I'd like to tell you a curious story. Jane was a 52 year old woman in need of a kidney transplant. Thankfully she had three loving sons who were all very happy to give her one of theirs. So Jane's doctors performed tests to find out which of the three boys would be the best match, but the results surprised everyone. In the words of Jeremy Kyle, the DNA test showed that Jane was not the mother of two of the boys... Hang on, said Jane, child birth is not something you easily forget. They're definitely mine. And she was right. It turns out Jane was a chimera. Chimerism is the existence of two genetically different cell lines in one organism. This can arise for a number of reasons- it can be iatrogenic, like when someone has an organ transplant, or it can be naturally occurring. In Jane's case, it began in her mum's womb, with two eggs that had been fertilised by different sperm creating two embryos. Ordinarily, they would develop into two non-identical twins. However in Jane's case the two balls of cells fused early in development creating one person with both cell lines. Thus when doctors did the first tissue typing tests on Jane, just by chance they had only sampled the 'yellow' cell line which was responsible for one of her sons. When they went back again they found the 'pink' cell line which had given rise to the other two boys. This particular type of human chimerism is thought to be pretty rare- there are only 30 case reports in the literature. (Though remarkably both House and CSI's Gil Grissom have encountered cases.) What happens far more frequently is fetal microchimerism- which occurs in pregnant women when cells cross the placenta from baby to mum. This is awesome because we used to think the placenta was this barrier which prevented any cells crossing over. Now we've found both cells and free floating DNA cross the placenta, and that the cells can hang around for decades after the baby was born. Why? As is often the case in medicine we're not sure but one theory is that the fetal cells might have healing properties for mum. In pregnant mice who've had a heart attack, fetal cells can travel to the mum's heart where the develop into new heart muscle to repair the damage. Whilst we're still in the early stages of understanding why this happens, we already have a practical application. In the United States today, a pregnant woman can have a blood test which isn't looking for abnormalities in her DNA but in that of her fetus. The DNA test isn't conclusive enough to be used to diagnose genetic conditions, but it is a good screening test for certain trisomies including Down's syndrome. Now, we started with a curious tale, so lets close with a curious fact, and one that's appropriate for Mother's Day: This exchange of cells across the placenta is a two way process. So you may well have some of your mum's cells rushing through your veins right now. In my case they're probably the ones that tell me to put on sensible shoes and put that boy down... (FYI: This is a story I originally posted on my own blog)
Dr Catherine Carver
over 8 years ago
Spinal stenosis is a condition in which the spinal canal narrows and pinches the nerves, resulting in back and leg pain. Spinal stenosis often occurs in older adults, although younger people who are born with a small spinal canal may also develop symptoms.
over 5 years ago
This animation shows a simplified version of the macrophage's role in the initiation of atherosclerosis. In an atherosclerotic-prone blood vessel, macrophages invade the subendothelial space. Oxidised Low-Density Lipoproteins (oxLDL) present within the vessel wall will bind to scavenger receptors on the macrophage's surface, such as CD36. This will activate the macrophage, and it will phagocytose the oxLDL. As this process continues, the macrophage increases in size and forms a Foam Cell, which is too large to pass between the endothelial cells back into the lumen. Therefore, the foam cells remain in the subendothelial space and are the main cells present within an atherosclerotic plaque. *** Done for Student Selected Component (SSC), University of Aberdeen. Year 2. 2011. Made in Adobe Photoshop CS2 and Adobe Imageready.
over 10 years ago
1. Sleep (I realize I’m posting this at 12:30 am…) (http://www.helpguide.org/life/sleep_tips.htm) I know there’s a popular perception of sleep deprivation going hand in hand with working hard or succeeding academically. However, that is only true if you’re working very last minute, and don’t care about retaining the information–you basically just want to get through your upcoming test/assignment. I would like to clarify that, although learning about 10 months of material in 2 weeks is overwhelming, it is NOT last minute because whatever you’re working on right now, you’ll have to remember in 2 weeks for your exam. Besides the exam, if you’re studying medicine, you need to remember most of these things for the rest of your life. In order to retain that information, you need to stay alert, well rested and motivated. Prolonged sleep deprivation can make you feel very ‘CBA’ very fast. 2. Stay Energized Sleep is only one factor in staying motivated and alert; another is staying energized¬–in a healthy way. Simply put: if you feel well, you’ll work well. Eat well: difficult, I know, when you’ve got so little time to spare; but as much as you can, try to eat more whole foods (aka things that don’t come in wrappers or have their own commercial) and keep a balanced diet (too much of anything is usually not good). Everyone snacks while they’re doing exams, but try to find a vice that won’t put you in a sugar coma (some good examples include berries and other fruits, nuts, carrots with hummus to dip in, granola bars, etc). Note: drinking tea is also an excellent way to stay energized! Stay active: Again, I know something like this is difficult to keep up in normal everyday life, let alone during exam stress. Even if it is just for 15-20 minutes, some cardio (note: the more strenuous the workout in a short period of time, the more benefit you’ll get) is a fantastic ‘eye-opener’ (I learned that phrase while learning how to take an alcohol history and now I really like it)! No one wants to go for a run in the morning, but after you get past the first 2-3 minutes of wanting to collapse, your body starts to feel really grateful. This is the BEST way to stimulate your senses and wake yourself up. I promise it’s better than any energy drink or cup of coffee you could have. Take small breaks: SMALL breaks!!! About 10 minutes. Every once in a while, you need to get up and walk around to give yourself a break, have some fresh air, grab a snack, but try not to get carried away; try to avoid having a short attention span. 3. Make Lists I cannot stress enough how counterproductive it is to overwhelm yourself with the amount of work you have. Whether you think about it or not, that pile is not going anywhere. Thinking about it won’t wish it away. Stop psyching yourself out and just get on with it– step by step. Making a list of objectives you need to accomplish that day or week is a great way to start; then, cross them out as you go along (such a satisfying feeling). Being able to visualize your progress will be a great motivator. Remember: it is important to be systematic with your studying approach; if you jump around between modules because they’re boring you’re just going to confuse yourself and make it hard to remember things when that exam comes Note: I have a white board in my room where I write my objectives for the week. Some days it motivates, some days it I want to throw it out the window (but I can't reach the latch)… 4. Practice Questions Practice questions are excellent for monitoring your progress; they’re also excellent at scaring you. Do not fear! This is a good thing, because now you know what you’re missing, go back and read up on what you forgot to take a look at, and come back and do the questions later. Then give yourself a sticker for getting it right ? Practice questions are also great for last minute studying too because they can help you do what I call “backwards studying”–which is what I just described: figuring out what you need to learn based on what the questions look like. 5. Be realistic Set realistic goals for yourself; most importantly, set realistic daily goals for yourself so that when you get all or most or even some of them done you can go to sleep with a level of satisfaction. Also, you need to pick your battles. Example: if you suck at neuro, then one module’s loss is another’s gain. Don’t spend too much time trying to get through one thing, just keep moving forward, and come back to it later 6. ‘Do not disturb’ Facebook, twitter, instagram, youtube, whatsapp, texting, pinterest, meme websites, so many fantastic ways to kill your time… Do yourself a favor, save them for your breaks. If someone is dying or on fire, they will most likely call you, not text you or write on your wall; you do not need to check your phone that often unless you're expecting something time sensitive. 7.Don’t Compare Everyone studying in your program is going to be stressed about things; do NOT let it rub off on you. You know those moments when you hear a peer or a prof/tutor describing something you have never even heard of, then you start panicking? Yeah, don’t do that. It happens to everyone. Instead of worrying so much, just go read about it! Simple solution right? What else are you going to do? Plus, a lot of the time other students seem to know more than they need to about certain things (which I can tell you right now, doesn’t always mean they’re doing better than you; knowing random, very specific factoids doesn’t mean they can bring it in clinic. Everyone can pull a Hermione and know a book inside out, but this is not necessarily the hallmark of a good doctor), what’s it to you? Worry about yourself, be confident in your abilities, and don’t trouble yourself with comparing to other people 8.Practice for Practicals Everyone is afraid of practical exams, like the OSCE (at any rest station you're likely to find me with my head in my hands trying to stabilize my breathing pattern and trying not to cry). The best way to be ready is to practice and practice and practice and practice. It’s like learning to drive a car. At first you’re too aware of your foot on the gas, the position of your hand on the wheel, etc; but, after driving for a little while, these things become subconscious. In the same way, when you walk into a station, you could be so worried about how you’ll do your introduction and gain consent, and remembering to wash your hands, and getting equipment and and and and and; the anxiety affects your confidence and your competence. If you practice enough, then no matter what they throw at you, you will get most of the points because the process will be second nature to you. Practice on your roommates, friends, family members, patients with a doctor's help...when appropriate... Even your stuffed animals if you're really desperate. DO NOT leave practicing for these practicals to the last minute; and if you do, make sure you go through every thing over and over again until you’re explaining examinations in your sleep. NOTE: When I'm practicing for OSCE alone, I record myself over and over again and play it back to myself and criticize it, and then practice againn. 9.Consistency You don’t necessarily have to study in the same place every day; however, it is always good to have some level of routine. Some examples include: waking up/sleeping at the same time everyday, going for a run at the same time every day, having the same study routine, etc. Repetition is a good way to keep your brain focused on new activities because, like I said before, the more you repeat things, the more they become second nature to you. Hope these tips are of some use to you; if not, feel free to sound off in the comments some alternate ways to get through exams. Remember that while exams are stressful, this is the time where you build your character and find out what you’re truly capable of. When you drop your pen after that final exam, you want to feel satisfied and relieved, not regretful. Happy Studying ?
