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Why the obsession with Vitamin D?

7 Feb, 11 | by Bob Phillips

So, in the dark and cold climes of an early Northern Spring, Archi has been assailed by questions of vitamin D. There are, it is claimed, near-miraculous things from Vitamin D sufficiency – less cancer, less heart disease, less rickets. Well, I’ll buy the last one, but the others? And does any child really need supplements, or just those in poverty or the middle classes? (For two reasons; the first for nutritional health, the second for social acceptability.)

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Hurtful or helpful?

14 Jan, 11 | by Bob Phillips

When you’re thinking about applying the results of a clinical trial, its’ often difficult to get a meaningful handle on the balance that should be made between the beneficial and adverse effects of a treatment. If the medicine gives pain relief from your laparotomy to 1 extra patient in every three that take it (NNT=3), but makes 1 in 10 significantly very very constipated (NNH = 10) then is it worth using? more…

Q: Who’s still prescribing 0.45% saline for rehydration?

18 Apr, 10 | by Bob Phillips

Me … well, actually I don’t anymore, but that’s mainly because I don’t do rehydration. I tend to do hyperhydration to stop the methotrexate causing any more damage than I know it’s going to.

BUT if I did prescribe any fluids for a dried up sprogling, I’d reach for 0.45% saline with a sniff of K+. Am I doing it all wrong? more…

Motherhood, apple pie, psychosis and anaphylaxis

28 Mar, 10 | by Bob Phillips

I’ve been worrying about this for some time now.

How should we, as health professionals, address the deeply held beliefs of our patients when they aren’t true? Especially when they may harm others, although in a fairly obscure or indirect way? more…

Q: Spandex on prescription?

24 Jan, 10 | by Bob Phillips

PolymerFast drying, figure hugging and a joy to not iron, lycra (R) has revolutionised my laundry life. There are potentially even greater benefits though, with the use of lycra suits being promoted for children with cerebral palsies. more…

Q: Midazolam or Ketamine

24 Apr, 09 | by Bob Phillips

You have a 7 year old in the ED that needs sutures to a wound inflected when he and his twin were playing Pirates of the Caribbean with kitchen knives … he’s not the sort of chap that will lie still while you stitch him up … so what would you use to keep him down? more…

Q: Portacath or Hickman Line, madam?

7 Dec, 08 | by Bob Phillips

PortacathA 6 year old girl with Acute Lymphoblastic Leukaemia presents with another episode of febrile neutropenia with positive blood culture from her Hickman line. On a ward round, her parents discuss that they would like her to have a Portacath device inserted so that she can go swimming and is more comfortable around her friends. They are worried that she will be more susceptible to infection as the device is just below the skin and would like to avoid further hospital admissions. They ask if the portacath will increase her risk of infection during her remainder of her treatment? more…

Q: How long do you wait to clamp a cord?

7 Dec, 08 | by Bob Phillips

Too many red cellsWhen I was doing neonates, it was considered good practice to get little babies spliced away from their Mother, given oxygen to breathe and wrapped up warm, all pretty damn quickly. I keep hearing rumours from my neonatally biased friends that perhaps there are other, better ways of doing things.

So – how long do you advise waiting until clamping the umbilical cord after delivery? Two, three minutes (where the baby can chill & develop polycythaemia?) or as little time as it takes you to get hold of a clamp (so the child can be deprived of the last few teaspoons of good fetal blood?).

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Does atomoxetine aggravate mood problems?

2 May, 08 | by BMJ

ATX chemical compoundA 13 year old boy with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) comes to the clinic with his mother for a review. He was started on atomoxetine 6 weeks prior to this visit for hyperactive/impulsive symptoms and poor concentration. The boy was admitted in the hospital one week ago for changed behaviour, disorientation, irrelevant speech and self-harming behaviour. He was reported as very aggressive and hostile towards other children and adults. In past use of stimulant medication was not considered because of the risk of abuse and drug diversion. Mother correlates this hospitalization due to side effect of atomoxetine. She asks your opinion about increased aggression and hostility related to atomoxetine .

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