Clinical and other debates

RE: Clinical and other debates

Kate Richardson — Wed, 17 May 2017 23:04:54 GMT

[quote user="Anthony Todd"]

Loses impact if you repeat the one star too often, and I'm beyond caring unless I a get reasoned criticism.

[/quote]

Loses impact if you post more than 3 times in a row with no replies in between.....

RE: Clinical and other debates

Anthony Todd — Wed, 17 May 2017 23:00:24 GMT

[quote user="Thomas Johnson"]to come up with a list of the conditions or presentations that we would like to discuss,[/quote]

Don't let the idea be dropped just because I made an unpopular/stupid/ignorant post.

I won't post another word but don't drop the idea!!

RE: Clinical and other debates

Anthony Todd — Wed, 17 May 2017 18:13:40 GMT

Loses impact if you repeat the one star too often, and I'm beyond caring unless I a get reasoned criticism.

RE: Clinical and other debates

Anthony Todd — Wed, 17 May 2017 16:58:52 GMT

[quote user="Arlo Guthrie"]Yes, that's right.[/quote]

Or you could just copy topic and paste in a new message if you've got something to add [not me obviously]???

eg Caroline Allen

A seizuring dog (young or old)

RE: Clinical and other debates

Arlo Guthrie — Wed, 17 May 2017 16:45:38 GMT

[quote user="Thomas Johnson"]It wasn't me, but I suspect because the point of this thread is to come up with a list of the conditions or presentations that we would like to discuss, and then each one can be given its own thread on a weekly basis, because otherwise it'll end up as a complete mess with lots of things being discussed at the same time and be very difficult to follow.[/quote]

Yes, that's right.

RE: Clinical and other debates

Anthony Todd — Wed, 17 May 2017 16:24:29 GMT

[quote user="Thomas Johnson"]It wasn't me, but I suspect because the point of this thread is to come up with a list of the conditions or presentations that we would like to discuss,[/quote]

Fair enough, point taken, I just beat the gun again. Actually it's a pretty good list and should cover most of the "common" conditions seen in practice.

PS I gave Caroline 5 stars, 'cos common conditions are common.....

Has anyone got an analysis of consults by system, which would be a useful start.

PS Add PUO in cats. [I'll stay silent. promise]

RE: Clinical and other debates

Thomas Johnson — Wed, 17 May 2017 16:16:25 GMT

[quote user="Anthony Todd"]

Why did I expect the anonymous one star?

How does it help, not me, I know it works, but the original poster or new grads.

[/quote]

It wasn't me, but I suspect because the point of this thread is to come up with a list of the conditions or presentations that we would like to discuss, and then each one can be given its own thread on a weekly basis, because otherwise it'll end up as a complete mess with lots of things being discussed at the same time and be very difficult to follow.

RE: Clinical and other debates

Anthony Todd — Wed, 17 May 2017 16:08:54 GMT

Why did I expect the anonymous one star?

How does it help, not me, I know it works, but the original poster or new grads.

RE: Clinical and other debates

Anthony Todd — Wed, 17 May 2017 15:31:02 GMT

[quote user="Caroline Allen"]

In terms of the 'pragmatic' approach I think every test needs to be justified. It is about how do you get to your diagnosis with the minimum of tests and there is a place for properly justified and monitored trial treatments. I appreciate this may not fit with the model in some corporates, but I still believe it is an important skill and makes vets better medics. Also are we really going to say that unless you can afford £1000's we can't help you even when there are potentially easily treatable ddxs. The flip side is not to be afraid to pts if all the likely ddx are bad.

Some cases we've been initially discussing have been:

[/quote]

These are some presentations that dinovets saw in large numbers and treated and diagnosed cheaply and successfully.[or not]

[quote user="Caroline Allen"]An ascitic dog[/quote]

Drain as much fluid as you can on first presentation, in the consult, measure SG, [one drop] spin a sample and look for cells and/or send it off. Diuretics until results come back depending on SG.

Once the fluid is off you can palpate for masses etc.

[quote user="Caroline Allen"]A seizuring dog (young or old)[/quote]

Pentobarb or phenobarb to control then look for [significant] diagnosis

[quote user="Caroline Allen"]A cat with chronic diarrhoea[/quote]

Depends, if unwell look for systemic disease if OK then single source diet trial and NO MILK ALWAYS KEEP INDOORS. Water only if clinically normal for 36 hours initially

[quote user="Caroline Allen"]A jaundiced cat[/quote]

Bloods on first presentation [yes, honest] plus symptomatic relief.

[quote user="Caroline Allen"]Off back legs[/quote]

Clinical and neuro exam gives you most possibilities on first consult. Proceed with Xrays etc if necessary.

And my favourite "polydypsia/polyuria" in a clinically normal dog

Accurately measure boiled water consumption on first presentation to confirm owner's perception. Then a urine sample.

PS The format wasn't me; it just fills the space itself!

RE: Clinical and other debates

Caroline Allen — Wed, 17 May 2017 14:53:51 GMT

I think best to just give it a go and see how it goes.

