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Foo20151013 2023 1fq5o2?1444773981
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The Hypocrite's Oath

A medical student reflects on exams: the pressure to perform, and the temptation to cheat (original post here) New and naive the journey begins, Forsaking folly for study and service, To "make the world a better place", To "alleviate suffering" to "give hope". The public trust, respect, maybe even revere us. They offer us their arms for a third attempt, They bleed and bruise so we can learn, Enduring pain for our practice. They think our vocation "the noblest of professions". Their trust they freely offer, We snatch it, thinking ourselves worthy, Considering ourselves men of noble blood, Trustworthy, moral and virtuous beings. Hours, days, years invested in books, Given in worship to the acquisition of knowledge. On wards we arrive in dress rehearsal, Regurgitating information at the whim of the gods. We desire their glory and brilliance, Panting for success, respect, power, control, Nothing terrifies more than failure, Exams loom incessantly... Offers of assistance entice. Tantalising tip-offs tempt, Some sharpen skills whilst others sully their souls. Time to swear the Hypocrite's Oath.  
David Jones
over 6 years ago
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452

Diagnosing angina: Key differences between men and women

Professor Noel Bairey-Merz discusses 'Diagnosing angina and the key differences between men and women' at the 2015 ESC congress in London.  
youtube.com
almost 4 years ago
Foo20151013 2023 dd0lu2?1444774205
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Male Postnatal Depression - a sign of equality or a load of nonsense?

Storylines on popular TV dramas are a great way of raising the public's awareness of a disease. They're almost as effective as a celebrity contracting an illness. For example, when Wiggles member Greg Page quit the group because of postural orthostatic tachycardia syndrome, I had a spate of patients, mostly young and female, coming in with self-diagnosed "Wiggles Disease". A 30% increase in the number of mammograms in the under-40s was attributed to Kylie Minogue's breast cancer diagnosis. The list goes on. Thanks to a storyline on the TV drama Desperate Housewives, I received questions about male postnatal depression from local housewives desperate for information: "Does it really exist?" "I thought postnatal depression was to do with hormones, so how can males get it?" "First it's male menopause, now it's male postnatal depression. Why can't they keep their grubby mitts off our conditions?" "It's like that politically correct crap about a 'couple' being pregnant. 'We' weren't pregnant, 'I' was. His contribution was five seconds of ecstasy and I was landed with nine months of morning sickness, tiredness, stretch marks and sore boobs!" One of my patients, a retired hospital matron now in her 90s, had quite a few words to say on the subject. "Male postnatal depression -- what rot! The women's liberation movement started insisting on equality and now the men are getting their revenge. You know, dear, it all began going downhill for women when they started letting fathers into the labour wards. How can a man look at his wife in the same way if he has seen a blood-and-muck-covered baby come out of her … you know? Men don't really want to be there. They just think they should -- it's a modern expectation. Poor things have no real choice." Before I had the chance to express my paucity of empathy she continued to pontificate. "Modern women just don't understand men. They are going about it the wrong way. Take young couples who live with each other out of wedlock and share all kind of intimacies. I'm not talking about sex; no, things more intimate than that, like bathroom activities, make-up removal, shaving, and so on." Her voice dropped to a horrified whisper. "And I'm told that some young women don't even shut the door when they're toileting. No wonder they can't get their de facto boyfriends to marry them. Foolish girls. Men need some mystery. Even when you're married, toileting should definitely be kept private." I have mixed feelings about male postnatal depression. I have no doubt that males can develop depression after the arrival of a newborn into the household; however, labelling it "postnatal depression" doesn't sit all that comfortably with me. I'm all for equality, but the simple fact of the matter is that males and females are biologically different, especially in the reproductive arena, and no amount of political correctness or male sharing-and-caring can alter that. Depressed fathers need to be identified, supported and treated, that goes without saying, but how about we leave the "postnatal" tag to the ladies? As one of my female patients said: "We are the ones who go through the 'natal'. When the boys start giving birth, then they can be prenatal, postnatal or any kind of natal they want!" (This blog post has been adapted from a column first published in Australian Doctor http://bit.ly/1aKdvMM)  
Dr Genevieve Yates
over 5 years ago
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Haemochromotosis brief overview

Haemochromatosis  Autosomal recessive  Excessive iron accumulation  0.5% of the Caucasians  Woman usually present a decade later than men due to menstrual …  
Sarah Wagstaffe
over 9 years ago
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Global Epidemiology of HIV Infection among Men Who Have Sex with Men | The New York Academy of Sciences

