New to Meducation?
Sign up
Already signed up? Log In



Biochemistry Help: The Cori Cycle

The Cori Cycle is responsible for removing excess Lactic acid or Lactate from the muscle. It is then uptaken by the Liver where it is converted back into Pyruvate, then into Glucose again. This video explains how!
almost 6 years ago
Preview 300x225

Immunology & Schistosomiasis (Bilharzia)

An interactive learning resource that explores the life cycle of the Schistosoma mansoni parasite and how it exploits the human immune system in order to survive. All links are back up and running. Please let me know if you experience any diffuclties. Thank you!  
Daniel Sapier
over 10 years ago
Foo20151013 2023 1o5bbyd?1444774101

Student Credits for Contributing to Online Content

I have some very exciting news to share with you today - the University of California (UC) in San Francisco will become the first medical school to give academic credit to students for editing content on Wikipedia. Wikipedia has had a tempestuous history in academia. It was originally considered to be a very unreliable source until it was shown to be as accurate as the Encyclopaedia Britannica in 2005. Since then it has been gaining recognition among both students and academics as a reliable and important part of the research phase. Wikipedia acts as a base upon which further research can be built - its strong focus and policies surrounding citation mean that it’s easy to dig deeper into the information it provides. It’s brilliant to see that institutions are now recognising not only the value of using Wikipedia, but also the importance of contributing back to it and the value the service provides to both the student and the reader. Like me, you're probably wondering how this will work. Well, students will be given the opportunity to improve commonly used but lower quality Wikipedia articles. Professors will then give credits based on the quality of each student's contribution to the article. Not only will it enhance the quality of online medical resources, it will also encourage collaborative working which will, in turn, lead to innovative thinking and advances in medicine. This progress is such great news for the future of medical education. I can’t wait for the day Meducation Authors are rewarded with credits for the amazing content they give to us! As Charles Darwin once said “In the long history of humankind (and animal kind, too) those who learned to collaborate and improvise most effectively have prevailed.”  
Nicole Chalmers
almost 8 years ago
Foo20151013 2023 x3l6t5?1444774041

Anatomy For Life: Calling all Bio / Medically Minded Artists and Students

Introduction Hello and welcome. If you are one of the few who have been following my blog since last year then you may be aware of a certain promise that has yet to be fulfilled... That promise is of a new set of schematic images similar to my Arterial Schematic that seems to have gained some popularity on Meducation. The truth of the matter is that I have actually been working on a separate project since finishing my finals. This separate project has involved making the website and doing some of the design work for 'Anatomy For Life,' an exciting medically-related charity art auction and exhibition. The event is due to be held in Brighton (venue TBC) during National Transplant week (8-14th July) to help raise money for organ donation and body donation via the charity; 'Live Life Then Give Life'. Where you come in... The exciting thing about the Anatomy For Life (AFL) art auction is that we are looking for everyone and anyone to donate. It doesn't matter if you get usually get paid £1,000 per drawing or if you haven't picked up a paintbrush since school. Each and every donation will be displayed on a level playing field, giving the unique opportunity for amateurs to pitch up against the professional medical illustrators out there and vice versa! As long as the artwork donated fits the criteria below you have free reign: Artwork submitted must be (at least loosely) associated with the 'Anatomy' theme. Artwork submitted must be on roughly A6 card (4"x6"). The AFL team recommend a paper weight of 250gsm or above. Create your artwork using any art media you choose on/with the A6 card. Sign the BACK of your masterpiece, but not the front* Donations should be received by the 17th June 2013 *The AFL team will be exhibiting the art work shown and running the auction anonymously. Artists will not be attributed to their donations until after the event via our online gallery. Once you have completed you artwork(s) you should fill out our downloadable information form and provide us with your name, a short bio about you and what inspired your donated artwork. You can also let us know if you want the AFL team to e-mail you a certificate in recognition of your contribution! Some Context... Organ donation is the act of donating ones organs or tissues to help save someone else's life after your own passing. One person can donate enough organs to save several peoples lives, which in the minds of many is a truly admirable feat! Body donation usually refers to the act of donating ones own body to medical education, so that students may continue to learn the real-life anatomy that forms part of becoming a competent doctor or surgeon. Organ donation is currently on the rise in the U.K thanks to the fantastic work of the Organ Donor Register and the charities that support organ donation such as 'Live Life Then Give Life'. However, the U.K still has one of the highest family-refusal rates in Europe for organ donation. It is hoped that by raising awareness of the benefits of organ donation this refusal rate can be reduced either by more people being registered organ donors or by families having more access to information about the topic. We really want to hear from you... If you have something you think might benefit our project please do let us know! Go To Our Main Website Donate Artwork to Us! Tweet to Us on Twitter Like Us on Facebook Thats all folks, LARF  
Dr. Luke Farmery
over 8 years ago
Foo20151013 2023 estj3l?1444774164

