35 e-Letters

published between 2011 and 2014

  • Old Age: Medicine is activity
    Pankaj Jorwal


    This article points out the well documented fact that increased physical activity has clear-cut protective effect from all cause mortality(1). Developing countries like India are also acknowledging such facts and are issuing guidelines for the same so as to promote health care of elderly even at primary health care level(2).

    With development and prosperity the average individual age is increasin...

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  • Holistic care needs to be met with holistic education
    James M Read

    The increasing numbers of frail elderly patients certainly poses a challenge for all parts of the healthcare landscape within the UK and beyond. Whilst organisational change and modifications to where, when and how we deliver care is important this must be underpinned by appropriate education for doctors and allied healthcare professionals.

    Much of this needs to be aimed at more junior staff, especially medical...

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  • Less health care might be fair in the older patient.
    M. Justin Zaman

    Predicting prognosis in this older group of patients is complex due to their highly variable health status, driven by their fundamentally different prognosis to younger patients. We have published two recent pieces on this theme, showing that firstly though there was an incremental reduction in the use of evidence-based therapies for ACS (acute coronary syndrome) with older age and that better survival was associated with...

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  • Evaluating the 5Fs mnemonic for cholelithiasis in a peruvian population
    Daniel E. Mendoza-Quispe
    Dear editor: We read with great interest the paper by Bass et al[1] on the mnemonics of cholelithiatis in the november 2013 issue of PMJ. The authors conclude that Family History should be considered as a predictive factor. We would like to share our own experience on this matter. We collected 173 consecutive patients diagnosed of cholelithiasis, inpatients and ambulatory care patients, during January and February, 2014. In all c...
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  • The patient, too must be on the same page as the team
    oscar,m jolobe

    When Professor Weller and her colleagues speak of members of the team being "on the same page"(1) no mention is made of the patient(or the patient's advocate)(2) being also on the identical page. To facilitate the inclusion of the patient in the team I have proposed the use of an abbreviated patient-held health record which essentially documents the problem list and the corresponding drug list, and this should be updated...

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  • Re-Freud's unconscious mind and the "EBM World"
    Dr.Animesh Tripathi

    I would like to thank the author on a thoughtful reflection on the "unconscious mind" and would like to comment on its relevance in modern medicine especially psychiatry and allied fields.

    Understandably concepts like the "drive theory" or "defence mechanisms" do not lend themselves to critical appraisal in "Evidence- based Medicine" terms easily but that in it should not detract from their usefulness in every...

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  • 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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