over 8 years ago
This animation shows a simplified version of the macrophage's role in the initiation of atherosclerosis. In an atherosclerotic-prone blood vessel, macrophages invade the subendothelial space. Oxidised Low-Density Lipoproteins (oxLDL) present within the vessel wall will bind to scavenger receptors on the macrophage's surface, such as CD36. This will activate the macrophage, and it will phagocytose the oxLDL. As this process continues, the macrophage increases in size and forms a Foam Cell, which is too large to pass between the endothelial cells back into the lumen. Therefore, the foam cells remain in the subendothelial space and are the main cells present within an atherosclerotic plaque. *** Done for Student Selected Component (SSC), University of Aberdeen. Year 2. 2011. Made in Adobe Photoshop CS2 and Adobe Imageready.
over 10 years ago
Introduction Hello and welcome! I am finally back to blogging after having a brief hiatus in order to take my final exams. Whilst the trauma is still fresh in my mind, I would like to share with you the top 5 social media tips that helped me through the dark days of undergraduate medicine. Some of you may have already read my old essay on 'How Medical Students should interact with Social Media Networking Sites' and this document deals with some of the problems with professionalism surrounding the use of social media. This blog will not cover such issues, but will instead focus on how you can use social media to benefit your learning/ revision processes. Top Tip 1: YouTube For those of you who are unaware, YouTube is a video-sharing website. Sometimes the site is overlooked as a 'social media' resource but if you consider the simple definition of Social Networking Sites as 'those with user led content,' you can quickly see how YouTube definitely falls into the social media category. It wasn't until I got to University that I realised the potency of YouTube as an educational tool. It has a use at every stage of medical education and it is FREE. If you are still in your pre-clinical training then there are a wealth of videos that depict cellular processes and 3D anatomy - very useful content for the visual learner. For the clinical student, there are a number of OSCE demonstration videos that may be useful in honing your examination skills. There are also a number of presentations on clinical topics that have been uploaded, however, YouTube has no quality control measures for these videos (to my knowledge) so it may be best to subscribe to a more official source if you like to use podcasts/ uploaded presentations for your revision. Another reason YouTube comes in as my number 1 top tip is because I find it difficult to procrastinate whilst using the site. Sure, you can start looking up music and videos that have nothing to do with medicine but personally I find that having a little bit of music on in the background helps me work for longer periods, which is a definite bonus during the revision period. On the other hand, there are many that find YouTube difficult to harness due to the draw of funny videos and favourite Vloggers (Video Bloggers) that can distract the unwary from revision for hours on end. At the end of the day, YouTube was created for funny videos (predominantly of cats it seems) and not for medical education, and this should be kept in mind if you choose to use it as a tool for your learning. Top Tip 2: Facebook Yes, the dreaded Facebook comes in at number two for me. Facebook is by far and away my largest source of procrastination when it comes to writing / working / revising or learning. It is a true devil in disguise, however, there are some very useful features for those who like to work in groups during their revision... For example, during the last six months I have organised a small revision group through Facebook. We set up a 'private page' and each week I would post what topics would be covered in the weeks session. Due to the nature of Facebook, people were obviously able to reply to my posts with suggestions for future topics etc. We were also able to upload photos of useful resources that one or more of us had seen in a tutorial in which the other students hadn't been able to attend. And most importantly, we were able to upload revision notes for each other via the Facebook 'files' tab. This last feature was invaluable for sharing basic notes between a few close colleagues. However, for proper file sharing I strongly recommend the file sharing service 'Dropbox,' which provides free storage for your documents and the ability to access files from any computer or device with internet. Coming back to Facebook, my final thoughts are: if you don't like group work or seeing what your colleagues are doing via their statuses or private messages then it probably isn't a useful resource for you. If you have the motivation (unlike myself) to freeze your Facebook account I can imagine you would end up procrastinating far less (or you'll start procrastinating on something else entirely!). Top Tip 3: Twitter Twitter is a microblogging site. This means that users upload microblogs or 'Tweets' containing useful information they have found on the internet or read in other people's tweets. Twitter's utility as an educational resource is directly related to the 'type' of people you follow. For example, I use Twitter primarily to connect with other people interested in social media, art & medicine and medical education. This means my home screen on twitter is full of people posting about these topics, which I find useful. Alternatively, I could have used my Twitter account to 'follow' all the same friends I 'follow' on Facebook. This would have meant my Twitter home page would have felt like a fast-paced, less detailed version of my Facebook feed just with more hashtags and acronyms - not very useful for finding educational resources. With this in mind, consider setting up two twitter accounts to tease apart the useful tweets about the latest clinical podcast from the useless tweets about what your second cousin once removed just had for lunch. A friend suggested to me that if you really get into twitter it is also possible to use one account and 'group' your followers so that you can see different 'types' of tweets at different times. This seems like a good way to filter the information you are reading, as long as you can figure out how to set up the filters in the first place. Like all Social Media Sites, Twitter gets its fair share of bad press re. online professionalism and its tendency to lure users into hours of procrastination. So again, use with caution. Top Tip 4: Meducation It would not be right to write this blog and not include Meducation in the line-up. Meducation is the first website that I have personally come across where users (students, doctors etc) upload and share information (i.e. the very soul of what social networking is about) that is principally about medicine and nothing else. I'm sure there may be other similar sites out there, but the execution of this site is marvellous and that is what has set it apart from its competitors and lead to its rapid growth (especially over the last two years, whilst i've been aware of the site). When I say 'execution,' I mean the user interface (which is clean and simple), the free resources (giving a taste of the quality of material) and the premium resources (which lecture on a variety of interesting clinical topics rather than sticking to the bread and butter topics 24/7). One of my favourite features of Meducation is the ability to ask 'Questions' to other users. These questions are usually asked by people wishing to improve niche knowledge and so being able to answer a question always feels like a great achievement. Both the questions and answers are mostly always interesting, however the odd question does slip through the net where it appears the person asking the question might have skipped the 'quick google search' phase of working through a tough topic. Meducation harnesses social networking in an environment almost free from professionalism and procrastination issues. Therefore, I cannot critique the site from this angle. Instead, I have decided to highlight the 'Exam Room' feature of the website. The 'Exam Room' lets the user take a 'mock exam' using what I can only assume is a database of questions crafted by the Meducation team themselves (+/- submissions from their user base). However, it is in my opinion that this feature is not up to scratch with the level and volume of questions provided by the competitors in this niche market. I feel wrong making this criticism whilst blogging on Meducation and therefore I will not list or link the competitors I am thinking of here, but they will be available via my unaffiliated blog (Occipital Designs). I hope the Meducation team realise that I make this observation because I feel that with a little work their question database could be improved to the point where it is even better than other sites AND there would also be all the other resources Meducation has to offer. This would make Meducation a truly phenomenal resource. Top Tip 5: Blogging Blogging itself is very useful. Perhaps not necessarily for the learning / revision process but for honing the reflective process. Reflective writing is a large component of undergrad medical education and is disliked by many students for a number of reasons, not least of which is because many find some difficulty in putting their thoughts and feelings on to paper and would much prefer to write with the stiffness and stasis of academic prose. Blogging is great practice for breaking away from essay-writing mode and if you write about something you enjoy you will quickly find you are easily incorporating your own personal thoughts and feelings into your writing (as I have done throughout this blog). This is a very organic form of reflection and I believe it can greatly improve your writing when you come to write those inevitable reflective reports. Conclusion Thanks for reading this blog. I hope I have at least highlighted some yet unharnessed aspects of the sites and resources people already commonly use. Please stay tuned in the next week or two for more on social media in medicine. I am working together with a colleague to produce 'Guidelines for Social Media in Medicine,' in light of the recent material on the subject by the General Medical Council. Please feel free to comment below if you feel you have a Top Tip that I haven't included! LARF Twitter Occipital Designs My Blog As always, any views expressed here are mine alone and are not representative of any organisation. A Worthy Cause... Also, on a separate note: check out Anatomy For Life - a charity medical art auction raising money for organ donation. Main Site Facebook Twitter
Dr. Luke Farmery
over 8 years ago
