A wonderful Christmas meal atSilversmiths was my GP group treat for being so good in 2012!
We managed not to talk just about how great the food was, we also chewed over some meaty clinical dilemmas.
Ranging from pregabalin, it's use and misuse, chronic pain management in general and our frustrations with thesis services. Reorganising and managing reception/admin teams, nail biting and whether a particular little girl was in need of psychological assessment and knees!
A very pleasant and fruitful way to catch up and mull over some big issues for 3 hours!
Thursday 6 December 2012
Tuesday 20 November 2012
Diagnosing patient's preference
Is it just me, or did I miss something? The editorial with the above title in BMJ this month make me chuckle, then sigh and shake my head!
http://www.bmj.com/content/345/bmj.e7745?etoc=
Surely this is what we spend our days in General Practice land doing already? I'm sure I was marked on it when I submitted videos for MRCGP nearly 10 years ago? Why are the words communication skills not used?
I particularly like the tantalising comments about the possibility of reducing costs by asking patients what they really want. I also liked the editorial comments about making the patient part of the team, making the decision together with clinicians.
I did, of course listen to the podcast and the authors seem very genuine and again, there is no mention of General Practice or any mention of communication skills training.
I guess if there is any change in secondary care as a result of these papers, that must be a good thing. I'm just amazed this is where they are at.
http://www.bmj.com/content/345/bmj.e7745?etoc=
Surely this is what we spend our days in General Practice land doing already? I'm sure I was marked on it when I submitted videos for MRCGP nearly 10 years ago? Why are the words communication skills not used?
I particularly like the tantalising comments about the possibility of reducing costs by asking patients what they really want. I also liked the editorial comments about making the patient part of the team, making the decision together with clinicians.
I did, of course listen to the podcast and the authors seem very genuine and again, there is no mention of General Practice or any mention of communication skills training.
I guess if there is any change in secondary care as a result of these papers, that must be a good thing. I'm just amazed this is where they are at.
Friday 9 November 2012
Reading
Squeezing in some medical reading, which is harder for me than podcasts as you have to sit down!
I'm enjoying Will Self's Booker Prize short listed 'Umbrella' although there are no chapters and keeping up with the narrative requires a lot of concentration. He has a lot to say about medical care, labelling stigma and institutionalisation. I wonder how non medics find it to read. I know he wrote this when he was unwell, then found out to have Polycythaemia Rubra Vera and I've read articles by him about his experience as a patient-
http://www.guardian.co.uk/books/2011/oct/21/will-self-blood-disease
I keep reading other people's opinion of Ben Goldacre's Bad Pharma, once I've chewed through Umbrella that will be the next big read on my list!
I'm enjoying Will Self's Booker Prize short listed 'Umbrella' although there are no chapters and keeping up with the narrative requires a lot of concentration. He has a lot to say about medical care, labelling stigma and institutionalisation. I wonder how non medics find it to read. I know he wrote this when he was unwell, then found out to have Polycythaemia Rubra Vera and I've read articles by him about his experience as a patient-
http://www.guardian.co.uk/books/2011/oct/21/will-self-blood-disease
I keep reading other people's opinion of Ben Goldacre's Bad Pharma, once I've chewed through Umbrella that will be the next big read on my list!
Friday 19 October 2012
Lots of stuff!
Yesterday I had a wonder day devoted to studying, I was on the RCGP Alcohol Management in Primary Care Course and in addition I squeezed in 2 podcasts from Inside Health! one on the bus there and one back.
So the first had one really interesting interview with a neurology profesor about who can stop their anti-epileptics and when they can do it.
The second had a good article about benign essential tremor again from specialist, but a different one. How to diagnose, features that suggest alternative diagnoses and alarming features of a tremor.
The course was excellent too! Delivered by the wonderful Jenny Keen of the Primary care substance misuse team.
A very productive day!
So the first had one really interesting interview with a neurology profesor about who can stop their anti-epileptics and when they can do it.
