Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 Thank you Dr. Mira and Narendra.We will try to present these cases in our dept. soon. When more than one disease and system is involved and different drugs given, can we comment about the drug interactions? AnupamaMira Desai <desaimirak@...> wrote: Dear anupama, ur anxiety is valid For PG case study, the selection of the case is the purview of local examiner. all u need is to present the case in logical sequence giving justification for the treatment given,investigation done and if a new symptom / complain develops co-relate with the disease pathology or drug treatment i.e. ADR if any .For ur practice u can select the common clinical conditions like Malaria, meningitis, CV stroke along with some other disese where the patient is hospitalize for long time. As long as u can justify the treatment and identify the deficiency ,the job is done. Best of Luck Mira desai Ahmedabad Narendra <naren_bachewar (DOT) co.in> wrote: Hello Anupama,I am here to give my personal opinine. For UGs prescription witting is must as most of them after completion of their graduation will do the same through out their life. But for Pharmacology PGs, We don't write prescriptions, What we require for our future is sound knowledge of Medicines, their pharmacology, For teaching and Research activity. So for Pg exams we can use cases with more than two factors like..CCF with Diabetic nephropathy,HT with DM with psoriasis,Anti tubercular for a patient with raised liver enzymes,HIV with Tuberculosis, Like these.But this is my personal opinion, others may differ.RegardsDr. NarendraGMC, Nagpur>> Netrumians, > We have a practical on Case study and comment in our P.G exam. Can you help me out in deciding which cases to be selected from medicine wards and how to procede with the exercise.> In U.G practicals, we give single disease exercise and comment is about the prescription format and also the drugs.> Is it the same for P.G case study? Please help.> Anupama.> > > ---------------------------------> Find out what India is talking about on - Answers India > Send FREE SMS to your friend's mobile from Messenger Version 8. Get it NOW>a, Find out what India is talking about on - Answers India Send FREE SMS to your friend's mobile from Messenger Version 8. Get it NOW Find out what India is talking about on - Answers India Send FREE SMS to your friend's mobile from Messenger Version 8. Get it NOW Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 14, 2006 Report Share Posted December 14, 2006 Hello Anupama, As Dr. Mira madam said as long as you can Identify the problem or Justify the treatment, your job is done. Yes, ofcourse the drug interactions are important and we should consider all the possible interactions. But I don't think to mention them untill and unless your examiner particularly asks you to do that. Regards Dr. Narendrs GMC, Ngapur. > > > > Netrumians, > > We have a practical on Case study and comment in > our P.G exam. Can you help me out in deciding which cases to be > selected from medicine wards and how to procede with the exercise. > > In U.G practicals, we give single disease exercise > and comment is about the prescription format and also the drugs. > > Is it the same for P.G case study? Please help. > > > Anupama. > > > > > > --------------------------------- > > Find out what India is talking about on - Answers India > > Send FREE SMS to your friend's mobile from Messenger > Version 8. Get it NOW > > > > > > > a, > --------------------------------- > Find out what India is talking about on - Answers India > Send FREE SMS to your friend's mobile from Messenger Version 8. Get it NOW > > > > > --------------------------------- > Find out what India is talking about on - Answers India > Send FREE SMS to your friend's mobile from Messenger Version 8. Get it NOW > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 14, 2006 Report Share Posted December 14, 2006 Dear Anupama Teaching pharmacotherapy through the case study method is a novel concept, that has not really been implemented methodically and in toto as yet. Certain centres abroad have adopted it. It is also used in law and if I am not mistaken in political science. I have been trying it in my lectures for some time now. Its plus points are that it helps student correlate between theory and practice; and also involves them actively to develop analytical thinking. However there are a few hindrances that you can overcome by being cautious in your approach. Queries occur when there is a discrepancy between what our text books say and what is practiced. Secondly, in tertiary care centres, simple straightforward cases may not be easy to find, except in OPDs. In such situations it is better to speak to the prescribing clinician first to understand the reason of their choice of drugs. Also one needs to be tactful while discussing the cases with the students...we must not give wrong messages. I am sure you will find your experience with this method more fulfilling and fruitful if you keep these issues in mind. Best luck and do give us your feeedback of your experiences. Chetna Desi Ahmedabad On 13/12/06, anupama sukhlecha <anupama_acad@...