41 e-Letters

published between 2010 and 2013

  • Re:Avoiding Burnout
    Elisabeth Paice

    Dear Editor Our editorial was triggered by a PMJ paper showing that in a study carried out in the US, 76% of first year doctors exhibited burnout. We quoted other evidence that burnout may occur surprisingly early in careers and is not necessarily related to seniority. We know that jobs which require daily face to face interaction with people who are distressed or challenging lead to high levels of burnout. Sadly it is th...

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  • Re:Informant based questionnaire I-AGeD tool to improve poor recognition of delirium in emergency room.
    Brian Suffoletto

    We agree that delirium is serious, and more structured instruments are needed for providers of multiple specialties to detect delirium in multiple health care settings. While we have no experience on the I-AGeD in our emergency departments, we note that caregivers often are not available at the time of emergency presentation. Also, we find veracity of caregiver reports highly dependent on relationship and time spent wit...

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  • Informant based questionnaire I-AGeD tool to improve poor recognition of delirium in emergency room.
    Jos van Campen

    Dear Madame, Sir,

    In their interesting study Suffoletto et al [1] examined delirium recognition by emergency physicians. Trained researchers identified delirium in 24/259 (9%) of emergency room older patients. Diagnosis was based on CAM -ICU criteria, Richmond Agitation and Sedation scale and an interview with the surrogate. By contrast, emergency physicians recognised delirium in only 8/24 cases and misidenti...

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  • Avoiding Burnout
    David Levine

    Avoiding burnout in new doctors: sleep, supervision and teams Elisabeth Paice, Diana Hamilton-Fairley 2013;89:493-494 doi:10.1136/postgradmedj-2013-132214

    I applaud Paice and Hamilton-Fairley's call for better work schedules and supervision, but burnout seems to increase with seniority and probably reflects more fundamental problems. Achieving even the aims mentioned may be more difficult than the authors suggest...

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  • relevance of time frame and left circumflex as the culprit artery
    oscar,m jolobe

    The occurrence of coronary occlusion in patients without protocol positive ST segment elevation(1) might be attributable either to early catheterisation(2)or to left circumflex artery occlusion(3)(4), the latter also being significantly(p < 0.001) commoner in non ST segment elevation(NSTEMI) patients catheterised within 6 hours of arrival in hospital than in STEMI counterparts also catheterised within that time frame(...

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  • Transthoracic ultrasonography to differentiate bullous emphysema from pneumothorax: a bright future in black and white.
    Subramanian Senthilkumaran

    Respected Editor, The case report by Lai et al. [1] was both interesting and informative. We agree with the usefulness of CT thorax to differentiate pneumothorax from giant bulla with double wall sign. Though CT offers the most accurate diagnostic information, it is difficult to transport unstable patient to a CT suite which is in a remote area from a resuscitative area or to wait for a specialized technician to perform it...

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  • Cost-effective prescribing: Medical schools must take responsibility
    Mohammed A. Rashid

    Nwulu and colleagues present a highly relevant analysis of the financial implications of prescribing by F1 doctors in a UK teaching hospital1.

    It seems that the most important of the recommendations they discuss are for undergraduate medical education. Whilst they mention that most of the 79 doctors they investigated graduated from the same medical school, they do not categorise this further. As their data ind...

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  • Lewy Body Dementia in the Emergency Department
    Bruce D. Adams


    We applaud the timely study by Kennelly et al and agree fully that ED physicians generally lack proficiency for recognizing and managing behavioral complications of dementia. As they succinctly state, "Failure of physicians to identify and highlight cognitive impairment can lead to disastrous consequences".[1] We venture that ED physicians are even less aware of the unique and potentially lethal emergenc...

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  • the current world record for giant left atrium
    oscar,m jolobe

    The 76 year old patient recently reported in this journal with left atrial diameter of 10 cm(1), has been superseded, in the record books, by a 40 year old man with left atrial diameter of 21.5 cm attributable to severe mitral stenosis(2). The latter patient presented with dysphagia, hoarseness, and exertional dyspnoea. References (1)Shah BN., Rubens M Giant left atrium: a forgotten cause of cardiomegaly Postgrad Med J 2...

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  • In response to Dr Levine's letter (13th July 2012)
    Emma M. Salisbury

    We recognise and acknowledge the issues raised by Dr Levine in his letter (13th July 2012). Newly qualified doctors can expect to be as prepared as their undergraduate training allows and their level of clinical supervision facilitates. These are important additional factors when considering preparedness of medical graduates commencing work at foundation year 1 (F1) level. F1 doctors must be able to increase their leve...

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