The second had a good article about benign essential tremor again from specialist, but a different one. How to diagnose, features that suggest alternative diagnoses and alarming features of a tremor.
The course was excellent too! Delivered by the wonderful Jenny Keen of the Primary care substance misuse team.
A very productive day!
Tuesday 16 October 2012
BMJ podcasts
I don't know why but I've had to re-subscribe to this podcast again and have missed a lot of them. But the latest 2 are great-
12/10/12- Over treatment is discussed mainly with reference to the American system but very pertinent to the UK when changes by the coalition government are in process.
5/10/12 discussed the recent advert by the British Heart Foundation to encourage the public to try hands only resuscitation. Apparently the campaign was hugely successful and viewed by a lot of the public. Perhaps I should be encouraging my patients to look at the advert?
http://www.bhf.org.uk/heart-health/life-saving-skills/hands-only-cpr.aspx
12/10/12- Over treatment is discussed mainly with reference to the American system but very pertinent to the UK when changes by the coalition government are in process.
5/10/12 discussed the recent advert by the British Heart Foundation to encourage the public to try hands only resuscitation. Apparently the campaign was hugely successful and viewed by a lot of the public. Perhaps I should be encouraging my patients to look at the advert?
http://www.bhf.org.uk/heart-health/life-saving-skills/hands-only-cpr.aspx
Wednesday 3 October 2012
B12 and Vitamin D + a new resource
2 Important topics, both covered on Inside Health on 4th September, with interesting opinions and research from 2 specialists.
Firstly, a study showing taking Vitamin D can improve recovery from TB and a discussion about how Vitamin D might be modulating immune response. Apparently one of the first ever randomised controlled trials, conducted by the Brompton Hospital in the last century found patients recieving sunlight or cod liver oil were more likely to survive TB than those who didn't.
Secondly, a specialist who feels we under diagnose and under treat B12 deficiency. He feels anyone with a level under 300 mcg is deficient or at least has an indadequate level. He also believes we should treat with im hydroxycobalamin not to BNF recommended doses in every case- we should be administering more frequently in certain people and using response to treatment instead to judge the amount needed.
This is timely for me as I'm just starting an audit in measuring B12/FBC in patients taking metformin- at Wincobank that is over 400 patients. Other drugs to consider B12 deficiency include phenytoin, h2 receptor antagonists and PPis.
Finally a new resource recommended in the back of the MPS magazine- an app for the iPhone called Medscape. It's from the States, is a free resource and is an encyclopaedia of pretty much everything- Drugs, Conditions, Procedures Drug interactions & calculators. Looks pretty useful, navigated around the app quite easily and have used it to check a drug interaction. I note it also has information about herbal medicines in this category, so could be very useful. I will report back!
www.medscape.com
Firstly, a study showing taking Vitamin D can improve recovery from TB and a discussion about how Vitamin D might be modulating immune response. Apparently one of the first ever randomised controlled trials, conducted by the Brompton Hospital in the last century found patients recieving sunlight or cod liver oil were more likely to survive TB than those who didn't.
Secondly, a specialist who feels we under diagnose and under treat B12 deficiency. He feels anyone with a level under 300 mcg is deficient or at least has an indadequate level. He also believes we should treat with im hydroxycobalamin not to BNF recommended doses in every case- we should be administering more frequently in certain people and using response to treatment instead to judge the amount needed.
This is timely for me as I'm just starting an audit in measuring B12/FBC in patients taking metformin- at Wincobank that is over 400 patients. Other drugs to consider B12 deficiency include phenytoin, h2 receptor antagonists and PPis.
Finally a new resource recommended in the back of the MPS magazine- an app for the iPhone called Medscape. It's from the States, is a free resource and is an encyclopaedia of pretty much everything- Drugs, Conditions, Procedures Drug interactions & calculators. Looks pretty useful, navigated around the app quite easily and have used it to check a drug interaction. I note it also has information about herbal medicines in this category, so could be very useful. I will report back!
www.medscape.com
Wednesday 19 September 2012
Back to Work! Back to podcasts!
