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BRITISH MEDICAL JOURNAL

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Bmj

  1. 1. Search this site • Register for free services BMJ : British Medical Journal Subscribe • Sign in 1. Acute Elderly Care Unit- Do We Need One? o SYED RAZA, SpR Acute Medicine &Cardiology DEWSBURY, United Kingdom Acute Medical Units in most hospitals admit patients aged 16 and above. A fair proportion of patients are frail elderly reaching 100th birthday and beyond. These patients have multiple co- morbidities with complex needs. Very often the admissions are deemed inappropriate or unnecessary. Dealing with these patients do require expertise for which all acute physicians are not adequately trained. It is often noted that these patients are either under or over treated. They often suffer complications which are iatrogenic. They also tend to stay longer on the Acute Medical Assessment Unit which leaves the units with fewer beds for younger but more sicker patients. Keeping the above in mind, should there be a separate unit that would cater the needs of these elderly patients? Do we need trained acute geriatricians? Should there be a compulsory period of training for all acute medicine trainees? Competing interests: None declared Submit rapid response Published 22 December 2007 1. Survival of the fittest o SYED M RAZA, Consultant Cardiologist Dr Sulaiman Al Habib Hospital, KSA
  2. 2. It is without any doubt that competition which is healthy and with a clear vision is always beneficial. This holds true for competition in any sphere of life including healthcare. It is essential that there is a clear goal as to why one is competing. Any competition in a healthy spirit is always mutually rewarding. As far as the healthcare setting is concerned this certainly would lead to improvement in services, better provision of care and patient satisfaction. The competition should not merely be to grab the funding but to survive as the fittest! Competing interests: None declared Submit rapid response Published 6 July 20111. Are doctors Jacks of all trades? o SYED M RAZA, Consultant Cardiologist Dr Sulaiman Al Habib Hospital, KSA This is in reply to the recently published view, if we as doctors should be reporting potential terrorists. In my view this is common sense that any and every potential threat must be reported. Doctors have been seen in various roles i.e. teacher, manager, clinical leader, and so on. Having said that, one must not assume that we as doctors can play the role of a police or investigating officer and actively look for any suspected potential terrorist. We are just doctors and not a Jack of all trades. Competing interests: None declared Submit rapid response Published 21 July 20111. Re:GMC Induction Program: Welcome but more fundamental action needed. o SYED M RAZA, Consultant Cardiologist Dr Sulaiman Al Habib Hospital, KSA Safety for patients is the paramount issue for all NHS hospitals today. GMC has issued several key statements and guidelines as how to be a competent and safe doctor. Despite this there are several untoward incidents and near misses’ in NHS hospitals countrywide of which many go unreported.
  3. 3. Induction program for new doctors being introduced by GMC is welcome by all medical fraternity but I feel this came too late. There are several countries worldwide which introduced this programme a long time ago. The recruitment process for employing new doctors should be more stringent. This should also hold true for hiring locum doctors. Currently, there is very little induction programme for locum doctors. The locum doctors must show a sense of responsibility towards patients care and more importantly must demonstrate that they are capable and safe doctors. Unfortunately, the pre- employment assessment process for the above is lacking. Competing interests: None declared Submit rapid response Published 21 September 20111. Re: Indolent endocarditis missed despite several admissions o SYED M S RAZA, Consultant Cardiologist, MD,MRCP(UK) Dr Sulaiman Al Habib Hospital, KSA Prosthetic valve infective endocarditis affects 2-3% of patients after surgery. The acute endocarditis usually develops within 2-3 months of surgery and is usually caused by more virulent and antibiotic resistant organisms. Late-onset infections on the other hand are caused mainly by contamination with low-virulence organisms during surgery or by transient asymptomatic bacteremias, most often with streptococci; S. epidermidis; diphtheroids; and the fastidious gram-negative bacilli, Haemophilus sp, Actinobacillus actinomycetemcomitans, and Cardiobacterium hominis.The later is usually more difficult to diagnose. Although Transoesophageal Echocardiogram(TOE) has much higher sensitivity in identifying endocarditis vegetation and abscesses compared to Transthotracic Echocardiography (TTE)- 97% versus 67%, it can occasionally miss anterior aortic root abscess which is in fact better picked up by TTE. Competing interests: None declared Submit rapid response Published 27 December 2010

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