Points mean Prizes (and jobs)

Thousands of doctors are currently preparing portfolios and stressing about situational judgements as they go into core and specialty training interviews. As a medical student I wasn’t even aware when these interviews were and had only the briefest imaginings of what they might entail. Even at finals, specialty applications felt a million miles away; but it’s as if you’ve only just got through the misery of MTAS and you’re suddenly an F2 realising that the last 15 months have, to your surprise, disappeared. Yes, the interview is certainly a stressful situation, and for many medics it’s only the second ‘proper’ interview they’ve ever had. Time pressures, the scope of stations and performing under the watchful eye of the great and good of the medical profession only add to the stress. But, there are ways to make this process bearable, and, dare I say it, enjoyable (kind of). The most important step is preparation. Not just the preparation that starts in the days to weeks before the interview; this should be for refining your skills, getting your answers super-slick and getting to know yourself inside-out. Preparation starts at university (and no, which school you’re in doesn’t make a single difference). What the interviewers are looking for can be found in the person specification unique to each specialty (found at I.e. if you know you were born to perform heart surgery, start looking at what the interviewers for cardiothoracics are looking for. Even if you’re completely confused about your career path, it’s time to start thinking. Many specialties still have a short-listing stage dependent on the application form. Whether assessed on the form or at interview each specialty will (generally) award points for other/higher degrees, publications, presentations, prizes, teaching experience, audit and ‘commitment to specialty’. At the CT1/ST1 stage it doesn’t matter what subject area you published/presented/taught in etc. to score in that section; but having something relevant will help you discuss your commitment to that specialty. ‘Relevant’ in itself is misleading however; every experience is likely to be relevant when you identify the transferable skills involved and what you learned from the experience. Some specialties are stricter and you’ll need demonstrable evidence that you haven’t just applied on a whim. These tend to be the more competitive specialties which demand evidence you’ve had a really good look at what the job involves and have taken steps to broaden your knowledge. There is typically also at least one skills station which may be general (e.g. breaking bad news to a patient) or specialty-specific (e.g. interpreting images for radiology) but are still based on applicants demonstrating they fit the person specification. Many of the mark schemes are also freely available on the relevant Royal College website, and I encourage you to have a look and see where you could get a few more points (or give yourself a pat on the back that you couldn’t). It’s unlikely that the mark scheme/person spec. will be exactly the same every year, but the general overview is enduring. NB. The GP application is a bit different, but that’s for another post. The take home message is get involved early on, and be involved consistently. It may eat up some of your free time but you’ll appreciate it as soon as you look at the application form. If you’re struggling for practical ideas, take a look at the Royal College and specialty trainee websites for inspiration (some, for example the Royal College of Radiologists, have great audit ideas). The RSM and each medical school have a list of available prize essays and exams. A wise person once said to me “there’s no such thing as a wasted conversation”: Speaking to trainees and consultants about how they got to where they are not only gives you great insight into what they do but being friendly and enthusiastic can open up doors for you to help in audits and publications. And the final tip? Write everything down. Not only will this stand you in good stead as a safe doctor, but you’ll be surprised how much you can forget in a very short time. Then, unlike me, you won’t have to spend ages trying to think of reasonable examples of ‘when I dealt with stress’. Written by Lydia Spurr, FY3 Doctor Lydia is a Resident Meducation Blogger  
Dr Lydia Spurr
over 7 years ago
Foo20151013 2023 vqxw?1444774199

Probiotics - There's a New Superhero in Town!

