We are proud to announce that we have been successful in our application for funding from Tenovus-Scotland to start our first clinical trial of 2013. Richard Stretton, James Chalmers, and Tom Fardon will be leading on the study, looking into the effects of pulmonary rehabilitation in bronchiectatic patients.
In a bid to improve data collection on the use of inhalers in the community one American company has now developed Asthmapolis, a GPS device to strap onto your inhaler and track usage on your iPhone. Looks like it could be a useful piece of kit for piecing together asthmatic triggers, but I have some issues over the name. Clearly Asthmapolis is meant to sound like a futuristic and fresh approach to disease management, but there are an awful lot of scottish patients who might think they are being monitored by the Asthma Police.
Patient outcome is not altered by longer shifts, but juniors’ training suffers overall:
I’ve been watching “Junior Doctors – You Life In Their Hands”. More out of morbid fascination, rather than anything else. It’s quite revealing, and not in a particularly flattering way.
Have you watched it – any thoughts?
The Japan earthquake and Tsunami has lead to critical incidents at nuclear power stations, and, understandably, concern over radiation levels throughout Japan. At the site of the incident, radiation levels soared to 400mSv per hour, but quickly fell to 0.6mSv per hour at the front gate of the plant hours later. Levels throughout Japan have been reported as 6uSv per hour this morning.
But what does these figures actually mean? And how do they relate to the doses of radiation we expose our patients to in clinical practice?
A CXR is about 0.02 mSv
Background radiation for a year in Dundee is 2.5 mSv
A helical CT scan of the Chest, Abdomen and Pelvis is about 12 mSv
Radiation sickness usually occurs at 1 Sv
Louis Slotin received 5.1 Sv during the criticality accident in 1946 that lead to his death
Radical radiotherapy is usually of the order of 50 Sv, in a number of fractions
If you want to learn more about the risks of ionising radiation associated with common radiological investigations, you can visit the Radiation Tutorial that Smithy devised last year.
The half way ball was in Cardrona on the 19th Feb, and I was llucky enough to be invited along to the proceedings. The meal was lovely, the company was excellent, and I was asked to make a speech. I’ve been asked to put the speech up online, so here seems as good a place as any to put it. With apologies to Baz Lurhman:
Ladies and Gentlemen of the class of 2013. If I could offer you only one tip for the future, audit would be it.
The benefits of audit have been proved by actual scientists whereas the rest of my advice has no basis more reliable than my own meandering experience…I will dispense this advice now.
Ask more questions. You seek knowledge, and all around are those willing to dispense it. A day spent on the wards, in clinics, and with patients is worth a week with any book. You spend your days but a stone’s throw from all the medicine you’ll ever need to learn; take a deep breath, wash your hands, and leave the blue carpet.
You’re not as bad at blood gases as you imagine. Actually, you probably are.
Don’t worry about the future; or do worry, but know that worrying is as effective as trying to carry out a total hip replacement by playing Angry Birds on your iPhone.
The real troubles in your life are apt to be things that never crossed your currently inebriated mind; these troubles will blindside you one Tuesday, probably on call, most likely in your first week as a house officer. But you will cope, and you will flourish.
Do one thing everyday that scares you: I am available for tutorials, that should do the trick.
Sing. But not my ward round.
Don’t be reckless with patients, don’t put up with doctors who are reckless with you.
Floss. But not on my ward round.
Don’t waste your time on jealousy; sometimes you’re ahead, sometimes you’re behind…the race is long, and in the end, the portfolio exam is a doddle.
Unless you get me.
Remember the compliments you receive, forget the insults; if you succeed in doing this, tell me how.
Keep notes from tutorials, throw away your lecture notes (They’re all on blackboard anyway).
Stretch. But not on my ward round.
Don’t feel guilty if you don’t know what specialty you want to enter by the end of 3rd year…many of the best doctors, and most interesting people I know didn’t know at 22 what they wanted to do with their lives. Some of the consultants I know just make up their minds.
Get plenty of calcium. Be kind to your knees, you’ll miss them when they’re gone, as you can see at Thursday night 5-a-side (we’re always looking for new players, but no one who’s actually any good…)
Maybe you’ll become a physician, maybe you won’t, maybe you’ll learn bronchoscopy, maybe you won’t, maybe you like hammers and chisels, maybe you won’t. Maybe you’ll change your mind at 40, quit your consultant job and go surfing. What ever you do, don’t congratulate yourself too much or berate yourself either – your choices are half chance, so are everybody else’s. It’s never too early, and it’s never too late.
Enjoy your mind, use it every way you can…don’t be afraid of it, or what other people think of it, it’s the greatest instrument you’ll ever own..
Dance. But not on my ward round.
Read the protocols, we write them for a reason. Remember that there’s no code, only guidelines, and they’re just for guidance.
Do NOT read Heat magazine, it will only make you feel intelligent.
Get to know your supervisors, they’ve been where you are, they’ve seen it all before, and you never know when they’ll be gone for good
Be nice to your peers; they are the best link to your past and the people you will be working with in 3 years. Understand that friends come and go, but you will see more of your colleagues than you will of your spouse.
Live in Glasgow once, but leave before it makes you hard; live in Edinburgh once, but leave before you like humous.
Travel. Around my ward round.
Accept certain inalienable truths, lectures will be boring, the ITA will be cold, and lectures might not all be on blackboard before the event. You will qualify, and then teach students, and when you do you will remember that my lectures were riveting, my ITA sessions were fabulous, and all those lectures were there, every time.
Respect your elders. Particularly on my ward round.
Be careful whose advice you take, but, be patient with those who
Listen to your patients, they will tell you their diagnosis, if you give them the opportunity.
Buy an iPad. And download my app.
But trust me on the audit…
Eat your greens, Old Ma DundeeChest used to tell me. She was right.
I suspect that the chances of developing COPD are more influenced by smoking…
I’m trying to some up with a new, improved way of collecting feedback from the medical students. My plan is to make it easy, and quick to put in the feedback. Let’s see if it works…
Or how about this one:
[polldaddy survey="CAE8638338FD18E5" type="button" title="End of Block Feedback" style="rounded" text_color="FFFFFF" back_color="FA002A"]
Or this one:
[polldaddy survey="CAE8638338FD18E5" type="slider" title="End of Block Feedback" body="Please complete this survey to give feedback on the block. Many thanks." button="Get Started »"]
Or this one:
Refresh your memory with this snippet screencast about what oxygen saturations to target in acutely unwell patients. Remember, if in doubt, aim for the lower target.
Back again with another 60 second screencast. This time, what’s wrong with this 65 year old farmer with sudden onset breathlessness, and a worrying CXR. Yes, I know it’s far longer than 60 seconds, but that’s more a guideline.