At the NYAS March 2011 Music, Science and Medicine conference, Assistant Professor of Psychiatry and Neuroscience at Mount Sinai School of Medicine and 2010 Blavatnik Award winner, Daniela Schiller, talks to Roger Bingham about how she got into science and reviews research in modifying fear memories.  
nyas.org
over 5 years ago
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Multiple Endocrine Neoplasia (MEN) | almostadoctor

Links to brief synopsis of Multiple Endocrine Neoplasia on almostadoctor.co.uk  
almostadoctor.com - free medical student revision notes
over 5 years ago
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Breast Cancer

Remember, although rare, men can also get breast cancer. Less than 1% of breast cancers occur in men. Benign breast masses are 15x more common than breast cancer   Epidemiology In the UK, a woman has a 1/9 chance of developing breast cancer It is the most common cause of death in women aged 35-55  
almostadoctor.com - free medical student revision notes
over 5 years ago
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Sterilisation

Sterilisation Can be controversial in some cultures Should only be undertaken in stable relationships where the couple is certain they do not want any more children   Epidemiology Rates falling in developed countries UK is unusual as the number of men receiving the operation is greater than the number of women 18% of men between 18-69 have had a vasectomy  
almostadoctor.com - free medical student revision notes
over 5 years ago
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Prostate Cancer

  By the age of 80, >80% of men have prostate cancer It is the second most common cancer in men, and the 4th most common cause of death for men in England and Wales. Rates of prostate cancer are particularly low in Asians, and particularly high in African Americans and Scandinavians. The tumours are adenomas and are usually located in the peripheral prostate.  
almostadoctor.com - free medical student revision notes
over 5 years ago
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Anxiety and Generalised Anxiety Disorder (GAD)

Generalised Anxiety Disorder (GAD) Epidemiology Very common. Prevalence: Men – 2-4% Women 3-4.5% Accounts for 1/3 of all psychiatric diagnosis Accounts for 10% of all GP consultations Closely related to depression – and many patients move between the two states. Often patients satisfy the criteria for both anxiety and depression  
almostadoctor.com - free medical student revision notes
over 5 years ago
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The prevalence of and factors associated with paying for sex among men resident in Britain

Stream The prevalence of and factors associated with paying for sex among men resident in Britain by BMJ talk medicine from desktop or your mobile device  
SoundCloud
over 4 years ago
Foo20151013 2023 1nuvntv?1444774080
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Obesity Part 1 – Fat Kid in a Fat Society

