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 'Postgraduate Medical Journal' source. Wed, 08 Feb 2012 18:50:41 +0100 http://www.medworm.com/index.php?rid=5610682&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1036%2F115%3Frss%3D1 Since 2008, coroners' courts in the UK have allowed ‘narrative verdicts’. They now accept that it is sometimes impossible to assign any single cause to a death, such as natural or accidental death. Instead of forcing juries to strive for the illusion of certainty, or to try and squeeze all the evidence into pre-ordained categories, the law now allows them to describe what has happened, to set out what is known and unknown, and to express their views in narrative form. This is such a sensible option, and so clearly fits with all the complexities and ambiguities of real life that it seems surprising that it took so long for anyone to come up with the idea. It also makes one wonder why a parallel concept of ‘narrative diagnosis’ hasn't become established in medicine. C... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5610682 Wed, 18 Jan 2012 05:00:00 +0100 5610682 http://www.medworm.com/index.php?rid=5610681&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1036%2F113%3Frss%3D1 A 77-year-old man was admitted to our hospital with a 2-day history of dyspnoea that had started suddenly. Chest x-ray showed a left hydropneumothorax under tension with mediastinal shift (figure 1); blood analyses revealed a high inflammatory reaction. Chest drainage improved symptoms initially with re-expansion of the collapsed lung and a yellowish purulent effusion discharged from the chest drain with little or no air leakage under continuous suction. Biochemical test results of the fluid included: lactate dehydrogenase (LDH) 1522 IU/l, glucose 2 mg/dl and protein 5.7 g/dl. Figure 1Chest x-ray showing a left hydropneumothorax under tension with mediastinal shift. After admission, the patient continued to eat with no epigastric pain despite his severe condition. Although ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5610681 Wed, 18 Jan 2012 05:00:00 +0100 5610681 http://www.medworm.com/index.php?rid=5610680&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1036%2F105%3Frss%3D1 This article describes the assessment of ventricular mechanics by echocardiographic techniques which are widely available to all cardiologists. The different deformation patterns and how the assessment of these can be used in the clinical setting are discussed. Left ventricular anatomy LV myocardial fibres... (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5610680 Wed, 18 Jan 2012 05:00:00 +0100 5610680 http://www.medworm.com/index.php?rid=5610679&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1036%2F97%3Frss%3D1 Chronic kidney disease (CKD) is defined as evidence of kidney damage or a glomerular filtration rate (GFR) ≤60 ml/min/1.73 m2 (table 1). The most common causes of CKD are hypertension and diabetes mellitus. The many causes of CKD are associated with different varying prognoses. Patients with adult polycystic kidney disease have a 50% lifetime risk of needing dialysis compared with 25% for type 1 diabetes and <5% for type 2 diabetes. Dialysis is usually considered when GFR falls below 10 ml/min/1.73 m2 but the exact timing will often be dictated by clinical circumstances. This may be refractory oedema, hyperkalaemia and acidosis, uraemia or unacceptable symptoms. Dialysis only partially replaces the excretory function of the kidneys and so the morbidity and mortali... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5610679 Wed, 18 Jan 2012 05:00:00 +0100 5610679 http://www.medworm.com/index.php?rid=5610678&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1036%2F88%3Frss%3D1 Long lists of causes of peripheral neuropathy make peripheral nerve disease a dry and uninspiring subject. A simple scheme based on the answers to just six questions should enable the clinician to recognise characteristic patterns, investigate relevant subgroups appropriately, and identify treatable disorders quickly: which systems are involved? What is the distribution of weakness? What is the nature of the sensory involvement? Is there any evidence of upper motor neuron involvement? What is the temporal evolution? Is there any evidence for a hereditary neuropathy? Standard screening investigations suffice for the common length dependent axonal neuropathies while complex presentations need more detailed investigations targeted to their clinical phenotype. (Source: Postgraduate Medical Jou... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5610678 Wed, 18 Jan 2012 05:00:00 +0100 5610678 http://www.medworm.com/index.php?rid=5610677&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1036%2F79%3Frss%3D1 With the availability of improved brain imaging techniques, the high prevalence and clinical importance of cerebral small vessel disease have been increasingly recognised in recent years. As age is one of the most important risk factors for this condition, its prevalence is set to rise further as populations age. This may lead to an increase in the clinical consequences of white matter disease, namely cognitive decline, decreased mobility and increased stroke risk. Given the impact this will have on individuals and on healthcare systems, knowledge of the risk factors for small vessel disease, its prevention and its treatment is becoming more important. Although a lot of data are now available on the epidemiology, risk factors, clinical consequences and prognosis of leukoaraiosis, some of t... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5610677 Wed, 18 Jan 2012 05:00:00 +0100 5610677 http://www.medworm.com/index.php?rid=5610676&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1036%2F73%3Frss%3D1 Chronic pain can lead to significant disability with social and economic implications in the community. Traditional non-steroidal anti-inflammatory drugs (NSAIDs) have been part of the management of chronic pain. The risk of adverse events with traditional NSAIDs has led to the development of alternative therapeutic options. Differential blockade of the enzymes involved in pain and inflammation can offer therapeutic options without the gastrointestinal side effects. However, this may be at the expense of other major cardiovascular side effects. Pain pathways that involve peripheral transmission may be altered by local application of analgesia to the skin overlying the painful area. Recent guidelines for osteoarthritis treatment from the National Institute for Health and Clinical Excellence... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5610676 Wed, 18 Jan 2012 05:00:00 +0100 5610676 http://www.medworm.com/index.php?rid=5610675&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1036%2F66%3Frss%3D1 Chronic pain is pain that persists past the normal time of healing, and is seen as a common problem with a significant socioeconomic impact. Pharmacological management for chronic non-cancer pain also involves the prescription of opioids, with the aim of an improved quality of life for the patient. New guidelines have been published to aid prescribing clinicians improve opioid safety and patient care, and include recommendations on when to refer patients to a pain specialist. In recent years there has been a rapid increase in opioid prescription in the UK and USA, prompting further concern regarding opioid abuse and side effects. Opioid use may also result in physical dependence and tolerance. Earlier recognition and diagnosis of unwanted effects of long term opioid use is needed, such as ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5610675 Wed, 18 Jan 2012 05:00:00 +0100 5610675 http://www.medworm.com/index.php?rid=5610674&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1036%2F59%3Frss%3D1 Conclusion The authors found a low awareness of current guidance on testing for HIV and a high level of perceived barriers to testing. Reducing the high number of late diagnoses is a clinical and public health priority. To achieve this, the authors recommend improved policy dispersal coupled with education that targets perceived barriers to testing. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5610674 Wed, 18 Jan 2012 05:00:00 +0100 5610674 http://www.medworm.com/index.php?rid=5610673&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1036%2F57%3Frss%3D1 Acute and chronic pain has a major impact on the individual, the family, the National Health Service and society. Acute pain is common following surgical procedures and often only partially controlled. Chronic pain currently affects around 7–8 million people in the UK, and in the USA, estimates suggest that more than 75 million people live with chronic pain.1 It is likely that the number of people with chronic pain will continue to grow as a result of increasing longevity, rising prevalence of co-morbidities such as diabetes mellitus and obesity, and improving survival rates for cancer and trauma patients. Rather than solely being a normal adaptive response following tissue injury, we now understand pain as an evolving plastic phenomenon that can be influenced by a variety of physiol... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5610673 Wed, 18 Jan 2012 05:00:00 +0100 5610673 http://www.medworm.com/index.php?rid=5526642&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1035%2F55%3Frss%3D1 A week ago I was standing with my wife by the River Tagus in Lisbon, next to the Monument to the Discoveries. The monument is at the spot where Vasco da Gama set out to discover the southeast passage from Europe to Asia, past the Cape of Good Hope. Vasco's discovery marked the beginning of the Portuguese maritime empire. At the furthest tip of Europe, Portugal was perfectly situated to found such an empire. As well as conquering parts of Africa, they gained footholds in China and India, and colonised Brazil on the other side of the Atlantic. Whether or not the Africans, Chinese, Indians or South Americans ever appreciated being ‘discovered’, Portugal established the first global village where everyone spoke the same language.1 It was relatively short-lived, and never equalled t... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5526642 Mon, 19 Dec 2011 05:00:00 +0100 5526642 http://www.medworm.com/index.php?rid=5526641&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1035%2F49%3Frss%3D1 The management and prevention of arterial thrombosis has been transformed by the recognition of the role of platelets in this process and the development of effective antiplatelet drugs. The limited role of thromboxane A2 in platelet activation explains why aspirin therapy, which effectively inhibits release of thromboxane A2 by platelets, is insufficient in high risk conditions such as acute coronary syndromes (ACS) or percutaneous coronary intervention (PCI). The platelet P2Y12 receptor, one of two adenosine diphosphate (ADP) receptors on platelets, plays a central and unique role in platelet activation through amplifying the effects of numerous platelet agonists (figure 1).1 Platelet activation leads not only to aggregation but also to the release of pro-thrombotic and pro-inflammatory ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5526641 Mon, 19 Dec 2011 05:00:00 +0100 5526641 http://www.medworm.com/index.php?rid=5526640&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1035%2F38%3Frss%3D1 Cardiomyopathy is defined as a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction due to a variety of causes that are frequently genetic. These are either confined to the heart or are part of generalised systemic disorders, often leading to cardiovascular death or progressive heart failure related disability. Determination of exact aetiology of cardiomyopathy can be difficult but remains important for both treatment and prognosis. Cardiovascular magnetic resonance imaging allows comprehensive assessment of patients suspected to have cardiomyopathy and is therefore being increasingly used in diagnosis and follow-up of these patients. This review presents the main features of common cardiomyopathies on cardiovascular magnetic resonance ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5526640 Mon, 19 Dec 2011 05:00:00 +0100 5526640 http://www.medworm.com/index.php?rid=5526639&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1035%2F34%3Frss%3D1 Antiplatelet therapy has proven efficacy in the secondary prevention of recurrent non-cardioembolic ischaemic stroke. Recent evidence suggests clopidogrel is as effective as combined therapy with aspirin and extended-release dipyridamole for the prevention of recurrent stroke. As cerebrovascular and ischaemic heart disease are closely related, it would be sensible to use a drug shown to prevent vascular events in both territories. Clopidogrel meets these criteria, is superior to aspirin monotherapy, and has fewer side effects compared with extended-release dipyridamole. While there is no direct evidence supporting the use of clopidogrel in transient ischaemic attacks, it is likely that clopidogrel is effective because transient ischaemic attacks and stroke are part of the same disease spec... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5526639 Mon, 19 Dec 2011 05:00:00 +0100 5526639 http://www.medworm.com/index.php?rid=5526638&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1035%2F28%3Frss%3D1 Conclusions Eosinophilia is associated with African or Asian ethnicity in an inner city gastroenterology service. This association is probably explained by imported helminths, which are prevalent in this setting, may be a cause of gastrointestinal symptoms and is easily diagnosed and treated by standard protocols. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5526638 Mon, 19 Dec 2011 05:00:00 +0100 5526638 http://www.medworm.com/index.php?rid=5526637&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1035%2F21%3Frss%3D1 Conclusions A twofold increased risk of mortality was found with aspirin treatment in animal models of S pneumoniae infection. No relevant human studies were identified. It is difficult to generalise from animal models to clinical medicine, but based on these findings and the prevalence and severity of S pneumoniae infections worldwide, future study of the effects of antipyretic therapy in S pneumoniae infection in humans is recommended. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5526637 Mon, 19 Dec 2011 05:00:00 +0100 5526637 http://www.medworm.com/index.php?rid=5526636&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1035%2F15%3Frss%3D1 Conclusion Comparison of clinical and pathological features revealed that this disease presents as an advanced disease in much younger individuals in this study compared to other studies. Elucidation of the underlying factors may have immense therapeutic implications. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5526636 Mon, 19 Dec 2011 05:00:00 +0100 5526636 http://www.medworm.com/index.php?rid=5526635&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1035%2F10%3Frss%3D1 Conclusion Careful consideration, recognising its potential impact on assessment score, should be given to the rating scale used when instituting MSF within a system of workplace based assessment. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5526635 Mon, 19 Dec 2011 05:00:00 +0100 5526635 http://www.medworm.com/index.php?rid=5526634&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1035%2F5%3Frss%3D1 Conclusions There is a large and unpredictable degree of variation in the on-call experience of Scottish trainees. The minimum recommended number of on-call shifts may not be adequate to ensure a high proportion of trainees are prepared for unsupervised on-call. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5526634 Mon, 19 Dec 2011 05:00:00 +0100 5526634 http://www.medworm.com/index.php?rid=5526633&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F88%2F1035%2F1%3Frss%3D1 Many quality improvement (QI) projects often fail to achieve their goals. Some fail for technical reasons, such as invalid measures, inattention to key contextual factors that determine the intervention's effectiveness, or not pilot testing the effort to identify and remove implementation barriers. But, an even larger number of projects fail because of adaptive challenges. ‘Adaptive challenges can only be addressed through changes in people's priorities, beliefs, habits, and loyalties.’1 2 A challenge for leaders is engaging people in deciding the change is needed, while also accepting that there may be things people want to preserve. For example, convincing physicians to include nurses during patient rounds, but letting them work out the logistics. Technical challenges are iss... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5526633 Mon, 19 Dec 2011 05:00:00 +0100 5526633 http://www.medworm.com/index.php?rid=5450203&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1034%2F847%3Frss%3D1 Recently I fractured a tooth. I was going to book an appointment with my usual dentist when a friend recommended his own dentist, promising me I would get outstanding treatment. I thought it worth a try, and made a booking. Before my appointment I had to fill in a long questionnaire about my medical and dental history. When I arrived I found splendid premises and magnificent equipment. The dentist gave me the longest and most thorough examination of my dental and oral health I have ever had, followed by x-rays and ultrasound images. He sat me down and explained his findings, which included not only the broken tooth but a lot of cavities and fillings in need of replacement or investigation, as well as some gum disease and discolouration. I was very impressed. He fed this data into a compute... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5450203 Fri, 25 Nov 2011 05:00:00 +0100 5450203 http://www.medworm.com/index.php?rid=5450202&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1034%2F841%3Frss%3D1 Introduction Heart failure is increasing in prevalence.1 This is in part due to reduced mortality as a result of major advances in treatment since 1986, when the VHEFT-I study was published.2 It is also associated with ageing of the population, and longer survival of people with conditions that lead on to heart failure such as ischaemic heart disease, hypertension and atrial fibrillation. The incidence and prevalence of heart failure rise with age. In the 1980s the Framingham study of those aged ≥45 years found that the age-adjusted prevalence of overt heart failure was 24/1000 in men and 25/1000 in women.3 In Finland the prevalence of heart failure in those aged 75–86 years was 8.2%.4 The EPIC study found that the prevalence of heart failure in those aged >25 ye... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5450202 Fri, 25 Nov 2011 05:00:00 +0100 5450202 http://www.medworm.com/index.php?rid=5450201&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1034%2F837%3Frss%3D1 While the complaints process is intended to improve healthcare, some doctors appear to practise defensive medicine after receiving a complaint. This response occurs in countries that use a tort-based medicolegal system as well as in countries with less professional liability. Defensive medicine is based on avoiding malpractice liability rather than considering a risk–benefit analysis for both investigations and treatment. There is also evidence that this style of practice is low quality in terms of decision-making, cost and patient outcomes. Western medical practice is based on biomedicine: determining medical failure using the underlying, taken-for-granted assumptions of biomedicine can potentially contribute to a response of shame after an adverse outcome or a complaint. Shame is i... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5450201 Fri, 25 Nov 2011 05:00:00 +0100 5450201 http://www.medworm.com/index.php?rid=5450200&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1034%2F829%3Frss%3D1 Vascular parkinsonism (VP) accounts for 2.5–5% of all cases of parkinsonism in various population based and clinical cohort studies. VP develops as a result of ischaemic cerebrovascular disease, so aetiologically it is classified as secondary parkinsonism. It has been variably referred to in the literature as arteriosclerotic parkinsonism, vascular pseudo-parkinsonism, and lower body parkinsonism. The most important consideration while making a diagnosis of VP should be to differentiate VP from Parkinson's disease (PD) because of prognostic and therapeutic implications. The salient clinical features in VP which differentiate it from PD are presentation with postural instability and falls rather than with upper limb rest tremor or bradykinesia; short shuffling parkinsonian gait in VP ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5450200 Fri, 25 Nov 2011 05:00:00 +0100 5450200 http://www.medworm.com/index.php?rid=5450199&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1034%2F819%3Frss%3D1 Fibroid in pregnancy is common in clinical obstetric practice. The topic is becoming more relevant in contemporary obstetrics due to the demographic shift towards delayed childbearing, the rising rate of obesity, and many pregnancies occurring after the treatment of fibroids. However, there are conflicting reports in the literature on many so-called fibroid complications in pregnancy, and there are inadequate data on the optimum management strategy. An evidence base is lacking on the pregnancy outcome of many conventional and newer treatment modalities of fibroids. This review addresses the characteristics and behaviour of fibroids during pregnancy, their incidence and demography, diagnosis, the complications that can arise during pregnancy and their antenatal management, the labour patter... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5450199 Fri, 25 Nov 2011 05:00:00 +0100 5450199 http://www.medworm.com/index.php?rid=5450198&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1034%2F814%3Frss%3D1 Conclusions Resident peer-to-peer education was associated with improvement of knowledge but did not result in decreased UC utilisation. A more active approach must be taken and other factors need to be further explored to reduce unnecessary placement of UC by residents in the ED. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5450198 Fri, 25 Nov 2011 05:00:00 +0100 5450198 http://www.medworm.com/index.php?rid=5450197&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1034%2F807%3Frss%3D1 Conclusion Overall, GPs reported a positive response to the RCGP revalidation proposals. Concerns were focused on collecting the newer types of supporting information and the ability of GPs non-principals to collect this evidence. GP revalidation training and preparation is required. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5450197 Fri, 25 Nov 2011 05:00:00 +0100 5450197 http://www.medworm.com/index.php?rid=5450196&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1034%2F800%3Frss%3D1 Conclusions Core components of the Foundation programme have been delivered successfully to thousands of trainees across Scotland using web based systems to deliver and support education and assessment. There is great potential for further exploration of this carefully managed, rich dataset at individual, regional, and national levels to inform the future of medical education. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5450196 Fri, 25 Nov 2011 05:00:00 +0100 5450196 http://www.medworm.com/index.php?rid=5450195&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1034%2F795%3Frss%3D1 Conclusions The proportion of operating performed by SpRs and SHOs has fallen over the last decade, coinciding with implementation of structural changes to training, the advent of minimally invasive techniques, and the drive for a consultant led health service. Trainees may therefore require increased supervision as well as protected theatre sessions to balance operative training with ward based duties. Education must be integrated into working practice in order for trainees to achieve expected competencies and ultimately produce adequately experienced consultants. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5450195 Fri, 25 Nov 2011 05:00:00 +0100 5450195 http://www.medworm.com/index.php?rid=5450194&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1034%2F793%3Frss%3D1 Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the USA.1 Its defining feature is limitation of expiratory airflow, which is usually relentlessly progressive. Current therapies have meaningful, but limited benefits. For those who have resting hypoxaemia, supplemental oxygen improves survival. Rehabilitation can improve health status and exercise performance. However, neither of these treatments alters lung function or the rate at which it declines. Volume reduction surgery, by removing the most dysfunctional parts of the lung, can reduce exacerbations2 and improve lung function, performance, symptoms and survival, but only in a subset of patients, and the effects are limited, both in magnitude and in duration.3 4 Currently available pharmacoth... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5450194 Fri, 25 Nov 2011 05:00:00 +0100 5450194 http://www.medworm.com/index.php?rid=5389317&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1033%2F792%3Frss%3D1 This article was originally published in the British Journal of Ophthalmology (Br J Ophthalmol 2009;93:284–9) and later published in Postgraduate Medical Journal as a republished article. The title in the republished article in Postgraduate Medical Journal should have been prefixed with "Republished review:" and the doi should have been doi:10.1136/pgmj.2008.150151rep. We apologise for this error. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5389317 Wed, 02 Nov 2011 04:00:00 +0100 5389317 http://www.medworm.com/index.php?rid=5389316&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1033%2F791%3Frss%3D1 For many years, I have helped to run an annual training day on management for young psychiatrists and psychologists who are about to become consultants. We usually spend most of the day doing an exercise where they turn themselves into the managing boards of two imaginary mental health institutions and compete for business. Over the years we have had fun inventing the names and characteristics of these two institutions. There were a few years when I called one of them ‘the Spielrein Institute’. I chose the name as a joke—at least, I thought it was a joke at the time. I took it from a real historical figure called Sabina Spielrein. Like many people, all I knew about her was that she was a patient of Carl Jung and had then become his mistress. I knew Sigmund Freud was someh... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5389316 Wed, 02 Nov 2011 04:00:00 +0100 5389316 http://www.medworm.com/index.php?rid=5389315&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1033%2F790%3Frss%3D1 A 36-year-old woman presented with a 1 year history of non-progressive shortness of breath on exertion. On physical examination the patient's vital signs were normal. Findings of the cardiovascular examination, including an electrocardiogram, were unremarkable. Chest radiography showed cardiomegaly with a deformed cardiac silhouette and narrow pedicle (figure 1). Two dimensional echocardiography was suggestive of pericardial effusion which was managed initially as tuberculous effusion. However, the patient did not respond to the treatment. CT followed by MRI were performed which revealed multiple multiloculated cystic lesions around the cardiac chambers with mild compression and pericardial effusion. On T2 MRI, the cyst wall showed typical hypointensity confirming the diagnosis of per... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5389315 Wed, 02 Nov 2011 04:00:00 +0100 5389315 http://www.medworm.com/index.php?rid=5389314&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1033%2F783%3Frss%3D1 Conclusion With the risk of bias in mind, it is concluded that more than half of the RCARs described erroneous verbal communication between staff members as root causes of or contributing factors of severe patient safety incidents. The RCARs rich descriptions of the incidents revealed the organisational factors and needs related to these errors. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5389314 Wed, 02 Nov 2011 04:00:00 +0100 5389314 http://www.medworm.com/index.php?rid=5389313&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1033%2F776%3Frss%3D1 Although statins significantly decrease the incidence of cardiovascular disease (CVD), residual CVD risk remains high. This may partly be due to uncorrected atherogenic dyslipidaemia. The driving force behind atherogenic dyslipidaemia is hypertriglyceridaemia, which results from hepatic oversecretion and/or hypocatabolism of triglyceride-rich lipoproteins, and is typical of type 2 diabetes and metabolic syndrome. Persistent atherogenic dyslipidaemia in patients treated with a statin according to low-density lipoprotein-cholesterol goals may be corrected with niacin, fibrates or n–3 fatty acids. Clinical trial evidence to inform best practice is limited, but new data support adding fenofibrate to a statin. A consistent feature of fibrate clinical trials is the specific benefit of thes... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5389313 Wed, 02 Nov 2011 04:00:00 +0100 5389313 http://www.medworm.com/index.php?rid=5389312&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1033%2F769%3Frss%3D1 Conclusions Receiving PC earlier has a similar effect on reducing symptoms but greater effects on reducing care giver burden, compared to later referral. In this phase II trial, the authors lacked the power to detect small differences. The effect of PC is maintained for 6 weeks after withdrawal but then appears to wane. Trial Registration Number National Institutes of Health, USA, http://www.Clinicaltrials.gov, NCT00364936. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5389312 Wed, 02 Nov 2011 04:00:00 +0100 5389312 http://www.medworm.com/index.php?rid=5389311&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1033%2F763%3Frss%3D1 Conclusions The prevalence of CDCM is higher in SAs compared to WEs with type 2 diabetes, whereas the prevalence of NCCM is higher in WEs compared to SAs. Taking into account comorbidities, SAs (compared to WEs) with type 2 diabetes had an excess risk of having HbA1c ≥7% ranging from 1.86- to 2.27-fold. Further research is needed to identify the reasons for unfavourable metabolic conditions in SAs and also develop and evaluate interventions. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5389311 Wed, 02 Nov 2011 04:00:00 +0100 5389311 http://www.medworm.com/index.php?rid=5389310&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1033%2F757%3Frss%3D1 Conclusion The 30 day mortality rate in consecutive patients with community acquired bacteraemic infection was 25.0%. These figures could be used as performance indicators to compare outcomes in different UK NHS trusts. With the exception of delay in appropriate antibiotic treatment, predictors of mortality at 30 days were non-modifiable. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5389310 Wed, 02 Nov 2011 04:00:00 +0100 5389310 http://www.medworm.com/index.php?rid=5389309&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1033%2F750%3Frss%3D1 Conclusions The pilot study was successful in taking the first steps to developing a validated survey questionnaire for a key staff group, foundation year doctors, in a priority area. However, the findings raise concerns about trainee experience of and attitudes to reporting, and the frequency with which incidents go unreported. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5389309 Wed, 02 Nov 2011 04:00:00 +0100 5389309 http://www.medworm.com/index.php?rid=5389308&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1033%2F746%3Frss%3D1 Conclusion There is morbidity associated with both treatment and non-treatment of incidental PE. However, despite the uncertainty about the natural history and clinical significance of incidental PE, the majority of patients at the authors' institution received prompt anticoagulation. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5389308 Wed, 02 Nov 2011 04:00:00 +0100 5389308 http://www.medworm.com/index.php?rid=5389307&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1033%2F739%3Frss%3D1 Conclusions There were variations among wards, organisations and specialties in error rates and how quickly they were rectified. Exploring reasons for differences between organisations may be useful in identifying best practice and potential solutions. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5389307 Wed, 02 Nov 2011 04:00:00 +0100 5389307 http://www.medworm.com/index.php?rid=5389306&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1033%2F737%3Frss%3D1 Irreversible physical function loss—that part of physical function loss that remains in the absence of clinically perceptible disease activity—was elegantly conceptualised by Aletaha et al1 a few years ago. They introduced the idea of the irreversible health assessment questionnaire (HAQ) score, which is the residual HAQ score if a patient is in clinical remission. While one may argue the construct validity of an irreversible HAQ score (eg, the absence of clinical disease activity does not necessarily imply the absence of joint inflammation), the model is valuable because it allows the investigator to disentangle the contribution of signs and symptoms and that of structural damage on physical function. From many studies performed during the past 10 years we have learnt that str... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5389306 Wed, 02 Nov 2011 04:00:00 +0100 5389306 http://www.medworm.com/index.php?rid=5262314&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1032%2F735%3Frss%3D1 The 20th century saw two key discoveries in genetics. One took place in the laboratory and established the helical structure of DNA. The other was more of an intellectual revolution: the development of selfish gene theory, also known as gene centred evolution. Most doctors will be far more familiar with the first of these discoveries than the second. They would no doubt find it easier to explain how the DNA molecule winds round in a helix and makes a mirror image of itself, than they could expand on how genes can be said to be selfish. This emphasis on the physical properties of molecules rather than abstract theoretical ideas is perhaps understandable. Knowing the structure of DNA has certainly led to fantastic advances in biological science and in medicine. However, it may also have led ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5262314 Tue, 27 Sep 2011 04:00:00 +0100 5262314 http://www.medworm.com/index.php?rid=5262313&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1032%2F734%3Frss%3D1 A 36-year-old construction worker described a 3-month history of bilateral pain, stiffness and swelling of the ankles and lower limb joints. Symptoms were worse in the mornings and were associated with generalised fatigue. He had no significant medical history and was taking regular naproxen only with no recorded drug allergies. On examination, cardiovascular and respiratory systems were normal. There was bilateral synovitis of the ankles. Of note, the patient had multiple small papules within the large tattoos on his upper limbs. The lesions were non-tender and were of the same colour as the underlying tattoo ink (figure 1). Figure 1Multiple cutaneous lesions within tattoo ink. A chest radiograph showed bilateral florid hilar lymphadenopathy, with normal lung fields (figure 2). Blood tes... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5262313 Tue, 27 Sep 2011 04:00:00 +0100 5262313 http://www.medworm.com/index.php?rid=5262312&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1032%2F724%3Frss%3D1 Guidelines on contraindications for lung function tests have been based on expert opinion from >30 years ago. High-risk contraindications to lung function testing are associated with cardiovascular complications such as myocardial infarct, pulmonary embolism or ascending aortic aneurysm. Slightly less risky but still serious contraindications are predominantly centred on recovery from major thoracic, abdominal or head surgery. Less serious surgical procedures will present a possible risk, but the RR depends upon whether the lung function is essential or can wait until the patient's condition improves. In recent decades there have been moves towards less invasive surgical techniques, keyhole surgery and new technology such as laser surgery which minimise the amount of collateral dam... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5262312 Tue, 27 Sep 2011 04:00:00 +0100 5262312 http://www.medworm.com/index.php?rid=5262311&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1032%2F714%3Frss%3D1 Acute ischaemic stroke (AIS) is the leading cause of death and disability in developed nations. In the past decade pharmacologic and endovascular therapy has been approved for use in treatment of patients presenting with AIS. The time window from symptom onset to be eligible for treatment is narrow, allowing for only a small proportion of these patients to be treated. Currently the established method of treatment is intravenous thrombolytic therapy for patients without contraindication, presenting within the time window of 4.5 h from the onset of symptoms. The improvement in patient outcome with this therapy is poor. This has led to exploration of intra-arterial mechanical thrombectomy devices to both increase the time window and also attempt to improve patient outcome with and withou... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5262311 Tue, 27 Sep 2011 04:00:00 +0100 5262311 http://www.medworm.com/index.php?rid=5262310&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1032%2F706%3Frss%3D1 Hypertension is a chronic disorder which often entails debilitating cardiovascular and renal complications. Hypertension mostly arises as a complex quantitative trait that is affected by varying combinations of genetic and environmental factors. Secondary hypertension has been encountered with increasing frequency. The common causes of secondary hypertension include renal parenchymal disease, renal artery stenosis, primary aldosteronism, phaeochromocytoma, and Cushing's syndrome. The detection of a secondary cause is of the utmost importance because it provides an opportunity to convert an incurable disease into a potentially curable one. Early identification and treatment will provide a better opportunity for cure, prevent target organ damage, reduce socioeconomic burden and health expend... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5262310 Tue, 27 Sep 2011 04:00:00 +0100 5262310 http://www.medworm.com/index.php?rid=5262309&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1032%2F700%3Frss%3D1 Discussion By implementing a standardised admissions template and a mandatory discharge face sheet, the hospital improved its processes of documentation and increased adherence to quality-performance measures. By strengthening residents' learning and commitment to quality improvement, the hospital created a foundation for future changes in the systems that affect patient care. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5262309 Tue, 27 Sep 2011 04:00:00 +0100 5262309 http://www.medworm.com/index.php?rid=5262308&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1032%2F694%3Frss%3D1 Conclusions This report identifies that the majority of safety incidents associated with obesity were related to infrastructure, suggesting that there is inadequate provision in place for the care of obese patients. While levels of harm were mostly low, the occurrence of incidents resulting in severe harm or death highlights the specific dangers associated with the care of the obese patient. A global approach to improving the safety of care delivery for obese patients is recommended, including obesity specific training, management structures, care pathways, and equipment provisioning.Further planning and development of operation policies is needed to ensure the safe delivery of healthcare to obese patients in the future. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5262308 Tue, 27 Sep 2011 04:00:00 +0100 5262308 http://www.medworm.com/index.php?rid=5262307&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1032%2F688%3Frss%3D1 Conclusion The DM care model with partnership between general practice and social work demonstrated better diabetic control with improvement of self efficacy and minimisation of risk behaviours. Trial registration Current Controlled Trials ISRCTN78882965. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5262307 Tue, 27 Sep 2011 04:00:00 +0100 5262307 http://www.medworm.com/index.php?rid=5262306&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1032%2F680%3Frss%3D1 Conclusion These results demonstrate that residents in the Netherlands perceive their knowledge and skills in certain essential medical management concepts to be inadequate. The results suggest that a course in medical management should be considered as a mandatory part of the curricula of residency training programmes. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5262306 Tue, 27 Sep 2011 04:00:00 +0100 5262306 http://www.medworm.com/index.php?rid=5262305&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1032%2F670%3Frss%3D1 Conclusion Leakage from research publication to guideline utilisation occurs in a wide variety of clinical settings and at all steps of the awareness-to-adherence pathway. This review confirms that clinical guidelines are insufficient to implement research and suggests there may be different factors influencing clinicians at each step of this pathway. Recommendations to improve guideline adherence need to be tailored to each step. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5262305 Tue, 27 Sep 2011 04:00:00 +0100 5262305 http://www.medworm.com/index.php?rid=5262304&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1032%2F664%3Frss%3D1 Conclusion Losartan significantly decreased proteinuria and UAGT excretion, and preserved renal function in non-diabetic patients with CKD. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5262304 Tue, 27 Sep 2011 04:00:00 +0100 5262304 http://www.medworm.com/index.php?rid=5262303&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1032%2F658%3Frss%3D1 Conclusions This study reports a novel independent association of DPN with low haemoglobin values. In the study population with type 2 DM and proliferative retinopathy, DPN was also independently associated with male gender, age, and PVD. Further studies are needed to confirm the association with low haemoglobin and identify the underlying mechanism. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5262303 Tue, 27 Sep 2011 04:00:00 +0100 5262303 http://www.medworm.com/index.php?rid=5262302&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1032%2F657%3Frss%3D1 The Shorter Oxford Dictionary defines ‘exacerbation’ as ‘an increase in the severity of a disease’—which does not imply reversibility or otherwise. However, we wonder how many chest physicians define exacerbation as ‘an acute and temporary deterioration in either symptoms or signs (and for the sophisticated, biomarkers)’ of asthma, chronic obstructive pulmonary disease (COPD) or whatever. We know that many of our patients do not understand the term; some confuse it with exasperations. The editorial by Mark FitzGerald1 (see page 365) proposes to discard this term in favour of the phrase ‘lung attack’. Is this mere sensationalism or trendy fiddling with what actually works well (as with the Church of England discarding the Book of Common ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5262302 Tue, 27 Sep 2011 04:00:00 +0100 5262302 http://www.medworm.com/index.php?rid=5262301&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1032%2F655%3Frss%3D1 Acute exacerbations of asthma and chronic obstructive lung disease (COPD) are significant burdens on the health care system.1 2 The economic burden is particularly high with both types of exacerbations. Unfortunately the management of these common occurrences is often haphazard and fragmented. The gaps in care relate both to the management of the specific episode in question3 and to the risk stratification of patients subsequent to the event.4 This lack of current and ongoing optimal care is disappointing, especially given the documented poor prognostic factors associated with these events. Patients hospitalised with acute asthma, and especially episodes of near fatal asthma, are associated with significantly increased future risks of intubation.5 In the case of COPD the outcomes are even ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5262301 Tue, 27 Sep 2011 04:00:00 +0100 5262301 http://www.medworm.com/index.php?rid=5164030&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1031%2F653%3Frss%3D1 Many years ago, before the age of the internet, I picked up a collection of short stories called A Month of Mystery, edited by the film director Alfred Hitchcock. Most of the stories were humdrum, but one of them struck me as a masterpiece. It was by an American writer from the early 20th century named Melville Davisson Post. Although I never came across his writing again, his name stuck in my mind. Earlier this year, on a whim, I Googled him, and discovered that some of his works were still in print. I ordered a volume of his mystery stories, read them, and have been possessed by them ever since. More to the point, I have been thinking of how they could be used as a way of teaching doctors to examine own reasoning processes. Davisson Post was a lawyer who gave up his career because of ill... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5164030 Mon, 22 Aug 2011 23:00:00 +0100 5164030 http://www.medworm.com/index.php?rid=5164029&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1031%2F652%3Frss%3D1 A 78-year-old man presented with abdominal pain and confusion secondary to a pelviureteric junction stone and urosepsis. Blood cultures grew Candida albicans and treatment with intravenous fluconazole 200 mg once a day was started. He was then referred for an ophthalmological review. The patient reported blurred vision in the right eye only when directly questioned. Visual acuities were 20/60 and 20/30 in the right and left eyes, respectively. Anterior segment examination was normal. Dilated funduscopy revealed bilateral vitritis with multiple small white chorioretinal lesions and associated retinal haemorrhages, consistent with endogenous Candida endophthalmitis (figure 1). Figure 1Fundal photographs of right eye (A) and left eye (B) illustrating chorioretinal infiltrates and retinal... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5164029 Mon, 22 Aug 2011 23:00:00 +0100 5164029 http://www.medworm.com/index.php?rid=5164028&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1031%2F643%3Frss%3D1 Conclusions Mobile phone-like EMF do not seem to induce cognitive and psychomotor effects. Nonetheless, the existence of sponsorship and publication biases should encourage WHO intervention to develop official research standards and guidelines. In addition, future research should address critical and neglected issues such as investigation of repeated, intensive and chronic exposures, especially in highly sensitive populations such as children. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5164028 Mon, 22 Aug 2011 23:00:00 +0100 5164028 http://www.medworm.com/index.php?rid=5164027&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1031%2F636%3Frss%3D1 In this study, the literature on this subject was reviewed and the implications for practice were considered. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5164027 Mon, 22 Aug 2011 23:00:00 +0100 5164027 http://www.medworm.com/index.php?rid=5164026&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1031%2F630%3Frss%3D1 Spontaneous haemopneumothorax (SHP) can be life threatening and is an important cause for unexplained signs of significant hypovolaemia. There is still some debate relating to patient selection and timing of surgery, particularly in those who become stable following chest tube insertion without further blood loss. Review of the literature over the past decade in the management of SHP are presented and discussed. Surgery should be considered early in the management of SHP to reduce morbidity associated with continued haemorrhage and inadequate drainage. Lower postoperative complications and shorter hospital stay following video assisted thoracic surgery compared with thoracotomy have led to its increased acceptance as an alternative approach for SHP patients who are haemodynamically stable.... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5164026 Mon, 22 Aug 2011 23:00:00 +0100 5164026 http://www.medworm.com/index.php?rid=5164025&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1031%2F623%3Frss%3D1 Tremor is, by definition, a rhythmic oscillation of a body part. It is the most prevalent movement disorder in clinical medicine, so doctors working in many specialities and in general practice can expect to encounter it. Most tremors can be classified on the basis of four observable clinical characteristics: anatomical pattern; the relative prominence of the tremor at rest, on maintaining a posture, and with action; tremor frequency; and tremor amplitude. A resting tremor suggests Parkinson's disease, and the diagnosis then depends on a judgement about whether the patient has other signs of parkinsonism. The most common causes of postural tremor are physiological tremor, essential tremor and drug-induced tremor. The differential diagnosis may also include dystonic tremor and psychogenic t... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5164025 Mon, 22 Aug 2011 23:00:00 +0100 5164025 http://www.medworm.com/index.php?rid=5164024&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1031%2F612%3Frss%3D1 Acute respiratory distress syndrome (ARDS) is a life threatening respiratory failure due to lung injury from a variety of precipitants. Pathologically ARDS is characterised by diffuse alveolar damage, alveolar capillary leakage, and protein rich pulmonary oedema leading to the clinical manifestation of poor lung compliance, severe hypoxaemia, and bilateral infiltrates on chest radiograph. Several aetiological factors associated with the development of ARDS are identified with sepsis, pneumonia, and trauma with multiple transfusions accounting for most cases. Despite the absence of a robust diagnostic definition, extensive epidemiological investigations suggest ARDS remains a significant health burden with substantial morbidity and mortality. Improvements in outcome following ARDS over the ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5164024 Mon, 22 Aug 2011 23:00:00 +0100 5164024 http://www.medworm.com/index.php?rid=5164023&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1031%2F605%3Frss%3D1 Conclusion Clock and star drawing may serve as reproducible, inexpensive bedside tools for diagnosing and grading the severity of hepatic encephalopathy. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5164023 Mon, 22 Aug 2011 23:00:00 +0100 5164023 http://www.medworm.com/index.php?rid=5164022&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1031%2F601%3Frss%3D1 Conclusions It is possible to carry a pregnancy successfully to term when the pregnancy is complicated by uterine leiomyomas. When caesarean delivery is needed, myomectomy can be performed at the time of caesarean section routinely without significant complications. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5164022 Mon, 22 Aug 2011 23:00:00 +0100 5164022 http://www.medworm.com/index.php?rid=5164021&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1031%2F596%3Frss%3D1 Conclusions Anaemia in RA is common, multifactorial, and potentially both serious and correctable. Established malignancy was present in 10 patients and premalignancy in a further 10 (10% of total). Treatable causes were commonly identified. Clinicians need to investigate the nature and cause of persistent anaemia, and must not assume it to be simply ACD without evidence. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5164021 Mon, 22 Aug 2011 23:00:00 +0100 5164021 http://www.medworm.com/index.php?rid=5164020&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1031%2F590%3Frss%3D1 Conclusions Preparedness for practice data can be enriched by repeated collection over several years, comparison of different perspectives, and incorporation of free text responses. The non-technical skills of decision-making, initiative, prioritisation, and coping with stress are important components of preparing new doctors for practice. Education for Foundation trainees should focus on the areas in which graduates are perceived to be less prepared, such as acute care, prescribing, and procedural skills. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5164020 Mon, 22 Aug 2011 23:00:00 +0100 5164020 http://www.medworm.com/index.php?rid=5164019&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1031%2F585%3Frss%3D1 Conclusions Cancer patients endured a burden of long travel times in 2007. The prevailing policy of the Ministry of Health to build a single centralised modern centre would not have alleviated this burden. Based on these findings, three outlying cancer clinics were created which now provide non-radiotherapy oncology management of patients nearer their homes. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5164019 Mon, 22 Aug 2011 23:00:00 +0100 5164019 http://www.medworm.com/index.php?rid=5164018&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1031%2F579%3Frss%3D1 Conclusions Overtime work and performance related feedback from supervisors seem to be important work related factors concerning junior doctors' levels of strain and recovery. In addition, performance feedback from colleagues seems to be a major resource for recovery. The findings have implications regarding work time regulations and the necessity of leadership skill development training regarding feedback talks and fostering a desirable social climate in the healthcare system for the wellbeing of junior doctors. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5164018 Mon, 22 Aug 2011 23:00:00 +0100 5164018 http://www.medworm.com/index.php?rid=5164017&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1031%2F575%3Frss%3D1 Increasingly, many centres around the world are delivering multidisciplinary care for patients with Parkinson's disease (PD).1 2 Indeed, a multidisciplinary team approach currently seems inevitable for anyone who understands even a little about PD. After all, this really is a wretched disorder, with a complex and diverse phenotype. Patients become progressively incapacitated, not only because of the well known motor symptoms (bradykinesia, rigidity, tremor, gait impairment and postural instability), but also because of a wide variety of non-motor symptoms. These include neuropsychiatric disorders (cognitive disturbances, hallucinations, psychosis), sleep disorders (insomnia, rapid eye movement sleep behaviour disorder, periodic leg movements), autonomic dysfunction (orthostatic hypotension... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5164017 Mon, 22 Aug 2011 23:00:00 +0100 5164017 http://www.medworm.com/index.php?rid=5064662&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1030%2F573%3Frss%3D1 Earlier this year, the General Medical Council (GMC) in the UK published a document setting out standards for training junior doctors.1 As such documents go, it is clear, comprehensive and—as the GMC might say itself—fit for purpose. While no-one would be tempted to set it to music, it's certainly useful to have a standard in writing like the following one: ‘Trainees must be supported to acquire the necessary skills and experience through induction, effective educational and clinical supervision, an appropriate workload, relevant learning opportunities, personal support and time to learn’. It's also helpful to have such a standard broken down into unambiguous requirements including this: ‘Working patterns and intensity of work by day and by night must be appro... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5064662 Sun, 24 Jul 2011 23:00:00 +0100 5064662 http://www.medworm.com/index.php?rid=5064661&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1030%2F571%3Frss%3D1 We report a postpartum patient in whom neuroimaging demonstrated intracranial hypotension and CVST following epidural anaesthesia. After an uncomplicated pregnancy, an 18-year-old primigravida delivered a live male infant at term via vacuum-assisted delivery and epidural anaesthesia. Within hours she developed a moderately severe diffuse postural headache, which was exacerbated by sitting upright. Over the following days, the headache intensified to 10 out of 10 in severity with associated nausea, vomiting and photophobia. Despite having intravenous fluids, analgesia, caffeine and an epidural blood patch, she experienced relative pain relief for only 1 day. She then developed mild neck stiffness. She had no focal neurological signs. A CT scan of brain demonstrated thrombosis in the st... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5064661 Sun, 24 Jul 2011 23:00:00 +0100 5064661 http://www.medworm.com/index.php?rid=5064660&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1030%2F570%3Frss%3D1 Case report A previously healthy 77-year-old man presented with difficulty in swallowing saliva following a 4-day history of sore throat. He was dysphonic with an indurated cellulitic fullness in the left lateral aspect of his neck. Nasendoscopy demonstrated ipsilateral pharyngeal wall swelling and contralateral laryngeal deviation. Contrast-enhanced CT examination demonstrated gas and fluid in the pretracheal and left perivascular deep neck spaces (figure 1A), in keeping with infection caused by gas-forming organisms. The gas and fluid tracked into the superior and anterior mediastinum with an associated mediastinal collection (figure 1B). Transcervical drainage confirmed malodorous dishwater-type fluid and grey necrotic tissue consistent with necrotising fasciitis that extended into the ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5064660 Sun, 24 Jul 2011 23:00:00 +0100 5064660 http://www.medworm.com/index.php?rid=5064659&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1030%2F565%3Frss%3D1 Conclusion Electronic prescribing appears to reduce rates of dosing errors in paediatrics, but larger studies are required to assess the effect on the severity of these errors and in different settings. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5064659 Sun, 24 Jul 2011 23:00:00 +0100 5064659 http://www.medworm.com/index.php?rid=5064658&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1030%2F558%3Frss%3D1 In the rush to assess the role of stem cell therapy for cardiovascular disease the details of translation are easily overlooked. This review summarises the progress to date in translating the exciting preclinical results of cardiac repair into man and considers the questions that this area of research has stimulated about the challenges of moving from bench to bedside. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5064658 Sun, 24 Jul 2011 23:00:00 +0100 5064658 http://www.medworm.com/index.php?rid=5064657&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1030%2F550%3Frss%3D1 This article identifies and reviews systematically the current literature regarding the use of CPET as a preoperative tool for stratifying risk in major non-cardiopulmonary surgery. Specifically, it focuses on evaluating the capacity of CPET variables to predict the risk of postoperative complications and mortality in comparison to other methods of risk assessment. Furthermore, the potential for combining results from CPET and non-CPET methods of risk prediction to enhance the capacity to identify high risk patients is considered. The review indicates that CPET can identify patients at increased risk of adverse perioperative outcomes. However, the selection of variables and threshold values to indicate high risk differ for different surgical procedures and underlying conditions. Furthermor... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5064657 Sun, 24 Jul 2011 23:00:00 +0100 5064657 http://www.medworm.com/index.php?rid=5064656&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1030%2F542%3Frss%3D1 Stratifying preoperative risk and guiding perioperative therapy objectively has acquired critical importance, given robust data demonstrating that morbidity following non-cardiac surgery confers substantially increased risk of death, even beyond hospital discharge. The development of useful perioperative biomarkers depends fundamentally on both prospective morbidity data that enable the identification of higher risk patients as well as the translational understanding of pathophysiological mechanisms underlying postoperative organ dysfunction, the development of which may be specific to the perioperative environment. The emergence of cardiac insufficiency, rather than cardiac ischaemia, as the dominant factor associated with excess risk of prolonged postoperative morbidity has promoted the ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5064656 Sun, 24 Jul 2011 23:00:00 +0100 5064656 http://www.medworm.com/index.php?rid=5064655&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1030%2F535%3Frss%3D1 Perioperative morbidity is associated with reduced long term survival. Comorbid disease, cardiovascular illness, and functional capacity can predispose patients to adverse surgical outcomes. Accurate risk stratification would facilitate informed patient consent and identify those individuals who may benefit from specific perioperative interventions. The ideal clinical risk scoring system would be objective, accurate, economical, simple to perform, based entirely on information available preoperatively, and suitable for patients undergoing both elective and emergency surgery. The POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) scoring systems are the most widely validated perioperative risk predictors currently utilised; however, their incl... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5064655 Sun, 24 Jul 2011 23:00:00 +0100 5064655 http://www.medworm.com/index.php?rid=5064654&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1030%2F529%3Frss%3D1 Conclusion The results of this study demonstrate that the increased extent of glomerular amyloid deposits may be associated with the decline of GFR in patients with renal amyloidosis. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5064654 Sun, 24 Jul 2011 23:00:00 +0100 5064654 http://www.medworm.com/index.php?rid=5064653&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1030%2F524%3Frss%3D1 Conclusion The provision of standardised proximate feedback was associated with significantly fewer errors and an improved learning curve. Reducing errors in the skills lab environment should lead to safer clinical performance. This may help to make training more efficient and improve patient safety. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5064653 Sun, 24 Jul 2011 23:00:00 +0100 5064653 http://www.medworm.com/index.php?rid=5064652&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1030%2F519%3Frss%3D1 Conclusion Medical faculty and residents should be more aware of their behaviour and attitudes in practice, especially their interaction with colleagues so that students' professional behaviour can be improved. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5064652 Sun, 24 Jul 2011 23:00:00 +0100 5064652 http://www.medworm.com/index.php?rid=5064651&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1030%2F514%3Frss%3D1 Conclusion Hypovitaminosis D, low dietary calcium and high phytate consumption are highly prevalent among young healthy adults in the western part of India. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5064651 Sun, 24 Jul 2011 23:00:00 +0100 5064651 http://www.medworm.com/index.php?rid=5064650&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1030%2F509%3Frss%3D1 It is an uncontested truth that many medical students and practising clinicians dread having to get their research proposal through a research ethics committee. In this paper, the author, a long-standing member of a research ethics committee, offers a practical guide on applying for research ethics approval, detailing common mistakes and flaws in applications, and giving specific guidance on getting through what can seem a daunting process. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5064650 Sun, 24 Jul 2011 23:00:00 +0100 5064650 http://www.medworm.com/index.php?rid=5064649&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1030%2F507%3Frss%3D1 Prescribing is an essential part of physicians' daily work, a professional and ethical responsibility. It implies a complex decision-making process that is conditioned not only by physicians' academic and cultural background but also by other factors such as pharmaceutical market width, medicines promotion by the pharmaceutical industry, access to independent information, medical care context in which the physician works and continuous education programmes or incentives from healthcare provider organisations. Left to pharmaceutical market whims, prescribing is known to be shifted towards newer and usually more expensive medicines.1 The most appropriate drugs for patients should be selected according to principles well described in the WHO ‘Guide to good prescribing’, such as co... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=5064649 Sun, 24 Jul 2011 23:00:00 +0100 5064649 http://www.medworm.com/index.php?rid=4971435&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1029%2F505%3Frss%3D1 A few weeks ago I was invited to run a workshop on reflective practice at a conference. I assumed the arrangements would be much as usual—a 90 min slot with maybe 10 or 12 people attending. I was mistaken. When I arrived I discovered the organisers had planned two slots for me, each lasting only three-quarters of an hour. Twenty-five people had already signed up for each of the slots. The thought of teaching reflective practice to such large numbers in such a short space of time seemed absurd, a contradiction in terms. It challenged my autonomic nervous so much that I had to go to the toilet. While there, I managed to collect my thoughts. I remembered how often health professionals complain that it's impossible to practise reflectively because time is so short and the circumstances t... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4971435 Fri, 24 Jun 2011 23:00:00 +0100 4971435 http://www.medworm.com/index.php?rid=4971434&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1029%2F503%3Frss%3D1 Case history A middle-aged man with systemic lupus erythematosus (SLE) presented with acute onset of abdominal pain associated with diarrhoea and vomiting. The patient was haemodynamically stable and the hydration was maintained. The patient also had intermittent urgency and a sense of incomplete urinary bladder emptying. Emergency multidetector CT scans of the abdomen and pelvis revealed moderate to severe wall oedema and mucosal swelling of the small bowel (figure 1) and entire length of the large colon (figure 2). There was moderate to severe stranding and increased vascularity within the mesentery and the mesocolon (figures 1 and 2). The major abdominal vessels, including the mesenteric arteries and veins, however, were patent. Figure 1Contrast-enhanced axial CT scan of the abdomen sho... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4971434 Fri, 24 Jun 2011 23:00:00 +0100 4971434 http://www.medworm.com/index.php?rid=4971433&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1029%2F502%3Frss%3D1 A 35-year-old woman presented with massive haematemesis. Emergency upper gastrointestinal endoscopy revealed oesophageal varices, and endoscopic sclerotherapy was provided. Liver function tests were normal. CT showed massive splenomegaly with grossly dilated and tortuous splenic vein (thin arrow) and attenuated main portal vein (thick arrow) and its intrahepatic branches (figure 1). Mild atrophy of the liver with a smooth outline was noted. These features were highly suggestive of non-cirrhotic portal fibrosis (NCPF). Multiple saccular and fusiform aneurysms were seen, involving the entire splenic artery (arrows) in coronal-reformatted and volume-rendered images (figure 2), the largest measuring approximately 2.5 cm. Splenic artery aneurysms are seen in less than 10% of patients with ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4971433 Fri, 24 Jun 2011 23:00:00 +0100 4971433 http://www.medworm.com/index.php?rid=4971432&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1029%2F496%3Frss%3D1 Antiphospholipid syndrome (APS) is an autoimmune disease characterised by a heterogenous group of antibodies directed against negatively charged phospholipids including antiphospholipid antibodies (aPL), anticardiolipin antibodies (aCL) and β-2 glycoprotein I (aβ-2-GP1). The major features of this disorder include arterial and venous thrombosis and recurrent fetal loss. The vasculature of the eye is frequently involved and may be the presenting manifestation. A diagnosis of APS should be considered in a young patients without traditional thromboembolic risk factors presenting with ocular vaso-occlusive disease. Management of these patients involves a team-approach with a haematologist/oncologist or rheumatologist to manage the coagulation status of these patients to prevent furth... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4971432 Fri, 24 Jun 2011 23:00:00 +0100 4971432 http://www.medworm.com/index.php?rid=4971431&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1029%2F487%3Frss%3D1 The eye is an easily accessible, highly compartmentalised and immune-privileged organ that offers unique advantages as a gene therapy target. Significant advancements have been made in understanding the genetic pathogenesis of ocular diseases, and gene replacement and gene silencing have been implicated as potentially efficacious therapies. Recent improvements have been made in the safety and specificity of vector-based ocular gene transfer methods. Proof-of-concept for vector-based gene therapies has also been established in several experimental models of human ocular diseases. After nearly two decades of ocular gene therapy research, preliminary successes are now being reported in phase 1 clinical trials for the treatment of Leber congenital amaurosis. This review describes current devel... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4971431 Fri, 24 Jun 2011 23:00:00 +0100 4971431 http://www.medworm.com/index.php?rid=4971430&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1029%2F482%3Frss%3D1 Excessive dynamic airway collapse (EDAC) refers to abnormal and exaggerated bulging of the posterior wall within the airway lumen during exhalation. This condition is pathological if the reduced airway lumen is <50% of the normal. It is a relatively new disease entity that is recognised more easily now with the increased use of multi-detector row CT. EDAC is often asymptomatic and diagnosed incidentally. Although the term excessive dynamic airway collapse is often used interchangeably with tracheobronchomalacia, both entities represent morphologically and physiologically distinct processes. Considering the confusion between the two entities, the prevalence of stand-alone EDAC remains unclear. The prevalence of tracheobronchomalacia and EDAC depends upon the patient population, associate... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4971430 Fri, 24 Jun 2011 23:00:00 +0100 4971430 http://www.medworm.com/index.php?rid=4971429&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1029%2F472%3Frss%3D1 There are no existing guidelines supporting the withdrawal or continuation of renin–angiotensin–aldosterone system (RAAS) antagonists in the preoperative setting. RAAS antagonists include ACE inhibitors, angiotensin II receptor subtype 1 blockers and direct renin inhibitors (eg, aliskiren), as well as the aldosterone antagonists. The use of these agents before surgery has been associated with a variable incidence of hypotension during the initial 30 min after induction of anaesthesia; however, these hypotensive episodes have not been conclusively linked to any significant postoperative complications, although recent data suggest an increase in postoperative morbidity and mortality in patients undergoing coronary artery bypass grafting. Further studies are required to be ab... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4971429 Fri, 24 Jun 2011 23:00:00 +0100 4971429 http://www.medworm.com/index.php?rid=4971428&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1029%2F468%3Frss%3D1 Conclusions Using a thin catheter for HSG and pressing on the cervix with the vaginal speculum to prevent leakage of the dye is a successful method to study the uterine cavity and fallopian tubes, and it significantly reduces the pain as compared to a metal cannula. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4971428 Fri, 24 Jun 2011 23:00:00 +0100 4971428 http://www.medworm.com/index.php?rid=4971427&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1029%2F463%3Frss%3D1 Conclusions Serum resistin concentrations are elevated in patients with acute STEMI. This increase is more prominent in patients with T2DM than in those without. However, serum resistin is not correlated with age, gender, BMI, and insulin resistance. These data suggest that serum resistin concentration might be used as a diagnostic biomarker for acute STEMI. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4971427 Fri, 24 Jun 2011 23:00:00 +0100 4971427 http://www.medworm.com/index.php?rid=4971426&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1029%2F458%3Frss%3D1 Conclusions Sleep apnoea is common in patients with severe AS. The severity of CSA correlates with pulmonary hypertension, which may suggest that myocardial adaptation is exhausting. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4971426 Fri, 24 Jun 2011 23:00:00 +0100 4971426 http://www.medworm.com/index.php?rid=4971425&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1029%2F453%3Frss%3D1 Conclusions The MUSTER model should be disseminated widely so that there is a robust, evidence based and consistent approach to environmental investigations which satisfies complainants, enhances practitioner knowledge base, and improves communication. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4971425 Fri, 24 Jun 2011 23:00:00 +0100 4971425 http://www.medworm.com/index.php?rid=4971424&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1029%2F450%3Frss%3D1 Conclusion The majority of healthcare professionals have a very poor knowledge of commonly used abbreviations. Use of unambiguous and approved list of abbreviations is suggested in order to ensure good communication in patient care. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4971424 Fri, 24 Jun 2011 23:00:00 +0100 4971424 http://www.medworm.com/index.php?rid=4971423&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1029%2F445%3Frss%3D1 Conclusion Functional imaging and then cardiac CT are the main investigations required in the assessment of patients with stable chest pain. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4971423 Fri, 24 Jun 2011 23:00:00 +0100 4971423 http://www.medworm.com/index.php?rid=4971422&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1029%2F443%3Frss%3D1 In March 2010, the National Institute for Health and Clinical Excellence (NICE) published evidence-based recommendations on best practice in the assessment and diagnosis of patients with chest pain that may be of cardiac origin.1 For those with suspected ‘stable angina’, they recommend initial clinical risk assessment to estimate the likelihood of coronary artery disease following which the requirement for diagnostic testing (anatomical testing for obstructive coronary artery disease and/or functional testing for myocardial ischaemia) is ascertained. As such, the guideline aims to provide objective clinical criteria for determining whether diagnostic testing is necessary and if so what test should be used. One of the most controversial decisions in the guidance is the omission ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4971422 Fri, 24 Jun 2011 23:00:00 +0100 4971422 http://www.medworm.com/index.php?rid=4873963&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1028%2F441%3Frss%3D1 Writing in the BMJ recently, a specialist registrar described how she found herself admitted to a ward full of other women, all more than twice her age.1 From her hospital bed she could overhear doctors talking to each other, and to their patients. "When the time came for the consultant ward round," she wrote, "it was impossible for me not to hear every word of each consultation". The lack of privacy was disturbing but it enabled the registrar, Jennifer Graves, to notice something else too. "What interested me," she wrote "was listening to these same ladies explaining to their relatives later in the day what the doctor had said. Not one of the other patients told their relatives the correct information". After discussing the different reasons why this happened—including deafness, dem... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4873963 Wed, 25 May 2011 23:00:00 +0100 4873963 http://www.medworm.com/index.php?rid=4873962&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1028%2F440%3Frss%3D1 Horner's syndrome describes a triad of pupillary miosis, partial eyelid ptosis and facial anhidrosis caused by disruption of the sympathetic pathway from the posterior hypothalamus to the eye. Diagnostic confirmation is crucial as causes can include life-threatening carotid dissection and apical lung tumours. Often the signs are subtle, with a difference of only 1-2 mm between affected and unaffected pupils and a similarly mild degree of ptosis. Anhidrosis is rarely obvious and generally present only in preganglionic lesions, as the sudomotor fibres diverge from the main pathway just after the superior cervical ganglion. Historically pharmacological confirmation used 4% topical cocaine to inhibit norepinephrine re-uptake, dilating only the normal pupil. In modern practice, this is now diff... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4873962 Wed, 25 May 2011 23:00:00 +0100 4873962 http://www.medworm.com/index.php?rid=4873961&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1028%2F438%3Frss%3D1 A 42-year-old woman presented with a 3-month history of transient episodes of syncope. These sudden episodes occurred without warning and were associated with loss of consciousness, palpitations, epigastric discomfort and a fixed upward gaze of both eyes. Her symptoms had progressed with increasing frequency to 2–3 times a day and each episode persisted for more than 20 min. The patient had no significant medical or family history. Her physical examination was unremarkable and no arrhythmias were noted on ECG. Blood tests and head CT images were unremarkable. A bedside transthoracic echocardiogram was performed, which showed in subcostal view, an elliptical shaped mobile mass located in the right atrium, measuring about 6 cmx5 cm in size, prolapsing through the tricusp... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4873961 Wed, 25 May 2011 23:00:00 +0100 4873961 http://www.medworm.com/index.php?rid=4873960&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1028%2F436%3Frss%3D1 A 30-year-old woman presented with a history of palpitations for 15 years and dyspnoea on exertion for 6 years. Her symptomatic status had worsened from New York Heart Association (NYHA) class 2 to NYHA class 3 in the last 1 year. On clinical examination, she had evidence of congestive cardiac failure and rheumatic mitral valve disease. ECG showed right axis deviation, left ventricular hypertrophy and atrial fibrillation (AF) with controlled ventricular rate. Her chest x-ray (figure 1) showed cardiomegaly and a hump-like convexity at the left cardiac border suggestive of an enlarged left atrial appendage (LAA). Transthoracic echocardiogram revealed dilation of all cardiac chambers with a markedly enlarged left atrium (LA, 12 cm). The mitral valve was thick and fibrosed ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4873960 Wed, 25 May 2011 23:00:00 +0100 4873960 http://www.medworm.com/index.php?rid=4873959&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1028%2F428%3Frss%3D1 Conclusions Hospital-wide interventions were associated with improvements in safety climate at a large academic medical centre. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4873959 Wed, 25 May 2011 23:00:00 +0100 4873959 http://www.medworm.com/index.php?rid=4873958&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1028%2F417%3Frss%3D1 Diabetes in pregnancy is increasing and therefore it is important to raise awareness of the associated health risks to the mother, the growing fetus, and the future child. Perinatal mortality and morbidity is increased in diabetic pregnancies through increased stillbirths and congenital malformation rates. These are mainly the result of early fetal exposure to maternal hyperglycaemia. In the mother, pregnancy may lead to worsening or development of diabetic complications such as retinopathy, nephropathy, and hypoglycaemia. This review defines pregestational and gestational diabetes and the associated health risks to the growing fetus and mother. Management is discussed, focusing on clinical evidence based guidelines published by the American Diabetic Association and the UK National Institu... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4873958 Wed, 25 May 2011 23:00:00 +0100 4873958 http://www.medworm.com/index.php?rid=4873957&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1028%2F410%3Frss%3D1 Trigeminal neuralgia is defined as sudden, usually unilateral, severe, brief, stabbing recurrent episodes of pain within the distribution of one or more branches of the trigeminal nerve, which has a profound effect on quality of life. The diagnosis is made on history alone, and time needs to be taken to elicit the key features and differentiate from toothache or one of the trigeminal autonomic cephalalgias. Most trigeminal neuralgia is idiopathic, but a small percentage is due to secondary causes—for example, tumours or multiple sclerosis—which can be picked up on CT or MRI. Recently published international guidelines suggest that carbamazepine and oxcarbazepine are the first-line drugs. There is limited evidence for the use of lamotrigine and baclofen. If there is a decrease i... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4873957 Wed, 25 May 2011 23:00:00 +0100 4873957 http://www.medworm.com/index.php?rid=4873956&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1028%2F405%3Frss%3D1 Conclusion Clinicians should be aware that postprandial hypoglycaemia is a common finding in eating disorders patients receiving inpatient treatment. As hypoglycaemia is predicted by low BMI, weight restoration is a priority for treatment in patients experiencing hypoglycaemia. Future research should investigate the nutrient composition of refeeding regimens and whether altering the macronutrient composition attenuates the presence of hypoglycaemia. Investigation is warranted in a community sample of eating disorder patients to see if this finding is replicated in non-hospitalised patients. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4873956 Wed, 25 May 2011 23:00:00 +0100 4873956 http://www.medworm.com/index.php?rid=4873955&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1028%2F400%3Frss%3D1 Conclusion EF is a significant predictor of all-cause mortality and cardiovascular mortality in patients with preserved or mildly depressed EF. Modalities of EF measurement are interchangeable and do not play a significant role in prognostication in a post-MI population. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4873955 Wed, 25 May 2011 23:00:00 +0100 4873955 http://www.medworm.com/index.php?rid=4873954&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1028%2F394%3Frss%3D1 Conclusions Contrary to previous hospital based research, patients tended to remember important components of both face-to-face and telephone consultations—perhaps reflecting the familiar, less anxiety provoking environment of primary care. The unsuccessful use of strategies to improve recall may reflect selective use in cognitively impaired patients. Clinicians should compensate for situations where recall is poorer such as patients presenting multiple problems or with brain injury. Patients might be advised to restrict the number of problems they present in any one consultation. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4873954 Wed, 25 May 2011 23:00:00 +0100 4873954 http://www.medworm.com/index.php?rid=4873953&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1028%2F389%3Frss%3D1 Conclusions Maintenance haemodialysis therapy is an important risk factor for prolonged hospitalisation regardless of the primary reason for admission. Such patients require admission more frequently than the general hospital population, particularly within 100 days before and after initiation of their first dialysis treatment. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4873953 Wed, 25 May 2011 23:00:00 +0100 4873953 http://www.medworm.com/index.php?rid=4873952&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1028%2F387%3Frss%3D1 Khat (also called Qat) is a shrub whose leaves (figure 1A) have been chewed for their central stimulatory effect by people of East Africa and the Arabian peninsular since the time of the Islamic conquest (around 640 AD) to the present day. Its stimulatory effects have been used in preparation for battle, religious ceremonies including weddings, and simply as a social pastime. It is used by some Muslims after fasting at Ramadan and has also found use as an appetite suppressant in the obese. Khat is predominantly cultivated in Kenya, Yemen and Ethiopia. In Ethiopia it is the second biggest export after coffee. Somalia has become the biggest net importer, its own production destroyed by years of civil war. Figure 1(A) Khat (Catha edulis Celestrasae) leaves, likely of Kenyan origin, where it i... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4873952 Wed, 25 May 2011 23:00:00 +0100 4873952 http://www.medworm.com/index.php?rid=4743029&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1027%2F386%3Frss%3D1 A 64-year-old man was admitted to hospital with shortness of breath and abdominal swelling. His background history included an inferior ST-elevation myocardial infarction (MI), 18 months previously, treated by stenting of his right coronary artery. On examination, there was a pansystolic murmur and signs of right heart failure, with markedly elevated jugular venous pressure, ascites and peripheral oedema. After treatment elsewhere with diuretics and intermittent paracentesis, he was transferred to our hospital for cardiac catheterisation. Left ventriculography demonstrated a large ventricular septal defect (VSD). The left anterior oblique projection (figure 1 and supplementary avi file) showed opacification of the right ventricle from the left ventricle. The calculated left-to-right s... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4743029 Thu, 21 Apr 2011 23:00:00 +0100 4743029 http://www.medworm.com/index.php?rid=4743028&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1027%2F384%3Frss%3D1 We describe the novel use of intravascular ultrasound-virtual histology (IVUS-VH) imaging in two previously healthy female patients (47 years old and 39 years old, respectively) who presented with acute myocardial infarction (AMI) and highlight the usefulness of this new invasive coronary imaging technique. Both patients had thrombotic occlusion of the left anterior descending (LAD) arteries (figures 1A and 2A). As they were both young females with minimal cardiovascular risk factors, IVUS-VH imaging was performed to gain a better understanding of the pathophysiology of AMI. IVUS-VH images for the latter patient had features suggestive of a ruptured vulnerable plaque (figure 2B) with a large underlying area of necrotic core seen. This was not observed for the former patient (figu... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4743028 Thu, 21 Apr 2011 23:00:00 +0100 4743028 http://www.medworm.com/index.php?rid=4743027&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1027%2F382%3Frss%3D1 A 64-year-old woman, with a history of epilepsy, presented with refractory status epilepticus. Upon admission to the intensive care unit she was treated with anticonvulsive agents (benzodiazepines, phenobarbital, and valproic acid). Her Glasgow Coma Scale (GCS) was 8; she had a fever (38.5°C) and hypoglycaemia (0.58 g/l). An electroencephalogram (EEG) performed after the anticonvulsant drugs were administered revealed a predominant left cortical slow wave activity. A magnetic resonance (MR) brain scan was performed, including axial diffusion weighted imaging (DWI) (figure 1) with apparent diffusion coefficient (ADC) map (figure 2) and axial fluid attenuated inversion recovery (FLAIR) (figure 3) weighted sequences. The left hemispheric cortex appeared hyperintense in DWI (arrows) t... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4743027 Thu, 21 Apr 2011 23:00:00 +0100 4743027 http://www.medworm.com/index.php?rid=4743026&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1027%2F379%3Frss%3D1 Conclusion Predefined processes of care may help to recognise those developing or likely to develop severe pancreatitis, ensure accurate documentation of severity, expedite critical care review and/or admission, and help to encourage the timely management of those with a treatable underlying cause of their pancreatitis. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4743026 Thu, 21 Apr 2011 23:00:00 +0100 4743026 http://www.medworm.com/index.php?rid=4743025&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1027%2F369%3Frss%3D1 Sporadic Creutzfeldt–Jacob disease (CJD) is a rare untreatable neurodegenerative disease which every neurologist will occasionally encounter during their career. However, it is likely to appear on their differential diagnosis list significantly more frequently. Numerous conditions can present with subacute encephalopathy which might be sporadic CJD and this article explores these diagnoses. It includes the commonest sporadic CJD mimics which are neurodegenerative, and highlights the relatively rare treatable mimics which must not be missed. It discusses relevant investigations, including serum antibodies, CSF, electroencephalography and MR brain imaging, and strategies when preliminary investigations fail to support sporadic CJD but no alternative diagnosis is readily apparent. (Sour... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4743025 Thu, 21 Apr 2011 23:00:00 +0100 4743025 http://www.medworm.com/index.php?rid=4743024&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1027%2F362%3Frss%3D1 Acute gastrointestinal (GI) haemorrhage is a frequent and potentially life threatening medical presentation, the management of which depends on more than one speciality. Upper GI haemorrhage is often treated by endoscopic methods, failing which radiological intervention or surgery are the alternative methods of treatment. Radiology is crucial both in the diagnosis and treatment of lower GI haemorrhage, where the role of endoscopy is limited by poor visibility. CT angiography is now the first line investigation of choice and catheter angiography is used as a prelude to intervention. Interventional radiological techniques for treatment include embolisation for both upper and lower GI arterial haemorrhage and transjugular intrahepatic portosystemic shunting for upper GI variceal haemorrhage r... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4743024 Thu, 21 Apr 2011 23:00:00 +0100 4743024 http://www.medworm.com/index.php?rid=4743023&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1027%2F355%3Frss%3D1 Head injury from physical abuse is unfortunately a common occurrence in our society. It is a major cause of mortality and long-term physical and psychological disability in children. Diagnosis of non-accidental head injury may be difficult, as most infants present with non-specific clinical findings and without external signs of trauma. Neuroimaging plays a fundamental role both for medical management and medicolegal aspects of child abuse. It is therefore imperative for the radiologist to promptly recognise the radiological findings of various forms of non-accidental head injury to render a more accurate opinion. A standardised imaging protocol and good communication between professionals are essential for optimum management. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4743023 Thu, 21 Apr 2011 23:00:00 +0100 4743023 http://www.medworm.com/index.php?rid=4743022&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1027%2F349%3Frss%3D1 Prescribing in pregnancy often causes uncertainty and anxiety for the clinician and may lead to the omission of necessary treatment. Many drugs have inadequate data to assure safety, and therefore the clinician is left with a dilemma as to where the balance of risks and benefits lie with respect to the mother and her fetus. Understanding under what circumstances women can be prescribed medication and using principles of prescribing in pregnancy to further clarify the potential risks will aid good clinical decision-making. An appreciation of the available resources and the conviction to find the best available evidence will best serve the patient and her fetus. Teratogenicity refers to the potential for a drug to cause fetal malformations and affects the embryo 3–8 weeks after co... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4743022 Thu, 21 Apr 2011 23:00:00 +0100 4743022 http://www.medworm.com/index.php?rid=4743021&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1027%2F345%3Frss%3D1 Conclusion Kotter's model is well studied in non-healthcare contexts and has potential to be adapted for improving patient safety. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4743021 Thu, 21 Apr 2011 23:00:00 +0100 4743021 http://www.medworm.com/index.php?rid=4743020&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1027%2F340%3Frss%3D1 Conclusions Use of the ISBAR tool improves JMO perception of handover communication in a time neutral fashion. Consideration should be given to the introduction of ISBAR in all JMO handover settings. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4743020 Thu, 21 Apr 2011 23:00:00 +0100 4743020 http://www.medworm.com/index.php?rid=4743019&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1027%2F335%3Frss%3D1 Conclusion False-negative rates of 0% (within 12 months) and 8% (within 3 years) for diagnosis of GC are reassuring, but an inadequate number of biopsies compromises the quality assurance of endoscopy. GC presents without alarm symptoms in <10%. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4743019 Thu, 21 Apr 2011 23:00:00 +0100 4743019 http://www.medworm.com/index.php?rid=4743018&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1027%2F331%3Frss%3D1 The objectives of this study were to assess the effects briefings and debriefings had on theatre start time, list lengths, and the staff's impression of these meetings. Materials and methods Briefings and debriefings were conducted before the start of theatre lists over a 6 month period in 2007 in a district general hospital in north Bristol, UK. Both quantitative and qualitative data were collected. Using the hospital theatre database, theatre start and finish time was found and list length calculated. A questionnaire was devised and used to assess staff attitude to the briefings and debriefings. Results Staff felt that the briefings highlighted potential problems, improved the team culture, and led to organisational change. Theatre start times tended to be earlier and lists length... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4743018 Thu, 21 Apr 2011 23:00:00 +0100 4743018 http://www.medworm.com/index.php?rid=4743017&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1027%2F325%3Frss%3D1 Conclusions These clinical results could be useful for rapid assessment of the treatment and prognosis of patients with aortic dissection. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4743017 Thu, 21 Apr 2011 23:00:00 +0100 4743017 http://www.medworm.com/index.php?rid=4743016&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1027%2F323%3Frss%3D1 Ethical decision-making and effective team working are at the core of medical professionalism and patient safety. But new concepts of patient autonomy may be at odds with traditional views of the primacy of preserving life,1 and maintaining a focus on patient safety within complex clinical environments is evermore challenging. These two fields are under-developed and under-theorised in medical education.2 What is lawful may not be seen as ethical; and what professionals regard as ethical may not be lawful. New nurses and doctors have to learn different ways of doing things and to do them with new people. The rules of play are often unwritten. Investigating what people ‘know’ and ‘do’ is difficult as well. Neurocognitive scientists suggest that self-reported and pred... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4743016 Thu, 21 Apr 2011 23:00:00 +0100 4743016 http://www.medworm.com/index.php?rid=4665969&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1026%2F322%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4665969 Wed, 30 Mar 2011 23:00:00 +0100 4665969 http://www.medworm.com/index.php?rid=4665968&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1026%2F317%3Frss%3D1 Background The urgent need for patient safety education for healthcare students has been recognised by many accreditation bodies, but to date there has been sporadic attention to undergraduate/graduate medical programmes. Medical students themselves have identified quality and safety of care as an important area of instruction; as future doctors and healthcare leaders, they must be prepared to practise safe healthcare. Medical education has yet to fully embrace patient safety concepts and principles into existing medical curricula. Universities are continuing to produce graduate doctors lacking in the patient safety knowledge, skills and behaviours thought necessary to deliver safe care. A significant challenge is that patient safety is still a relatively new concept and area of study; thu... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4665968 Wed, 30 Mar 2011 23:00:00 +0100 4665968 http://www.medworm.com/index.php?rid=4665967&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1026%2F311%3Frss%3D1 Conclusions There is now a large body of evidence supporting a reduction in acute coronary events following the implementation of comprehensive smoke-free legislation, with the effect increasing over time from implementation. Countries that have not yet adopted smoke-free legislation should be encouraged to do so. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4665967 Wed, 30 Mar 2011 23:00:00 +0100 4665967 http://www.medworm.com/index.php?rid=4665966&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1026%2F307%3Frss%3D1 Sir Harold Ridley is recognised today as the inventor of intraocular lens implantation, one the most successful and common procedures in all of surgery. His story, however, is not largely one of triumph and public accolade. This paper reviews Ridley's invention of the intraocular lens and highlights the struggles he faced after his discovery. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4665966 Wed, 30 Mar 2011 23:00:00 +0100 4665966 http://www.medworm.com/index.php?rid=4665965&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1026%2F298%3Frss%3D1 Hypoglycaemia is a major burden on patients and society and is often a barrier to the achievement of tight glycaemic control. Intact awareness of hypoglycaemia is crucial to recognising and treating hypoglycaemia before it becomes severe enough to impair consciousness. Repeated hypoglycaemia can lead to impaired awareness increasing the risk of severe hypoglycaemia up to sixfold. Hypoglycaemia is much less common in those with type 2 diabetes, the incidence increasing with longer duration of treatment with insulin, associated comorbidities, and in the elderly. Alcohol, advancing age and exercise may predispose to hypoglycaemia. Newer agents acting via the incretin axis are associated with low rates of hypoglycaemia. Intensification of therapy to achieve tight glucose control can increase t... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4665965 Wed, 30 Mar 2011 23:00:00 +0100 4665965 http://www.medworm.com/index.php?rid=4665964&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1026%2F288%3Frss%3D1 This article discusses the methods available for imaging the small bowel in paediatric Crohn's disease and the relative merits of each modality. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4665964 Wed, 30 Mar 2011 23:00:00 +0100 4665964 http://www.medworm.com/index.php?rid=4665963&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1026%2F274%3Frss%3D1 Abdominal radiographs are one of the most commonly performed radiological examinations and have an established role in the assessment of the acute abdomen. The main indication is for suspected bowel obstruction and in conjunction with an erect chest x-ray for suspected visceral perforation. Often, the pattern of gas points to a particular pathology, and accurate interpretation is important for prompt diagnosis. The diagnosis in most cases will be confirmed by further imaging studies such as ultrasound, contrast studies or, most commonly in contemporary practice, CT. This pictorial review summarises the various types of intraluminal and extraluminal gas patterns, illustrates some of the common clinical diagnoses made from plain films, describes some commonly encountered clinical problems wi... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4665963 Wed, 30 Mar 2011 23:00:00 +0100 4665963 http://www.medworm.com/index.php?rid=4665962&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1026%2F269%3Frss%3D1 Many adult patients with strabismus are under the misconception that nothing can be done to correct the problem or that treatment is associated with a high degree of risk. Moreover, many optometrists, comprehensive ophthalmologists and primary care physicians are similarly misinformed. In fact, most adult patients with strabismus can be successfully treated, with ~80% of patients achieving satisfactory alignment with one surgical procedure. In addition, adult strabismus surgery carries a relatively low risk, with serious complications being anecdotal and rare. The majority of adults will experience some improvement in binocular function after strabismus surgery even if the strabismus has been longstanding. Most commonly this takes the form of an expansion of binocular visual fields; howeve... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4665962 Wed, 30 Mar 2011 23:00:00 +0100 4665962 http://www.medworm.com/index.php?rid=4665961&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1026%2F264%3Frss%3D1 Conclusions The new pathway led to more effective use of clinic appointments, reduced diagnostic delay, and more rapid treatment decision times. Patient satisfaction with the speed of the diagnostic process increased. It is recommended that hospital trusts in England consider adopting similar ‘straight to test’ triaging to select patients for lung cancer clinics. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4665961 Wed, 30 Mar 2011 23:00:00 +0100 4665961 http://www.medworm.com/index.php?rid=4665960&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1026%2F257%3Frss%3D1 Conclusions Independent of social class there is high prevalence of neonatal mortality. There is a close association between utilisation of health care services during pregnancy, postnatal period and neonatal deaths due to TS. It is argued that there is a need for a two pronged approach to reduce neonatal mortality due to TS: (1) to train traditional birth attendants, and expand the reach of existing antenatal care and childbirth facilities; and (2) to empower women to increase their awareness to take decisions about seeking proper medical assistance during pregnancy and childbirth. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4665960 Wed, 30 Mar 2011 23:00:00 +0100 4665960 http://www.medworm.com/index.php?rid=4665959&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1026%2F251%3Frss%3D1 Conclusions Compared with BMI, measures of central obesity, particularly WHtR, show a better association with obesity related cardiovascular risk conditions for both sexes, except for hypertension in men, in Jinan, China. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4665959 Wed, 30 Mar 2011 23:00:00 +0100 4665959 http://www.medworm.com/index.php?rid=4665958&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1026%2F245%3Frss%3D1 Conclusions Appendicitis and gallstones are considered to be avoidable causes of death. Mortality rates for each cause have not shown any substantial falls in the recent periods covered by this study. It is possible that deaths were not, in fact, avoidable, but audits into the circumstances of deaths from these diseases may be warranted. Mortality data based on underlying cause alone substantially underestimate deaths from these two conditions. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4665958 Wed, 30 Mar 2011 23:00:00 +0100 4665958 http://www.medworm.com/index.php?rid=4665957&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1026%2F243%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4665957 Wed, 30 Mar 2011 23:00:00 +0100 4665957 http://www.medworm.com/index.php?rid=4523065&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1025%2F242%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4523065 Fri, 25 Feb 2011 00:00:00 +0100 4523065 http://www.medworm.com/index.php?rid=4523064&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1025%2F241%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4523064 Fri, 25 Feb 2011 00:00:00 +0100 4523064 http://www.medworm.com/index.php?rid=4523063&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1025%2F240%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4523063 Fri, 25 Feb 2011 00:00:00 +0100 4523063 http://www.medworm.com/index.php?rid=4523062&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1025%2F239%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4523062 Fri, 25 Feb 2011 00:00:00 +0100 4523062 http://www.medworm.com/index.php?rid=4523061&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1025%2F223%3Frss%3D1 Chronic hepatitis B is one of the most common infectious diseases worldwide. In patients with an impaired immune system the prevalence of HBsAg is even higher and the course of hepatitis B infection is often aggravated. In HIV/HBV co-infected patients, liver related morbidity and mortality can be reduced by implementing highly active antiretroviral treatment (HAART) that contains substances active against HBV. Reactivation of HBV during chemotherapy may occur in HBsAg positive patients but can even occur in serologically recovered anti-HBc positive, HBsAg negative patients resulting in high mortality from liver disease. HBsAg positive patients irrespective of HBV DNA levels should receive preemptive treatment with HBV polymerase inhibitors which should be continued for 12 months after... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4523061 Fri, 25 Feb 2011 00:00:00 +0100 4523061 http://www.medworm.com/index.php?rid=4523060&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1025%2F215%3Frss%3D1 The idiopathic inflammatory bowel diseases comprise mainly two types of intestinal disorder, Crohn disease and ulcerative colitis. The clinical course is marked by exacerbations and remissions that occur spontaneously in response to treatment or intercurrent illness. The disease affects approximately 240 000 patients in the UK. Acute severe ulcerative colitis is a medical emergency; prompt effective treatment at the point of admission can avoid significant morbidity and be potentially life-saving. Although such patients need specialist management, it is imperative that emergency care physicians are aware of the important principles of management of this condition to achieve successful outcomes. Corticosteroids remain the cornerstone of initial therapy, but a third of patients will fail to ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4523060 Fri, 25 Feb 2011 00:00:00 +0100 4523060 http://www.medworm.com/index.php?rid=4523059&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1025%2F207%3Frss%3D1 This article reviews these cystic lesions of the pancreas, neoplastic and pseudocysts, and aims to update readers with the current trends in their diagnosis and management. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4523059 Fri, 25 Feb 2011 00:00:00 +0100 4523059 http://www.medworm.com/index.php?rid=4523058&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1025%2F199%3Frss%3D1 Advanced age is associated with the finding of abnormalities on neurological and cognitive assessment. This review aims to identify studies that evaluated community samples of patients without a history of neurological disease and attempts to combine these data. While neurological signs were common, they were not universal and should not be considered an inevitable component of ageing. Additionally, they are associated with an increased risk of multiple adverse outcomes including functional decline and death. Therefore they should not be considered benign. Cognitive changes detected in studies that examined healthy older adults were only mild. More pronounced change suggests the development of dementia or mild cognitive impairment (a precursor to dementia). Changes in either neurological o... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4523058 Fri, 25 Feb 2011 00:00:00 +0100 4523058 http://www.medworm.com/index.php?rid=4523057&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1025%2F189%3Frss%3D1 Peripheral arterial disease is usually secondary to stenotic or occlusive atherosclerosis and is both common and increasing in western society. The majority of symptomatic patients have intermittent claudication and only a minority (<2% and typically those with diabetes mellitus or renal failure) progress to critical limb ischaemia, heralded by the onset of rest pain and/or tissue loss. Imaging is largely reserved for patients with disabling symptoms in whom revascularisation is planned. In these patients, accurate depiction of the vascular anatomy is critical for clinical decision making as the distribution and severity of disease are key factors determining whether revascularisation should be by endovascular techniques or open surgery. Driven by advances in technology, non-invasive va... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4523057 Fri, 25 Feb 2011 00:00:00 +0100 4523057 http://www.medworm.com/index.php?rid=4523056&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1025%2F180%3Frss%3D1 Non-invasive assessment of coronary artery patency has been attempted with different imaging modalities over the last few decades. The continuous motion of the heart, the respiratory movement, together with the small and tortuous nature of the coronary arteries, made this a technically challenging task. Over the last decade, significant advances in computed tomography (CT) technology helped CT coronary angiography (CTCA) to evolve as a non-invasive alternative to conventional catheter based coronary angiography. Clinical experience with CTCA has since grown rapidly and led to its acceptance as a useful diagnostic technique for coronary artery disease in certain patient populations. Recently, there has been exponential growth in the availability and use of CTCA in several centres across the... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4523056 Fri, 25 Feb 2011 00:00:00 +0100 4523056 http://www.medworm.com/index.php?rid=4523055&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1025%2F175%3Frss%3D1 Conclusion Vaginal birth for preterm infants in breech presentation is possibly associated with a higher risk of adverse neonatal outcomes compared with caesarean birth in Canadian NICUs. It is not clear whether adverse outcomes are due to the mode of delivery or whether breech birth is associated with other risk factors, an issue that can only be resolved by a randomised controlled trial. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4523055 Fri, 25 Feb 2011 00:00:00 +0100 4523055 http://www.medworm.com/index.php?rid=4523054&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1025%2F170%3Frss%3D1 Conclusions Despite some improvement and better awareness, there are still significant delays before hospital doctors consider the diagnosis of HIV for patients in low prevalence areas, even among some patient groups with high risk. Hospitals should consider moving to opt-out routine HIV testing of all medical admissions. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4523054 Fri, 25 Feb 2011 00:00:00 +0100 4523054 http://www.medworm.com/index.php?rid=4523053&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F87%2F1025%2F166%3Frss%3D1 Conclusion This study shows that in a district general hospital a neurologist can contribute to inpatient diagnosis and management with minimal diagnostic change over time, suggesting reliability of this service. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=4523053 Fri, 25 Feb 2011 00:00:00 +0100 4523053