Archive | Reviews

Book Review: Raby’s Radiology Survival Guide

A while ago we posted a review of the A&E Radiology Survival Course, a stalwart of A&E teaching for some time.  To go with this course (and also for independent reference), there is the A&E Radiology Survival Guide – and the third edition has just been released.  RuralGP was pleased to receive a review copy, and here’s our thoughts below.

3rd Edition - soon to be published

3rd Edition – soon to be published

The ‘Raby guide to radiology’ has become a core reference in A&E departments across the country.  Designed to tell you what not to miss, and develop effective systems to interpret your radiographs, the red book was an excellent source of knowledge to turn to on many a busy shift.  And so it’s great to see the book updated into its current Third Edition, written by Nigel Raby, Laurence Berman and Gerald de Lacey.

What’s changed?  Actually not very much.  A cleaner look, which makes it easier to read page numbers, and to locate particular sections.  The authors realise that it’s thumbed frequently on a typical A&E shift, so it must be quick and easy to use.  There’s some re-ordering of the content: for example paediatric sections are now separate chapters, and the ‘what’s common’ and ‘what not to miss’ are more clearly highlighted.

Of course the guidance has been updated too, and whilst the book focusses on plain radiographs, there’s more helpful guidance about the pros/cons of different imaging modalities, which is helpful.  There’s far less guidance about skull xrays, as these days CT is the image of choice.  And there’s occasional – appropriate – mention of protocols such as the use of metal detectors in children who have swallowed foreign objects.

By purchasing the book, you will also receive access to the online version.  Whilst this will require yet another username/password to remember, it might appeal to folks who want to keep the guidance available without keeping the book nearby.

So… the verdict.  Is it worth buying?  Absolutely yes, if you want to get better at plain film interpretation in the A&E setting.  Is it worth upgrading from the 2nd edition?  Again, yes, as the new edition follows latest guidance, as well as being even easier to use.

Score: 5/5

£27 from Amazon at time of writing.

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Helicopter Safety

Courtesy of defenceimages.mod.uk.

For anyone who is likely to come across a search and rescue helicopter, this comprehensive guide may be of interest.  Just published by Duncan Tripp, winchman/paramedic with RAF Lossiemouth, it offers advice and information about many relevant aspects of helicopter search and rescue – from BASICS Responders who may require casualty evacuation, to mountain rescue teams needing search assistance.

The 31 page document describes considerations for approaching helicopters (which of course is generally don’t, until the pilot indicates that it is safe), emergency ditching procedures and functions of the search tools on board.  There is also a guide on winching people, dogs and stretchers, and the command/control structure that develops for aircraft during a major incident.

You can download the document (PDF, 9.5MB) from the link below.

Click to download the guide (PDF).

 

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Book Review: Rural Social Work Practice in Scotland

Rural Social Work Practice in Scotland

Colin Turbett; ISBN 9781 86178 0836

£15.95 from the British Association of Social Workers

At first, it would be possible to dismiss this book as a text irrelevant to medical practice, but to do so would to miss an accessible, up-to-date and highly relevant account of providing a professional “person-based” service to rural communities.

Colin Turbett, team manager for North Ayrshire Council Social Services on the Isle of Arran, has written this book with the aim of drawing on very recent international research on rural social care.  He combines this with personal experience to offer a pragmatic and easy-to-read guidebook for practitioners from many different disciplines, which was published in December 2010.

He starts by defining the challenges that exist in providing social care in rural communities, followed by the interpersonal dilemmas that exist for all professionals working in small populations.  Issues such as dual relationships, confidentiality and isolation are all addressed: experienced advice is offered with balanced observations which are easy to relate to.  The handling of client/patient information encountered via “off-duty” informal channels and the dilemma on when to act on it, is one such example; and indeed there are plenty other situations which are described to illustrate the concepts tackled throughout the book.

Subsequent chapters focus more on social care policy, and there has been much development in these areas, particularly in Scotland.  These may be less appealing for the health professional, however on offer is a very neat, potted summary of issues such as Direct Payments, Personal Care and GIRFEC and the challenges of managing a service to meet the fluctuating needs of a dynamic population.  A robust argument is made for improved recognition of Gypsy Travellers, through a detailed and rational account of their particular needs.  The book is forward-looking in ending with a chapter on telecare, and its implications for rural areas.

At £15.95, the book is highly recommended to all health and social care professionals who work in rural Scotland – and beyond.

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iPhone apps for rural doctors

In the last few years, the number of medical applications (or apps) for the iPhone has expanded exponentially.

Some are gimmicky, or seek to address a need that doesn’t exist.  However, there are also some excellent apps out there, making a huge amount of knowledge and rapid calculation available to both hospital and GP doctors.