> wrote: Thank you Dr. Mira and Narendra.We will try to present these cases in our dept. soon. When more than one disease and system is involved and different drugs given, can we comment about the drug interactions? Anupama Mira Desai <desaimirak (DOT) co.in> wrote: Dear anupama, ur anxiety is valid For PG case study, the selection of the case is the purview of local examiner. all u need is to present the case in logical sequence giving justification for the treatment given,investigation done and if a new symptom / complain develops co-relate with the disease pathology or drug treatment i.e .. ADR if any .For ur practice u can select the common clinical conditions like Malaria, meningitis, CV stroke along with some other disese where the patient is hospitalize for long time. As long as u can justify the treatment and identify the deficiency ,the job is done. Best of Luck Mira desai Ahmedabad Narendra <naren_bachewar (DOT) co.in> wrote: Hello Anupama,I am here to give my personal opinine. For UGs prescription witting is must as most of them after completion of their graduation will do the same through out their life. But for Pharmacology PGs, We don't write prescriptions, What we require for our future is sound knowledge of Medicines, their pharmacology, For teaching and Research activity. So for Pg exams we can use cases with more than two factors like.. CCF with Diabetic nephropathy,HT with DM with psoriasis,Anti tubercular for a patient with raised liver enzymes,HIV with Tuberculosis, Like these.But this is my personal opinion, others may differ. RegardsDr. NarendraGMC, Nagpur>> Netrumians, > We have a practical on Case study and comment in our P.G exam. Can you help me out in deciding which cases to be selected from medicine wards and how to procede with the exercise. > In U.G practicals, we give single disease exercise and comment is about the prescription format and also the drugs.> Is it the same for P.G case study? Please help.> Anupama.> > > ---------------------------------> Find out what India is talking about on - Answers India > Send FREE SMS to your friend's mobile from Messenger Version 8. Get it NOW> a, Find out what India is talking about on - Answers India Send FREE SMS to your friend's mobile from Messenger Version 8. Get it NOW Find out what India is talking about on - Answers India Send FREE SMS to your friend's mobile from Messenger Version 8. Get it NOW -- Chetna Desai Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2010 Report Share Posted February 22, 2010 When I went to see the ENT chap under my new health insurance, he told me that he hardly saw any cholesteatomas. He said he was based in Hawaii and saw lots there because of the testing. The Dr also said that if he was based nearer to, or in Mexico he would likely see more too. The implication was that this is a poor person's disease as I guess poorer people don't look after their ears properly! Is this true or a load of codswallop? That said, if I ever try to use q-tips / cotton buds, I always get an ear infection and in fact in the UK they have found a strong link. So if this is due to dirt / poor maintenance of ones ears how is one to care for them better?? OR do you think it means that poorer folk have not had medication to deal with ear infections. I was so stunned I stupidly didn't ask what the guy meant. Instead I have decided to try to see someone who is more au fait with cholesteatomas or rather deals with them more often Aj Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2010 Report Share Posted February 23, 2010 Sounds like codswallop to me. I'm no doctor, but my understanding is that poor eustacian tube function leads to frequent ear infections which in turn can lead to Cholestetomas in some cases. Therefore I would contend that this is more nature than nurture, in that some people are more genetically pre-disposed to having this condition. The only way your doctor's theory may be accurate is if poor eustacian tube function (or ear infections) is more prevalent in the mexican population that in other populations, and I'll bet there's no scientific evidence to back that up. Basically a very long winded way of saying that I think your doctor is talking out of his a$$!!! Just my 2 cents... From: <amandajlear@...>Subject: Querycholesteatoma Date: Monday, February 22, 2010, 11:06 PM When I went to see the ENT chap under my new health insurance, he told me that he hardly saw any cholesteatomas. He said he was based in Hawaii and saw lots there because of the testing. The Dr also said that if he was based nearer to, or in Mexico he would likely see more too. The implication was that this is a poor person's disease as I guess poorer people don't look after their ears properly!Is this true or a load of codswallop? That said, if I ever try to use q-tips / cotton buds, I always get an ear infection and in fact in the UK they have found a strong link. So if this is due to dirt / poor maintenance of ones ears how is one to care for them better?? OR do you think it means that poorer folk have not had medication to deal with ear infections. I was so stunned I stupidly didn't ask what the guy meant. Instead I have decided to try to see someone who is more au fait with cholesteatomas or rather deals with them more oftenAj Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2010 Report Share Posted February 24, 2010 Today we had an important 9am appointment with a Hereford (UK) otologist surgeon, Mr . Paige has had ongoing glue ear/mucopurolent discharge since she was about 6 months old. At our last consultation at the hospital last week we expressed our frustration with the myriad of ineffectual ear/nose drops and repeated & damaging (whilst also ineffective) courses of antibiotics to a young locum who was about to offer more. She examined the little girl, paused & went off to get a more senior physician. He came in, similarly examined her, asked about her history & raised the possibility of cholesteatoma - a horrible middle ear infection that (I have since learned online) virtually destroys vital bones/ossicles, and can Only be treated with microsurgery, removing these bones, carving a door hole into the head, for infection, water, you name it. More surgery, no swimming, depleted or destroyed hearing right through to her teens. So at this stage, if it is C-toma, every day counts.Mr finally saw us about 10.30. He was a typical surgeon; brusque, irritable, overworked, overbooked, no time for charm or bedside manner, & clearly didn't abide fools (read anybody else) easily. I had been beefing up on the subject for three days & nights (with the inclusion of this discussion group), and had questions & terminology to hand that