276 e-Letters

  • 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    The 76 year old patient recently reported in this journal with left atrial diameter of 10 cm(1), has been superseded, in the record books, by a 40 year old man with left atrial diameter of 21.5 cm attributable to severe mitral stenosis(2).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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  • Unpreparedness
    David Levine

    Newly qualified doctors can expect to be as prepared as their undergraduate training allows. For the initial management of acutely ill patients, perhaps involving practical procedures, we have to ensure that training and assessment of both students and doctors occur, as far as possible, under similar conditions to those in which doctors will work. 4 days of shadowing help but are not enough. The reality for many newly...

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  • "Xanthelasma palpebrarum -a cutaneous sign of increased cardiovascular risk"-still a misunderstanding
    Gopal Chandra Ghosh

    Xanthelasma palpebrarum ia a sharply demarcated yellowish flat plaque om the upper and lower eyelid, mostly near the inner canthus.In a prospective study done in Copenhagen University revealed that xanthelasme palpebrarum predict risk of myocardial infarction, ischaemic heart disease, severe atherosclerosis, and death in the general population[1].In present study which is a cross-sectional study revealed that xanthelasma...

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  • Natriuretic peptide levels must be interpreted in the light of clinical probability of heart failure
    oscar,m jolobe

    Given the recognition that "choosing appropriate thresholds[for serum natriuretic peptide] is problematic"(1), the best diagnostic strategy for obtaining maximum diagnostic "mileage" from natriuretic peptide levels might be that of interpreting any given result in the light of whether the patient has high, medium, or low clinical probability of heart failure. For that to come about, instead of reinforcing the idea that "In...

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  • Perception
    Russell D Brown

    I can well remember my feelings of unpreparedness in both the areas that current graduates identify as feeling most unready for.

    However, I suspect that having this perception is not a bad thing. I hope that they are able to maintain such a degree of insight and use it to the advantage of their patients and themselves in the long term.

    Should I be asked, I would encourage them to think on it in terms of...

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  • Hazards inherent in the use of either nonsteroidals or paracetamol
    oscar,m jolobe

    Notwithstanding the absence of robust evidence to justify the use of antipyretic analgesics either for reducing patient discomfort or for reducing morbidity and mortality in febrile illnesses(1), it is only in recent times(2)(3) that the issue of drug-related mortality has been adressed in patients receiving either nonsteroidal anti-inflammatory drugs(NSAIDs) or paracetamol for febrile illnesses. Due to insensible losse...

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  • is it showing the exact picture of igA nephropathy?
    gopal chandra ghosh

    I want to highlight few points about the study.First, IgA nephropathy is seen in nearly 40% of renal biopsy specimens of acute glomerulonephritis patients in asia in various study.In this study it is comprising only 8.1% of cases.Second, it is an crossectional study, taking data from the renal biopsy report thus not showing the exact % of acute glomerulonephritis caused by IgA nephropathy.So the finding is quite exaggerat...

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