As the days are slowly getting longer, and spring looms in the near future, it can only be the deep inhale of the medical student ready to embrace the months of revision that lies ahead. Books are dusted off the shelves and Gray's anatomy wrenched open with an immense sigh of distain. But which book should we be pulling off the shelves? If you're anything like me then you're a medical book hoarder. Now let me "Google define" this geeky lexis lingo - a person who collects medical books (lots of medical books) and believes by having the book they will automatically do better!... I wish with a deep sigh! So when I do actually open the page of one, as they are usually thrown across the bed-room floor always closed, it is important to know which one really is the best to choose?!? These are all the crazy thoughts of the medical book hoarder, however, there is some sanity amongst the madness. That is to say, when you find a really good medical book and get into the topic you start to learn stuff thick and fast, and before you know it you’ll be drawing out neuronal pathways and cardiac myocyte action potentials. Yet, the trick is not picking up the shiniest and most expensive book, oh no, otherwise we would all be walking around with the 130 something pounds gray’s anatomy atlas. The trick is to pick a book that speaks to you, and one in which you can get your head around – It’s as if the books each have their own personality. Here are a list of books that I would highly recommend: Tortora – Principles of anatomy and physiology Tortora is a fantastic book for year 1 medical students, it is the only book I found that truly bridges the gap between A levels and medical students without going off on a ridiculous and confusing tangent. While it lacks subtle detail, it is impressive in how simplified it can make topics appear, and really helps build a foundation to anatomy and physiology knowledge The whole book is easy to follow and numerous pretty pictures and diagrams, which make learning a whole lot easier. Tortora scores a whopping 8/10 by the medical book hoarder Sherwood – From cells to systems Sherwood is the marmite of the medical book field, you either love this book or your hate it. For me, Sherwood used to be my bible in year two. It goes into intricate physiological detail in every area of the body. It has great explanations and really pushes your learning to a greater level than tortora in year one. The book doesn’t just regurgitate facts it really explores concepts. However: I cannot be bias, and I must say that I know a number of people who hate this book in every sense of the word. A lot of people think there is too much block text without distractions such as pictures or tables. They think the text is very waffly, not getting straight to the point and sometimes discusses very advanced concepts that do not appear relevant The truth be told, if you want to study from Sherwood you need to a very good attention span and be prepared to put in the long-hours of work so it’s not for everyone. Nonetheless, if you manage to put the effort in, you will reap the rewards! Sherwood scores a fair 5-6/10 by the medical book hoarder Moore & Dalley – Clinical anatomy At first glance Moore & Dalley can be an absolute mindfield with an array of pastel colours that all amalgamate into one! It’s also full of table after table of muscle and blood vessels with complicated diagrams mixed throughout. This is not a medical book for the faint hearted, and if your foundation of anatomy is a little shakey you’ll fall further down the rabbit hole than Alice ever did. That being said, for those who have mastered the simplistic anatomy of tortora and spent hours pondering anatomy flash cards, this may be the book for you. Moore & Dalley does not skimp on the detail and thus if you’re willing to learn the ins and out of the muscles of the neck then look no further. Its sections are actually broken down nicely into superficial and deep structures and then into muscles, vessels, nerves and lymph, with big sections on organs. This is a book for any budding surgeon! Moore & Dalley scores a 6/10 by the medical book hoarder Macleod’s clinical examination Clinical examination is something that involves practical skills and seeing patients, using your hands to manipulate the body in ways you never realised you could. Many people will argue that the day of the examination book is over, and it’s all about learning while on the job and leaving the theory on the book shelf. I would like to oppose this theory, with claims that a little understanding of theory can hugely improve your clinical practice. Macleod’s takes you through basic history and examination skills within each of the main specialties, discussing examination sequences and giving detailed explanations surrounding examination findings. It is a book that you can truly relate to what you have seen or what you will see on the wards. My personal opinion is that preparation is the key, and macleod’s is the ultimate book to give you that added confidence become you tackle clinical medicine on the wards Macleod’s clinical examination scores a 7/10 by the medical book hoarder Oxford textbook of clinical pathology When it comes to learning pathology there are a whole host of medical books on the market from underwood to robbins. Each book has its own price range and delves into varying degrees of complexity. Robbins is expensive and a complex of mix of cellular biology and pathophysiological mechanisms. Underwood is cheap, but lacking in certain areas and quite difficult to understand certain topics. The Oxford textbook of clinical pathology trumps them all. The book is fantastic for any second year or third year attempting to learn pathology and classify disease. It is the only book that I have found that neatly categories diseases in a way in which you can follow, helping you to understand complications of certain diseases, while providing you with an insight into pathology. After reading this book you’ll be sure to be able to classify all the glomerulonephritis’s while having at least some hang of the pink and purples of the histological slide. Oxford textbook of clinical pathology scores a 8/10 by the medical book hoarder Medical Pharmacology at glance Pharmacology is the arch nemesis of the Peninsula student (well maybe if we discount anatomy!!), hours of time is spent avoiding the topic followed immediately by hours of complaining we are never taught any of it. Truth be told, we are taught pharmacology, it just comes in drips and drabs. By the time we’ve learnt the whole of the clotting cascade and the intrinsic mechanisms of the P450 pathway, were back on to ICE’ing the hell out of patients and forget what we learned in less than a day. Medical pharmacology at a glance however, is the saviour of the day. I am not usually a fan of the at a glance books. I find that they are just a book of facts in a completely random order that don’t really help unless you’re an expert in the subject. The pharmacology version is different: It goes into just the right amount of detail without throwing you off the cliff with discussion about bioavailability and complex half-life curves relating to titration and renal function. This book has the essential drugs, it has the essential facts, and it is the essential length, meaning you don’t have to spend ours reading just to learn a few facts! In my opinion, this is one of those books that deserves the mantel piece! Medical Pharmacology at a glance scores a whopping 9/10 by the medical book hoarder. Anatomy colouring book This is the last book in our discussion, but by far the greatest. After the passing comments about this book by my housemates, limited to the sluggish boy description of “it’s terrible” or “its S**t”, I feel I need to hold my own and defend this books corner. If your description of a good book is one which is engaging, interesting, fun, interaction, and actually useful to your medical learning then this book has it all. While it may be a colouring book and allows your autistic side to run wild, the book actually covers a lot of in depth anatomy with some superb pictures that would rival any of the big anatomical textbooks. There is knowledge I have gained from this book that I still reel off during the question time onslaught of surgery. Without a doubt my one piece of advice to all 1st and 2nd years would be BUY THIS BOOK and you will not regret it! Anatomy colouring book scores a tremendous 10/10 by the medical book hoarder Let the inner GEEK run free and get buying:)!!
over 8 years ago
Great people make mistakes. Unfortunately, medicine is a subject where mistakes are not tolerated. Doctors are supposed to be infallible; or, at least, that is the present dogma. Medical students regularly fall victim to expecting too much of themselves, but this is perhaps not a bad trait when enlisting as a doctor. If it weren’t for mistakes in our understanding, then we wouldn’t progress. Studying a BSc in Anatomy has exposed me to the real world of science – where the negative is just as important as the positive. What isn’t there is just as important as what is. If you look into the history of Anatomy, it truly is a comedy of errors. So, here are three top mistakes by three incredibly influential figures who still managed to be remembered for the right reasons. 3. A Fiery Stare Culprit: Alcmaeon of Croton Go back far enough and you’ll bump into someone called Alcmaeon. Around the 5th century, he was one of the first dissectors – but not an anatomist. Alcmaeon was concerned with human intellect and was desperately searching for the seat of the soul. He made a number of major errors - quite understandable for his time! Alcmaeon insisted that sleep occurs when the blood vessels filled and we wake when they empty. Perhaps the most outrageous today is the fact that he insisted the eyes contained water both fire and water… Don’t be quick to mock. Alcmaeon identified the optic tract, the brain as the seat of the mind (along with Herophilus) and the Eustachian tubes. 2. Heart to Heart Culprit: Claudius Galen Legend has it that Galen’s father had a dream in which an angel/deity visited him and told him that his son would be a great physician. That would have to make for a pretty impressive opening line in a personal statement by today’s standards. Galen was highly influential on modern day medicine and his treatise of Anatomy and healing lasted for over a thousand years. Many of Galen’s mistakes were due to his dissections of animals rather than humans. Unfortunately, dissection was banned in Galen’s day and where his job as physician to the gladiators provided some nice exposed viscera to study, it did not allow him to develop a solid foundation. Galen’s biggest mistake lay in the circulation. He was convinced that blood flowed in a back and forth, ebb-like motion between the chambers of the heart and that it was burnt by muscle for fuel. Many years later, great physician William Harvey proposed our modern understanding of circulation. 1. The Da Vinci Code Culprit: Leonardo Da Vinci If you had chance to see the Royal Collection’s latest exhibition then you were in for a treat. It showcased the somewhat overlooked anatomical sketches of Leonardo Da Vinci. A man renowned for his intelligence and creativity, Da Vinci also turns out to be a pretty impressive anatomist. In his sketches he produces some of the most advanced 3D representations of the human skeleton, muscles and various organs. One theory of his is, however, perplexing. In his sketches is a diagram of the spinal cord……linked to penis. That’s right, Da Vinci was convinced the two were connected (no sexist comments please) and that semen production occurred inside the brain and spinal cord, being stored and released at will. He can be forgiven for the fact that he remarkably corrected himself some years later. His contributions to human physiology are astounding for their time including identification of a ‘hierarchal’ nervous system, the concept of equal ‘inheritence’ and identification of the retina as a ‘light sensing organ’. The list of errors is endless. However, they’re not really errors. They’re signposts that people were thinking. All great people fail, otherwise they wouldn’t be great.