So, I've been good and booked my appraisal, I've recovered from last week and appearing in coroner's court to give evidence, now back to some learning!
There is a new series of Inside Health with dr mark Porter again, which I have missed the first few episodes of iver the summer. I cracked on with this weeks episode and squeezed in last weeks whilst cooking tea!
Worth it alone for the comments by Professor Alan Morice (ex Sheffield Consultant and a lecturer I remember well!) about treating non-acid reflux and cough- apparently PPis can make it worse not better, start with metoclopramide or domperidone instead!
Also pertinently after discussions at coroner's court last week an article about gallstones, prevalence, management and when cholecystectomy is necessary.
This reminds me of a lady I saw last week who had caught me shortly after the Eat Fast Live Longer Program we had discussed alternate day fasting as a way to loose weight, after her tries of standard low fat diet hadn't been successful. She was thrilled to have lost 3 kg in a month and had got her partner to chan§ge his diet too.
The second episode I listened to was from 11/9/12 and again excellent, discussing how to look at OA and how to discuss exercise/ conservative measures with patients. I had read about the new NICE guidance and read the ARC leaflet about ' wear tear and repair' but this podcast also addressed how to get the messages over to patients. Quietly political as ever, it also included a discussion with Lawrence Buckman of the GP council for the BM A about the appalling lack if funding for musculoskeletal services. Excellent all round!
There is a new series of Inside Health with dr mark Porter again, which I have missed the first few episodes of iver the summer. I cracked on with this weeks episode and squeezed in last weeks whilst cooking tea!
Worth it alone for the comments by Professor Alan Morice (ex Sheffield Consultant and a lecturer I remember well!) about treating non-acid reflux and cough- apparently PPis can make it worse not better, start with metoclopramide or domperidone instead!
Also pertinently after discussions at coroner's court last week an article about gallstones, prevalence, management and when cholecystectomy is necessary.
This reminds me of a lady I saw last week who had caught me shortly after the Eat Fast Live Longer Program we had discussed alternate day fasting as a way to loose weight, after her tries of standard low fat diet hadn't been successful. She was thrilled to have lost 3 kg in a month and had got her partner to chan§ge his diet too.
The second episode I listened to was from 11/9/12 and again excellent, discussing how to look at OA and how to discuss exercise/ conservative measures with patients. I had read about the new NICE guidance and read the ARC leaflet about ' wear tear and repair' but this podcast also addressed how to get the messages over to patients. Quietly political as ever, it also included a discussion with Lawrence Buckman of the GP council for the BM A about the appalling lack if funding for musculoskeletal services. Excellent all round!
Wednesday 8 August 2012
Eat, Fast, Live Longer
Another good Horizon Program I saw last night on the iPlayer from Dr Michael Moseley, about eating, or not eating as it were.
Lots to think about (and digest!) about research going on in the States mainly, into fasting to improve CV risk profiles. Lots of convincing evidence from experts and personal stories, including Harmander Singh, the 101 year old Marathon runner who regularly fasts and eats child sized portions of food.
Eat Fast and Live Longer
Further support that my time would be better discussing lifestyle issues with patients instead of dishing out pills. I'm not sure how telling people to fast/how to do it will go down in Wincobank, but I'm gong to give it a go!
Lots to think about (and digest!) about research going on in the States mainly, into fasting to improve CV risk profiles. Lots of convincing evidence from experts and personal stories, including Harmander Singh, the 101 year old Marathon runner who regularly fasts and eats child sized portions of food.
Further support that my time would be better discussing lifestyle issues with patients instead of dishing out pills. I'm not sure how telling people to fast/how to do it will go down in Wincobank, but I'm gong to give it a go!
Friday 13 July 2012
Guts: The strange and mysterious world of the human stomach
Wednesday 11 July 2012
The sun is shining!
