DundeeChest 3.0

Archive for the ‘General Respiratory’ Category

Calm down dear, its only your 210th admission.

The more the merrier. Or if not merry, at least alive. That is the message from a recent paper in the New England Journal looking at the survival rates for common conditions depending on the patient load of the admitting hospital.  It would appear that having to admit yet another pneumonia is actually good for the health of the other four you already admitted this week. Looking at all the admissions through Medicare to US hospitals for MI, CCF and Pneumonia the authors found that the hospitals with the larger patient volume of each condition had improved 30 day survival for that particular illness. The improvement in mortality wasn’t relentless though, (otherwise we should have a giant überhospital for all UK pneumonia patients where no-one dies) given that they found once your hospital topped 210 pneumonia patients there was no further survival benefit. Mind you, EWTD means they are all probably clerked by the same lonely registrar…..

Alternatively, it will tell you what the weather is like out at the smoking shelter...

The Department of Health is trying to prove that although it can spend more money than the GNP of a small African nation on a dysfunctional patient database, it is up to speed with the world of mobile technology.  They have produced an iPhone app to help patients quit smoking and surprisingly it, well, actually works (as an App I mean, I couldn’t attest to its impact). There are prominent hints and tips about kicking the habit and a few nice scary facts (in red, no less) to try and keep the underlying fear factor above the “can’t be arsed” threshold.  By far the best feature however is the timer that starts from the second you quit and then tracks how much money you have saved. If nothing else I recommend non-smokers to download it and start the counter for that nice warm smug feeling you get when you see how much of your cash hasn’t gone up in smoke.  I will have to restrain myself from shoving it in the faces of smokers and laughing though….

Another week in East Block, another week of learning opportunities!

Monday
Dr Fardon has an all day clinic
Dr Winter has a morning clinic
Dr France has an afternoon clinic
Dr Brown has an afternoon bronchoscopy list

Tuesday
The X-Ray meeting is at 08:30
Dr Fardon has a morning clinic
Dr Winter has a morning clinic
Dr Smith has a morning clinic
Dr Smith has an afternoon sleep clinic

Wednesday
Dr Smith has a morning clinic
Prof Lipworth has a morning asthma clinic
There is a bronchoscopy list in the morning
The FaME awards ceremony is at 1pm in LT1
Dr Fardon is teaching 4th years about ABGs at 3, if anyone wants to tag along

Thursday
Dr Fardon has a SPN clinic in the morning
Dr Rodgers has a CF clinic in the morning
The medical grand round is at 1pm, in LT1
The Lung Cancer MDT is at 2pm

Friday
The respiratory department business meeting is at 9am
Dr Fardon has an EBUS list in the morning
Dr Schembri has a sleep clinic in the morning
The respiratory department education meeting is a 1pm
Dr Fardon will teach some 3rd years at 2, if anyone wants to tag along

I have a great opportunity for a student to do a little bit of research with me. We have a large database of referrals we need to search through to work out what our cough referral burden is. Then we need to come up with guidelines for primary care to follow before referral to secondary care.

I think one student could do it, or possibly share it between two…

First ones to e-mail me get the shot!

You know where I am.

Doh!, indeed.

As ever, the best piece of writing (in my humble opinion) from over the weekend comes from the “Bad Science” blog.  Ben Goldacre’s mind is hardwired for statistics, and this week he has turned it to the oft touted health benefits of smoking, and in particular, protection against Alzheimers.  He discusses a recently published systematic review which – surprise surprise (and I’m sure I’m not spoiling it for anyone here – hey? what? smokings bad! You don’t say) – shows that the risk of alzheimers is increased in smokers.  The really interesting part however, if you are into this sort of thing, is the analysis of papers where the researchers were associated with the Tobacco industry. Now that is a surprise I won’t spoil.

Hands up if you want a chest drain....

Well, probably not.  Is bigger better? That is the question (with apologies to Billy Shakespeare) that wafts around the room when discussing the chest drain options for an Empyema.  Long has it been argued that drains of a wider bore ensure complete drainage of tenacious pus from the chest cavity, and sidestep the problem of getting repeatedly blocked.  The pros and cons of both wide bore surgical drains using blunt dissection, and their smaller counterparts inserted with the seldinger technique, are batted back and forth among chest physicians and cardiothoracic surgeons alike.  This recent paper in Chest looks to clarify the issue by looking afresh at the MIST1 trial data and determines that the smaller drains did not lead to increased rate of death, or need for surgery, but were associated with less pain. Their conclusion is that the small drains seem to be doing the job just fine thank you very much, but needless to say a properly designed study looking specifically at this issue is needed. Don’t they always say that?  For a good discussion around the topic I would check out the editorial in the same issue.

A great web resource

Basic Chest X-Ray Interpretation

Good training for medical students

Cases of the week directory

Strained metaphor to get amusing picture into blog...

We know that asthma often goes hand in hand with other atopic conditions such as eczema and hayfever but it appears it may be holding hands with a few other diseases too.  German researchers have taken a sneaky peek at the Swedish Hospital Discharge Register for the years 1964–2007 on 148,295 hospitalized asthma patients.  They found that the rate of hospitalisation for an autoimmune disease was higher amongst the Asthmatic population than the general population, the most common being Polyarteritis Nodosa and Addisons disease.  There is a healthy amount of speculation about Lymphocytes, cytokines and HLA systems, but that makes my brain hurt and its Friday so I wouldn’t dare to comment……

Case of the week 4 is now up. A 66 year old man is referred to the psychiatry clinic for assessment of memory loss. If you want to know how this relates to respiratory medicine click here, or head over to the cases of the week section.