almost 8 years ago
Introduction This post describe the creation of a Stroke Summary video. The aim of this project was to assess the attitudes of medical students towards the use of video animation in medical education. An educational tutorial was produced outlining the basic principles of stroke. This aimed to provide a summary of different aspects relating to stroke, outlined in the Bristol University curriculum. This intended to be a short, concise animation covering stroke presentation, definition and recognition, with an overview of the blood supply to the brain and the classification of stroke presentation used in clinical practice. This was followed by some key facts and a summary of different management stages. After the video animation was produced an assessment of student’s attitudes using an online questionnaire was undertaken. This consisted of ten short questions and an open text feedback for additional comments. The video was then edited with reference to feedback given by students and the results analysed. This report will outline relevant research and project work that lead to this assignment being undertaken. A description of the method followed to generate the video animation and to collect feedback on students will be outlined followed by analysis of results. This will then be discussed in relation to previous work and research. Background There are a number of reasons this project has been undertaken. On a personal level, I have a long-standing interest in teaching and medical education. As part of a previous project I created a series of audio tutorials in cardiovascular medicine and assessed student attitudes to audio learning. The findings of this report showed that a large number of students found these audio tutorials useful and would like more of these available to supplement their learning. One of the questions given to students at this time assessed how useful they found different types of educational material. This project showed students reporting audio tutorials more useful than previously thought, while also reporting that they were not readily available. Although a video tutorial was not provided to them at this time, feedback questions assessed attitudes to video tutorials as a learning resource. Students reported low availability and felt they would be more useful than audio tutorials. Some results from this project are shown in figure 1. Figure 1. Results from previous research by Buick (2007), showing attitudes of students towards different learning tutorials. The majority of students report audio tutorials to be ‘quite useful’ or ‘very useful’. Video tutorials are thought by students to be more useful that audio tutorials, however there is a large proportion that do not have access to these learning resources. As a number of students reported an inability to access to video tutorials, it was thought that creating a video animation tutorial followed by assessing students attitudes would be a useful follow up project. If this is found to be a useful resource, other students may generate video tutorials in the future. Therefore student feedback also assessed attitudes towards authenticity, relating to who generates the tutorial and whether they find the ability to feedback a useful tool. Medical education is widely researched globally, although it is not often a consideration for those studying medicine. Those involved in teaching and educating future doctors have looked at different methods of passing on knowledge. A high quality medical education given to future healthcare professionals is important. It is widely accepted that a better knowledge results in better care for patients and education is at the centre of any healthcare system. This is reflected in the cost of educating medical students and training doctors in the UK. In the 1997 it was reported by the Department of Health that estimates of 200 million pounds would be spent per year for an increase in 1000 medical students being trained in the UK. This suggests that the cost of training a medical student is in the region of £200,0001. Medical education in the UK is split in two halves, with undergraduate and postgraduate training. The Department of Health has recently invested millions of pounds into the development of online tutorials for postgraduate training posts in a number of different specialities. Justification for is given by reducing the cost of training through the use of standardised online tutorials. This will be a more cost effective method than the standard in hospital teaching. This approach has not been undertaken for undergraduate medical education. Universities are seen as primarily responsible for undergraduate training. Many of these institutions have used the Internet to aid teaching and have produced video tutorials. However, as reflected in the previous project (Buick, 2007), resources are often limited and students do not feel they have ready access to these educational tutorials. The benefits of different types of learning resource have been researched. These include online audio downloads (Spickard et al, 2004), practice exam questions and interactive tutorials (Hudsen, 2004). Research showing the benefit of video was shown by Balslev et al (2005) comparing video and written text while teaching a patient case. Balsley et al (2005) found those who learnt using a video presentation rather than those given written text showed a significant increase in data exploration, theory evaluation and exploration. However, there is little research looking specifically at video animation for explaining conditions. Animation software is now available on personal computers and is also possible using Microsoft PowerPointTM, which is the most widely used presentation software. It is clear that recent trends show training can benefit from this type of learning resource. Generation of high quality video tutorials can help students learn while reducing the cost of training. It is for this reason that more material is likely to become available, either from funded production supported by external organisations or by the trainers and trainees themselves who have technology able to produce material such as this on their home computer. Ethical and Legal Issues During the development of this video some ethical and legal issues arose that had to be addressed before a final video could be made. When considering what imagery would be used in the video, I wanted to include pictures of clinical signs relevant to the audio narration. However, taking images from the Internet without prior consent was not thought to be ethical and therefore clinical signs were displayed graphically through drawings and diagrams. Plagiarism and copyright were some of the legal issues surrounding the presentation of medical information. Narrated information was generated using a number of information sources, none of which were exclusively quoted. Therefore an end reference list was generated showing all supporting information sources. Images used in the animation were either self generated or taken from sources such as Wikipedia.org. This resource supplies images under a free software license such as GNU general public license2. This allows anyone to freely use and edit images while referencing the original source. Skills Needed To Develop This Video Animation To generate the video a number I had to develop a number of new skills. Unlike previous work that had been undertaken this media was generated using animation software. To use this effectively I had to research the different functions that were available. To do this I combined reading books aimed to teach beginners such as Macromedia Flash 8 for Dummies (Ellen Finkelstein and Gurdy Leete, 2006) and online sources such as www.learnflash.com . To generate voice narration, another program was used that allowed editing and splicing of audio tracks. This was then split up into a number of narrated sections and added to the animation. Method Script To produce the tutorial the first stage was to construct a script for narration. This involved outlining the areas to be covered. The main headings used were: Stroke definition This gave a clinical definition and a lay person recognition mnemonic called FAST which is used to help members of the general public recognise stroke. Pathophysiology This covered blood supply to the brain. This combined diagrams of the circle of Willis, with images of the brain. Arterial blood supply were then displayed over the brain images while relating this to the arterial vessels leaving the circle of Willis Classification Students at Bristol university are asked to understand the Oxford / Bamford classification. This was covered in detail with explanations of clinical signs that may be seen and graphical representation of these. Prevalence This section covered prevalence, national impact and cost of stroke in the UK. Management In this section management was split up it to immediate management, medical management, in hospital care and some of the procedures considered for different cases. Risk factors for stroke and research into this was also written up and narrated. However at a later stage this was not included due to time constraints and video length. Narration An audio narration was generated using software called ‘Garage Band’ which allows audio tracks to be recorded and edited. The narration was exported in 45 sections so that this could then be added to the animation at relevant points. Animation The animation was made using Adobe Flash. This software is used for making websites and animations used for Internet adverts. It has the facility to export as a ‘flash video format’, which can then be played using a media player online. This software generates animation by allowing objects to be drawn on a stage and moved around using command lines and tools. This was used as it has the ability to animate objects and add audio narration. It also is designed for exporting animations to the Internet allowing the material to be accessed by a large number of people. Feedback A short questionnaire was generated which consisted of ten questions and placed online using a survey collection website (www.surveymonkey.com). Students were directed to the feedback questionnaire and allowed to submit this anonymously. Adapting the tutorial Some feedback constructively suggested changes that could be made. The video was updated after some concern about the speed of narration and that some of the narrative sections seemed to overlap. Analysis and Report The results of the feedback were then collected and displayed in a table. This was then added to the report and discussed with reference to research and previous project work. Results Students were allowed to access to the video animation through the Internet. After uploading the video an email was sent to students studying COMP2 at Bristol University. These students are required to know about aspects of stroke covered in this tutorial to pass this section of the course. The email notified them of the options to view the tutorial and how to give feedback. In total 30 students completed the feedback questionnaire and out of these 4 students provided optional written feedback. The results to the questions given were generally very positive. The majority of students showed a strong preference to video animations as a useful tool in medical education. The results are displayed in Table 1 below. TABLE 1 shows the ten question asked of the students and to what extent they agreed with each statement. Results are given in the percentage of students who chose the relevant category. Written Feedback Four written comments were made: "Really useful presentation!! Would be much better if someone proof read the whole thing as there are some spelling mistakes; also if the pauses between facts were longer it would be more easier to take in some facts. Overall, really nicely done!!" "Some of speech went too quickly, but good overall" "Very clearly written with excellent use of images to match the text and commentary!" "The Video was excellent." Discussion Student attitudes to this video tutorial were very positive. This was in contrast to the attitudes previously shown in the audio tutorial project (Buick, 2007) where video tutorials were not thought to be a useful resource. These results support recent developments in the generation of online video training for doctors by the Department of Health and previous research by Balsley et al (2005). Question one showed that the majority of students strongly agreed that the stroke video would be a useful resource. Questions two, three and four aimed to establish what aspects of a disease were best outlined using a video animation. Results showed that students agree or strongly agreed that defining the condition, pathophysiology and management were all well explained in this format. Interestingly, a large majority of students (70%) felt pathophysiology was best represented kinaesthetically. This may be due to the visual aspect that can be associated with pathophysiology. Disease processes are often represented using diagrams in textbooks with text explaining the disease process. Using computer technology it is possible to turn the text into audio narration and allow the user to view dynamic diagrams. In this way, students can better conceptualise the disease process, facilitating a more complete understanding of disease and its clinical manifestations. Question five aimed to highlight the benefit of visual stimulation as well as audio narration as a positive learning method. All students agreed or strongly agreed that the combination of these two aspects was beneficial. Question six showed a very strong response from students wanting access to more video tutorials, with 70% of students strongly agreeing to this statement. It is often the case that students take part in generating teaching material, and some students may be concerned that this material is inaccurate. However, many students do not think that this is a significant problem. This is reflected by the spread of student’s opinion seen in question 7, where there was no clear consensus of opinion. It may be that as students learn from a number of different resources, that any inaccuracies will be revealed and perhaps stimulate a better understanding through the process of verifying correct answers and practicing evidence based medicine. Question nine and ten show that most students value resources that allow sharing of educational material and feel they could help others learn. They would also value the option to feedback on this material. The written feedback showed positive responses from students. However there was feedback on some aspects of the video that they felt could be changed. The narration was delivered quickly with few gaps between statements to keep the tutorial short and concise, however this was thought to be distracting and made it less easy to follow. Following this feedback the narration was changed and placed back on the Internet for others to review. Further research and investigation could include the generation of a larger resource of video animations. My research has suggested that using animation to cover pathophysiology may be most beneficial. The software used to make this video also allows for the incorporation of interactive elements. The video produced in this project or other videos could have online menus, allowing users to select which part of the tutorial they wish to view rather than having to watch the whole animation, or they include interactive questions. Reflections Strength and weaknesses Strengths of this project include its unique approach to medical education. There have been few animated videos produced for undergraduate medical students that use this advanced software. This software is used by professional web developers but can be used effectively by students and doctors for educational purposes to produce video animation and interactive tutorials. For these reasons, I passionately believe that this technology could be used to revolutionise the way students learn medicine. If done effectively this could provide a more cost effective and engaging learning experience. This will ultimately benefit patients and doctors alike. This material can be place online allowing remote access. This is increasingly important for medical students studying on placements who are often learning away from the university setting. Weaknesses of this project include that of the work intensity of generating animated video. It is estimated that it takes around 6 to 9 hours to produce a minute of animated video. This does not include the research and recording of narration. The total sum of time to generate material and the additional skills needed to use the software makes generation of larger numbers of videos not possible by a small community of learners such as a university. Although it was done in this case, it is difficult to edit the material after it has been created. This may mean that material will become inaccurate when new advances occur. The feedback sample collected was opportunistic and the response rate was low. These factors may bias the results as only a subsection of opinions may have been obtained. These opinions may not be representative of the population studied or generalisable to them. It was difficult obtaining a professional medical opinion about the video in the time that I was allocated. However this has been organised for a later time. Knowledge and skills gained During this project I was able to learn about stroke its presentation, classification, management and risk factors. I read texts, which summarised stroke and research into risk factors and management of stroke. The challenge of usefully condensing a subject into a short educational tutorial was a challenging one. I feel I improved my skills of summarising information effectively. I gained knowledge of some of the challenges of undertaking a project such as this. One of the largest challenges included how long it took to produce the animation. In the future I will be aware of these difficulties and allow for time to gather information and generate the material. I also learnt the benefit of gaining feedback and allowing for adaption to this. It took more time to respond to feedback but this resulted in a better product that other students can use. I also reflected on the impact of stroke itself. Stroke has a major impact on patients, health care and carers. Much can be done in the recognition classification and management. A better understanding benefits all areas and I have gained a better knowledge and the importance of helping others gain a good understanding of stroke. I learned how to generate a video animation for the use of teaching in medicine and combine this with audio presentation. I learned how long it can take to generate material like this and the skill of organising my time effectively to manage a project. I can use this skill in the future to produce more educational material to help teach during my medical career. I also gained skills in learning how to place material on the Internet for others to access and will also use this in the future. Conclusions Previously evidence has shown the use of videos in medical education to be beneficial. It has normally been used to demonstrate clinical examination and procedures this study suggest there is a place for explanation of pathophysiology and disease summaries. However, there has been little research in to its use for graphically representing condition summaries. Computer technology now allows people to generate animation on their personal computer. It is possible that over time more students and doctors will start producing innovative visual and audio teaching material. This project indicates that this would be well received by students. References Planning the Medical Workforce: Medical Workforce Standing Advisory Committee: Third Report December. 1997 Page 40. The GNU project launched in 1984. Balslev T, de Grave W S, Muijtjens A M and Scherpbier A J (2005) Comparison of text and video cases in a postgraduate problem-based learning format Medical Education; 39: 1086–1092 Buick (2007) Year 3 External SSC. Bristol University Medical School. Spickard A, Smithers J, Cordray D, Gigante J, Wofford J L. (2004) A randomised trial of an online lecture with and without audio; Medical Education 38 (7), 787–790. Hudson J. N., (2004) Computer-aided learning in the real world of medical education: does the quality of interaction with the computer affect student learning? Medical Education 38 (8), 887–895. Ellen Finkelstein and Gurdy Leete, (2006) Macromedia Flash 8 for Dummies. Wiley publishing Inc. ISBN 0764596918
Dr Alastair Buick
almost 12 years ago
Welcome back to the LEGO Operating Room! In this episode, Dr Balfour discusses surgery for Crohn's Disease and explains the operation of a small bowel resect...
