bestBETs

You see a patient following rotator cuff repair. You wonder whether treating them in a gym rehabilitation class would be as efficacious as a course of 1:1 physiotherapy treatment at improving pain, range of movement and function.

A 52 year-old women presented to the emergency department with a history of sudden onset of hearing loss in her right ear, which came on over the preceding hour. She had no past medical history of note. Examination of the ear was unremarkable and Weber’s / Rinne’s tests suggested that her hearing loss was sensorineural in nature. A diagnosis of sudden onset idiopathic sensorineural hearing loss (SSHL) was made. The ENT surgeon on call was contacted and advised prescribing acyclovir. You wonder what the evidence is to support this strategy.

A patient presents to the Emergency Department with isolated Weber C ankle fracture. He is placed in a non weight bearing plaster cast. He has a previous history of DVT and is an active smoker. You are concerned about the risk of recurrent DVT and discuss the potential benefits of thromboprophylaxis with him. He is keen, but unfortunately claims to be needle phobic and is reluctant to take daily subcutaneous LMWH. You wonder if there is any evidence to support any type of oral thromboprophylaxis in this situation.

A 43 year old female presents to the ED with symptoms and signs suggestive of DVT. According to local protocol she requires a Doppler ultrasound study to diagnose or exclude a DVT. Unfortunately there is no scan available from radiology for 2 days. One of the new ED registrars is trained in ultrasound to level 2, including peripheral vascular studies. You wonder if there is evidence that the scan performed by the EM trainee will be equivalent to that performed in the radiology department, thus avoiding delay in diagnosis and possible unnecessary treatment.

You are the Subspecialty Paediatric Emergency Medicine Trainee working in the Paediatric Emergency Department review clinic. The next patient is a four-year-old girl who has been brought back for review of throat swab results, as prior to being seen in the PED last week she had been on amoxicillin from the GP for four days without clinical effect. Her mother tells you she has now had an additional week of Penicillin V without improvement. She has had intermittent fever for nine days, is miserable with red eyes and a cracked, sore mouth, a transient rash, and this morning her mother noticed that her hands and feet were sore with peeling skin. The throat swab is negative. You realise that Kawasaki disease is a significant possibility in this case, and wonder whether you should start aspirin prior to urgent paediatric cardiology review – and if so, at what dose?

A 55 yr old male presents with a 10 year history of hypertension. The patient has been taking a combination of Lisinopril and Hydrochlorithiazide for the past 5 years. The patient has heard that chiropractic manipulation may have a lowering effect on blood pressure and would like to know if there is any evidence to support this.

A 55 year old female patient presents to the physiotherapy department for assessment of lateral hip pain that came on insidiously 2 years ago. She has been diagnosed with (Greater Trochanteric Pain Syndrome (GTPS) by an orthopaedic consultant, but the patient would like to know what the accuracy/validity of the clinical diagnosis is without also having an MRI scan.

You are a member of a multi disciplinary team (MDT) working on an adult in-patient neurological rehabilitation unit. A patient is admitted with a neurological condition for a period of rehabilitation. The MDT wants to set goals to direct the patient’s intervention. You want to use an outcome measure that will reflect change in functional ability and/or quality of life.

A 42 year old women presents with pain on thumb movements in her dominant hand. On examination, she has tenderness over the radial styloid process and crepitations over the first dorsal compartment of the distal radius. Finkelstein test was positive. You diagnose de Quervain’s tenosynovitis and plan to give her a splint, but wonder if steroid injection is better than splinting for the treatment of de Quervain’s tenosynovitis.

A 55 year old female patient presents to with a 7 week history of a gradual onset of pain and a range of movement limited in a capsular pattern confirming adhesive capsulitis. Her pain is limiting your treatment options to restore movement. You are unsure if a course of acupuncture or a corticosteroid injection may help to decrease her pain and assist with restoring her range of movement. You wonder if there is any evidence to help you choose.