When you think of the term 'bacteria', it immediately conjures up an image of a faceless, ruthless enemy-one that requires your poor body to maintain constant vigilance, fighting the good fight forever and always. And should you happen to lose the battle, well, the after effects are always messy. But what some people might not know is that bacteria are our silent saviours as well. These 'good' bacteria are known as probiotics, where 'pro' means 'for' and 'bios' is 'life'. The WHO defines probiotics as "live micro-organisms which, when administered in adequate amounts, confer a health bene?t on the host". Discovered by the Russian scientist Metchnikoff in the 20th century; simply put, probiotics are micro-organisms such as bacteria or yeast, which improve the health of an individual. Our bodies contain more than 500 different species of bacteria which serve to maintain our health by keeping harmful pathogens in check, supporting the immune system and helping in digestion and absorption of nutrients. From the very first breath you take, you are exposed to probiotics. How so? As an infant passes through it's mother's birth canal, it receives a good dose of healthy bacteria, which in turn serve to populate it's own gastro-intestinal tract. However, unfortunately, as we go through life, our exposure to overly processed foods, anti-bacterial products, sterilized and pasteurized food etc, might mean that in our zeal to have everything sanitary and hygienic, we might be depriving ourselves of the beneficial effects of such microorganisms. For any health care provider, the focus should not only be on eradicating disease but improving overall health as well. Here, probiotic containing foods and supplements play an important role as they not only combat diseases but also confer better health in general. Self dosing yourself with bacteria might sound a little bizarre at first-after all, we take antibiotics to fight bacteria. But let's not forget that long before probiotics became a viable medical option, our grandparents (and their parents before them) advocated the intake of yoghurt drinks (lassi). The fermented milk acts as an instant probiotic delivery system to the body! Although they are still being studied, probiotics may help several specific illnesses, studies show. They have proven useful in treating childhood diarrheas as well as antibiotic associated diarrhea. Clinical trial results are mixed, but several small studies suggest that certain probiotics may help maintain remission of ulcerative colitis and prevent relapse of Crohn’s disease and the recurrence of pouchitis (a complication of surgery during treatment of ulcerative colitis). They may also help to maintain a healthy urogenital system, preventing problems such as vaginitis and UTIs. Like all things, probiotics may have their disadvantages too. They are considered dangerous for people with impaired immune systems and one must take care to ensure that the correct strain of bacteria related to their required health benefit is present in such supplements. But when all is said and done and all the pros and cons of probiotics are weighed; stand back ladies and gentlemen, there's a new superhero in town, and what's more-it's here to stay!  
Huda Qadir
over 7 years ago
Foo20151013 2023 e9tc1t?1444774226

Grand Round: Dos and Don’ts

“To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.” The words of Sir William Osler, the acclaimed father of modern medicine, are still no less profound. They hark from an age when medicine still retained a sense of ceremony: an amphitheatre filled to the rafters, the clinicians poised in their white coats and ties, all eyes convergent on their quarry or rather the patient seated before them. Any memory of such scenes live out a vestigial existence in black&white photos or histrionic depictions recalling the rise of modern medicine. To think this is how the tradition of grand rounds proceeded in the not so distant past. Today grand rounds have a more tuitional flavour to them. The Socratic dialogue which reportedly took place has been superseded by the much less appetising PowerPoint presentation. It’s a weekly event marked in the calendar. For the ever-busy junior doctor it at least offers the prospect of a free lunch. I gest, they serve a social as well as an educational function. On the other hand medical student grand rounds are purely a learning exercise. They are most importantly not a race to find and present the most ‘interesting’ case in the trust because this is usually interpretted as a vanishingly rare condition, which even your ejudicating consultant has never encountered in a lifetime of experience. It falls short of the primary aim: to learn about the patients who you will be seeing as a junior doctor and as the addage goes - common things are common. What will make your grand round interesting, is not the patient you choose but how you choose to present that patient. Unfortunately, as fair a point Sir Osler makes, the old practice of patient participation in grand rounds has long since faded. You will have to call upon your thespian talents to retell the story to your fellow students. Of course not everyone’s a natural showman, however fortune favours the prepared and in my experience there are only a handful of things to worry about. Structure. This is the back bone of your presentation. Obviously a solid introductory line about the patient with all the salient points goes without saying, it’s no different to presenting to the consultant on ward rounds or in the clinic. Always set the scene. If you clerked your patient on a hectic night oncall down in majors, then say so. It makes the case less one dimensional. The history is your chance to show off - to consider the presenting complaint expressed in the patient’s own words and to form a working differential, which you can encourage your colleagues to reel off at the outset. The quality of the history should guide your audience to the right diagnosis. Equip them with all the information they need, so not just the positive findings. Showing that you have ruled out important red flag symptoms or signs will illustrate good detective work on your part. However you wish to order the relevant past medical/family history, medications, social impact etc is up to you. It’s a subjective thing, you just have to play the game and cater to the consultant’s likes. You can only gage these after a few cases so do the honourable thing and let your colleagues present first. Performance. Never read your slides in front of an audience. Their attention will rapidly wane (especially if they’re postprandial). The slides are an aide-memoire and to treat them as a script is to admit your presence adds nothing more to your presentation. Communicating with the audience requires you to present uncluttered slides, expanding on short headings and obliging your colleagues to listen for the little nuggets of clinical knowledge you have so generously lain in store. Insight. When the consultant asks you the significance of an investigation, always know on what grounds it was ordered and the limitations of the results. The astute student will be aware of its diagnostic or prognostic potential.The same may be said of imaging. Perusing the radiologists report and using it to guide the audience through (anoynmised) CXRs, CTs, US etc is a feather in your cap. Literature reviews of your choosing constitute a mandatory part of the presentation. They are demonstrative of not only your wider reading but your initiative to find the relevant evidence base e.g. the research underlying the management plan of a condition or perhaps its future treatments. Timing. Waffling is only detrimental to the performance. Rehearsing the presentation with a firm mate is a sure way to keep to time constraints. Memorability, for the right reasons, relies on a concise and interactive presentation. A splash of imagination will not go unnoticed. The consultant marking you has seen it all before; surprising titbits of knowledge or amusing quirks in your presentation will hopefully appeal to their curious and humorous side. If anything it might break the tedium grand rounds are renown for. Oratory is a universal skill and is responsible for so much (undue) anxiety. The more timid can take comfort grand rounds aren’t quite the grand occasions they used to be. Illustrator Edward Wong This blog post is a reproduction of an article published in the Medical Student Newspaper, December 2013 issue.  
James Wong
over 7 years ago
Foo20151013 2023 zwf33b?1444774244

"So are you enjoying it?"