over 6 years ago
Cranial Nerve 1- Olfaction This patient has difficulty identifying the smells presented. Loss of smell is anosmia. The most common cause is a cold (as in this patient) or nasal allergies. Other causes include trauma or a meningioma affecting the olfactory tracts. Anosmia is also seen in Kallman syndrome because of agenesis of the olfactory bulbs. Cranial Nerve 2- Visual acuity This patientâs visual acuity is being tested with a Rosenbaum chart. First the left eye is tested, then the right eye. He is tested with his glasses on so this represents corrected visual acuity. He has 20/70 vision in the left eye and 20/40 in the right. His decreased visual acuity is from optic nerve damage. Cranial Nerve II- Visual field The patient's visual fields are being tested with gross confrontation. A right sided visual field deficit for both eyes is shown. This is a right hemianopia from a lesion behind the optic chiasm involving the left optic tract, radiation or striate cortex. Cranial Nerve II- Fundoscopy The first photograph is of a fundus showing papilledema. The findings of papilledema include 1. Loss of venous pulsation 2. Swelling of the optic nerve head so there is loss of the disc margin 3. Venous engorgement 4. Disc hyperemi 5. Loss of the physiologic cup an 6. Flame shaped hemorrhages. This photograph shows all the signs except the hemorrhages and loss of venous pulsations. The second photograph shows optic atrophy, which is pallor of the optic disc resulting form damage to the optic nerve from pressure, ischemia, or demyelination. Images Courtesy Dr. Kathleen Digre, University of Uta Cranial Nerves 2 & 3- Pupillary Light Refle The swinging flashlight test is used to show a relative afferent pupillary defect or a Marcus Gunn pupil of the left eye. The left eye has perceived less light stimulus (a defect in the sensory or afferent pathway) then the opposite eye so the pupil dilates with the same light stimulus that caused constriction when the normal eye was stimulated. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Inspection & Ocular Alignmen This patient with ocular myasthenia gravis has bilateral ptosis, left greater than right. There is also ocular misalignment because of weakness of the eye muscles especially of the left eye. Note the reflection of the light source doesn't fall on the same location of each eyeball. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Versions • The first patient shown has incomplete abduction of her left eye from a 6th nerve palsy. • The second patient has a left 3rd nerve palsy resulting in ptosis, dilated pupil, limited adduction, elevation, and depression of the left eye. Second Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Duction Each eye is examined with the other covered (this is called ductions). The patient is unable to adduct either the left or the right eye. If you watch closely you can see nystagmus upon abduction of each eye. When both eyes are tested together (testing versions) you can see the bilateral adduction defect with nystagmus of the abducting eye. This is bilateral internuclear ophthalmoplegia often caused by a demyelinating lesion effecting the MLF bilaterally. The adduction defect occurs because there is disruption of the MLF (internuclear) connections between the abducens nucleus and the lower motor neurons in the oculomotor nucleus that innervate the medial rectus muscle. Saccades Smooth Pursui The patient shown has progressive supranuclear palsy. As part of this disease there is disruption of fixation by square wave jerks and impairment of smooth pursuit movements. Saccadic eye movements are also impaired. Although not shown in this video, vertical saccadic eye movements are usually the initial deficit in this disorder. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Utah Optokinetic Nystagmu This patient has poor optokinetic nystagmus when the tape is moved to the right or left. The patient lacks the input from the parietal-occipital gaze centers to initiate smooth pursuit movements therefore her visual tracking of the objects on the tape is inconsistent and erratic. Patients who have a lesion of the parietal-occipital gaze center will have absent optokinetic nystagmus when the tape is moved toward the side of the lesion. Vestibulo-ocular refle The vestibulo-ocular reflex should be present in a comatose patient with intact brainstem function. This is called intact "Doll’s eyes" because in the old fashion dolls the eyes were weighted with lead so when the head was turned one way the eyes turned in the opposite direction. Absent "Doll’s eyes" or vestibulo-ocular reflex indicates brainstem dysfunction at the midbrain-pontine level. Vergenc Light-near dissociation occurs when the pupils don't react to light but constrict with convergence as part of the near reflex. This is what happens in the Argyll-Robertson pupil (usually seen with neurosyphilis) where there is a pretectal lesion affecting the retinomesencephalic afferents controlling the light reflex but sparing the occipitomesencephalic pathways for the near reflex. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerve 5- Sensor There is a sensory deficit for both light touch and pain on the left side of the face for all divisions of the 5th nerve. Note that the deficit is first recognized just to the left of the midline and not exactly at the midline. Patients with psychogenic sensory loss often identify the sensory change as beginning right at the midline. Cranial Nerves 5 & 7 - Corneal refle A patient with an absent corneal reflex either has a CN 5 sensory deficit or a CN 7 motor deficit. The corneal reflex is particularly helpful in assessing brainstem function in the unconscious patient. An absent corneal reflex in this setting would indicate brainstem dysfunction. Cranial Nerve 5- Motor • The first patient shown has weakness of the pterygoids and the jaw deviates towards the side of the weakness. • The second patient shown has a positive jaw jerk which indicates an upper motor lesion affecting the 5th cranial nerve. First Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 7- Motor • The first patient has weakness of all the muscles of facial expression on the right side of the face indicating a lesion of the facial nucleus or the peripheral 7th nerve. • The second patient has weakness of the lower half of his left face including the orbicularis oculi muscle but sparing the forehead. This is consistent with a central 7th or upper motor neuron lesion. Video Courtesy of Alejandro Stern, Stern Foundatio Cranial Nerve 7- Sensory, Tast The patient has difficulty correctly identifying taste on the right side of the tongue indicating a lesion of the sensory limb of the 7th nerve. Cranial Nerve 8- Auditory Acuity, Weber & Rinne Test This patient has decreased hearing acuity of the right ear. The Weber test lateralizes to the right ear and bone conduction is greater than air conduction on the right. He has a conductive hearing loss. Cranial Nerve 8- Vestibula Patients with vestibular disease typically complain of vertigo – the illusion of a spinning movement. Nystagmus is the principle finding in vestibular disease. It is horizontal and torsional with the slow phase of the nystagmus toward the abnormal side in peripheral vestibular nerve disease. Visual fixation can suppress the nystagmus. In central causes of vertigo (located in the brainstem) the nystagmus can be horizontal, upbeat, downbeat, or torsional and is not suppressed by visual fixation. Cranial Nerve 9 & 10- Moto When the patient says "ah" there is excessive nasal air escape. The palate elevates more on the left side and the uvula deviates toward the left side because the right side is weak. This patient has a deficit of the right 9th & 10th cranial nerves. Video Courtesy of Alejandro Stern, Stern Foundatio Cranial Nerve 9 & 10- Sensory and Motor: Gag Refle Using a tongue blade, the left side of the patient's palate is touched which results in a gag reflex with the left side of the palate elevating more then the right and the uvula deviating to the left consistent with a right CN 9 & 10 deficit. Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 11- Moto When the patient contracts the muscles of the neck the left sternocleidomastoid muscle is easily seen but the right is absent. Looking at the back of the patient, the left trapezius muscle is outlined and present but the right is atrophic and hard to identify. These findings indicate a lesion of the right 11th cranial nerve. Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 12- Moto Notice the atrophy and fasciculation of the right side of this patient's tongue. The tongue deviates to the right as well because of weakness of the right intrinsic tongue muscles. These findings are present because of a lesion of the right 12th cranial nerve.
