#haiku sleepless in empty / bed I lay composing haiku / blooms of the bereft

#haiku a million monkeys / tapping industriously- / cogito ergo ...

#haiku I in some strange world / now speak allusive thoughts in / seventeen phonemes

#haiku to live to write truth / to act to speak true - cohere / authenticity

My recent realisation that an unjust world is the best of all possible worlds lead further to the realisation that there can be no Ultimate Reckoning, no Judgement Day

I seem inadvertently to be compiling a list of the overrated: being right is overrated...

#haiku "Brevity is the / soul of wit." - "...to make settled / things strange" IMAGINE!

#haiku Five - 5 - syllables / Lines one, three. Line two: seven. / This is a haiku.

#haiku sighs moans grunts whimpers / plead pray protest please Please PLEASE! / Yes! There. Here. Now! YES!

#haiku fantastic pleasure / unendurable torment / my nape almost kissed

#haiku action as intent / revealed: poetry as lush / language compressed

How how is it that people with scoliosis don't know that their spines curve?

Plan for 73.6 live for 36.8

#haiku tick tock tick tock - Aiiiii! / lub-dub lub-dub shhhhhhhhhh lub-dub / gravel on wood - done

#haiku delicious joy / drenching bliss: ecstacy: sweeeeet: / sugar on child's tongue

These status updates remind me of the Journal of Mundane Behaviour - such a rich research resource

Today was rather unexceptional at work & I was grateful considering I got no sleep last night

There's so little risk in being honest with strangers we should perhaps have a daily "sit & talk to a stranger"...

I do not envy Abelard

haiku commentary - tears are neither + nor -, they are simply emotive and they = spring... wrinkles=winter

#haiku life is like a pearled / string of moments: now and then: / tears, smiles, hugs, wrinkles....

Erudition in overrated

Musing on the discipline of pleasure and the pleasure of discipline...

What is the colour of magic? The smell of ecstacy? The taste of anguish? The feel of conviction? The sound of mystery?

Have I said that I really like ee cummings?

#haiku flickering candles / soft skin cinnamon sweat salt / sighs ...uh... ahhhhhhh. Oh. Yes.

#haiku each heartbeat restores / the world; summer, fall, snow, blooms: / all recreated

Fitzgerald had it wrong: the rich are not truly different...

Diamond is to carbon as poetry is to prose....

soul tired

...& so easily are clay feet revealed....

#haiku open on eight sides / no mind in exhalation / violence as repose

#haiku open on eight sides / no mind in exhalation / repose as violence

#haiku Soft hair against my / cheek; scents of joy remembered: / conflate past-future...

#haiku After chrysalis - / samadhi, love, satori / -Lepidoptera

...& my soul exhaled....

one grain

Do you curate

#haiku Purring sigh so deep/ everything slick molten bright/ juddering climax

In search of dopamine and oxytocin

"Communication isn't as simple as saying what you mean."

Favourite word: tinyurl.com/b3pmxf

I collect books to read and probably read 1:9

Machines take consistency to absurd lengths

Working on autobiographical memory

Searching for the story after the fairy tale ending

Great loves are not made of fire and ice

tinyurl.com/avdjel

It's lack of reflection that leads people to believe in hard/clear/determined margins. Edges tend to be fuzzy however sharp they feel - sense and perception are 2 very different things...

Science verifies or falsifies hypotheses but how do scientists generate hypotheses? Clinical medical diagnostics is essentially hypotheses generation and yet when I ask doctors how they arrive at diagnoses they very often tell me that they take a history or examine the patient. The truth is that histories and examinations do not generate diagnoses....

Valentine's Haiku 2

For Valentine's Day:

Loving: fierce hugs, kisses,

Little nips - Passion.

Valentine's Haiku

For Valentine's Day:

Loving: long hugs, soft kisses

Sweet smiles - Tenderness

HAPPY VALENTINES!

Anti-emetics

A little note on Cyclizine and Metoclopramide

It is surprising and sometimes annoying when people state categorically and definitively that cyclizine and metoclopramide antagonise each other. Cyclizine acts centrally on H1, M1, M2 and M3 receptors and Metoclopramide acts both centrally and peripherally on D2 and M1 receptors. Theoretically, there may be competitive inhibition of the one or other at M1 receptors without clinical effect.

These antiemetics do not "block each other" or "cancel each other out".

Act in haste repent at leisure - Why is the repenting always so EXPENSIVE!

protein... fibre... resveratrol....

In search of the counterintuitive

Ahhhhhhhhhh! My soul is almost almost a circle - not quite infinite-sided....

An unjust world is the best of all possible worlds!

Enhanced human cognition is a bandwidth issue

To the space between S & R!