"When did the pain start Mr Smith?" "Ah so do you enjoy it?" 'It' of course refers to your five year medical degree. Patients can be nice can't they. Often it seems that all patients want to talk about is you. I thought the public didn't like students, aren't students lazy drunks who wake up at midday, squander their government hand-outs on designer clothes, and whose prevailing role in society was to keep the nation's budget baked bean industry in the black? Apparently the same isn't thought of medical students, well maybe it is, but god patients are polite. The thing is I have found these questions difficult; it is surprising how they can catch you off guard. Asking if I am enjoying 'it' after I have woken up at dawn, sat on a bus for 40 minutes, and hunted down a clinician who had no idea I was meant to be there, could lead on to a very awkward consultation. But of course it doesn't "yes it is really good thank you". "Do you take any medications, either from your GP or over the counter?" "Are you training to be a GP then?" Medicine is a fascinating topic and indeed career, which surely human nature makes us all interested in. As individuals lucky enough to be studying it, maybe we forget how intriguing the medical profession is? This paired with patients sat in a small formal environment with someone they don’t know could bring out the polite ‘Michael Parkinson’ in anybody. Isn't this just good manners, taking an interest. Well yes. Just because I can be faintly aloof doesn't mean the rest of the world has to me. But perhaps there is a little more to it, we ask difficult personal questions, sometimes without even knowing it, we all know when taking a sexual history to expect the consultation to be awkward or embarrassing, but people can be apprehensive talking about anything, be it their cardiovascular disease, medications, even their date of birth. We often then go on to an examination: inspecting from the end of the bed, exposing a patient, palpating. Given a bit context you can see why a patient may want to shift the attention back to someone like us for a bit, and come on, the medical student is fair game, the best target, asking the consultant whether they enjoys their job, rather you than me. If we can oblige, and make a patient feel a bit more at ease we should, and it certainly won't be doing our student patient relationship any harm. Hopefully next time my answers will be a bit more forthcoming. "Any change in your bowels, blood in any motions?" "How many years do you have left?" It is a good thing we are all polite.  
Joe de Silva
over 7 years ago
Foo20151013 2023 vvr5q9?1444774253