over 10 years ago
This is a review of 'Research Skills for Medical Students' 1st Edition (Allen, AK – 2012 Sage: London ISBN 9780857256010) Themes – Research Skills, Critical Analysis Medical Students Thesis – Research and critical analysis are important skills as highlighted by Tomorrow’s Doctors Detailed Review Allen, drawing on many years’ experience as a researcher and lecturer in the Institute of Education, at Cardiff University has bridged the gap in Research methodology literature targeted at medical students. Pushing away from comparative texts somewhat dry and unengaging tones, this book encourages student interaction, empowering the student from start to finish. Not so much a book as a helpful hand guiding the student through the pitfalls and benefits of research and critical analysis from start to finish. Part of the Learning Matters Medical Education series, in which each book relates to an outcome of Tomorrow’s Doctors, this book is written from the a lecturers standpoint, guiding students through making sense of research, judging research quality, how to carry out research personally, writing research articles and how to get writings published. All of these are now imperative skills in what is a very competitive medical employment market. This concise book, through its clarity, forcefulness, correct and direct use of potentially new words to the reader, Allen manages to fully develop the books objectives, using expert narrative skills. With Allen’s interest in Global health, it is little wonder why this books exposition is clear and impartial, Allen consistently refers back to the Tomorrows doctors guidelines at the beginning of each chapter, enabling students to link the purpose of that chapter to the grander scheme. This enables Allen to argue the relevance of each chapter to the student before they have disregarded it. Openly declared as a book aimed at medical students (and Foundation trainees where appropriate) the authors style remains formal, but with parent like undertones. It is written to encapsulate and involve the student reader personally, with Allen frequently using ‘you’ as if directly speaking to the reader, and useful and appropriate activities that engage the reader in the research process, in an easy to use student friendly format. This book is an excellent guide for all undergraduate health students, not limited to medical students, and I thank Ann K Allen for imparting her knowledge in such a useful and interactive way.' This was original published on medical educator.
over 8 years ago
Last June I was sitting the most terrifying exams of my life to date. The last medical school exams, what we all called our "finals" even though the official line was just "fourth year exams". I felt like the hours of revision, the practical work on wards and in the skills lab, would all be wasted - there was no way I was prepared! The following 2 or 3 weeks (I forget exactly how long) seemed to drag, my fate hanging over my head like a finely balanced sword. One slight stumble and that was it, four years of medical school wasted. I would have to cut my exchange programme short, I'd have to spend all summer revising, I'd fail the resits, I'd be thrown out. Oh, I may as well give up now - I'm not good enough for this! Melodramatic? Yes. Truly how I felt? Definitely. I spent hours tormenting myself, planning how I'd break the news to my parents, deciding on a backup plan if - or when, as I believed - it all went South. I plumped for TEFL in some far flung, exotic clime where I could forget my old life and pretend it never happened. Definitely well thought out. On results day I was with a friend, sat on the pavement outside a library in Japan at midnight, nervously waiting for the results to go online. Email notification: technical problems, results released ASAP. Email notification: Results online! Email notification: Passed. Oh thank god, the world is beautiful again. My life plans can go on unchanged. I have passed! Remembering that time now, I still feel the rush of relief, the overflowing joy, the amazement. It was enough, I was prepared. The hours of worry, the back-up plan, all unnecessary. But will that change my feelings in the future, when I'm waiting for the results of professional exams? Will I be more calm, relaxed, confident even? Oh no, of course I won't. That's just not how it works!
over 8 years ago
Worst experience ever? - this is pretty difficult as I've worked in some of the poorest countries in the world and seen some things that should never happen like children dying of dehydration and malaria. But this recent experience was definitely the worst. It was midnight and I was trying to get my 16 month old to sleep having woken up after vomiting in his cot. Despite paracetamol, ibuprofen, stripping to nappy, damp sponging and having the window open he went rigid and started fitting. It only lasted a minute or two yet felt like an eternity as he was unable to breathe and became progressively blue as my mind raced ahead to brain damage or some other horrible sequalae. The fitting stopped and my mind turned to whether I was going to have to start CPR. I lay him on the floor and put my ear to his chest and was glad to hear a strong heartbeat but he was floppy with a compromised airway so I quickly got him in the recovery position. The ambulance arrived in 8 minutes and after some oxygen and some observations he was strapped in and ready to go. He had been unconscious for about 15 minutes but was starting to come round, much to my relief. The ambulance crew were great and their quick response made all the difference but then they took nearly half an hour to get to A&E in the middle of the night because they took the most awkward route imaginable. I don't know if it was a deliberate delaying tactic or just a lack of local knowledge but even without a blue light I could have done it in half the time! Why do ambulances not have GPS - ideally with local traffic info built in? We arrived in A&E and were ushered to a miserable receptionist who took our details and told us to have a seat. I noticed above her head that the wait time was 3.5 hours, though we did see a junior nurse who took his observations again. Not long after the screen changed to a 5 hour wait and a bit later to a 6 hour wait! I am glad to say that by about 3 hours my little man was back to his usual self (as evidenced by his attempts at destroying the department) and so after getting the nurse to repeat his obs (all normal) we decided to take him home, knowing we had a few more hours to wait for the doctor, and that the doctor was now unlikely to do anything as he was now well. I tell the story in such detail in part for catharsis, in part to share my brief insight into being on the other side of the consultation, but also because it illustrated a number of system failures. It was a horrible experience but made a lot worse by those system failures. And I couldn't help but feel even more sorry for those around me who didn't have the medical experience that I had to contextualise it all. Sickness, in ourselves or our loved ones, is bad enough without the system making it worse. I had 3 hours of walking around the department with my son in my arms which gave me plenty of time to observe what was going on around me and consider whether it could be improved. I did of course not have access to all areas and so couldn't see what was happening behind the scenes so things may have been busier than I was aware of. Also it was only one evening so not necessarily representative. There were about 15 children in the department and for the 3 hours we were there only a handful of new patients that arrived so no obvious reason for the increasing delay. As I walked around it was clear to me that at least half of the children didn't need to be there. Some were fast asleep on the benches, arguably suggesting they didn't need emergency treatment. One lad had a minor head injury that just needed a clean and some advice. Whilst I didn't ask anyone what was wrong with people talk and so you hear what some of the problems were. Some were definately far more appropriate for general practice. So how could things have been improved and could technology have helped as well? One thing that struck me is that the 'triage' nurse would have been much better as a senior doctor. Not necessarily a consultant but certainly someone with the experience to make decisions. Had this been the case I think a good number could have been sent home very quickly, maybe with some basic treatment or maybe just with advice. Even if it was more complex it may have been that an urgent outpatient in a few days time would have been a much more satisfactory way of dealing with the problem. Even in our case where immediate discharge wouldn't have been appropriate a senior doctor could have made a quick assessment and said "let's observe him for a couple of hours and then repeat is obs - if he is well, the obs are normal and you are happy then you can go home". This would have made the world of difference to us. So where does the technology come in? I've already mentioned Sat Nav for the ambulance but there are a number of other points where technology could have played a part in improving patient experience. Starting with the ambulance if they had access to real time data on hospital A&E waiting times they may have been able to divert us to a hospital with a much shorter time. This is even more important for adult hospitals were the turnover of patients is much higher. Such information could help staff and patients make more informed decisions. The ambulance took us to hospital which was probably appropriate for us but not for everyone. Unfortunately many of the other services like GP out of hours are not always prepared to accept such patients and again the ambulance crews need to know where is available and what access and waiting times they have. Walk-in patients are often also totally inappropriate and an easy method of redirection would be beneficial for all concerned. But this requires change and may even require such radical ideas as paying for transport to take patients to alternative locations if they are more appropraite. The reasons patient's choose A&E when other services would be far more appropriate are many and complex. It can be about transport and convenience and past experiences and many other things. It is likely that at least some of it is that patients often struggle to get an appointment to see their own GP within a reasonable time frame or just that their impression is that it will be difficult to get an appointment so they don't even try. But imagine a system where the waiting times for appointments for all GPs and out of hours services were readily available to hospitals, ambulances, NHS direct etc. Even better imagine that authorised people could book appointments directly, even when the practice was closed. How many patients would be happy to avoid a long wait in A&E if they had the reassurance of a GP appointment the next day? And the technology already exists to do some of this and it wouldn't be that hard to adapt current technology to provide this functionality. Yet it still doesn't happen. I have my theories as to why but this is enough for one post. In case you were wondering my son appears to have made a full recovery with no obvious ongoing problems. I think I have recovered and then he makes the same breathing noises he made just before the fit and I am transported back to that fateful night. I think it will take time for the feelings to fade.
Dr Damian Williams
over 8 years ago
Hypo-politicosis = A behavioral condition where political thought and action is dangerously below an optimal range. Leading to the ostrich phenomenon of delusionary belief that there is nothing outside of medicine. In an age of ever great openness, communication and democratic rights, the population of the western world is disengaging with political ideology, political debate and political engagement. This disengagement is nowhere more prevalent than in the UK. The total membership of all the political parties are at the lowest since they were formed. There are less trade unionist today than a century ago. And most importantly the proportion of people that vote regularly is at an all-time low. Surely, this is a sign of a dysfunctional democracy? Can we truly call it a democracy if the state’s citizens have no interest or control over how the state is run? What worries me even more than this dire situation, is the lack of interest in politics from fellow medical students. If you were to sit in a bar in a medical school city, I am sure you would be able to hear groups of medical students unwinding over a pint and discussing some political issues. But those political issues almost always evolve around medicine, such as abortion laws, public health initiatives, doctor’s pay and the re-structuring of the NHS. This insular mind set worries me because there is more to life than medicine! And while so much of our lives may be taken up with the learning and practice of medicine, our lives will be affected by so much more, and before medical school we all had to take an interest in so much more just to get an interview. Do you remember having the time and inclination to take an interest in something that wasn’t medicine? Like reading history or poetry? This insular mindset is detrimental because it means that as a demographic group we may not engage as fully as we should do with the rest of society, this could be bad for us but more importantly bad for the greater society. If medics become too disengaged in the greater political debates then we may find that society decides that doctors are easy targets and easy scapegoats. We may find our working lives extended, our social lives curtailed, our pensions decimated and our earning power diminished because we did not engage with the public and discuss these issues openly. We may also lose influence with the government if medics don’t vote for their local MPs, question their local party officials and fight our corner over important issues via the BMA. The other side of this coin is that medics are selected from some of the brightest in the country, educated at great expense by the state, trained and employed by the state and pay a huge amount of tax to the state. If we engage in politics less then society as a whole may suffer from a lack of highly intelligent, highly educated individuals, who should hopefully have a strong social conscience and interest in well run state, from putting their thinking skills to good use on societal problems. Dr Liam Fox is a conservative back-bench MP and use to be in the shadow cabinet. He has used the skills he developed as a doctor to try and follow an evidence based political career. He recently released a book called “Rising tides” (http://www.amazon.co.uk/Rising-Tides-Facing-Challenges-New-ebook/dp/B00CUE0DKQ) which analyses many of the world’s current political issues and I would highly recommend as many people as possible read it. I also hope that in future I can walk into a bar, meet some medical colleagues and talk about an issue that affects more of society than just medics! How about using a scientific approach to discuss how Britain’s education system could be improved? Or how Britain could use its welfare resources better to decreased homelessness (which would also reduce a burden on A and E’s)?