Here, we point to some of the most useful applications – some of which are great for regular general practice, others which suit those who need to work in a community hospital/A&E environment.  If you can add any other suggestions, please leave a comment at the foot of this page.

Key to cost: free, £ is <£1, ££ is £1-5, ££££ is >£10

  • MedCalc (£).  This longrunning ever-increasing collection of useful medical calculations is a stalwart for daily practice.  You probably won’t need the APACHE score nor the paediatric ET tube sizes, but how about the opioid & steroid conversion tool, abbreviated mental test (AMT) and dermatome map?  Highly recommended.
  • LabTests (££). Background info, as well as useful clinical interpretation guide to nearly every lab test, and certainly all the ones I’ve come across in daily practice.  Whilst sitting in front of DocMan, do you ever get inquisitive about what fibrinogen is actually for, or when to get concerned about a slightly raised Alk Phos?  This app, costing a couple of quid, can give you a quick reference to find out those answers for next time.
  • 3D4 Medical (££).  A number of apps cover different body systems, revealed in stunning 3D and some animated images.  I like to use it to demonstrate the cause of muscular pain, or explain fractures on x-ray.  Sometimes slow to load up, but this is because of the high-resolution images which can be easily manipulated to view from different angles.  Can take a good chunk of your memory too.
  • Paeds Drugs (££).  For any GP on call for a local A&E unit, one of the most worrying calls is for an unconscious child.  Preparation can be key to good clinical management, hence the use of Breslow tapes and acronyms such as WET FLAG.  However, this app – from experienced paediatric critical care colleagues in London – offers to do all this with minimal fuss and input.  All you need is the child’s age, or even better their weight.  Drug doses for all the emergency drugs imaginable then appear in an easy-to-use format, uncluttered and logically laid out.  As a bonus, it even provides normal ranges for vital signs.  Recommended.
  • EMS Tracker (free).  BASICS responders will like this one, but perhaps also those who are involved in emergency hospital care.  This is a log of activity – from call-out and arrival times, to observations, procedures and drug delivery.  Again this is a well thought-out app, with events recorded in a single tap.  Useful for keeping track of events at scene, as well as being able to document and report times accurately, this is well worth having in your iPhone especially if you respond to prehospital incidents.  It even allows you to email or text the full log for your records.
  • Oxford Handbook of General Practice (££££).  The bible comes to iPhone – but at a price.  More expensive than the print version, it’s difficult to justify the expense.  However, the prospect of being able to dip into this no matter where I am – when covering our local hospital, in satellite surgeries or on home visits – persuaded me that this would be worthwhile, and I haven’t looked back.  I hope that OUP see sense and come up with better pricing (note that future updates are NOT covered), but for now I have very easy access to this very thorough companion.  The OH of Emergency Medicine is also available, but I can keep that in the back of the car for now.
  • A2Z of Dermatology (££).  A useful atlas of dermatological conditions – the range is adequate for most GP presentations, and if it’s not for your reference, it is useful for reassuring/explaining to patients or parents about the diagnosis.
  • Pocket ECG (free).  Particularly useful if you’re teaching students or colleagues… this is a useful reference for all the ECG changes that you’re likely to come across – there’s a quiz too so if you’re feeling the need to test yourself this free app is a great addition.
  • DropBox (free).  Installing this on your iphone and home computer, allows files to be stored within a “cloud” which is easily accessible by both.  This is useful for rotas, guidelines and local protocols – but be aware that you need to open each file from your iPhone to ensure that it exists in the phone’s memory.  If you don’t do this, and you move out of a 3G area (like the majority of rural areas at present), you won’t be able to access the file.
  • STAT Depression Screener (free).  This is designed for patients to self-test, but it can come in very handy if you want to do a PHQ9 screen but don’t have the questions with you.  Perhaps a home visit, or a branch surgery when the computer isn’t connecting well.
  • Flashlight+ (free).  There are loads of apps to make use of the LED camera flash.  This one seems to work well, and from a medical point of view, can be a great way to quickly check pupillary reflexes when on home visits.

Can you recommend any others?  If so, please add it via the comments box below.

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Single Handed by Rosie Donovan

Here’s an interesting insight into the work of some of our more remote colleagues.  Granted, this isn’t recent news, but I thought it might tempt readers who’ve not seen this before.

Rosie Donovan is a Scottish photographer who carried out a photo-documentary of the lives of several remote & rural GPs in Scotland.  The exhibition that resulted is apparently on permanent display at RCGP in Edinburgh, and is also available in a book – you can order yours on her website.

However, much of the content is available to peruse on the site too – note that you can click the portrait photos to find out more about each story.

Sometime soon, I hope that some practitioners’ profiles can feature on this blog.  For the time being, I’m sure Rosie’s commentaries will provide an insightful read.

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