Clinics - Making the most of it

Commencing the first clinical year is a milestone. Things will now be different as your student career steers straight into the unchartered waters of clinical medicine. New challenges and responsibilities lie ahead and not just in an academic sense. After all this is the awaited moment, the start of the apprenticeship you have so desired and laboured for. It won’t be long before these clinical years like the preclinical years before them, will seem just as distant and insular, so why not make the most of it? The first days hold so much excitation and promise and for many they deliver, however, it would be wise not to be too optimistic. I am afraid your firm head standing abreast the doors in a prophetic splaying of arms is an unlikely sight. In this new clinical environment, it is natural to be a little flummoxed. The quizzical looks of doctors and nurses as you first walk in, a sure sign of your unexpected arrival, is a recurring theme. If the wards are going to be your new hunting ground, proper introductions with the medical team are in order. This might seem like a task of Herculean proportions, particularly in large teaching hospitals. Everyone is busy. Junior doctors scuttling around the ward desks job lists in hand, the registrar probably won’t have noticed you and as luck would have it your consultant firm head is away at a conference. Perseverance during these periods of frustration is a rewarding quality. Winning over the junior doctors with some keenness will help you no end. What I mean to say is that their role in our learning as students extends further than the security of sign-off signatures a week before the end of the rotation. They will give you opportunities. Take them! Although it never feels like it at the time, being a medical student does afford some privileges. The student badge clipped to your new clinic clothes is a license to learn: to embark on undying streaks of false answers, to fail as many skills and clerkings as is required and to do so unabashed. Unfortunately, the junior doctors are not there purely for your benefit, they cannot always spare the time to directly observe a history taking or an examination, instead you must report back. With practice this becomes more of a tick box exercise: gleaning as much information and then reconfiguring it into a structured presentation. However, the performance goes unseen and unheard. I do not need to iterate the inherent dangers of this practice. Possible solutions? Well receiving immediate feedback is more obtainable on GP visits or at outpatient clinics. They provide many opportunities to test your questioning style and bedside manner. Performing under scrutiny recreates OSCE conditions. Due to time pressure and no doubt the diagnostic cogs running overtime, it is fatefully easy to miss emotional cues or derail a conversation in a way which would be deemed insensitive. Often it occurs subconsciously so take full advantage of a GP or a fellow firm mate’s presence when taking a history. Self-directed learning will take on new meaning. The expanse of clinical knowledge has a vertiginous effect. No longer is there a structured timetable of lectures as a guide; for the most part you are alone. Teaching will become a valued commodity, so no matter how sincere the promises, do not rest until the calendars are out and a mutually agreed time is settled. I would not encourage ambuscaded attacks on staff but taking the initiative to arrange dedicated tutorial time with your superiors is best started early. Consigning oneself to the library and ploughing through books might appear the obvious remedy, it has proven effective for the last 2-3 years after all. But unfortunately it can not all be learnt with bookwork. Whether it is taking a psychiatric history, venipuncture or reading a chest X-ray, these are perishable skills and only repeated and refined practice will make them become second nature. Balancing studying with time on the wards is a challenge. Unsurprisingly, after a day spent on your feet, there is wavering incentive to merely open a book. Keeping it varied will prevent staleness taking hold. Attending a different clinic, brushing up on some pathology at a post-mortem or group study sessions adds flavour to the daily routine. During the heated weeks before OSCEs, group study becomes very attractive. While it does cement clinical skills, do not be fooled. Your colleagues tend not to share the same examination findings you would encounter on an oncology ward nor the measured responses of professional patient actors. So ward time is important but little exposure to all this clinical information will be gained by assuming a watchful presence. Attending every ward round, while a laudable achievement, will not secure the knowledge. Senior members of the team operate on another plane. It is a dazzling display of speed whenever a monster list of patients comes gushing out the printer. Before you have even registered each patient’s problem(s), the management plan has been dictated and written down. There is little else to do but feed off scraps of information drawn from the junior doctors on the journey to the next bed. Of course there will be lulls, when the pace falls off and there is ample time to digest a history. Although it is comforting to have the medical notes to check your findings once the round is over, it does diminish any element of mystery. The moment a patient enters the hospital is the best time to cross paths. At this point all the work is before the medical team, your initial guesses might be as good as anyone else’s. Visiting A&E of your own accord or as part of your medical team’s on call rota is well worth the effort. Being handed the initial A&E clerking and gingerly drawing back the curtain incur a chilling sense of responsibility. Embrace it, it will solidify not only clerking skills but also put into practice the explaining of investigations or results as well as treatment options. If you are feeling keen you could present to the consultant on post-take. Experiences like this become etched in your memory because of their proactive approach. You begin to remember conditions associated with patient cases you have seen before rather than their corresponding pages in the Oxford handbook. And there is something about the small thank you by the F1 or perhaps finding your name alongside theirs on the new patient list the following morning, which rekindles your enthusiasm. To be considered part of the medical team is the ideal position and a comforting thought. Good luck. This blog post is a reproduction of an article published in the Medical Student Newspaper, Freshers 2013 issue.  
James Wong
over 7 years ago
Foo20151013 2023 1vzj1mi?1444774262

Wikipedia - help or hindrance?

