Author: Robin Chan

Professional Burn Out – Am I Enough?

Behind every committed professional is the quietly disconcerting question “Am I enough?” Our profession is full of them; harm avoidant, reward dependent, goal orientated individuals.  However in remote practice, these effective traits can lead to frustration and burn out.  Supporting systems are still in development, recruitment and retention is...

Q. Is bed rest an effective treatment for anything?

Meta-analysis on 39 randomised control trials for 15 different conditions (5777 patients) Following a medical procedure: Out 24 RCTs-No outcomes improved significantly 8 worsened significantly in some procedures Lumbar puncture – vertigo, nausea and vomiting (no significant improvement in headache) Spinal anaesthesia – headache, back pain Radiculography – headache,...

Does induction of labour prevent shoulder dystocia?

 Early IOL for women with suspected fetal macrosomia,who do not have gestational diabetes,does not improve either maternal or fetal outcome.(Evid level 4) In women with gestational diabetes, the incidence of SD is reduced with early IOL.(Evid level 2+) The NICE diabetes guideline recommends that pregnant women with diabetes who...

What dose Ketorolac?

Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial Motov, Sergey et al. Annals of Emergency Medicine 2016 Dec. Study Design: N = 240, 18-65 years Randomised to receive 10mg, 15mg, 30mg IV ketorolac as single dose (double blinded)...

Even Short-term Oral Steroids Carry Serious Risk

Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1415 (Published 12 April 2017)Cite this as: BMJ 2017;357:j1415 Cohort study of more than 1.5 million adults 30 days of initiating these drugs, even at relatively low...

Should we be giving our women steroids prior to elective caesarean section?

Delivery by elective caesarean section at less than 39+0 weeks of gestation can lead to respiratory morbidity in neonates, requiring admission to the neonatal intensive care unit A recent retrospective cohort study showed that, compared with elective caesarean section births at 39+0 weeks of gestation, births at 37+0 weeks...

CKD goals, what am I doing with this raised PTH?

Phosphate-Binding Agents in Adults With CKD: A Network Meta-analysis of Randomised Trials.  Suetonia C. Palmer, PhD, Sharon Gardner, MA, Marcello Tonelli, MD, Dimitris Mavridis, PhD, David W. Johnson, PhD, Jonathan C. Craig, PhD, Richard French, MBChB, Marinella Ruospo, MScMed, Giovanni F.M. Strippoli, PhD’Correspondence information about the author PhD Giovanni...

Smoking cessation: Is abrupt quitting more effective than a gradual approach?

Lindson-Hawley N, Banting M, West R, Michie S, Shinkins B, Aveyard P. Gradual versus abrupt smoking cessation. A randomized, controlled noninferiority trial. Ann Intern Med 2016;164(9):585-592. Patients in the “abrupt cessation group” were asked to stop smoking on their quit day. Participants in the “gradual cessation group” were also...

Lung ultrasound for paediatric pneumonia

Q. Can Lung ultrasound reduce need for CXR in children with suspected pneumonia? Jones BP, Tay ET, Elikashvili I, et al. Feasibility and safety of substituting lung ultrasonography for chest radiography when diagnosing pneumonia in children: a randomized controlled trial. Chest 2016;150(1):131-138. randomized 191 children and adolescents with clinically suspected...