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    26 October 2005

    Fantasy Health Minister: I'm on the high scorers list

    As described in a previous post, it's an online game where you get to be the Health Minister and select from a range of policy decisions.

    I scored 8851 on my last attempt, which made me the seventh highest scorer. Note that I got the health of the nation to 96%, but some of the higher scorers did not do as well. This is because the score also depends on popularity, and you have to please everyone, including the private sector.

    At present, I'm the only Authoritarian on the high scorers' list.
    (I'm "dr_lee_xray"' in case you were wondering).
    Most of the others are Idealists...Pah!!

    Fantasy Health Minister

    16 October 2005

    CT vs MR cholangiography for biliary calculi

    In our hospital we tend to use CT cholangiography (CTCh) more often than than MR cholangiopancreatography (MRCP) for the non-invasive detection of common bile duct stones because CT is more readily available, and we find CTCh a simpler and more robust test. Of course MRCP has no radiation and does not need any injections, but how do the two tests compare in terms of diagnostic accuracy?

    A recent paper addresses this question. 40 patients had both CTCh and MRCP, with the following results:

    For detection of choledochal stones the two tests were comparable:
    CTCh: sens 87%, spec 96%
    MRCP: sens 80%, spec 88%

    For detection of gallstones MRCP was a bit better,
    CTCh: sens 78%, spec 100%
    MRCP: sens 94%, spec 88%
    (The reduced sensitivity of CTCh was due to non-opacification of the gall bladder due a stone being stuck in the gall bladder neck)

    CTCh demonstrated bile leakage in one patient, and air in the biliary tree in two patients, which were not detected on MRCP.
    CTCh also has the advantage over MRCP in demonstrating anastomotic patency, since opacification in CTCh reflects flow, whereas MRCP only demonstrates the presence of fluid.

    I've never been able to figure out why are there so few papers on CTCh compared to MRCP. According to the article, Biliscopin (the contrast agent used for CTCh) is not approved for use in the USA. I didn't realise this but perhaps that's part of the reason. (As an aside, it's odd how some substances are permitted in one country but not another, for no obvious reason. Buscopan, for instance, is not licensed for use in the USA either).

    Okada M, Fukada J, Toya K, Ito R, Ohashi T, Yorozu A.
    The value of drip infusion cholangiography using multidetector-row helical CT in patients with choledocholithiasis.
    Eur Radiol. 2005 Oct;15(10):2140-5

    9 October 2005

    Want to run the National Health Service?

    Here's an online game where you get to be the Health Minister and select from a range of policy decisions, which in turn have an effect on the health of the Nation, your budget, and your popularity.

    On my last attempt I got the health of the nation up to 96% (you start at 43%), kept within budget, and increased my popularity. You also get an indication of your political complexion. Mine varies but so far it's usually 'authoritarian', occasionally 'idealist' or 'realist', but never 'liberal'.

    Fantasy Health Minister