39 e-Letters

published between 2008 and 2011

  • The Dunning Kruger effect
    Ibrahim Imam

    Geraint Fuller's neurological reflections describe the Dunning Kruger effect (1). This is one expression of illusory superiority, the cognitive bias that makes us over-rate our attributes (2). Apart from Shakespeare, whom the author quoted, other eminent people have noted that the less skilled and less educated are usually unaware of their inadequacy. Charles Darwin for example says: 'ignorance more frequently begets confi...

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  • Should neurologists throw away their stethoscopes?
    John W Norris

    As a long term and avid reader of Practical Neurology I was somewhat surprised by the article and correspondence suggesting that the stethoscope is now an irrelevancy to clinical neurologists (Practical Neurology 2010;10:344) On the contrary, I believe neurologists should still use their stethoscopes. Heres why.

    Most neck bruits indicate underlying arterial disease. For instance, in a study comparing the 'blind...

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  • CSF:plasma glucose
    oscar,m jolobe

    Although it is true that, in patients with suspected meningitis, a CSF:plasma glucose of >0.5 suggests a viral aetiology(1), underrecognition of the fact that the ratio may sometimes fall below 0.5 has led to inclusion of a CSF:plasma ratio > 0.5 among the "clinical case definitions" of aseptic meningitis(2), notwithstanding the fact that CSF:plasma glucose ratios below 0.5(and even as low as 0.26) may be encounte...

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  • Warum in die Ferne schweifen, wenn das Gute liegt so nah? - Goethe. (Why search far afield when the good is so nearby?)
    Annett Blochberger

    Dear Editor

    Imagine my surprise on reading your recent editorial regarding head injury. Perhaps the editor could have looked a little closer to home before concluding that neurologists in the UK are not involved in the management of patients with head injuries per se.

    I am a neurosciences pharmacist who is working very closely with a consultant neurologist who has recently developed a fully comprehens...

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  • Formula given in this paper cannot be used to calculate the QTc
    Tony Lopez

    The formula given in this paper can only be used to calculate a QTc if the variables QT and RR are entered as time measured in seconds.

    The RR is not the "heart beat in beats per min". It is the time elapsing between R wave peaks eg ten small squares which equals 0.4 seconds.

    Sadly, despite the obvious good intentions of this paper, any neurologist who follows the instructions to calculate the QTc wil...

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  • sometimes a stethoscope may be more of a hinderance than a help
    oscar,m jolobe

    The irony of the provocative invocation "Get rid of your stethoscope"(1) is that, for evaluation of systolic blood pressure(SBP) in the context of hypertension-related neurological disorders such as stroke(hypertension being the underlying cause of 54% of strokes worldwide)(2), and reversible cerebral vasoconstrictor syndrome(3), palpatory measurement of sytolic blood pressure may be a good substitute for auscultation, a...

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  • I like my stethoscope!
    Nitin K. Sethi

    We read with interest Dr. Hawkes point of view titled "get rid of your stethoscope"1. In his indomitable style of writing (which we have grown to appreciate!) he makes a rather outlandish plea to neurologists around the world to sell their stethoscopes and move on to new more fancy gizmos. I trust Dr. Hawkes takes this polarized viewpoint with the intention to spur debate among the readers. Old technology is not synonymous...

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  • Saving the grand round
    Nitin K. Sethi

    I read with interest the article by Dr. Stern and the accompanying comments by Dr. Warlow in which they lament about the deteriorating standards of grand rounds in the academic neurology institutions of today. Here across the Atlantic we too are confronting some of the same issues. The standard of grand rounds varies from institution to institution. In certain institutions the job of organizing the grand rounds is wholly en...

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  • The grand round has a broad spectrum of educational benefit
    oscar,m jolobe

    Given the fact that the advent of medical admissions units(MAUs) and their ethos of "physician of the week" has coincided with increasing subspecialisation(1), physicians with a special interest who participate in the MAU on call rota are now the ones in greatest need of the educational benefit conferred by grand rounds. In this context the grand round has the potential to refresh those "generalist" diagnostic skills which...

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  • Re:Why I shall never stop examining patients
    Jan M. Keppel Hesselink

    Dear Editor,

    With great interest I savoured the editorial by Dr. Warlow (1). Apart from learning the meaning of the word shibboleth, his analysis is most crisp and brings us back to the most important factor in medicine: the interaction between patient and physician.As a pain specialist I see many patients suffering from neuropathic pain, and I always examine thesm, especially their painful feet.Although I can...

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