Introduction to Obesity One of my favourite past-times is to sit in a bar, restaurant, café or coffee shop and people watch. I am sure many of you reading this also enjoying doing this too. People are fascinating and it is intriguing to observe: what they do; how they act; what they wear and what they look like. My family and I have always observed those around us and discussed interesting points about others that we have noticed. When I first came up to visit Birmingham University my family all sat in a coffee shop in the centre of Birmingham and noticed that on average the people walking past us looked much slimmer than what we were used to seeing back in south Wales. Now, when I go home it is more painfully obvious than ever that the people in my home region are much, much heavier than they should be and are noticeably bigger than they used to be even a short number of years ago. This change in the population around me is what first made me seriously think about obesity, as a major problem affecting the world today. Nowadays obesity is all around us! It is noticeable, it is spreading and it should worry us all. Not just for our own individual health but also for the health of our society. Obesity affects everything from the social dynamic of families, to relationships at school or work, to how much the NHS costs to run. Obesity is a massive problem and if we as a society don’t start getting to grips with it, then it will have huge implications for all of us! I am currently in my 5th year at medical school. While I have been here I have taken a keen interest in obesity. The physiology, the psychology, the anatomy, the statistics and the wider affects on society of obesity have all been covered in curriculum lectures and extra curriculum lectures. I have taken part in additional modules on these subjects and sort out many experts in this field while on hospital placements. Obesity is fascinating for some many reasons and I thought that it would be a great topic to write some blogs about and hopefully start some discussions. Warning For my first blog on the topic of obesity I quickly want to write a bit about myself and my battle with weight. Everyone’s favourite topic is themselves, but I like to think that’s not why I have written this and I hope it doesn’t come across as a narcissistic ramble. I don’t intend to try and make myself come off well or suggest that I have all the answers (because I know very well that I don’t) and I hope it doesn’t come across like that. I want to write a bit of an autobiography because I wish to demonstrate how easy it is to go from a chunky kid to a technically obese teenager to a relatively fat adult without really realising what was happening. Chunky Child to Fat adult While planning this blog I realised that my Meducation profile picture was taken when I was at my all time fattest. At the graduation ceremony at the end of my 3rd year at university after completing my intercalation I was over 19 stones. At 6 foot 2” this gave me a BMI of >33 which is clinically obese. I had a neck circumference of >18”, a chest circumference of 48”, a waist of >40”, a seat of >52” and a thigh circumference of >28” per leg. Why do I know all of these rather obscure measurements? Partly because I am quite obsessive but mainly because I had to go to buy a tailor made suit because I could no longer buy a suit from a shop that I could fit into and still be able to move in. The only options left to me where massive black tent-suits or to go to a tailors. After the graduation I sat down at my computer (whilst eating a block of cheese) and compared my face from the graduation photos to pictures I had taken at the start of university and the difference in shape and size was amazingly obvious. I had got fat! I realised that if I had a patient who was my age and looked like me with my measurements then I would tell him to lose weight for the good of his health. So, I decided that finally enough was enough and I that I should do something about it. Before I describe how I got on with the weight management I will quickly tell the back story of how I came to be this size. I have always been a big guy. I come from a big family. I have big bones. I had “puppy fat”. I was surrounded by people who ate too much, ate rubbish and were over weight themselves, so I didn’t always feel that there was anything wrong with carrying a bit of tub around the middle. When I went to comprehensive school at age 12 I had a 36” waist. I thought I carried the weight quite well because I was always tall and had big ribs I could sort of hide the soft belly. Soon after arriving at the new school I had put on more weight and for the first time in my life I started to get bullied for being fat! And I didn’t like it. It made me really self-aware and knocked my confidence. Luckily, we started being taught rugby in PE lessons and I soon found that being bigger, heavier and stronger than everyone else was a massive advantage. I soon got my own back on the bullies… there is nowhere to hide on a rugby field! This helped me gain my confidence and I realised that the only way to stop the bullying was to confront the bullies and to remake myself in such a way as that they would be unable to bully me. I decided to take up rugby and to start getting fit. I joined a local club, starting playing regularly, joined a gym and was soon looking less tubby. Reflecting (good medical jargon, check) on my life now I can see that my PE teachers saved me. By getting me hooked on rugby they helped get me into many other sports and physical activity in general and without their initial support I think my life would have gone very differently. Rugby was my saviour and also later on a bit of a curse. As I grew up I got bigger and bigger but also sportier. I started putting muscle on my shoulders, chest and legs which I was convinced hid how fat I actually was. I developed a body shape that was large but solid. I was convinced that although I was still carrying lots of excess weight I no longer looked tubby-fat. When I was 14 my PE teachers introduced me to athletics. They soon realised that I was built for shot putt and discuss throwing and after some initial success at small school competitions I joined a club and took it up seriously. At this age I had a waist of about 38” but was doing about 3-4 hours of exercise almost everyday, what with rugby, running, gym, swimming and athletics – in and out of school. My weight had by now increased to roughly 15 stones and my BMI was over 30. I was physically fit and succeeding at sport but still carrying quite a lot of fat. I no longer thought of myself as fat but I knew that other people did. Between the ages of 14 and 18 I started to be picked for regional teams in rugby and for international athletic competitions for Wales. My sporting career was going very well but the downside of this was that I was doing sports that benefited from me being heavier. So the better I got the heavier I wanted to become. I got to the stage where I was eating almost every hour and doing my best to put on weight. At the time I thought that I was putting on muscle and being a huge, toned sports machine. It took me a while to realise that actually my muscles weren't getting any bigger but my waist was! By the time I had completed my A-levels I was for the first time over 18 stones and had a waste of nearly 40”. So, at this point I was doing everything that I had been told that would make me more adapted for my sport and I was succeeding but without noticing it I was actually putting on lots of useless excess weight that in the long term was not good for me! During my first year of university I gave up athletics and decided that I no longer needed to be as heavy for my sports. This decision combined with living away from home, cooking for myself and walking over an hour a day to and from Uni soon began to bear fruit. By the summer of my first year