At last! After 2 weeks if non- medical busyness ( I helped put on a show, played oboe live on local radio as we as family stuff!) I am sitting in sunshine reading the BJGP
Several interesting and useful articles this week- cancer in children, LUTS and what to do about them and flagging up child maltreatment.
Only half way through but thought I'd stop and think about those 3 for the mo!
Several interesting and useful articles this week- cancer in children, LUTS and what to do about them and flagging up child maltreatment.
Only half way through but thought I'd stop and think about those 3 for the mo!
Thursday 21 June 2012
GP confederations
This time last week me and the Nurse practitioner were sent to meet the other GPs in the North Sheffield proposed GP confederations.
I was a pleasant afternoon and the practices we were allocated all seemed to enjoy having a chat about what bothers us at the moment and how we could address this.
What difference will it make?? Well, who knows, but I can see advantages in working together to address problems we are having locally. whether we will manage to achieve anything, remains to be seen!
I was a pleasant afternoon and the practices we were allocated all seemed to enjoy having a chat about what bothers us at the moment and how we could address this.
What difference will it make?? Well, who knows, but I can see advantages in working together to address problems we are having locally. whether we will manage to achieve anything, remains to be seen!
Wednesday 13 June 2012
MPS
So I have been called to an inquest for a patient that I saw once before she was re admitted for an abdominal problem which turned to a fatal episode of sepsis. I've discussed it with the senior partner who has been to 'loads' of inquests. I've written a report to submit which had been in my pigeon hole for 3 weeks.
Inquest is in September and I feel partly curious partly very anxious about what will be expected of me.
Reading MPS Casenotes over lunch reminded me to put something down on the blog about it!
13/6/12 addition I had my first MPS contact regarding the letter I had drafted before I went away, basically re-writing the letter! I've done exactly what they advised so hopefully should be acceptable to submit soon.
Inquest is in September and I feel partly curious partly very anxious about what will be expected of me.
Reading MPS Casenotes over lunch reminded me to put something down on the blog about it!
13/6/12 addition I had my first MPS contact regarding the letter I had drafted before I went away, basically re-writing the letter! I've done exactly what they advised so hopefully should be acceptable to submit soon.
2 come along at once!
Back from Hols and a wonderful week where I didn't think about work or anything medical for a week. Truly refreshing.
After thinking there was no good GP blogs out there a couple of months ago I found out about another to add to Margaret McCartney's site. Check out-
http://www.darmipc.net/blog.html
This is a site run by a GP called Wilfred Treasure, who I'm amazed I've never come across before. From my first dip onto the site I can already tell this is going to be just my thing! Also if you follow the link it takes you to an iPhone friendly mobile site- so I can look at this during boys swimming lessons/on the bus etc!
Teaching next week and week after so what I'm supposed to be doing is refreshing my knowledge of the Calgary-Cambridge guides. Doesn't seem as interesting as Dr Treasures blog!
After thinking there was no good GP blogs out there a couple of months ago I found out about another to add to Margaret McCartney's site. Check out-
http://www.darmipc.net/blog.html
This is a site run by a GP called Wilfred Treasure, who I'm amazed I've never come across before. From my first dip onto the site I can already tell this is going to be just my thing! Also if you follow the link it takes you to an iPhone friendly mobile site- so I can look at this during boys swimming lessons/on the bus etc!
Teaching next week and week after so what I'm supposed to be doing is refreshing my knowledge of the Calgary-Cambridge guides. Doesn't seem as interesting as Dr Treasures blog!
Sunday 29 April 2012
More radio based education!
A long drive made much more pleasant on Friday by a sleeping child and good radio!
Woman's Hour was excellent with 2 GP relevant items. Domestic violence, which I wasn't expecting alot from, bit Learnt about Seachange, a charity that works with perpetrators and victims of DV and learnt about early warning signs for women to suspect they might be at risk in future- checking phone and emails apparently.
