eLetters

245 e-Letters

  • 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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  • 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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