It’s quick, it’s easy and we’ve all done it. Don’t blush, whether it’s at our leisure or behind the consultant’s back we can confess to having used the world’s sixth most popular website. You might have seen it, sitting pride of place on the podium of practically any Google result page. Of course, it’s the tell tale sign of one of Web 2.0’s speediest and most successful offspring, Wikipedia. Now for fear of patronizing a generation who have sucked on the teat of this resource since its fledgling years, the formalities will remain delightfully short. Wikipedia is the free, multilingual, online encyclopedia, which harnesses the collective intelligence of the world’s internet users to produce a collaboratively written and openly modifiable body of knowledge. The technology it runs on is a highly flexible web application called wiki. It is open-source software; hence the explosion of wiki sites all united under the banner of combined authorship. Anyone with internet access can edit the content and do so with relative anonymity. It would be unthinkable that a source, which does not prioritize the fidelity of its content, could possibly play a role in medical education. How ironic it seems that medical students can waste hours pondering which textbook to swear their allegiance for the forthcoming rotation, yet not spare a second thought typing their next medical query into Wikipedia. Evidently it has carved itself a niche and not just among medical students, but healthcare professionals as well. According to a small qualitative study published in the International Journal of Medical Informatics, 70% of their sample, which comprised of graduates from London medical schools currently at FY2 and ST1 level, used Wikipedia in a given week for ‘clinical purposes’. These ranged from general background reading to double checking a differential and looking up medications. We are so ensnared by the allure of instantaneous enlightenment; it’s somewhat comparable to relieving an itch. "Just Google it..." is common parlance. We need that quick fix. When the consultant asks about his or her favourite eponymous syndrome or you’re a little short on ammunition before a tutorial, the breadth and ease-of-use offered by a service accessible from our phones is a clandestine escape. The concept of Wikipedia, the idea that its articles are in a way living bodies because of the continual editing process, is its strength. Conversely textbooks are to a degree outmoded by the time they reach their publication date. While I commend the contributors of Wikipedia for at least trying to bolster their pages with references to high impact journals, it does not soften the fact that the authorship is unverifiable. Visitors, lay people, registered members under some less than flattering pseudonyms such as Epicgenius and Mean as custard, don’t impart the sense of credibility students (or for that matter patients)expect from an encyclopedia. Since the prestige of direct authorship if off the cards, it does beg the question of what is their motivation and I’m afraid ‘the pursuit of knowledge and improving humanity’s lot' is the quaint response. There is a distinct lack of transparency. It has become a playground where a contributor can impress his/her particular theory regarding a controversial subject unchallenged. Considering there is no direct ownership of the article, who then has the authority to curate the multiple theories on offer and portray a balanced view? Does an edit war ensue? It is not unheard of for drug representatives to tailor articles detailing their product and erase the less pleasant side-effects. Obviously Wikipedia is not unguarded, defences are in place and there is such a thing as quality control. Recent changes will come under the scrutiny of more established editors, pages that are particularly prone to vandalism are vetted and there are a special breed of editors called administrators, who uphold a custodial post, blocking and banishing rebellious editors. A study featured in the First Monday journal put Wikipedia to the test by deliberately slipping minor errors into the entries of past philosophers. Within 48 hours half of these errors had been addressed. Evidently, the service has the potential to improve over time; provided there is a pool of committed and qualified editors. Wikiproject Medicine is such a group of trusted editors composed primarily of doctors, medical students, nurses, clinical scientists and patients. Since 2004, its two hundred or so participants have graded an excess of 25,000 health-related articles according to quality parameters not dissimilar to peer review. However, the vast majority of articles are in a state of intermediate quality, somewhere between a stub and featured article. Having some degree of professional input towards a service as far reaching as Wikipedia will no doubt have an impact on global health, particularly in developing countries where internet access is considered a luxury. March this year saw the medical pages of the English Wikipedia reach a lofty 249,386,264 hits. Its ubiquity is enviable; it maintains a commanding lead over competing medical websites. The accessibility of this information has catapulted Wikipedia far beyond its scope as a humble encyclopedia and into a medical resource. Patients arrive to clinics armed with the printouts. As future doctors we will have to be just that one step ahead, to recognise the limitations of a source that does not put a premium on provenance but is nevertheless the current public health tool of choice. Illustrator Edward Wong This blog post is a reproduction of an article published in the Medical Student Newspaper, November 2013 issue.  
James Wong
over 7 years ago
Foo20151013 2023 10r211s?1444774270

Why can't we have a NICE'er EU?