almost 8 years ago
In the initial interviews with patients who suffer psychotic symptoms, it might be striking that the usage of terminology of descriptive psychopathology lingers on an arbitration of knowledge of 'truth' by using terms like delusions or hallucinations with their definition as false beliefs or false perceptions (Casey & Kelly 2007). These terms can cause annihilation of value to patient's experience, which may pose an initial strain on the egalitarian patient-doctor relationship. In an era, where deference to experts is dead, it might be worthy on agreeing on the effect of these experiences prior to lablelling them. Delusions can not be objectively detected and described, because it evolves and exists within subjective and interpersonal dimensions. Severe psycopathological symptoms share the fact that they are statistically deviant, and thus can be labeled as 'unshared'. Symptoms may be perceived as 'distressing' and they might be 'disabling' to them. The outcome behaviour which may raise concern can be a 'dysfunctional' behaviour (Adams & Sutker 2004). Jaspers considered the lack of understandability of how the patient reached conclusion to be the defining factor of a delusional idea. The notion of defining 'delusion' as false belief was challenged by Jaspers. Sims gives the example of a man who believed his wife was unfaithful to him because the fifth lamp-post alone on the left was unlit. What makes it a delusion is the methodology not the conclusion which may be right (Sims 1991). Some delusions might be mundane in their content, others may not be falsifiable. Dereistic thinking is not based on logic but rather on feelings. It is possible to find ways to evade falsification; an ad hoc hypotheses may also be part of the presentation. Fish stated that delusional elaboration may follow delusion and/or hallucination which may have convergence with the concept of the ad hoc hypothesis. Absence of verification from the patient's side does not lead to deductive falsification (Casey & Kelly 2007). Otherwise, the doctor-patient relationship carry the risk to transform to detective-suspect relationship, where the latter may perceive the need to present evidence of innocence. Mental health professionals are usually encountered by people who suffer to various degrees or make others suffer, and not because of various degrees of conviction. The primary role of the therapist is to be defined as some one who tries to alleviate the sufferings of others rather than correcting their beliefs. Communicating with patients in terms of how functional is their belief rather than it's truth may prove to be more egalitarian and clinically tuned. This may provide some middle ground in communication, without having to put an effort on defining the differences between what is 'true' and what is 'real'. The criterion for demarcation between what is real and what is pathologic may be different in the patient-doctor relationship. The assertion on the clinician's part on the falsity of a belief or experience can have the risk of dogmatism. The statistical deviance of symptoms, their distressing nature, disabling consequences, the resultant dysfunctional behaviour and apparent leap from evidence to conclusion may be a more agreeable surrogate starting points. This might be more in line with essence of medicine or 'ars medicina' (art of healing). Concordance with patients on their suffering may serve as an egalitarian platform prior to naming the symptoms. The term delusion commonly identified as false fixed belief, when used by a psychiatrist, it does not address only a symptom. It rather puts the interviewer in the position of an all knowing judge. After all, a service-user may argue that how come a doctor who never encountered or experienced any of the service-user's aspects of the problem as being persecuted at work and home, as plainly false. Then, does the psychiatrist know the truth. From a service-user point of view what he/she experience is real; which might not necessarily be true. The same applies for people who lead an average life, people who go to work bearing with them their superstitions, beliefs about ghosts, luck, horoscopes, zodiacs, or various revered beliefs. This term has the risk of creating a temporary crack in the mutual sense of equality between the therapist and the service-user. This may be due to the labelling of certain dysfunctional belief as unreal by one side. It has the potential for a subtle change in the relationship to the mental health professional placing himself/herself in the omniscient position and it contrasts with the essence of medical practice where practitioners assume the truth in what the patients say as in the rest of subjective symptoms as headache for example. The subsequent sequel of this is other labels such as 'bizarre delusions' or 'systematised delusions', further add to the deviation of the role of the professional therapist to an investigator in the domain of 'Truth' and architecture of 'Truth'. Furthermore, it might be strenuous to the relationship when the therapist - based on skeptic enquiry - starts explaining such symptoms. For example, if the service-user believes that Martians have abducted him, implanted a device in his brain and sent him/her back to earth, and the response communicated back is the 'delusional'. It could be argued by the service-user that the therapist who had not seen a Martian or a brain device before, labelled the whole story as 'delusion' in a rather perceived dismissive labelling with no intention to check on the existence of Martians or the device. In other words, the healer became the arbiter of truth, where both lack evidence for or against the whole thing; one member in the relationship stepped into power on basis of subjective view of plausibility or lack of thereof. In the case of hallucinations, the clinician labelling the patient's experience as hallucinations can be imposing fundamental dilemma for the patient. For example, if a patient hears a voice that says that everything is unreal apart from the voice, and the clinician says that the voice is the thing that is unreal. Both do not give evidence to their 'truth' apart from their statement. The clinician's existence to the patient's subjective reality is distorted by the multiple realities of the patient, and arguing on basis of mere existence that the 'voice' is the one that is 'false', does not give the patient a clue of the future methodology to discern from both, since percetption is deceived and/or distorted. In this case, another tool of the mind can be employed to address the patient. The same can be applied to a concept like 'over valued ideas', where the clinician decides that this particular idea is 'over valued', or that this 'idea' is 'over valued' in a pathological way. The value put on these ideas or not the patient values but the clinician's evaulation of 'value' and 'pathology'. The cut of point of 'value' and 'over value' seems to be subjective from the clinician's perspective. Also, 'derailment' pauses the notion of expecting a certain direction of talk. The concepts of 'grooming' and 'eye contact' implicitly entail the reference to a socio-cultural normative values. Thus, deviation from the normative value is reflected to the patient as pathology, which is an ambiguous definition, in comparison to the clarity of pathology. The usage of terms like 'dysfunctional unshared belief' or 'distressing auditory perception' or other related terms that address the secondary effect of a pathologic experience may be helpful to engage with the patient, and may be more logically plausible and philosophically coherent yet require empirical validation of beneficence. Taylor and Vaidya mention that it is often helpful to normalise, but this is not to minimise or be dismissive of patient's delusional beliefs.(Taylor & Vaidya 2009). The concept can be extended to cover other terms such as 'autistic thinking, 'apathy', 'blunting of affect', 'poor grooming', 'over-valued ideas', other terms can be applied to communicate these terms with service-users with minimal deviation from the therapeutic relationship. The limitation of these terms in communication of psychopathology are special circumstances as folie a deux, where a dysfunctional belief seems to be shared with others Also, symptoms such as Charles-Bonnet syndrome; usually does not have negative consequences. The proposed terms are not intended for use as a replacement to well carved descriptive psychopathological terms. Terms like 'delusion' or 'hallucination' are of value in teaching psychopathology. However in practice, meaningful egalitarian communication may require some skill in selecting suitable terms that is more than simplifying jargon. They also may carry the burden of having to add to the psychiatric terminology with subsequent effort in learning them. They can also be viewed as 'euphemism' or 'tautology'. However, this has been the case from 'hysteria' to 'medically unexplained symptoms' which seems to match with the zeitgeist of an era where 'Evidence Based Medicine' is its mantra; regardless advances in treatment. Accuracy of terminology might be necessary to match with essence of scientific enquiry; systematic observation and accurate taxonomy. The author does not expect that such proposal would be an easy answer to difficulties in communication during practice. This article may open a discussion on the most effective and appropriate terms that can be used while communicating with patients. Also, it might be more in-line with an egalitarian approach to seek to the opinion of service-users and professional bodies that represent the opinions of service-users. Empirical validation and subjection of the concept to testing is necessary. Patient's care should not be based on logic alone but rather on evidence. Despite the limitations of such proposal with regards to completeness, it's hoped that the introduction of any term may help to add to the main purpose of any classification or labelling that is accurate egalitarian communication. DISCLAIMER This blog is adapted from BMJ doc2doc clinical blogs Philosophical Streamlining of Psychopathology and its Clinical Implications http://doc2doc.bmj.com/blogs/clinicalblog/_philosophical-streamlining-of-psychopathology-its-clinical-implications The blog is based on an article named 'Towards a More Egalitarian Approach to Communicating Psychopathology' which is published in the Journal of Ethics in Mental Health, 2013 http://www.jemh.ca/issues/v8/documents/JEMHVol8Insight_TowardsaMoreEgalitarianApproachtoCommunicatingPsychopathology.pdf Bibliography Adams, H. E., Sutker P.B. (2004). Comprehensive Handbook of Psychopathology. New York: Springer Science Casey, P., Kelly B., (2007). Fish's Clinical Psychopathology: Signs and Symptoms in Psychiatry, Glasgow: Bell & Bain Limited Kingdon and Turkington (2002), The case study guide to congitive behavior therapy for psychosis, Wiley Kiran C. and Chaudhury S. (2009). Understanding delusion, Indian Journal of Psychiatry Maddux and Winstead (2005). Psychopathology foundations for a contemporary understanding, Lawrence Erlbaum Associates Inc. Popper (2005) The logic of scientific discovery, Routledge, United Kingdom Sidhom, E. (2013) Towards a More Egalitarian Approach to Communicating Psychopathology, JEMH · 2013· 8 | 1 © 2013 Journal of Ethics in Mental Health (ISSN: 1916-2405) Sims A., Symptoms in the mind, (1991) an introduction to psychopathology, Baillere Tindall Taylor and Vaidya (2009), Descriptive psychopathology, the signs and symptoms of behavioral disorders, Cambridge university press
