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What do Huskies have to do with statistical interpretation of results?

26/9/2019

 
There are lots of sayings in medicine, often recited by grumpy old doctors like me, to remind more junior staff how medicine “works”, or once worked!! Sayings like “if you hear hooves, think horses”, “common things are common” or “as rare as hen’s teeth”. All of these mean that a patient’s symptoms are usually explained by a common disease rather than a rare one and that treatment and investigations should be targeted at the common diagnoses rather than something more obscure.

Note: those doing exams are often the worst offenders as they are cramming obscure knowledge in order to cover “everything possible” that an exam might test them on, even if it is as rare as hens teeth!
​

But why do we say this? What is wrong with sending every test you can possibly think of for every possible disease, however rare, that might explain the patient’s symptoms? How do Doctors choose what tests to perform and have you ever considered how reliable the results that come back are!? You might be shocked to know that not all tests are completely accurate.

Okay, bear with me on this. The science is complicated and involves statistics… (stay with me everyone!!!) but it’s a fundamental part of medicine so I’m going to stick with it, come on, come with me… there is a “are you still confused” recap at the end, honest you will get it, Editor-Chief-in-Charge wrote it and she doesn’t do stats!
Fagon nomogram

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Is itching contagious? Mite be!

19/9/2019

 
Warning: this blog mite make you itch!
 
The Oncology Registrar sat in the Multidisciplinary Team meeting looking thoroughly miserable. They looked like they hadn’t slept for ages, and whilst this can often be the case for junior doctors, the Microbiologist knew the registrar had only just returned from annual leave.
 
Whilst trying to pay attention to the patient discussions the Microbiologist watched as the poor Registrar kept scratching at his hands and arms.
 
As the meeting drew to a close, the Microbiologist wandered over…they can’t help but meddle!!!
 
“You look like your suffering” he said sympathetically, when in fact he was “itching” to make a shrewd diagnosis!!!
 
“Yeah. My hands and arms are really itchy, and it was worse in that room as it was so hot. I think I’m allergic to something”.
 
The Microbiologist wasn’t so sure.
 
“Show me your hands” he said.
 
The Registrar helpfully held out his hands which looked red and inflamed.
 
Looking closely whilst not touching (oooh, all those germs!!! He’d seen the Infection Control hand plates in the past!!!) the Microbiologist soon realised the likely cause of the problem.

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CMV - An infection in pregnancy that can be devastating

6/9/2019

 
At the weekly Neonatal Unit Multidisciplinary Team Meeting the Microbiologist was asked about a baby with Cytomegalovirus infection. The baby had been born at term but was very small, below the 3rd centile. Other than the size of the baby there were no other concerns during the pregnancy. The baby had looked otherwise well and was behaving normally. A number of tests had been done to look for a reason why the baby might be small and a urine sample had tested positive for Cytomegalovirus DNA by PCR.
 
The Neonatologists wanted to know what they should do next and the MDT members looked at the Microbiologist expectantly, who started to feel somewhat uncomfortable under all those stares…

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    Blog Author:

    David Garner
    Consultant Microbiologist
    Surrey, UK

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