Started following (twitter): CNN, NYT, 10Dowining Street, BBC Click....

Had your dose of reseveratrol today?

If we've spoken - I don't have "normal" conversations. What point normal? I'm looking 4 the shape of your soul; mine's probably similar....

Exercise is a good proxy for control

In celebration of commitment devices & mental accounts - Yay! Tversky! ;-)

I do not know the shape of my soul - & I think that I should.

Prayers complete; why do I pray? It's self management in the same way as meditation....

Can you imagine: doctors used to touch paitents!? They called it an examination!

Can you imagine: operations were done under inebriation!?

learnt tonite that manual evacuation of a rectum is verboten without an anaesthetic (?GA) = abuse....

SIGNIFY!

can an entire cohort lack balance?

What cure for a sensation junkie?

Discovered Google Dictionary

Reading an '89 journal: the entries do not recall the events. Memory is fickle

Portrait of an artist as an old man

In search of a magnum opus

Simpler: how broad & how deep are your stated / known preferences?

How rich are your articulated preferences?

Twitter spam is going to be a huge problem - and I'm not talking about me :)

In search of an affectometer: a device that measures physiological arousal+ambient temperature+geolocation and tells you what you are feeling

At some point life will be perfect - even if only for a day....

Chat better than email for updates too? multiple lines text & multi-updates at a time.

With blogger added to ping I'll have to do more housekeeping

HAPPY NEW YEAR!

BEST WISHES TO EVERYONE FOR 2009!

TIABIM

TIABIM: Taking into account and bearing in mind.

Learning...

It has been more than a year since I reviewed the BTS guidelines on management of primary spontaneous pneumothoraces, which I have reviewed again tonight and which had not changed in the interim, so I felt somewhat "rebuked" when I recently aspirated a moderate sized pneumothorax in a patient with COPD and a pleural effusion.

The medical registrar was quite emphatic that that was not the right management. It was.

The matter is noteworthy for two reasons: the first is that I have been trying to review my management of uncommon and rare conditions at the point of care, synchronously, regardless of my confidence in my knowledge or skill simply as good habit; and the second is that personal confidence is only tenuously linked to being right.

I am not confrontational and verbal aggression is only rarely provocative. I am biased by my history to consider only confinement and physical aggression as aggression, so the opinions of colleagues rarely impose. I am free.

I felt vulnerable and I am not sure why.

Haiku

running rat in maze
trackless mapless lost lonesome
is man is woman

Haiku

sculpting snow dragons
fire breathers formed in ice
... diastolic hearts...

Hope

Can hope be a positive act instead of an expectation?

Meaning

I am reminded of Kegan: to consider the level at which we make meaning.

Evolution

I had wanted to post regularly, both as a discipline and to improve my skills writing and in some sense writing for the sake of writing would have fulfilled both aims, but I have also wanted my writing to be evolutionary.

Popularity and volume have not been relevant metrics; growth has been.

I had invited a group of colleagues to write guest posts as an opportunity for them and as a source for additional material for myself. It has obviously not happened.

I have been in some peri-transition state for a variety of reasons and I expect that the boundaries will only be marked in hindsight. I do not know what outcomes to expect.

I am past my youth. That is no easy thing to accept.

Time, Ends

Time is the only effective cost. If doing must be directed to desired ends, time is best used determining ends rather than doing. That sounds stupid. I believe it is not. What are your thoughts?

Career Development?

A subconsultant grade

Authors: Laurence Wood

ED ATTENDANCES BY AGE

EMERGENCY DEPARTMENT ATTENDANCES BY AGE: A WELSH EXPERIENCE

E. Hassen, R. Bhalla

There is a dearth of epidemiological research into paediatric attendances at Emergency Departments in the UK. Most Emergency Medicine research in the UK has looked at types of injuries although several have looked at all types of ED attendance. Only one study has looked at the epidemiology of ED attendances specifically. This latter study found that most attendances were due to injuries and that these varied by age and location and that the variations were not stable across sites. More information is needed from more sites for longer periods through the country in addition to the sentinel sites monitored by the DTI given the contingent and complex causes of ED attendances.

The lack of research in Emergency Medicine is due to the fact that this is a new speciality, that Emergency Medicine lacks political capital, that no dedicated funding exists for Emergency Medicine research, that no dedicated organisation is responsible for Emergency Medicine research, that Emergency Medicine practitioners have an action focus rather than a research focus and that Emergency Departments are under-resourced for service provision without the ability to do research. The Joint Statement on Children’s Attendances at Accident & Emergency Departments was published in 1999 with its most important references from 1985. The Care Group Workforce Team Recommendations 2003 Report did not deal with Emergency Medicine. The most recent numbers published for NHS Direct referrals to Emergency Departments were for 1999-2000, the first year that NHS Direct was operating.

