I gave a talk yesterday on congenital diaphragmatic hernia to an audience in the Royal Alexandra Hospital in Brighton. The meeting was to discuss the possibilities of restarting a paediatric surgical service for neonates with this problem, as paediatric surgical and neonatal services have recently both started operating on the same site.

there used to be a copy of pred.txt online. there isn't anymore, so here is a replacement. predator, or michael carlton, was an amazing guy who did a lot more than many of us could imagine. this is his story, and some of his writing.

• Pred.txt (pdf - 11MB)

Have been here now for >48 hours - by two hours, precisely (the train I was on was late, and arrived about 25 minutes later than expected: that's the result of having a single mainline from the capital). Interesting greetings, interesting place. I'm sure I'll figure it out pretty quickly, tho - things will definitely settle down this week.

I wrote a little while ago about the UK Medical Careers Research Group survey of 1999 medical school graduates, and how I had answered (most of) the questions. I also mentioned that I'd been taking part in it for the past however many years - well, we've been surveyed a number of times. Now - revelation! - I was tidying up just the other day and came across the form from 2004-05. So I guess I didn't send it in. Is it now too late? Anyway, some of it I'd filled in, other bits are obvious, so I've included it below...

Introduction

I received this survey in the mail today - "Calling all 1999 Graduates" - it said. I've taken part (kind of: I can't remember returning all the forms) in the past surveys, and this is the most recent one to come out. I guess in part that I have always been ambiguous about the responses: it's very hard to know how to reply to a single-response questionnaire, when really you (one) wants to put several choices, and justify them.... Anyway, am filling in the current one and, as usual, there's not enough space, so thought I'd put additional comments on here.

This is a copy of a talk that I gave on oxygen delivery on ECMO to some of the nurses and junior doctors at the hospital where I am working. As ever, it was designed using Open Office although I've also provided some micro$oft powerpoint versions. These, as before, are likely to have some problems with formatting, although content is the same. For the "commercial break," I played some videos that I found on a site called ... ahh, well I can't remember the site at the moment.

Methicillin Resistant Staphylococcus Aureus (MRSA) is a bug that is resistant to many antibiotics and has been the star of many headlines within the British press, becoming known as a "super bug." Within the UK, MRSA has predominantly been a hospital-acquired infection, although with increasing frequency over the past 10-15 years. By contrast, in North America, I have heard anecdotally of a number of cases of community-acquired MRSA infections - these are usually more severe and have a poorer outcome.

Our local experience with MRSA infection in patients on ECMO was the basis for this poster that was prepared for the ECMO conference in Colorado earlier this year. It sparked a number of interesting discussions between attendants; perhaps, to me, the most interesting revelation being the differing epidemiology between continents. I was also struck by the importance of microbiological consultation with the ICU - we have an extremely involved team who round daily and provide a 24-hour specialist service for our children. Combined with strict protocols for nursing and interventions, we have experienced an extremely low rate of MRSA infection.

I go out each night, go for a walk down the public footpath amongst the trees and bushes behind the hospital. If I'm lucky, the stars are out: silhouetted, against the cranes and the lights and the buildings, little glimpses of blackness with a twinkling reminder... Strolling further away, one can see between. The spaces enlarge, the glimpses become expanses and I can fit into vision entire constellations.

Half-a-world-away... REM flickers to the atmosphere. I stood in darkened streets, cool wind blowing, bus ride waiting. I had company: the stars, Orion. Up there, solid, we were together, we shared this journey, this voyage unto shores unknown. Now, half a world away, so much ground covered, so much in between. Petty differences, atmospheric subtleties but the essence is the same. Fighting.