at Uni, aged 19, I had for the first time in my life managed to control my weight. When I came to Uni I was 18 stone. After that first year I was down to 14 stone – a weight I had not been since I was 14 years old! I had played rugby for the Medical school during my first year but as a 2nd row/back row substitute. These positions needed me to be fit and not necessarily all that heavy and this helped me lose the weight. During my second year I began to start as a 2nd row and was soon asked to help out in the front row. I enjoyed playing these positions and again realised that I was pretty good at it and that extra weight would make me even better. So between 2nd year and the end of 3rd year I had put on nearly 5 stone in weight and this put me back to where I started at my graduation at the end of 3rd year. The ironic and sad thing is about all this that the fatter, less “good looking” and unhealthier I became, the better I was adapted for the sports I had chosen. It had never occurred to me that being good at competitive sports might actually be bad for my health. The Change and life lessons learnt At the beginning of my 4th year I had realised that I was fatter than I should be and had started to pick up a number of niggly injuries from playing these tough, body destroying positions in rugby. I decided that I would start to take the rugby less seriously and aim to stay fit and healthy rather than be good at a competitive sport. With this new attitude to life I resolved to lose weight. Over the course of the year there were a number of ups and downs. I firstly went back to all the men’s health magazines that I had stock piled over the years and started to work out where I was going wrong with my health. After a little investigation it became apparent that going running and working out in the gym was not enough to become healthy. If you want to be slim and healthy then your diet is far more important than what physical activity you do. My diet used to be almost entirely based on red meat and carbs: steak, mince, bacon, rice and pasta. Over the year I changed my diet to involve far more vegetables, more fibre, more fruit, more salad and way less meat! The result was that by Christmas 2012 I was finally back below 18 stones. The diet had started to have benefits. Then came exams! By the end of exams in April 2013 I had gone back up 19 stones and a waist of >40”. I was still spending nearly 2 hours a day doing weights in the gym and running or cycling 3 times a week. Even with all this exercise and a new self- awareness of my size, a terrible diet over the 3 week exam period had meant that I gained a lot of fat. After exams I went travelling in China for 3 weeks. While I was there I ate only local food and lots of coffee. Did not each lunch and was walking around exploring for over 6 hours a day. When I got back I was 17.5 stone, about 106kg. My waist had shrunk back down to 36” and I could fit into clothes I had not worn in years. This sudden weight loss was not explained by traveller’s diarrhoea or any increased activity above normal. What made me lose weight was eating a fairly healthy diet and eating far less calories than I normally would. I know this sounds like common sense but I had always read and believed that if you exercised enough then you could lose weight without having to decrease your calorie intake too much. I have always hated the sensation of being hungry and have always eaten regular to avoid this awful gnawing sensation. I had almost become hunger-phobic, always eating when given the opportunity just in case I might feel hungry later and not because I actually needed to eat. The time in China made me realise that actually I don’t NEED to eat that regularly and I don’t NEED to eat that much. I can survive perfectly ably without regular sustenance and have more than enough fat stores to live my life fully without needing to each too much. My eating had just become a habit, a WANT and completely unnecessary. After being home for a month I have had some ups and downs trying to put my new plans into action. Not eating works really easily in a foreign country, where it’s hot, you are busy and you don’t have a house full of food or relatives that want to feed you. I have managed to maintain my weight around 17.5 stones and kept my waist within 36” trousers. I am counting that as a success so far. The plan from now on is to get my weight down to under 16.5 stones because I believe that as this weight I will not be carrying too much excess weight and my BMI will be as close to “not obese” as it is likely to get without going on a starvation diet. I intend to achieve this goal by maintain my level of physical activity – at least 6 hours of gym work a week, 2 cardio sessions, tennis, squash, cycling, swimming and golf as the whim takes me. BUT MORE IMPORTANTLY, I intend to survive off far fewer calories with a diet based on bran flakes, salad, fruit, nuts, chicken and milk. I am hoping that this very simple plan will work! Conclusion Writing this short(-ish) autobiography was quite cathartic and I would really recommend it for other people who are trying to remake themselves. Its helped me put my thoughts in order. Over the years I wanted to lose weight because I wanted to look better. This desire has now matured into a drive to be not just slimmer but healthier; I no longer want to be slimmer just for the looks but also to reduce the pressure on my joints, to reduce the pressure on my cardiovascular system, to reduce my risks of being fat when I am older, to hopefully reduce the risk of dying prematurely and to some extent to make life cheaper – eating loads of meat to prevent hunger is expensive! I hope this blog has been mildly interesting, but also informative of just how easy it is for even a health conscious, sporty individual to become fat in our society. I also wanted to document how difficult it is to lose weight and maintain that new lower weight for any prolonged length of time. At some point I would like to do a blog on the best methods for weight loss but that may have to wait until I have found what works for me and if I do actually manage to achieve my goals. Would be a bit hypercritical to write such a blog while still having a BMI yo-yoing around 32 I feel! Thought for the day 1 - Gaining wait is easy, becoming fat is easy, losing fat is also technically easy! The hard part is developing AND then maintaining a healthy mental attitude towards your weight. The human body has evolved to survive starvation. We are almost perfectly made to build up high density fat stores just in case next year’s crops fail and we have to go a few months on broth. I will say it again – We are designed to survive hard conditions! The problem with the modern world and with modern society is that we no longer have to fight to survive. For the first time in human history food is no longer scarce… it is in fact incredibly abundant and cheap (http://www.youtube.com/watch?v=-Z74og9HbTM). It is no surprise that when a human body is allowed to eat want and how much it craves and then do as little activity as possible, that it puts on fat very quickly. This has to be one of the major ironies of our age – When the human race has evolved society enough that we no longer need to have fat stores in case of disaster, that we are now the fattest humans have ever been! 2 – The best bit of advice I was ever given is this: “Diets ALWAYS fail! No matter what the diet or how determined you are, if you diet then within 2 years you will be the same weight or heavier than you are now. The only way to a healthy body is through a healthy LIFESTYLE CHANGE! You have to make changes that you are prepared to keep for a long time.”  
jacob matthews
about 6 years ago
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The Oncentra Prostate v4.x for ultrasound‑guided real‑time HDR brachytherapy in men with localised prostate cancer | Advice | NICE