Then a wonderful item about Dr Russell a GP in Manchester who is finally hanging up her stethoscope aged 80! She was great, no politics or moans, just a vivid description of how in the 50+ years she had practiced medicine things have changed. An inspirational lady. The disappearance of measles and polio, using a home telephone instead of having to find a phone box. 2 things that struck me.
Woman's Hour was excellent with 2 GP relevant items. Domestic violence, which I wasn't expecting alot from, bit Learnt about Seachange, a charity that works with perpetrators and victims of DV and learnt about early warning signs for women to suspect they might be at risk in future- checking phone and emails apparently.
Then a wonderful item about Dr Russell a GP in Manchester who is finally hanging up her stethoscope aged 80! She was great, no politics or moans, just a vivid description of how in the 50+ years she had practiced medicine things have changed. An inspirational lady. The disappearance of measles and polio, using a home telephone instead of having to find a phone box. 2 things that struck me.
Wednesday 25 April 2012
Grieving
I'm trying to come to terms with my father dying in July last year.
I've written complaints to both the Hospital where he was admitted before he died and also to his GP practice. I have only just written to his GP practice and received the response nearly 2 weeks ago and it completely floored me. I new this was a risk of making the complaints but i felt i had to ask questions, both for myself and for my father's memory. As a scientist and passionate intellectual I strongly believe he would have wanted his case looked at objectively and lessons learnt from it.
I managed to read the letter which has completely wiped me out for nearly 2 weeks again tonight and didn't cry. I read it completely differently to how I read it initially. I'm still not happy with the GP practice's response so I'm going to write again and I've shared this letter as it's evolved from a rant to something more reflective and appropriate with a close GP friend.
My beloved Inside Health has come to my aide today and neatly encapsulated why I wanted to lodge these complaints in an article by Professor Susan Bewley an Obstetrician from University College London who was discussing the Confidential Enquiry into Maternal Deaths.
She said this-
I've written complaints to both the Hospital where he was admitted before he died and also to his GP practice. I have only just written to his GP practice and received the response nearly 2 weeks ago and it completely floored me. I new this was a risk of making the complaints but i felt i had to ask questions, both for myself and for my father's memory. As a scientist and passionate intellectual I strongly believe he would have wanted his case looked at objectively and lessons learnt from it.
I managed to read the letter which has completely wiped me out for nearly 2 weeks again tonight and didn't cry. I read it completely differently to how I read it initially. I'm still not happy with the GP practice's response so I'm going to write again and I've shared this letter as it's evolved from a rant to something more reflective and appropriate with a close GP friend.
My beloved Inside Health has come to my aide today and neatly encapsulated why I wanted to lodge these complaints in an article by Professor Susan Bewley an Obstetrician from University College London who was discussing the Confidential Enquiry into Maternal Deaths.
She said this-
“Good doctors (and
midwives) pay attention to detail and even in death the details or the stories
and journeys (women) have made are very important and I think that it is only
respectful to look at that in detail so that we can learn for the benefit of
the next (woman).
Friday 20 April 2012
Inside health back again
More podcasts! Hooray! This week looking at full blood counts, behind the scenes. Over the counter meds with a professor doing a big cochrane review. 1 PCM 1 ibuprofen and a strong coffee is best apparently!
Also read editorials of BJGP and briefly felt better about true health and social care bill.
Also read editorials of BJGP and briefly felt better about true health and social care bill.
Friday 13 April 2012
Easter holiday fun
As I've said before I think any educational activity in school Hols should get double CPD points!
I've managed to read a publication by the ARC on upper limb conditions, which I'd highly recommend. It came with my copy of BJGP. It goes through common problems but highlights considerations of differential diagnosis, easy clinical tests to do and clinical signs to look for in patients presenting with upper limb problems.
There is an email link to get on line updates, which I think I'll add to my collection!
