Saturday, 7 October 2017

Chestnut Avenue

Chestnut Avenue is dead, long live Chestnut Avenue.

So for some reason the beautiful arcade of horse chestnut trees that lined Tooting Bec Common's middle road have been removed and replaced by new ones. Whether it's because ALL of the old ones were rotten or (more likely) new trees need less maintenance I don't know.

It does now however look weird.

The council are not popular.

17° Mostly Cloudy
Tooting Bec Road, London, England, United Kingdom



Friday, 25 August 2017

Curse of the Trauma Centre


Major Trauma Centres are the pinnacle of modern evidence based care for those unfortunate enough to be involved in significant trauma.
However
The hospital that contains the MTC is hamstrung (cf Royal London, St Mary's) with constant lack of TU and HDU facilities.
Why is this? It's because trauma is never ending, and you triage up not down, meaning that cases previously treated in a local A&E now end up at the shiny hospital. All well and good if the care and outcome is better provided that someone has remembered to plan appropriately.
Of course, in the UK we have tendered low bids and come up short. Trauma is a disease of the young predominantly. These patients survive horrendous injuries, and in the case of head injuries their bodies function very well. This means of course that they take up beds. For extended periods of time. WHich no one has thought about. The budgets for these MTCs are for a couple of patients in ITU and a few in an HDU setting (<20%). In reality the patients often occupy >50% of the critical care beds at any one time. This leads to elective cancellations, higher patient load elsewhere and speedy step downs. This then leads to worse outcomes all round.
If they had been honest when planning then this would be sorted, as the money would have been utilised to make a proper team and wards and critical care capacity. But obviously no one did "cos it can be done for less than that". Then all the staff pay with their sanity.
51.5167° N, 0.175763° W

Friday, 12 May 2017

Next steps in research

So what now then?
You work hard. You get your PhD in clinical research. You fancy doing more. You work hard again, but this time on your own time only.
You eventually get the opportunity to take the next step up. You apply. You interview. You are lucky enough to get the job.
Now you're a lecturer. What the hell are you meant to do next?
Research, obviously. But what and how. That's the key, as you need to start making your own waves, making your own noises. Pushing your own agendas.
So how do you do it?
Well, first part is making a game plan - what do you want to investigate? Then, how do you want to do it? What is the boss going to allow you to do? How long will it take. How much will it cost. Where is the money coming from.
Once you've answered all of these tricky questions, you merely have to do it.
That's easy.
Right?
13° Mostly Sunny
51.5229° N, 0.15717° W