NICE has developed a Medtech Innovation Briefing (MIB) on the Oncentra Prostate v4.x ultrasound-guided real-time HDR brachytherapy in men with localised prostate cancer.  
nice.org.uk
almost 4 years ago
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Save Your Bones: Osteoporosis Update 2014 - Research on Aging

(Visit: http://www.uctv.tv) Osteoporosis may have no symptoms, but it causes bones to become weaker. As many as half of all women and a quarter of men older ...  
youtu.be
over 3 years ago
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DNA prostate test 'will predict deadliest cancer risk' - BBC News

DNA tests, like those for women's breast cancer, could soon be used to see which men face the highest risk of deadly prostate cancer, scientists say.  
BBC News
over 5 years ago
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Pneumothorax

A pneumothorax is a collection of air in the pleural space. They can be: Primary – no underlying lung disease. Typically, tall thin young men might have a spontaneous pneumothorax Secondary – to underlying lung disease   They can be divided into: Standard pneumothorax  
almostadoctor.com - free medical student revision notes
over 5 years ago
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Faecal Incontinence

Faecal incontinence Occurs in 15% aged >65Y, increasing incidence with age in men only. Causes include: Sphincter weakness (following childbirth/surgery); Anal/rectal pathology e.g. fistulae, Crohn’s, proctitis;  
almostadoctor.com - free medical student revision notes
over 5 years ago
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Trichomoniasis

This is a parasitic protozoan infection, the result of infection with the flagellated anaerobic trichomonas vaginalis. This is the most common protozoan infection in the developed world It is a sexually transmitted infection although men are usually asymptomatic.   Epidemiology  
almostadoctor.com - free medical student revision notes
over 5 years ago
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BPH - Benign Prostatic Hyperplasia

  This occurs most commonly in men over 60 24% of those ages 40-64, and 40% of those over 65 will have the condition. It is very rare in Asian men It does not occur in eunuchs Microscopically there is hyperplasia of both the connective (stromal)tissue, and of the glandular (epithelial)tissue, however, it is the connective tissue  
almostadoctor.com - free medical student revision notes
over 5 years ago
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Fear Disordes - Panic, Phobia and PTSD

Fear disorders; Panic, Phobia and PTSD It is often hard to distinguish what is ‘normal’ fear, and what classifies as a psychiatric diagnosis. In practice, often these patients have symptoms of anxiety and fear, and diagnosis from GAD may be difficult.   Epidemiology Affect 3% of men and 6% of women Long duration   Aetiology  
almostadoctor.com - free medical student revision notes
over 5 years ago