simply annoyed him. "Leave that up to me. Believe me, I know. This is my job.""And it's my job as parent to look after my daughter as best I can. If she was your daughter you'd do the same.""Er, yes...I would.""Better than coming in here uninformed & gambling that the doctor'll take care of everyfink..." I said, aping someone thick & cockney. He smiled.I went on to contest his assertion that it almost never happens in 3 year olds, based on my conversations (over 50 e-mails) with the US-based discussion group cholesteatoma.com...I asked him about labyrinthitis, atelactassis, congenital v acquired, Bezolds absess, paracetemol as a teratogenic agent...I was a ideal/nightmare patient's parent, and I was not to be dismissed.He dismissed us. We were to come back for a sedated observation at a later date to be decided in a phone call to his secretary. Who was not in the building. And now, I'm afraid we're overbooked...I hate arrogant doctors.He reminded me just a bit of that useless shiny-shoed suit that flung his bleak MS prognosis at Fran, in the same hospital.Anyway, we will sort it one way or the other. Am reading all your contributions avidly. Thanks muchly.Neilcholesteatoma From: mrs_jthompson@...Date: Tue, 23 Feb 2010 05:09:50 -0800Subject: Re: Query , I've always had health insurance, I'm not poor and I'm very clean. I was born with a defective eustation tube. That led to my ear aches, which led to a burst ear drum that led to my c-toma. And I went to more than 5 doctors before the c-toma was found because they insisted that it was normal to have ear aches as an adult. Your doctor is full of bull. I would consider choosing another doctor. He who calls you is faithful, who also will do it. 1 Th 5:24Sent from my iPhone On Feb 22, 2010, at 10:06 PM, "" <amandajlear (DOT) co.uk> wrote: When I went to see the ENT chap under my new health insurance, he told me that he hardly saw any cholesteatomas. He said he was based in Hawaii and saw lots there because of the testing. The Dr also said that if he was based nearer to, or in Mexico he would likely see more too. The implication was that this is a poor person's disease as I guess poorer people don't look after their ears properly! Is this true or a load of codswallop? That said, if I ever try to use q-tips / cotton buds, I always get an ear infection and in fact in the UK they have found a strong link. So if this is due to dirt / poor maintenance of ones ears how is one to care for them better?? OR do you think it means that poorer folk have not had medication to deal with ear infections. I was so stunned I stupidly didn't ask what the guy meant. Instead I have decided to try to see someone who is more au fait with cholesteatomas or rather deals with them more often Aj Do you have a story that started on Hotmail? Tell us now Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2010 Report Share Posted February 25, 2010 Neil wrote:- > > He dismissed us. > > We > were to come back for a sedated observation at a later date to be > decided in a phone call to his secretary. Who was not in the building. > And now, I'm afraid we're overbooked... > > I hate arrogant doctors. > Neil, If you hate arrogant doctors you've got involved with the wrong specialty - in ENT a lot of them are tossers, I'm afraid. Thankfully not to the same degree as general surgeons, but the problem remains. The spirit of on Justice still lives, sadly ! However they are certainly not ALL like that,so when you get one that you like make sure you are gentle with him/her. Try not to let your scepticism take over the conversation completely; I know that's hard, I've been there, but if you're consulting a professional sooner or later you've got to show a little faith ! Hope all goes well for your daughter, please keep us posted. , Milton Keynes ----------------------------------------- Planet Ink Club is a great way to save money and help the environment. Join today (http://www.planetinkclub.com) This message has been scanned by Supanet for viruses and dangerous content using ClamAV and SpamAssassin. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2010 Report Share Posted February 28, 2010 Glad you have the right person - that is brilliant. Lol over the choose and book. The irony of that one for me was that my Doc at the time suggested going to Hinchingbrooke - I nearly so no thanks I'll " choose and book " Addenbrookes (less local) - I'll regret that forever I think. Having said that, ironically Mr Jani now also goes to Hinchinbrooke - I wonder if my non dx has any bearing on that - probably will never know the answer to that one. Cheers > > wrote :- > > > - you are near enough to go to Addenbrookes - > >ask specifically to go to Mr Jani there - I cannot recommend > >him more highly. As I said I have had plenty of " consultant " > >experience. He instantly knew what my problem was, he is well > >respected in his field. Sees adults and used to be at GOSH. > >A very quietly spoken and sincere person. You will like him alot. > > > , > > Thank you for the recommendation, I will bear Mr Jani in mind if I need to be referred again. To be honest I have been very happy with Mr. O'Malley at Milton Keynes General for the last ten years; he saw my problem the first time he examined me, he did both my surgeries as soon as the NHS would let him, and (touch wood) I've had no recurrence since 2001. He is very brisk and business-like, but friendly with it - that suits me, I like my doctors to be like that. I've always got an answer to my questions without having to be too insistent. Because I've had no recurrence I was finally discharged last year, but with instructions to tell my GP to call his secretary directly if I ever have to go back rather than get involved in " this damned silly Choose-and-Book system " to quote the man's exact words, lol. > > > Quote Link to comment Share on other sites More sharing options...
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