The book of the week this week has been Chris Patten’s “Not quite the diplomat” – part autobiography, half recent history and a third political philosophy text. It is a fascinating insight into the international community of the last 3 decades. The book has really challenged some of my political beliefs – which I thought were pretty unshakeable – and one above all others, the EU. I read this book to help me decide who I should vote for in the upcoming MEP elections. I have to make a confession, my political views are on the right of the centre and I have always been quite a strong “Eurosceptic”. Although recently, I have found myself drifting further and further into the camp of “we must pull out of Europe at all costs” but Mr Patten’s arguments and insights have definitely made me question this stance. With the European Parliamentary elections coming up, I thought it might be an interesting time to put some ideas out there for discussion. From a young age, I have always been of the opinion that Great Britain is a world leading country, a still great power, one of the best countries in the world - democratic, tolerant, fair, sensible - and that we don’t need anyone else’s “help” or interference in how our country is run. I believe that British voters should have a democratic input on the rules that govern them. To borrow an American phrase “No taxation without representation!” I believe that democracy is not perfect but that it is the best system of government that humans have been able to develop. For all of its faults, voters normally swing back to the centre ground eventually and any silly policies can be undone. This system has inherently more checks and balances than any meritocracy, oligarchy or bureaucracy (taking it literally to mean being ruled by unelected officials). This is one of my major objections to how the European Union currently works. For all intents and purposes, it is not democratic. Institutions of the EU include the European Commission, the Council of the European Union, the European Council, the Court of Justice of the European Union, the European Central Bank, the Court of Auditors, and the European Parliament. Only one of these institutions is elected by the European demos (the parliament) and that institution doesn’t really make any changes to any policies – “the rubber stamp brigade”. The European Council is made up of the President of the European Council (Unelected), President of the European commission (Unelected) and the heads of the member states (elected) and is where quite a lot of the "major" policies come from but not all of the read tape (the European Commission and Parliament). I am happy to be proved wrong but it just seems that the EU, as a whole, is made up of unelected officials who increasing try to make rules that apply to all 28 member states without any consent from the voters in those states – it looks like the rule of “b-euro-crats” (bureaucrats – this version has far too many vowels for a dyslexic person to use). A beurocratic rule which many of us do not agree with but seemingly have to succumb to, a good example for medics is the European Working Time Directive (EWTD) which means that junior doctors only get paid for working 48h a week when they may spend many, many more hours in work. The EWTD has also made training a lot more difficult for many junior doctors and has many implications for how the health service is now run. Is it right that this law was imposed on us without our consent? If we imposed a treatment on a patient without their consent then we would be in very big trouble indeed! I cannot deny that the EU has done some good in the world and I cannot deny that Britain has benefited from being a member. I just wish that we could pay to have access to the markets, while retaining control over the laws in our lands. I want us to be in Europe, as a partner but not as a vassal. In short, I would like us to stay within the EU but with major reforms. I know that any reforms I suggest will not be read by anyone in power and I know they are probably unrealistic but I thought I would put it out there just to see what people think. I would like to see a NICE’er European Union. The National Institute for Clinical Excellence is a Non Departmental Public Body (NDPB), part of the UK Department of Health but a separate organisation ( NICE’s role is to advise the UK health service and social services. It does this by assessing the available evidence for treatments/ therapies/ policies etc and then by producing guidelines outlining the evidence and the suggested best course of action. None of these guidelines are enforced by law, for example, as a doctor you do not have to follow the NICE recommendations but if you ignore them and your patient suffers as a consequence then you are likely to be in big trouble with the General Medical Council. So, here would be my recommendations for EU reform: First, we all pay pretty much the same as we do now for access to the European market. We continue with free movement and we keep the European Council but elect the President. This way all the member states can meet up and decide if they want to share any major policies. We all benefit from free movement and we all benefit from a larger free trade area. Second, we get rid of most of the rest of the EU institutions and replace them with an institute a bit like NICE. The European Institute for Policy Excellence (EIPE) would be (hopefully) quite a small department that looks at the best available evidence and then produces guidance on the policy. A shorter executive summary would hopefully also be available for everyday people to read and understand what the policy is about - just like how patients can read NICE executive summaries to understand their condition better. Then any member state could choose to adopt the policy if their parliaments think it worthwhile. This voluntary opt-in system would mean that states retain control of their laws, would probably adopt the policies voluntarily (eventually) and that the European citizens might actually grow to like the EU laws if they can be shown to be evidence based, in the public’s best interests, in the control of the public and not just a law/red tape imposed from above. The European Union should be a place where our elected officials go to debate and agree policies in the best interests of their electorates. There should therefore be an opt-out of any policy for any member state that does not think it will benefit from a policy. This looser union that I would like to see will probably not happen and I do worry that one day we will wake up in the undemocratic united federal states of Europe but this worry should not force us to make an irrational choice now. We should not be voting to "leave the EU at all costs" but we should be voting for reform and a better more co-operative international community. I would not dare suggest who any of you should vote for but I hope you use your vote for change and reform and not more of the same.  
jacob matthews
over 7 years ago

Finals Countdown - Amateur Transplants

Back by popular demand, I have uploaded my video for the fantastic but little-known Amateur Transplants song "Finals Countdown" again, but this time it's bee...
over 6 years ago

CRYO Immediately Heals Sprained Ankle

When Coach Mike injured himself spraining his ankle before the Nike "Run a mile" event, he turned to a mix of localized CRYO sessions and NormaTec compression/decompression sessions to speed his recovery. We got him back on his feet with full force just in time for his marathon. Glad you feel better coach!  
Max Anderson
about 6 years ago

Examination of the Spine: A Pain in the Back

Tommy attempts to perform an examination of the spine.  
Ronak Ved
about 9 years ago

Anatomy of the Shoulder and Rotator Cuff

The rotator cuff (rotor cuff) is a term given to the group of muscles and their tendons that act to stabilize the shoulder. The Rotator Cuff muscles are connected individually to a group of flat tendons, which fuse together and surround the front, the back, and the top of the shoulder joint. The Rotator Cuff ligaments attach bone to bone and provide stability to the shoulder joint bones.
over 7 years ago
Foo20151013 2023 9huqgh?1444773995

Full Disclosure

I read a BBC article today about a doctor who had filmed examinations of women for voyeuristic purposes. One quote in particular stood out: "We had the challenge of identifying and locating a large number of women and explaining to them that their examinations had been secretly recorded by Bains for the purpose of his sexual gratification. It was horrendous. They were unaware that they were victims and this dated back over a three-year period." At least 30 women have been contacted to be told they were victims of someone's perversion. Until they were told, they had no idea they were victims. Only upon being told will they feel disgust and violation, not to mention distrust over future consultations. It reminded me of a discussion recently on here where a student was telling us about an experience where they saw a patient with horrific stitching and scarring after surgery. The doctor told the patient that it all looked like it was healing fine, then after the patient left, commented to the student that the stitching was some of the worst they'd ever seen. Was the doctor lying or being compassionate? Should the police tell the perverted doctor's victims, or leave them in peaceful ignorance? As I patient - I think I'd just rather not know, but I believe many doctors would argue that full disclosure is essential, especially in light of the Francis Report. I would be interested in medics' views, from ethical, procedural and "real-world" points of view.  
Jeremy Walker
over 8 years ago
Foo20151013 2023 4ktnps?1444774050

