bestBETs

A 42-year-old man presented to the emergency department with unilateral parasternal chest pain of recent onset. Examination revealed reproducible tenderness overlying the 2nd to 4th right sided costochondral junctions. Significant differentials were excluded subsequent to clinical examination and normal investigations, and a diagnosis of costochondritis was made. You prescribe ibuprofen, however he states he is intolerant to all non-steroidal anti-inflammatory drugs and asks whether there are any alternative treatments. Your registrar suggests giving either a local corticosteroid injection or oral soluble format prednisolone. You wonder what evidence exists to support this.

A 12-year-old boy presents to the Emergency Department (ED), with pain and swelling around his left clavicle which occurred during a game of rugby. You explain his clavicle might be broken and an x-ray is required to confirm the diagnosis. His father points out that he has multiple x-rays in the past for other sporting related injuries and asks if the x-rays are necessary? You wonder whether Ultrasound (US) would be an alternative means for diagnosing a fracture of this bone.

A young adult was paddling on a sandy shoreline during their summer holiday; they think they may have been stung by something in the water. They are showing local signs of envenomation including erythema and swelling. Ambulance crews have given no treatment as they were unclear as to what action to take. You wonder if warm water immersion will be an effective therapy for reducing the symptoms.

There is new emerging technology designed to electrically stimulate key muscles involved in swallowing for treating people with dysphagia. This is more commonly used in the United States but it is now being provided in the UK by independent practitioners. The Royal College of speech and language therapists do not endorse this treatment due to lack of a robust evidence base so we do not know if this type of therapy is effective and for which client group it is most effective for. Patients are beginning to ask therapists about this kind of treatment so a search of the available evidence is useful to inform patients of the most up to date evidence.

A 25yrs old gentleman presents to the ED after punching into a wall, xrays show boxer fracture with 60degrees volar angulation. Can he be managed conservatively with neighbour strapping or he needs surgery?

A 23 year old female with a diagnosis of Joint Hypermobility Syndrome is assessed by a Physiotherapist in an out-patient department. The patient is presenting with pain, which is decreasing her function. You wonder whether acupuncture is an effective treatment adjunction to use with this patient to decrease pain and increase her function.

A fifty year male attends Emergency Department (ED) with cardiac sounding chest pain 2 hours ago and the pain lasted for 30 minutes. Now he is pain free and there is no history of previous IHD. He is ex smoker but has no other risk factors for IHD. His ECG is completely normal. You wonder if Point of Care (POC) triple markers can be requested 2-3 hours after the onset of pain in such cases and ACS can be realibly ruled out to allow safe discharge from ED.

Avoiding emergency hospital admissions is an important subject, and this audit aims to seek whether patients were triaged appropriately, according to established guidelines, for admission on the Medical Assessment Unit (MAU). The importance of doctors making a correct diagnosis will also be analysed, therefore seeing whether the decision making process by doctors have an impact on avoidable admissions.

A 22/40 pregnant lady presents to physiotherapy with pelvic girdle pain. The physiotherapist wants to know whether acupuncture will improve her pain and function.

A 40 year old female arrives to the physiotherapy department with a diagnosed pelvic organ prolapse (POP) from the Gynaecology clinic. She wants to know if pelvic floor muscle exercises alone will help improve her POP symptoms.

A 44 year old man presents to the emergency department with severe epigastric pain. With a working diagnosis of acute pancreatitis, the result of serum amylase were inconclusive. As urinary trypsinogen have been recommended as an adjunct in supporting the diagnosis of pancreatitis, you wonder if it would be worthwhile performing a urine dipstick for this purpose.

After working on the A&E department for 4 months, you are presented with your umpteenth patient with renal colic. You notice that this is the third patient in a row who has presented in the morning and consider if there is a link between the Circadian rhythm and renal stones.

A 39 year old man presents to A&E with a loin pain that is diagnosed as renal colic on clinical grounds. In particular the consultant suspects an obstructive uropathy. However, you wonder if non-obstructing renal stones can cause similar pain to obstructive uropathy.

A 42 year old gentleman presents to the ED with loin pain radiating to the groin. Investigations confirm the diagnosis of a small renal stone. You wonder if, instead of invasive therapy or medical expulsion, the stone can simply be “washed out” with fluid and diuretics.