Dr Emad Sidhom
over 7 years ago
Through different periods of the Egyptian history from Pharaonic, Greco-Roman, Coptic, Islamic and Modern Era; Egyptians tend to respect, appreciate and care for elderly. There is also a rich Eastern Christian tradition in respecting and taking care of old people that has continued since the first centuries of Christianity. Churches used to develop retirement homes served by monastic personnel and nurses. Egyptian culture traditionally linked some aspects of mental illnesses to sin, possession of evil, separation from the divine and it is usually associated with stigmatisation for all family members. However, forgetfulness with ageing was normalised. Until now, it seems that the difference between normal ageing and dementia is blurred for some people. Recently, the term 'Alzheimer' became popular, and some people use it as synonymous to forgetfulness. El-Islam, stated that some people erroneously pronounce it as 'Zeheimer' removing the 'Al' assuming it is the Arabic equivalent to the English 'the'. In 2010, a film was produced with the title 'Zeheimer' confirming the mispronunciation. Elderly face many health challenges which affect their quality of life. Dementia is one of these challenges as it is considered to be one of the disorders which attack elderly and affect their memory, mental abilities, independence, decision making and most cognitive functions. Therefore, the focus on dementia has increased around the world due to the rapid spread of the syndrome and the economical and psychosocial burden it cause for patients, families and communities. (Grossber and Kamat 2011, Alzheimer’s Association 2009, Woods et al. 2009). In recent years, the proportion of older people is increasing due to the improvement in health care and scientific development. The demographic transition with ageing of the population is a global phenomenon which may demand international, national, regional and local action. In Egypt the ageing population at the age of 65 and older are less than 5% of the Egyptian population (The World FactBook, 2012), yet, the World Health Organization (WHO) asserts that a demographic shift is going to happen as most of the rapid ageing population will transfer to the low and middle income countries in the near future (WHO, 2012). Egyptian statistics assert this shift. The Information Decision Support Center published the first comprehensive study of the elderly in Egypt in 2008. According to the report, in 1986, 5 percent of Egyptians were age 60 and older. In 2015, they will make up to 11 percent of the population and in 2050; over a fifth. Caring of older persons constitutes an increasing segment of the Egyptian labor market. However, nation wide statistics about number of dementia sufferers in Egypt may be unavailable but the previous demographic transition is expected to be accompanied by an increase in dementia patients in Egypt and will affect priorities of health care needs as well. The Egyptian society may need adequate preparation with regards to health insurance, accommodation and care homes for the upcoming ageing population (El-Katatney, 2009). Although the number of care home increased from 29 in 1986 to be around 140 home in 2009; it cannot serve more than 4000 elderly from a total of 5 million. Not every elderly will need a care home but the total numbers of homes around Egypt are serving less than 1% of the elderly population. These facts created a new situation of needs for care homes besides the older people who are requiring non-hospital health care facility for assisted living. The Egyptian traditions used to be strongly associated with the culture of extended family and caring for elderly as a family responsibility. Yet, in recent years changes of the economic conditions and factors as internal and external immigration may have affected negatively on elderly care within family boundaries. There is still the stigma of sending elderly to care homes. Some perceive it as a sign of intolerance of siblings towards their elderly parents but it is generally more accepted nowadays. Therefore, the need for care homes become a demand at this time in Egypt as a replacement of the traditional extended family when many older people nowadays either do not have the choice or the facilities to continue living with their families (El-Katatney 2009). Many families among the Egyptian society seem to have turned from holding back from the idea of transferring to a care home to gradual acceptance since elderly care homes are becoming more accepted than the past and constitutes a new concept of elderly care. Currently, many are thinking to run away from a lonely empty home in search of human company or respite care but numbers of geriatric homes are extremely lower than required and much more are still needed (Abdennour, 2010). Thus, it seems that more care homes may be needed in Egypt. Dementia patients are usually over 65, this is one of the factors that put them at high risk of exposure to different physical conditions related to frailty, old age, and altered cognitive functions. Additionally, around 50% of people with dementia suffers from other comorbidities which affect their health and increases hospital admissions (National Audit Office 2007). Therefore, it is expected that the possibility of doctors and nurses needing to provide care for dementia patients in various care settings is increasing (RCN 2010). Considering previous facts, we have an urgent need in Egypt to start awareness about normal and upnormal ageing and what is the meaning of dementia. Moreover, change of health policies and development of health services is required to be developed to match community needs. Another challenge is the very low number of psychiatric doctors and facilities since the current state of mental health can summarised as; one psychiatrist for every 67000 citizens and one psychiatric hospital bed for every 7000 citizens (Okasha, 2001). Finally the need to develop gerontologically informed assessment tools for dementia screening to be applied particularly in general hospitals (Armstrong and Mitchell 2008) would be very helpful for detecting dementia patients and develop better communication and planning of care for elderly. References: El Katateny, E. 2009. Same old, same old: In 2050, a fifth of Egyptians will be age 60 and older. How will the country accommodate its aging population?. Online available at: http://etharelkatatney.wordpress.com/category/egypt-today/page/3/ Fakhr-El Islam, M. 2008. Arab culture and mental health care. Transcultural Psychiatry, vol. 45, pp. 671-682 Ageing and care of the elderly. Conference of European churches. 2007. [online] available at: http://csc.ceceurope.org/fileadmin/filer/csc/Ethics_Biotechnology/AgeingandCareElderly.pdf World Health Organization. 2012 a. Ageing and life course: ageing Publications. [Online] available at : http://www.who.int/ageing/publications/en/ World Health Organization. 2012 b. Ageing and life course: interesting facts about ageing. [Online] available at: http://www.who.int/ageing/about/facts/en/index.html World Health Organization 2012 c. Dementia a public health priority. [online] available at: http://whqlibdoc.who.int/publications/2012/9789241564458_eng.pdf World Health Organization. 2012 d. Why focus on ageing and health, now?. Department of Health. 2009. Living well with dementia: a national dementia strategy. [Online] available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_094058 Andrawes, G., O’Brien, L. and Wilkes, L. 2007. Mental illness and Egyptian families. International Journal of Mental Health Nursing, vol.16, pp. 178-187 National Audit Office. 2007. Improving service and support for people with dementia. London. [online[ Available at: http://www.nao.org.uk/publications/0607/support_for_people_with_dement.aspx Armstrong, J and Mitchell, E. 2008. Comprehensive nursing assessment in the care of older people. Nursing Older People, vol. 20, No. 1, pp. 36-40. Okasha, A. 2001. Egyptian contribution to the concept of mental health. Eastern Mediterranean Health Journal,Vol. 7, no. 3, pp. 377-380. Woods, R., Bruce, E., Edwards, R., Hounsome, B., Keady, J., Moniz-Cook, E., Orrell, M. and Tussell, I. 2009. Reminiscence groups for people with dementia and their family carers: pragmatic eight-centre randomised trial of joint reminiscence and maintenance versus usual treatment: a protocol. Trials Journal: open access, Vol. 10, [online] available at: http://www.trialsjournal.com/content/10/1/64 Grossberg, G. and Kamat, S. 2011. Alzheimer’s: the latest assessment and treatment strategies. Jones and Bartlett, publisher: The United States of America. Alzheimer’s Association. 2009. 2009 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, Volume 5, Issue 3. [online] Available at: http://www.alz.org/news_and_events_2009_facts_figures.asp Royal College of Nursing. 2010. Improving quality of care for people with dementia in general hospitals. London. National Audit Office. 2007. Improving service and support for people with dementia. London. [online[ Available at: http://www.nao.org.uk/publications/0607/support_for_people_with_dement.aspx Authors: Miss Amira El Baqary, Nursing Clinical instructor, The British University in Egypt firstname.lastname@example.org Dr Emad Sidhom, MBBCh, ABPsych-Specialist in Old Age Psychiatry-Behman Hospital email@example.com
Amira El Baqary
over 7 years ago
This is my first blog on Meducation. I decided to tell the reader a bit about myself, so that future blogs will make sense. At age 48 and in an active and successful academic practice of OB & GYN, my best friend died from a complication of cardiac surgery. This tragic event made my wife's and me consider other things in life than just work, thus at age 55, I decided to retire from my academic position and to start working as a locum in many different cultural settings. The plan was to work somewhere in an area of need for six months and alternate this with travel for six months. It did not quite work out exactly that way, but close enough. I worked in Japan, then Pakistan, Tasmania, Australia, New Zealand, Alaska, St Lucia, and Chiapas in Mexico. Much earlier I had had a two year experience in Africa. It was a very satisfying experience and my wife and I have never looked back. Many of my friends and colleagues kept urging me to write a book about our experiences and how we accomplished them. For a long time I kept resisting, probably because I felt that no one might be interested, and because I might have been lazy, and most likely for both of these reasons. I finally gave in, started writing and published an e book. The title is "Crosscultural Doctoring. On and Off the Beaten Path." the book can be down loaded for free from Smashwords at: http://www.smashwords.com/books/view/161522 The book is meant for medical as well as non medical people. It is written as a series of loosely connected anecdotes, some medical, some non medical, some funny, some not so funny. The book describes the immense satisfaction my wife and I experienced from our decision and I hope that reading the book might inspire others, medical or non medical people, who might be thinking about a career change or early retirement to jump of the beaten path. The book might also inspire other with similar experiences to write about them. I would love to receive some comments. William J. LeMaire JUNE 2014 Learn more about me please visit my website at: http://www.freewebs.com/wimsbook
DR William LeMaire
over 7 years ago