I've managed to read a publication by the ARC on upper limb conditions, which I'd highly recommend. It came with my copy of BJGP. It goes through common problems but highlights considerations of differential diagnosis, easy clinical tests to do and clinical signs to look for in patients presenting with upper limb problems.
There is an email link to get on line updates, which I think I'll add to my collection!
Friday 23 March 2012
Meet and moan
So we managed out first GP group meet for ages and over curry talked shop.
Lots of frustrations with communication between hospital and primary care. Lots of worries about local plans to put groups of GPs into groups working together.
Then we had a debrief about an ENT update course Ally had been on and talked about ENT examination, cholesteatoma diagnosing acoustic neuroma and Bells Palsy.
None of this put us off our curries I'm pleased to say!
Today a 2 page piece in the BJGP about training at White House Surgery where I have been locuming this week, by my former trainer, Richard Watton.
A good read and explains why there are so many young people working each time I go there !
Lots of frustrations with communication between hospital and primary care. Lots of worries about local plans to put groups of GPs into groups working together.
Then we had a debrief about an ENT update course Ally had been on and talked about ENT examination, cholesteatoma diagnosing acoustic neuroma and Bells Palsy.
None of this put us off our curries I'm pleased to say!
Today a 2 page piece in the BJGP about training at White House Surgery where I have been locuming this week, by my former trainer, Richard Watton.
A good read and explains why there are so many young people working each time I go there !
Tuesday 6 March 2012
Julian Tudor Hart
A letter from JTH in this months BJGP. As usual very clever but also straightforward and making important points. I like that he looks to history to solve dilemmas of the era. I also like that the answer he finds to alot of problems is solid generalism and good general practice.
I also appreciate his truly left wing politics!
Reminds me to get back into his book from the 80s I bought before Christmas.
I also appreciate his truly left wing politics!
Reminds me to get back into his book from the 80s I bought before Christmas.
Friday 24 February 2012
Podcasts galore!
Hello! All my learning for the past 3 weeks has been podcast- based and it's all been good! Having new headphones helped alot to keep my attention!
I've managed 2 inside healths- lots of interesting discussion on cholesterol and statins, gout, cough with ACE inhibitors. The speakers are always excellent on this and the sound quality is vastly superior to the BMJ and MEREC offerings.
Despite the sound quality the MEREC podcast talking about this months papers was still useful and an excellent BMJ podcast on menopause and hrt, where we are at and current best practice, with a professor of women's health .
That's nearly 2 hours ! I feel much better informed!
I've managed 2 inside healths- lots of interesting discussion on cholesterol and statins, gout, cough with ACE inhibitors. The speakers are always excellent on this and the sound quality is vastly superior to the BMJ and MEREC offerings.
Despite the sound quality the MEREC podcast talking about this months papers was still useful and an excellent BMJ podcast on menopause and hrt, where we are at and current best practice, with a professor of women's health .
That's nearly 2 hours ! I feel much better informed!
Wednesday 8 February 2012
Yet more podcasts!
So, a grim Grey February day. After playgroup I had a podcast session while making dinners for the next couple of nights.
I listened to Inside health as usual- and it was excellent as usual! Gluten Intolerance that isn't coeliac disease and gout were the highlights.
Next 2 BMJ podcasts- one wasn't very relevant and the other was highly relevant- looking at epilepsy and discussing with 2 neurologists drugs, depression and quality of life. I had to listen to it 3 times in the end as I kept missing the important points- sometimes multitasking really doesn't work when you need to focus on something! The sound quality on the BMJ podcasts is not as good as the BBC so with headphones I finally got it 3rd time around! I e-mailed 2 of my 1st year students to et them know about the epilepsy podcast as the Community Attachment patient they saw had epilepsy. One e-mailed back to say thank you.
Also, following stuff in the press and from e-mail alerts from RCGP about the Health and Social Care Bill.
half term next week so I'll have a week off
I listened to Inside health as usual- and it was excellent as usual! Gluten Intolerance that isn't coeliac disease and gout were the highlights.