Emergency Medicine is still an orphan speciality and needs research that proves the growing workload and the effectiveness (clinical, social and financial) of Emergency Departments. Towards that end we contribute this study.

This study looks at all types of ED attendance at one hospital to report on the use of the Emergency Department by children to see how these vary by age, sex and season.

DATA AND METHODS

Our hospital is a district general hospital in Wales serving a population of 250,000.

The Emergency Departments is fully computerised and records information on every attendance made. Data on all new ED attendances by children aged under 16 years of age were available for the period 1 January 2005 to 31 December 2005 (12,443 records).

RESULTS

In 2005 ED attendances peaked at age 2 and then decreased to a minimum at age 8 before rising again. For all attendances the peak was reached in week 28, which was also the week in which paediatric attendances peaked; however, as a proportion paediatric attendances peaked in week 27. For all ages males presented more frequently than females with the smallest difference at age 2 and the largest difference at age 12.

Figure 1 shows all ED attendances for the year for each week with trough at week 8 and peak at week 28.

Figure 2 shows all paediatric ED attendances for the year for each week with trough at week 7 and peak at week 28.

Figure 3 shows all paediatric ED attendances for the year for each age cohort.

Figure 4 shows all paediatric ED attendances for the year for each age cohort by sex as a percentage.

DISCUSSION

This study has looked exclusively at the numbers of children presenting to the ED. It has not looked at the presenting complaints, discharge diagnoses, discharge outcomes, process times and treatments initiated in the ED. These are all important and have all been reported by several investigators to the disadvantage of simple epidemiological information. Investigators have been interested in the effects of social class, ethnicity, learning disability, physical disability, injury types, injury sites, chronic medical conditions and acute medical conditions on attendance at Emergency Departments. Given that there will be more than 25 million ED attendances this year in the UK we know very little about how they will be distributed and how the distribution is changing over time.

Chronic medical conditions are uncommon in children including learning disabilities and physical disabilities and it is not these specifically that lead to ED attendances and yet it is the effects of these on ED attendances that have engaged the attentions of researchers. The factors responsible for ED attendances are many and varied and complex and not knowable. The recent Institute of Medicine Report on the future of Emergency Medical Services states explicitly that indicators should be developed and that these should include structure and process measures and that these should evolve towards outcome measures. To focus on outcome measures first is to put the cart before the horse considering that we do not have structure and process measures.

We have an advantage compared to the fragmented health services sector in America: most accidents and emergencies in the UK are dealt with by the NHS in the Accident & Emergency Department. Centralised data collection, analysis and dissemination are possible. We hope it happens; soon.

Gapcast

Human Development Trends

Arthur Schopenhauer

All truth passes through three stages.
First, it is ridiculed.
Second, it is violently opposed.
Third, it is accepted as being self-evident.

Arthur Schopenhauer (1788–1860)

All movement is information

All movement is information. In falls and road traffic accidents that is obvious because injuries tend to be musculoskeletal. It is less obvious in respiratory tract infections, heart failure and abdominal pain. Obvious or not, the information remains germane.

It is not possible to state explicitly the differences in the movements of patients with renal colic or cystitis or appendicitis, but the gestalt is distinguishable. A great deal of medicine is observation.

I often ask patients to move and those accompanying – friends, relatives and carers – frequently attempt to assist and I must ask that they do not. Always, I have to explain that I need to see them move themselves unless I wish to be misconstrued as callous. Sometimes, I expect, I am still so construed....

The drooping lid of myasthenia, the tremor of hypoglycaemia, the swallow-cough of stroke, the hunching of kidney stones and the pursing of emphysema all constitute relevant information.

Watch, observe and diagnose.

Wisdom

Wisdom leads to wiser choices in wicked domains. A choice is wiser if the benefits are greater for more people, but such a utilitarian argument is intrinsically oxymoronic. Wisdom is necessarily humane.

The uber-rational is not wise. There is a component to wisdom beyond defined scales of costs and benefits. The humane subsumes compassion and empathy.

To be wise, one must be engaged, caring, accepting and generous. This implies that wisdom is an orientation more than a skill in the same way that trust is an orientation. This means that building wisdom is entirely different to and separate from thinking better.

To be wise then, one must orientate differently.

The principles of medical ethics seem wise: to avoid harm, to act for the good and to respect the choices of those who consult us without neglecting the rights of the wider society.

These principles seem wise because they contextualise all our interactions in place, time and community seeking a balance. It is a dynamic balance that needs to be actively maintained.

Wisdom then must include an acceptance that understanding is developmental, that we were lesser and will be greater yet if we can be more inclusive whilst making finer distinctions.

Better thinking and widom are different: as you sow, so shall you reap....