Some cases we've been initially discussing have been:

An ascitic dog

A seizuring dog (young or old)

A cat with chronic diarrhoea

A jaundiced cat

Off back legs

RE: Clinical and other debates

Arlo Guthrie — Wed, 17 May 2017 08:02:19 GMT

[quote user="Sarah Keir"]I've been writing a BestBETS on pancreatitis and antibiotics - I would be happy to lead this thread[/quote]

Er, Sarah Keir, I think that's about 6 topics.

But you have given me another idea: Guest MRCVS moderators.

RE: Clinical and other debates

Sarah Keir — Tue, 16 May 2017 19:13:36 GMT

[quote user="villagevet"]

some topics of interest - could be presented as a case study and anon GP/OP approach followed by discussions (cf Clinicians Brief case studies but with open contributions from forum)

pancreatitis - acute

vestibular signs

feline 'asthma' presentation

chronic/recurrent cat flu

canine jaundice / biliary stasis / biliary peritonitis

[/quote]

I've been writing a BestBETS on pancreatitis and antibiotics - I would be happy to lead this thread

RE: Clinical and other debates

Neil Wheadon — Tue, 16 May 2017 17:06:03 GMT

[quote user="Anthony Todd"]they usually are synopses of others' work plus unsubstantiated opinions with no experimental evidence.[/quote]

Sounds familiar

Neil

PS This wasn't a jibe at Anthony, it made me giggle that in effect this is what this forum is about, including myself

RE: Clinical and other debates

Anthony Todd — Tue, 16 May 2017 16:56:55 GMT

[quote user="Arlo Guthrie"]Funnily enough, was discussing this very idea with a publisher yesterday![/quote]

Or you could just copy and paste it into a book or a file to download.

eg The thread on cat spays and ovarian ligation should be required reading for every vet student!!! this one :

Methods of ligating ovaries

Could go onto KINDLE too??

RE: Clinical and other debates

Anthony Todd — Tue, 16 May 2017 13:16:49 GMT

[quote user="Neil Wheadon"]Encourage references, such as a good article in Vet Times.[/quote]

Not so sure about these as they usually are synopses of others' work plus unsubstantiated opinions with no experimental evidence. Nor are they peer reviewed AFAIK.

RE: Clinical and other debates

Arlo Guthrie — Tue, 16 May 2017 10:43:50 GMT

[quote user="Neil Wheadon"]1) It would be useful if someone like Julian Earl can oversee it, just to keep things on track[/quote]

Julian and I are discussing that!

[quote user="Neil Wheadon"]2) Encourage references, such as a good article in Vet Times. They need to be open access though[/quote]

Yes, good point.

[quote user="Neil Wheadon"]3) A synopsis at the end would be very useful, to put each discussion into context and provide a reference. Perhaps this could form a mini library or even get published as David suggested but this I expect is harder than it sounds.[/quote]

Funnily enough, was discussing this very idea with a publisher yesterday!

RE: Clinical and other debates

Neil Wheadon — Tue, 16 May 2017 10:31:30 GMT

3 suggestions

1) It would be useful if someone like Julian Earl can oversee it, just to keep things on track

2) Encourage references, such as a good article in Vet Times. They need to be open access though

3) A synopsis at the end would be very useful, to put each discussion into context and provide a reference. Perhaps this could form a mini library or even get published as David suggested but this I expect is harder than it sounds.

Neil

RE: Clinical and other debates

Arlo Guthrie — Tue, 16 May 2017 09:16:05 GMT

OK, first things first, I have now created a new 'Topic of the Month' forum.

https://www.vetsurgeon.org/uk/general/f/219.aspx

First, please take a look at the blue box description at the top of the page.

This is really important, as it sets the scene for Topic of the Month discussions, and needs to convey, succinctly, what it is all about - in a way that will encourage maximum participation from as many members as possible.

Do you think (especially David Mills and Caroline Allen) that it clearly conveys what we (you) are trying to achieve here. Trying to focus on 'pragmatic' approaches, but don't want to do that to the exclusion of 'gold standard'.

In particular:

I'm trying to use a form of words that positions this as something that is fun/interesting (brainstorming to gather nuggets) and which has a very real value (as Neil Wheadon often puts it so eloquently!).
Historically, a central tenet of brainstormings per se has been 'no criticism' because it prevents people contributing. More recently, people have argued, and I agree, that without criticism the quality of ideas is reduced. To me, the answer lies in a simple rule for Topic of the Month, which is 'Challenge, don't criticise'.
Very important, I think, to stress the benefit of claiming CPD time when you read or post in these threads. In other words, you see a really useful piece of knowledge / information, and by using the 'Claim CPD' button, you not only get some time towards the annual requirement, but have a record / link to the post, and a record of what you learned. I struggle to think of a better application for our 'Claim CPD' button!

RE: Clinical and other debates

Martin Hamilton — Mon, 15 May 2017 22:54:59 GMT

As a recent graduate I'd love to have a discussion about antibiotic use in common cases such as acute onset diarrhoea and cat bite abscesses - quite a vast array of differing opinion in my own practice!

