DundeeChest 3.0

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Life In The Fast Lane‘s Latest Pulmonary Puzzle is a very nice example – take a look here. If you don’t have Life In The Fast Lane bookmarked yet, I strongly encourage you to do so – it’s one of the best all round medical blogs I’ve found, and it keeps a wry sense of humour to boot. It’s particularly useful if you want to be an A&E doc, but helpful to all.

And the Pulmonary Puzzles are spot on!

I just need a second post to test the system!

Another year, another go at making the website more functional and more appealing to you, the reader.

This means a new hosting service; a dedicated lifelone URL; a switch to WordPress self hosting; and trying out new themes. This one is attractive, for sure, but it doesn’t handle drop down menus. It does have this lovely featured post bar at the top though. The theme is called Nofelia.

We’ll see.

NIght shifts can be a bit of a blur. Creative Commons License Photo

A group from Innsbruck have now show that working night shifts is bad for our cardiovascular systems. Not a great shock – I remember in Falkirk, years ago as an SHO I took part in a study where we measured ambulatory blood pressures whilst on day shifts and night shifts. It clearly showed elevated diastolic pressures throughout the night, even if asleep…

So will I end up doing nights again? Probably. The reduction in junior doctor numbers, and hours, means we will doubtless have to fill the gaps with consultant hours. This creates a big issue – who will do my clinic in the morning, if I’m up at night in HDU putting in central lines, and managing unwell patients?

And do we ask my more ‘senior’ colleagues to do nights shifts after not doing them for 15 – 20 years?

Edit 31/01/10: BMJ Careers this week has an article written by a new consultant who has taken on a post as a “Hybrid Consultant”. She seems very happy with the role, it sounds like a terrible idea to me…

Alternative medicine, irks me.  Complimentary medicine I have no problems with whatsoever, but I find it very difficult to accept those who shun accepted medical practices in favour of solely alternative therapies.  Homeopathy particularly.  So the folks over at Homeopathy 1023 are trying to show the lack of efficacy of homeopathic treatments by encouraging a deliberate mass overdose of a homeopathic treatment.

The new BTS Asthma guidelines review the evidence for alternative therapies, eventually concluding that there is no evidence to support any homeopathic treatment in asthma, along with dietary supplements, electrolyte supplements, ionisers, buteyko technique….

“Do you know what they call alternative medicine that’s been proven to work…..?  Medicine” – Tim Minchin, “Storm”.

Not strictly safe for work this next video, but if you have 9 minutes to listen to a beat poem….

Image from Face of a Dreamer Flickr Stream

The mainstay of COPD management is bronchodilatation – the local, and national guidelines rely on beta-2 agonists, and anti-cholinergics. Recent(ish) data from the TORCH study suggested that inhaled corticosteroids increase the risk of fatal and non-fatal pneumonias.

Unopposed long acting beta agonists have been linked with increased cardiovascular death in asthmatics, although not in COPD. The most recent ’scare’ has been whether Spiriva increases cardiovascular death in COPD patients. Today the FDA rule that there is no compelling evidence to that effect.

To learn more about COPD visit the COPD GOLD guidelines pages, or the NICE guidelines on COPD.  We’ll be updating our local guidance on COPD soon, so keep checking the Knowledge Base section for updates.

To see some patients with COPD, come to ward 3, any day of any week!