The Spine Patient Outcomes Research Trial (SPORT) tried to randomise patients with disc herniation and radicular signs to receive either open discectomy or non-operative treatment. But the referee couldn’t keep control, and players kept changing sides and leaving before full time –fun to watch if you like that sort of thing. (more…)
The influenza season is now upon us, so it’s time again to lie awake thinking about the possibility of pandemic avian influenza A. You may remember that when The Rational Clinical Examination asked “Does this patient have influenza?
As a jobbing clinician, how often do you use a prognostic scoring system? Never, would be the answer for most of us, though we have a vague idea about the prognostic significance of various (mostly cancer-related) terms such as Duke’s C or Gleason 6. When I looked at prognostic scoring systems for heart failure (more…)
Ever heard of ancrod? It’s a tissue plasminogen activator which improves stroke outcomes slightly if given within a short time. However, this study shows no benefit in patients with acute ischaemic stroke who receive it at between 3 and 6 hours after the event. (more…)
I’m sure that individual susceptibility to the effect of drugs has been known from before the dawn of civilisation: in oral epics, most chieftains hold their drink better than underlings. As soon as there was Mendelian genetics, there was phamacogenetics – the linking of particular genes to particular drug responses. Now we have pharmacogenomics (more…)
You are unlikely to find the story-book red spotted caps of this fungus so late in the season, but I nominate it for illustrating that primitive tribes - in this case from Siberia – can show a sophisticated understanding of pharmacology. Groups of Siberian tribesmen would get their women to chew the fungus (more…)
Working in a urology unit thirty years ago, I was struck by the discrepancy between male patients’ symptoms of urgency, frequency and nocturia and the size of their prostates, which in those days we were very keen to remove. We tended to ignore the bladder, though that is where the problem often lies. (more…)
So what do we do about patients with chronic kidney disease who become anaemic? Watchers of QI, put your fingers on your buzzers. “Give them erythropoietin
This year, British GPs have suddenly been required to keep registers of chronic kidney disease, based on lab returns of estimated GFR from samples we have sent opportunistically. We have devoted at least three full practice meetings to the subject, while various partners have nobly gone off to hear renal physicians present their (vigorously dissenting) views. (more…)
In her Editor’s choice, Fiona Godlee reports receiving an e-mail from her distinguished predecessor Stephen Lock, asking for readers to come up with medical excuses to celebrate the four hundredth anniversary of the first performance of Monteverdi’s Orfeo on 23rd February 2007. No problem there, surely. (more…)