Next 2 BMJ podcasts- one wasn't very relevant and the other was highly relevant- looking at epilepsy and discussing with 2 neurologists drugs, depression and quality of life. I had to listen to it 3 times in the end as I kept missing the important points- sometimes multitasking really doesn't work when you need to focus on something! The sound quality on the BMJ podcasts is not as good as the BBC so with headphones I finally got it 3rd time around! I e-mailed 2 of my 1st year students to et them know about the epilepsy podcast as the Community Attachment patient they saw had epilepsy. One e-mailed back to say thank you.
Also, following stuff in the press and from e-mail alerts from RCGP about the Health and Social Care Bill.
half term next week so I'll have a week off
Wednesday 1 February 2012
Opinions and feelings
2 interesting topics - decisions about end of life care and asking patients about thier faith raised as topics this week.
A friend working on the other side of the city is trying to write an information sheet for carers of end stage dementia patients entering the local EMI home to get relatives thinking about how and where their beloved might end their life.
A hard one to get right but definitely important.
Secondly a Facebook discussion, a 20 something friend who I don't really know very well posted on the site she was shocked when her GP asked if she had any faith to turn to. She thought it was inappropriate. I think it's a well phrased nice open question! Some comments agreed with me but some people thought it was inappropriate to ask as well. A hard one to judge again.
A friend working on the other side of the city is trying to write an information sheet for carers of end stage dementia patients entering the local EMI home to get relatives thinking about how and where their beloved might end their life.
A hard one to get right but definitely important.
Secondly a Facebook discussion, a 20 something friend who I don't really know very well posted on the site she was shocked when her GP asked if she had any faith to turn to. She thought it was inappropriate. I think it's a well phrased nice open question! Some comments agreed with me but some people thought it was inappropriate to ask as well. A hard one to judge again.
Friday 27 January 2012
More Inside health
Another excellent episode !
Mark Porter did well not to be rude to the health minister, discussing NHS reforms and also a good slot on tinnitus and vitamin d.
Http://www.bbc.co.uk/iplayer/episode/b019rqcq/Inside_Health_24_01_2012/
MEREC monthly 46 battles with hypertension again and critiques the latest NICE update-
Www.npc.nhs.uk
Mark Porter did well not to be rude to the health minister, discussing NHS reforms and also a good slot on tinnitus and vitamin d.
Http://www.bbc.co.uk/iplayer/episode/b019rqcq/Inside_Health_24_01_2012/
MEREC monthly 46 battles with hypertension again and critiques the latest NICE update-
Www.npc.nhs.uk
Friday 20 January 2012
Another attempt!
Okay! Happy 2012! Time to do what I said I'd do in my appraisal....
This week I have listened to Mark Porter's new radio 4 program Inside health and can recommend it thoroughly.
http://www.bbc.co.uk/iplayer/episode/b019fxb5/Inside_Health_Health_bill_Memory_Resuscitation_Flu/
And I've just read this....
http://adc.bmj.com/content/97/1/21.full?keytype=ref&siteid=bmjjournals&ijkey=l806wm3AJxrfQ
I think my take home message from this is as usual back to basics- good clinical examination to detect pneumonia as opposed to URTI. I seem to have spent alot of time not giving abs to coughs the past few weeks, so I'm going to take on board this paper.
Byee!!
This week I have listened to Mark Porter's new radio 4 program Inside health and can recommend it thoroughly.
http://www.bbc.co.uk/iplayer/episode/b019fxb5/Inside_Health_Health_bill_Memory_Resuscitation_Flu/
And I've just read this....
http://adc.bmj.com/content/97/1/21.full?keytype=ref&siteid=bmjjournals&ijkey=l806wm3AJxrfQ
I think my take home message from this is as usual back to basics- good clinical examination to detect pneumonia as opposed to URTI. I seem to have spent alot of time not giving abs to coughs the past few weeks, so I'm going to take on board this paper.
Byee!!
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