RE: Clinical and other debates

Lindsey Edwards — Mon, 15 May 2017 20:13:11 GMT

some topics of interest - could be presented as a case study and anon GP/OP approach followed by discussions (cf Clinicians Brief case studies but with open contributions from forum)

pancreatitis - acute

vestibular signs

feline 'asthma' presentation

chronic/recurrent cat flu

canine jaundice / biliary stasis / biliary peritonitis

RE: Clinical and other debates

Arlo Guthrie — Mon, 15 May 2017 18:08:14 GMT

[quote user="Michael Woodhouse"]Or create 2 threads in parallel - one for the advice and one for discussion?[/quote]

I think probably the tangent button achieves the same thing, but with greater flexibility. People just need to think 'am I getting into an area that is tangential to the OP, or do I want to argue a specific sub-point at greater length than we want in the 'topic of the week'.

[quote user="Michael Woodhouse"]Do you want some large animal topics too,[/quote]

Absolutely. I'm really excited about this idea, and if there isn't a big enough following of LA vets at the outset, I am sure there will be soon enough!

RE: Clinical and other debates

Michael Woodhouse — Mon, 15 May 2017 16:21:09 GMT

[quote user="Arlo Guthrie"]The problem comes if a discussion gets diverted/hijacked/bogged down by one side or the other justifying / arguing the point. The objective here is to get the widest possible input to the discussion, and perhaps it would be a good idea to say that in 'topic of the week' threads, there is a limit to the number of times members are allowed to post in the thread. I dunno, say three times.[/quote]

Or create 2 threads in parallel - one for the advice and one for discussion?

Do you want some large animal topics too, or is there too small a following on here?

RE: Clinical and other debates

Arlo Guthrie — Mon, 15 May 2017 09:15:48 GMT

[quote user="J G Wray"]Should contributions to this forum be attributable so as to support "no blame"?[/quote]

Not sure I quite understand. I imagine 'Topic of the Week' is simply for discussing different approaches to common problems (best practice / pragmatic / new evidence etc). So the subject matter doesn't seem to me to be one that carries a risk of 'blame'.

RE: Clinical and other debates

J G Wray — Mon, 15 May 2017 08:59:44 GMT

Should contributions to this forum be attributable so as to support "no blame"?

RE: Clinical and other debates

Arlo Guthrie — Mon, 15 May 2017 08:39:28 GMT

[quote user="robloxley"]are you trying to replicate something like bestbetsforvets.org?[/quote]

Nope (actually, I hadn't even seen that site before, looks interesting but a bit different to what I was thinking of).

[quote user="David Mills"]Can you not create a "topic of the week" as a sticky at the top of the forum?[/quote]

David Mills That is a fantastic idea; why didn't I think of it? As you say, could be just a question of making it sticky, but I am going to give some thought about other ways to highlight. For example, I'd like to give it front page billing.

[quote user="Caroline Allen"]How about a thread of 'the pragmatic approach to' a number of common conditions? [/quote]

Caroline Allen That too. Combines perfectly with David's suggestion.

Thank you both very much.

[quote user="Anthony Todd"]Trouble is you're going to get dinosaureal dogmatic opinions based on "many resolved cases" and other modern opinions which are the opposite, but not based on a failure of the described treatment, rather on diagnostic and therapeutic dogma.[/quote]

I don't see that as a problem per se (the reverse, actually).

The problem comes if a discussion gets diverted/hijacked/bogged down by one side or the other justifying / arguing the point. The objective here is to get the widest possible input to the discussion, and perhaps it would be a good idea to say that in 'topic of the week' threads, there is a limit to the number of times members are allowed to post in the thread. I dunno, say three times.

It could perhaps focus everyone's minds. What I mean is that hopefully people would use their first post to share some piece of useful information, sit back, see what everyone else shares, and then use their second and third posts to react, in a more focused way, to what others have said (if that makes sense). If some specific point merits more than 2 additional posts from the same member, they can spin it off as a tangent thread.

So, first things first. Suggested topics so far:

[quote user="Beats"]"The best approach to malassezia otitis"[/quote]

[quote user="villagevet"]feeding/lack of in hospital - particularly for pancreatitis and other GI cases[/quote]

[quote user="David Mills"]

First line treatment of pyoderma

Diagnosis and treatment of CHF

Management of atopy

Management of CKD in cats

Fracture or orthopaedic rads (possibly by input by Malcolm/specialist towards the end?)

Management of acute and chronic diarrhoea

Approach to colitis

Approach to the anorexic +/- pyrexic cat

Euthanasia of healthy animals

Approach to skin lumps[/quote]

Can I please now have as many suggestions as possible for more discussion topics (esp broad, basic ones which also lend themselves to Caroline's point about discussing both the rolls royce and the pragmatic approaches.

I will then hold a vote to decide the running order for the first tranche of discussions.

And Beats, yes, that suggestion about Journal vs Reading club is a good one too; I'll come back to that one.