask yourself, “what do I want the listener to ... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1404068 Mon, 28 Apr 2008 08:10:00 +0100 1404068 http://wardround.blogspot.com/2008/04/wardround-18iv8.html Back on-line.The reading for Tuesday will be The strange malady of Alessandro’s uncle, Neil A (Tony) Holtzman. BMJ 2007;335:1306-1307, (doi:10.1136/bmj.39407.647014.80). Read it and think, then share your views.The two minute talks for Friday will be Making a diagnosis: you can decide among yourselves who will make each presentation.What constitutes Diabetes mellitus?What constitutes COPD?What constitutes Coronary artery disease?What constitutes Delirium?Two minutes please. practice it and make sure your timing is accurate. be concise and precise, quote your sources.Interesting topicsHypereosinophilic syndrome or look in uptodate which has an excellent article on the subject.And here is an article worth a read, Blood Eosinophilia: A New Paradigm in Disease Classification, Diagnosis, and ... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1386044 Sun, 20 Apr 2008 13:44:00 +0100 1386044 http://wardround.blogspot.com/2008/04/out-of-action-at-present.html (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1347368 Thu, 03 Apr 2008 13:07:00 +0100 1347368 http://wardround.blogspot.com/2008/03/wardround-7iii8.html Last week's talks were about substance abuse: acute management and harm reduction. Good talks, full of useful information but the handouts were a little to bulky for my liking...try something that can be taken in with one or two glances rather than a page that requires reading. Have a look at this as an example. This would probably be the equivalent of all the talks at a Friday meeting.What pearls have I taken away from these talks? (if I've missed a good one just add it to the comments section)Myocardial sensitisation to catecholamines with solvent inhalation: aim for calm and quiet surroundings, monitor cardiac rhythm and use sedation if necessary. The acute effects should have worn off by 6 hours , and if not consider a complication such as myocarditis.In acute alcohol withdrawal there ... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1288397 Sat, 08 Mar 2008 15:40:00 +0100 1288397 http://wardround.blogspot.com/2008/03/wardround-29ii8.html The talks this week were about interstitial lung diseases. You are getting the hang of it now; Information targeted at clinical practice and delivered so as to be memorable. The best talk/handout this week was Extrinsic allergic alveolitis (Dr NNT). Remember to ask about activities up to 6 hours before the onset of acute dyspnoea. Always consider infective causes. (I have a feeling that I need to take care not to evolve into an Infectious Diseases evangelist.)For next week the assignments are based on substance misuse:Glue (MR)Alcohol (NNT)Cocaine (KL)Crystal Meth (R)Two minutes please on the management of acute toxicity and harm reduction.The reading last week was Doctors’ education: the invisible influence of drug company sponsorship. Ray Moynihan. BMJ 2008;336:416-417. You may want to... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1272524 Sun, 02 Mar 2008 22:14:00 +0100 1272524 http://wardround.blogspot.com/2008/02/wardround-22ii8.html The reading for Tuesday will be, Doctors’ education: the invisible influence of drug company sponsorship. Ray Moynihan. BMJ 2008;336:416-417 (23 February).There is an extended podcast on rheumatoid arthritis, with slides available (60 minutes duration) at the training site.MJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1255058 Mon, 25 Feb 2008 12:19:00 +0100 1255058 http://wardround.blogspot.com/2008/02/wardround-15ii8.html A good attempt (first/second stabs) at the two minute talks on Friday. Much effort for so little gain. But this is the point of training...getting better. Next week we have Neuropathy as our topics, split into acute, subacute and chronic. Ask yourself "what do I want to learn?" "what do I want my colleagues to remember?" " how can I get he message accross so they remember?"Then prune it to two minutes, keep it concise and yet precise and quote your sources. make a handout to get the message accross. And be realistic; no one will read a 400 word A4 handout but they will glance at pictures. And another piece of advice. Have the handouts ready before the wardround starts.Here is my old podcast on NeuropathyIt won't be visible inside DGRI but it is also available here.The reading for Tuesday i... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1238163 Sun, 17 Feb 2008 21:51:00 +0100 1238163 http://wardround.blogspot.com/2008/02/wardround-8ii8.html The reading for Tuesday is Clinical craft: a lesson from Liverpool. D M Gore. Journal of Medical Ethics 27:74-75 (2001). Read and think.The talks this week were about rheumatological presentations to admissions units. Well done to Dr Lewin for a well presented (and acutely timed) talk on the red eye, diarrhoea, sore joints syndrome, and with little warning. It is worth having a looke at the recently produced guidelines for the hot swollen joint. By the way (SZ) it wasn't that difficult to find, being the second hit when I googled it. You might want to see my summary sheet. In dealing with the various scenarios, I would recommend differentiating joint/muscle symptoms with or without objective signs and with or without involvement of other organ systems. SIRS is sepsis until you know otherwi... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1221267 Sun, 10 Feb 2008 21:39:00 +0100 1221267 http://wardround.blogspot.com/2008/02/wardround-1ii8.html The Reading for next Tuesday is Waste in the NHS, Andrew Moore, Bandolier Extra, February 2002. Give yourself time to read it, then let's hear what you think.The two minute talks this week were about Gram stained rods and cocci. You should now be able to target appropriate antibiotics a little better. Don't ever think "I'll use a broad spectrum antibiotic".....plan the spectrum to cover the clinical situation.The talks for next week will be about rheumatological emergencies.The single hot joint SZGeneralised myalgia/arthralgia CGRed eye, diarrhoea, and sore joints PMA two minute talk please, keep it concise and precise, quote your sources and provide a one sheet handout.Interesting topicsHelicobacterMJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1197989 Sun, 03 Feb 2008 19:32:00 +0100 1197989 http://wardround.blogspot.com/2008/01/wardround-25i8.html Our discussion this week was about ethics. The use of jokes which might offend, open-ness with patients, harrassment, ethics committees, politics and medicine all had their moment. It can be helpful to think out loud. For next week the discussion will be about the ethics of offering or declining transplantation to a patient with several co-morbid conditions and difficulty adhering to established models of care.You will have an opinion (that’s an order). But why do you have that opinion? Can you see why others may have a different opinion? Who is right? How can you best structure the problem for analysis? Would an ethics committee help? How? How can you recognise whether you are virtuous (in your decision) or lacking both virtue and insight?The two minute talks this week were about urinar... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1177684 Fri, 25 Jan 2008 15:21:00 +0100 1177684 http://wardround.blogspot.com/2008/01/wardround-18i8.html The ethical dilemmas to read for Tuesday are to be found here and then An ethical dilemma, BMJ 2001;322: 1236-1240.Tutorials for Friday (Urinary infections)Interesting TopicsPICC lines (This is I think the original poster and can be read without visual aids )MJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1165314 Sun, 20 Jan 2008 22:51:00 +0100 1165314 http://wardround.blogspot.com/2008/01/wardround-11i8.html The discussion for Tuesday is this video by students. You may need to view it outside DGRI, I think youtube access will be blocked in the hospital network.The two minute tutorial theme this week (and next week) is immunisation. We heard about Pneumococcus (NS), HiB (SZ), meningococcus (MG) and influenza (CG). A little more tweaking is needed to get the essential information into two minutes. For next week we will hear about: BCG, smallpox, polio and Hep B. Any audits spring to mind?Two minutes please. Identify what you think is the essential information to get across, and remember that diluting that with waffle/unimportant points will impair meme transfer.Interesting topics.PancreatitisTrimethoprim and creatinineMJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1147260 Sun, 13 Jan 2008 16:16:00 +0100 1147260 http://wardround.blogspot.com/2008/01/wardround-4i8.html Happy new year for 2008. May your knowledge expand, ignorance regress and wisdom blossom.The reading for Tuesday 8 january will be The practice of clinical medicine as an art and as a science , John Saunders, Journal of Medical Ethics 26:18-22 (2000). The two minute tutorial theme for friday is immunisation: there is a medscape CME session which covers five main areas (a page each). Your task is to read the page allocated to you and translate it into UK guidance for the rest of us.There is a 'Green book' issued in the UK with guidance on immunisation so you could look into that for inspiration. You can find an on-line version here.Pneumococcus NSHiB SZmeningococcus MGinfluenza CGpolio SSTwo minutes maximum, keep it concise and precise with an A4 size handout to mak... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1130995 Fri, 04 Jan 2008 16:17:00 +0100 1130995 http://wardround.blogspot.com/2007/12/wardround-7xii7.html The two minute tutorials this week were acute endocrine emergencies. I will upload the Addisonoan Crisis sheet to the summary sheet section. Remember, think about hypoadrenalism in any patient with shock, especially if they have a history of steroid use.For next week the talks are themed around Malaria:Epidemiology HJFalciparum JRVivax (Kaur)Malariae/Ovale NSAcute malaria SSTravel prophylaxis KGTwo minutes please. Concise yet precise and quote your sources. The aim is not ‘to give a talk’ but to educate by giving a talk. Those handouts deemed up to scratch will be added to the permanent collection. We know this is a difficult task, that is why we challenge you with it.The paper for discussion on Tuesday isClinical decision-making: Coping with uncertainty. A F West; R R WestPostgraduate... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1082883 Mon, 10 Dec 2007 10:10:00 +0100 1082883 http://wardround.blogspot.com/2007/12/wardround-30xi7.html This week’s intellectual task, if it can be so called, was the three minute test. The score you achieved is far less important than what you learned from the exercise. When one looks up the treatment of “an emergency”, in this case (life threatening) hyperkalaemia, it is essential to see how you would enact it in real life. For example, drugs must get from the cupboard/trolley into the patient’s bloodstream and do not just magically do so as they might in your mind. When reading the book ask yourself how you would get each step done. And don't forget to get and use help efficiently.The case began with “Doctor, the lab have rung with his results. The creatinine is 491”. Elevated creatinine levels must always be qualified with a potassium result. Your response should have been a ... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1064853 Sun, 02 Dec 2007 22:22:00 +0100 1064853 http://wardround.blogspot.com/2007/11/wr-24xi7.html This week we had our occasional quiz. You will know, in your hearts and minds, two things.....what score you got and what proportion of your correct answers you guessed. Your next task is to revise the areas of which you were unsure.For next week:The reading for Tuesday will be What's wrong with the wards? K Teale BMJ 2007;334:97 (13 January).The two minute tutorials are suspended again on Friday, to be replaced by the 3 minute emergency quiz. bring a pen and piece of paper.Interesting topicsDuodenal ulcerMJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1049874 Mon, 26 Nov 2007 10:56:00 +0100 1049874 http://wardround.blogspot.com/2007/11/wardround-24xi7.html This week we had our occasional quiz. You will know, in your hearts and minds, two things.....what score you got and what proportion of your correct answers you guessed. Your next task is to revise the areas of which you were unsure.For next week:The reading for Tuesday will be What's wrong with the wards? K Teale BMJ 2007;334:97 (13 January).The two minute tutorials are suspended again on Friday, to be replaced by the 3 minute emergency quiz. bring a pen and piece of paper.Interesting topicsDuodenal ulcerMJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1049875 Mon, 26 Nov 2007 07:20:00 +0100 1049875 http://wardround.blogspot.com/2007/11/assessing-patient-with.html How to assess a patient with spondyloarthropathy.mp3 filealso available here with notes (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1034192 Sat, 17 Nov 2007 20:44:00 +0100 1034192 http://wardround.blogspot.com/2007/11/wardround-9xi7.html The two minute talks this week were based around “the use of...” various drugs. I hope that these have stimulated some thought....and curiosity about other drugs you use regularly. It is important as you continue in your training to give increasing thought to the reasons and evidence behind the guidelines and advice associated with drugs.Gentamicin: (SS) a drug with a narrow therapeutic window. Various methods exist for monitoring gentamicin levels. The aim is to give the correct dose (to achieve levels high enough for effect and low enough to be safe). It is because dose calculations do not always predict the correct dose that levels must be monitored to allow fine tuning of dose and frquency.Thrombolytics (HJ) nostalgia prompted my question about fibrinolytics (apologies). Another dr... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1019354 Sun, 11 Nov 2007 21:53:00 +0100 1019354 http://wardround.blogspot.com/2007/11/wardround-2xi7.html This week’s read and think had been The homeless man on morning rounds, an essay by J Lowenstein. If you found it interesting , you might want to read some of his collected essays in The Midnight Meal.For next Tuesday I would like you to read Thoughts for new medical students at a new medical school, Richard Smith BMJ 2003;327:1430-1433 (20 December), …and tell me which is your favourite box in the paper. This week’s two minute tutorials were themed around respiratory problems, addressing the respiratory history (nicely done SS, don’t forget occupational history); PFTs (needed a bit more work on transfer factor etc, KM); ABGs (good clear talk AA; NIV (you should have been able to explain why BiPAP helps, HA); The assessment of a breathless patient (quite rightly focussed on... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=1000988 Fri, 02 Nov 2007 15:13:00 +0100 1000988 http://wardround.blogspot.com/2007/10/wardround-26x7.html The paper for discussion on Tuesday will be The homeless man on morning rounds from The Midnight Meal and Other Essays about Doctors, Patients, and Medicine by Jerome Lowenstein. I have left a copy on the ward. ...and what is a home?The two minute tutorials for Friday will have a respiratory theme.:A respiratory history SSPFTs KMCXR interpretation HJABG interpretation AAThe approach to the (acutely) breathless patient JBNIV HAThese will be a challenge. Remember to keep it concise yet precise. Don't try to squeeze too much information in. Produce a handout and quote your sources.Interesting topics:Has Chlamydia changed to Chlamydophila? (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=987142 Mon, 29 Oct 2007 14:22:00 +0100 987142 http://wardround.blogspot.com/2007/10/extra-articular-ra_25.html A brief talk about extra-articular disease in RA.If you cannot see the pictures look at this other version. (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=979178 Thu, 25 Oct 2007 19:44:00 +0100 979178 http://wardround.blogspot.com/2007/10/wardround-5x7.html Thank you for the talks on skin infection which I very much enjoyed. I hope you now have a background knowledge to help you choose, or guide the choice, of antibiotics and their route of administration. Remember to ask yourself "what can I do to reduce the likelihood of recurrence?" when you see a patient with these disorders. What would you do?The two minute talks for next weekwill be on Atrial Fibrillation: two minutes please on the topics listed. Keep it concise yet precise, educate yourself and your colleagues, and quote your sources. Keep the info sheet short and simple.assessing thrombotic risk AAthe case for rate control SYCthe case for rhythm control KMIf anybody else wishes to join the group they must bring a two minute talk.I do not think there will be time for a discussion paper... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=933993 Mon, 08 Oct 2007 10:11:00 +0100 933993 http://wardround.blogspot.com/2007/09/21ix7.html Our two minute talks last week were based on the investigation of abnormal LFTs but we got sidetracked into the interpretation of hepatitis B serology. This was I hope a useful time both for the specifics of understanding HepB serology and the general point of structuring your knowledge in a way which is useful for practical use. When learning a new topic, or revising an old one remember that the way it is structured in the textbook may need translating to make it easier to remember or apply. Test yourself…which tests are useful for: Assessing response to Hep B immunisation? Checking for previous contact with Hep B? Acute hepB? Chronic Hep B? Next is Opportunistic infection (in HIV) Pneumocystis SYC Cytomegalovierus AA Atypical Mycobacteria AA Kaposi’s MR Two minutes please. Keep it... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=896037 Mon, 24 Sep 2007 13:37:00 +0100 896037 http://wardround.blogspot.com/2007/09/wardround-14ix7.html The two minute talks for next week will be about the appropriate use of investigations in the patient with abnormal LFTs. Tell me how to use and interpret:Viral tests AA' s successorautoimmune serology (and metabolic tests if you can fit it in) MRimaging SYCThe paper for discussion on Tuesday is WASTE IN THE NHS: THE PROBLEM, ITS SIZE, AND HOW WE CAN TACKLE IT. Andrew Moore, Bandolier.For Tuesday 25th the discussion paper is Measuring quality of life. Is there such a thing as a life not worth living? B. Farsides, RJ Dunlop BMJ 2001;322:1481-1483.Interesting topics:Sheffield tablesETTs - have a look at Ordering and Understanding the Exercise Stress Test by M Darrow.Aspirin primary prevention there is much written on this, but you have to start somewhere (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=875180 Sun, 16 Sep 2007 22:15:00 +0100 875180 http://wardround.blogspot.com/2007/09/wardround-7ix7.html The two minute talks for next Friday will be on the Organisms causing community acquired pneumonia and their associated clinical syndromes. Two minutes please on:Pneumococcus AAMycoplasma SYC Chlamydia (has its name chasnged?)Legionella MRThe paper for discussion a week on Tuesday will be WASTE IN THE NHS: THE PROBLEM, ITS SIZE, AND HOW WE CAN TACKLE IT. Andrew Moore DSc, Editor of Bandolier.MJM (Source: MJM Wardrounds) MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=856771 Mon, 10 Sep 2007 12:55:00 +0100 856771 http://wardround.blogspot.com/2007/09/wardround-31viii7.html The ophthalmoscope, stethoscope, pulse oximeter, otoscope and sphygmomanometer all explained in less than half an hour...what an achievement. I still remain uncertain about the correct cuff size for a sphyg. The AHA arec quoted as saying Proper cuff size selection is critical to accurate measurement. The bladder length and width of the cuff should be 80% and 40%, respectively, of the arm circumference. Blood pressure measurement errors are generally worse in cuffs that are too small vs those that are too big. That sounds like an audit just waiting to happen.For next week we will ahve two minute talks on practical procedures:Blood cultures (including from lines) GAJChest drain insertion AALP AWAscitic tap AGJoint aspiration MJMThe paper for discussion this week was What patients want to kno... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=838062 Mon, 03 Sep 2007 14:48:00 +0100 838062 http://wardround.blogspot.com/2007/08/wardround-24viii7.html Thank you for your ideas about the cause of the plague in Athens. If you want to read more there is much to be found on the internet. If you would like to see a published discussion about the plague of Athens have a look at The cause of the plague of Athens: plague, typhoid, typhus, smallpox, or measles? Burke A. Cunha, Infect Dis Clin N Am 18 (2004) 29–43. The two minute talks for this week will be about instruments in medicine: Ophthalmoscope GAJStethoscope AGSaturation meter MJMAuroscope AWSphygmomanometer AA Two minutes please. Keep it precise and concise, and quote sources. The reading for next week (4ix7) will be Metaphorical Medicine: using metaphors to enhance communication with patients who have pulmonary disease. Arroliga AC... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=824660 Mon, 27 Aug 2007 13:29:00 +0100 824660 http://wardround.blogspot.com/2007/08/wardround-17viii7.html The Roth Spot is a white-centered hemorrhage. It is a cotton wool spot surrounded by hemorrhage. The cotton wool comes from ischemic bursting of axons; the small hemorrhage comes from ischemic bursting of a pre-capillary arteriole. It is not specific to bacterial endocarditis.I will scan in this week's handouts on HSVE and JE. The prize for best talk this week goes to Dr Anderson for a novel way of presenting the information about Japanese encephalitis.Links to be added...Herpes simplex encephalitis, Japanese encephalitis.The talks this week are your diagnostic choices for the plague of Athens. Read the article and come up with a diagnosis. You have two minutes to convince the group you are correct.The History of the Peloponnesian War written by Thucydides in 431 B.C. If you click on the l... MJM Wardrounds blogs http://www.medworm.com/rss/comments.php?id=809582 Mon, 20 Aug 2007 09:53:00 +0100 809582