Creative writing workshops for medical education: learning from a pilot study with hospital staff.

A course in creative writing was designed as a possible tool in medical education. Twelve volunteers (six doctors and six non-medical staff) participated in seven workshops held weekly. Four aims were identified: to help put thoughts onto paper; to facilitate interpretation of narrative; to encourage expression of emotions related to illness and death, and to encourage creativity. The course was evaluated using participant observational analysis and two questionnaires. This paper discusses the outcomes in relation to these aims, but identifies additional issues raised by the development.Only six of the 12 participants produced a final piece of written work, with lack of self discipline being cited as the chief reason. There was a strong tendency for self reflection in the group, which needed appropriate support. How creativity can be encouraged remains unclear. The value of multidisciplinary learning in this context was identified.The value of creative writing for medical education remains difficult to measure, but the participants agreed unanimously that the course would be an enjoyable way of encouraging medical students in its stated aims.

Masseter muscle rigidity and malignant hyperthermia susceptibility in pediatric patients. An update on management and diagnosis.

BACKGROUND: Controversy exists regarding the definition of masseter muscle rigidity (MMR) and anesthetic management after MMR. This study reports current anesthetic management after MMR, estimates the incidence of clinical malignant hyperthermia (MH) in patients with MMR, and is the first to evaluate the coincidence of MMR with malignant hyperthermia susceptibility (MHS) according to the 1987 North American Malignant Hyperthermia Group protocol. METHODS: Practicing anesthesiologists referred pediatric patients for biopsy between 1986 and 1991 based on evidence of MMR after succinylcholine (1975-1991). The clinical scenario was described as MMR alone or MMR followed by signs of MH, including arterial CO2 tension > 50 mmHg, arterial pH < or = 7.25, and base deficit > 8. Patients had caffeine-halothane muscle contracture testing to determine MHS. RESULTS: Seventy patients (50 boys and 20 girls) were evaluated. Eighty-three percent (58 of 70) of anesthetics were halothane-succinylcholine. In 68% (48 of 70) of cases, the anesthetic was discontinued, whereas anesthesia was continued with nontriggering agents in 11% (8 of 70) and with triggering agents in 13% (9 of 70). Fifty-nine percent (41 of 70) of patients were diagnosed as MHS by muscle biopsy. In 7% (5 of 70) of patients, clinical MH developed within 10 min of MMR. CONCLUSIONS: This study, by using the current North American Malignant Hyperthermia Group protocol, reaffirms the high incidence (59%, 41 of 70) of MHS associated with MMR as confirmed by muscle biopsy. Of the MHS patients, 5 developed signs of clinical MH. Most anesthesiologists in this study, when confronted with MMR, discontinued anesthesia. Because of the potential lethality of MH and the > 50% concordance between MMR and MHS, the most conservative course of action after MMR is to discontinue the anesthetic and observe the patient for clinical evidence of MH. An acceptable alternative, depending on the urgency of the surgery, would be to continue anesthesia with nontriggering agents for MH, with appropriate monitoring.

Delpech and the origins of occupational psychiatry.

Auguste-Louis Delpech (1818-80) has been remembered principally as the author of the first detailed description of the serious consequences of exposure to carbon disulphide. A close reading of his work suggests that his reputation has been seriously undervalued. The subsequent development of occupational psychiatry, with its emphasis on the distinction between the organic and the functional, may be traced through publications on carbon disulphide. It is argued that a contemporary approach to occupational psychiatry is long overdue.

Prioritising waiting lists.

The 'top 22' patient conditions on the general surgical waiting list at Guy's Hospital were rated independently by five general surgeons. Each surgeon estimated the peri-operative mortality rates associated with each treatment; the proportion of patients who failed to benefit; the effect of successful treatment on life expectancy and on the patients' quality of life. the mean values were used to estimate the expected net benefits (in terms of quality-adjusted life-years) from treatment one year earlier than might otherwise have been the case. These benefits were then related to the operating times and length of stay associated with each treatment; this identified which treatments offered the greatest benefit per unit of each constrained resource. Of all conditions examined anal fissures where shown to be the least resource intensive in relation to the benefits generated, whilst varicose veins and epigastric hernias proved otherwise. For the full potential of this approach to be realised it needs to be repeated in other places and in other specialties. It nevertheless offers a more rational basis for interpreting waiting list data than presently exists and by using the short-cut methods is a relatively cheap way of generating much useful data.

Organic solvents and presenile dementia: a case referent study using death certificates.

Occupational exposure to organic solvents has been implicated in the development of "presenile dementia" in several studies. The death certificates of all men aged under 65 dying in England and Wales bearing presenile dementia as cause of death were collected for the years 1970-9 (n = 557): control death certificates were obtained, matched for age and sex. No significant differences were found between the groups as regards estimated occupational exposure to either organic solvents or lead.

The effects of noradrenaline on reticulocytes of the albino rat.

The observation that sympathomimetic drugs or electrostimulation of the lumbar sympathetic trunks produces reticulocytosis has been reported by a number of authors in the literature. The mechanism underlying this phenomenon has been determined, although there is speculation that the result is caused by either activation of the reticuloendothelial system, vasoconstriction of the marrow blood vessels or stimulation of the suprarenal glands, spleen, or other erythropoetin-producing organs. The present study is a series of experiments to determine if the action of noradrenaline, in producing reticulocytosis, can be localized to the bone marrow. In addition, an attempt was made to identify the adrenoreceptor involved. Anaesthetized animals were given an infusion of noradrenaline into the marrow cavity of one femur. Reticulocytes were counted in peripheral blood smears before and after the infusion. Reticulocytes were also counted from the bone marrow of the injected femur and compared to reticulocyte numbers in the contralateral uninjected femur of the same animal and the femoral bone marrow of untreated control animals. The data from these experiments were compared to those obtained in experiments in which the lumbar sympathetic trunks were stimulated. One group of several animals was given propranolol prior to the infusion of noradrenaline or stimulation of the sympathetic trunks. The reticulocyte counts from these animals were compared to those from animals which did not receive the beta-adrenoreceptor blocker. All animals which received either an infusion of noradrenaline or stimulation of the lumbar sympathetic trunks demonstrated a pronounced reticulocytosis and a decrease of reticulocytes in the bone marrow. The beta-adrenoreceptor antagonist, (+/-)-propranolol, was effective in blocking these changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Regional alterations in glucose consumption and metabolite levels during postischemic recovery in cat brain.

Local CMRgl (LCMRgl) and metabolite levels were measured in the same tissue samples following 4 h of recirculation after 1 h of occlusion of the middle cerebral artery in the cat. The rate of glucose utilization was calculated using direct measurement of tissue deoxyglucose-6-phosphate and using a "lumped" constant corrected in each sample for alterations in tissue glucose. Increased LCMRgl (compared with that in sham-operated animals) occurred in regions with only minor alterations in levels of lactate and phosphocreatine. By contrast, LCMRgl was markedly depressed in regions with major changes in lactate and high-energy phosphates. Interestingly, tissue levels of glucose and unphosphorylated deoxyglucose were abnormally elevated in regions with profound energy failure. These results indicate an inhibition of glucose utilization in regions damaged by ischemia, despite the persistent elevation of tissue lactate. Increased glucose metabolism at 4 h post ischemia was detected only in areas with minor anaerobic alteration of metabolite levels.