Poo transplants

When is it medically advisable to eat some one else's poo? When you need a poo transplant. Poo transplants could be the solution to one of the biggest problems facing the NHS today- the bacterial infection Clostridium difficile. C.diff, as it's known to its friends, infects about 18,000 people in England and Wales every year and is involved in the deaths of about 2000 people. C.diff typically arises due to imbalances in the normal gut bacteria. The gut is like a city, a city with about 100 trillion bacterial residents happily munching away on a banquet of bowel contents. The average person has about 1000 different types of bacteria in their gut, and about 3% of healthy adults have C.diff in that mix. The C.diff doesn't cause them any problems because its numbers are kept in check by the other gut bacteria. However treatment with broad spectrum antibiotics such as clindamycin, cephalosporins, ciprofloxacin and co-amoxiclav, can disrupt this happy community- killing off vast swathes of bacteria but crucially not the C.diff. Given free rein the C.diff multiplies rapidly and produces toxins which damage the gut. In some people this causes mild diarrhoea and abdominal pain, in others it can lead to torrential diarrhoea, perforation of the colon and death. Traditional treatment includes stopping any broad spectrum antibiotics and possibly prescribing antibiotics which target the C.diff such as metronidazole or vancomycin. However with antibiotic use comes the risk of resistance. Moreover our current approach isn't entirely effective and about 22% of patients treated suffer a recurrence. This can result in a cycle of illness and hospital admission which is costly to the patient and the hospital. So it's time to start thinking outside of the box. Cue the poo transplant. The thinking goes like this- if the cause of the problem is disruption to the normal community of gut bacteria, why not just pop those bacteria back in to crowd out the C.diff? Simples. Practically, the first step is to identify a donor, usually a close relative of the patient, and screen them for a range of infectious diseases and parasites. It's also advisable to make sure they haven't recently consumed anything the intended recipient is allergic to, before asking them to make their "donation". You then pop it in a household blender and blitz it down, adding saline or milk to achieve a slurry consistency. Next you need to strain your concoction to remove large materials- one medic in the UK uses coffee filters. Top tip. Then you're ready to administer it- about 25ml from above (e.g. via nasogastric tube), or 250ml from below. Now, its important to note that poo transplants are still an experimental treatment. To date only small case studies have been carried out, but with 200 total reported cases, an average cure rate of 96% and no serious adverse events reported to date, it's worth carrying out a large trial to assess it thoroughly. Poo transplants- arguably the ideal treatment for a cash strapped NHS. It's cheap, plentiful and it seems to work. Now to convince people to consume someone else's poo... Bottoms up! FYI: This was first posted on my own blog. Image Courtesy of Marcus007 at de.wikipedia [Public domain], from Wikimedia Commons  
Dr Catherine Carver
over 8 years ago
Foo20151013 2023 2hilgx?1444774083

So you want to be a medical student: READ THIS!

There are so many sources for advice out there for potential medical students. So many books, so many forums, so many careers advice people, and so many confusing and scary myths, that I thought it might be useful to just put up some simple guidelines on what is required to become a medical student and a short book list to get your started. I am now in my 5th year at university and my 4th year of actual medicine. Since getting into Medical School in 2009 I have gone back to my 6th form college in South Wales at least once a year to talk to the students who wanted to become medical or dental students, to offer some advice, answer any queries that I could. This year, I tried to to do the same sort of thing for high achieving pupils at my old comprehensive, because if you don't get the right advice young enough then you won't be able to do everything that is required of you to get into Medical school straight after your A-levels. Unfortunately, due to some new rules I wasn't allowed to. So, since I couldn't give any advice in person I thought that a blog might be the easiest alternative way to give young comprehensive students a guide in the right direction. So here goes... How to get into medical school: You must show that you have the academic capacity to cope with the huge volume of information that will try to teach you and that you have the determination/tenacity to achieve what you need to. To show this you must get good grades: a. >8A*s at GCSE + separate science modules if possible = you have to be able to do science. b. >3A’s at A-Level = Chemistry + Biology + anything else you want, as long as you can get an A. 2. You must have an understanding of what Medicine really involves: a. Work experience with a doctor – local GP, hospital work experience day, family connections, school connections – you should try to get as much as you can but don’t worry if you can’t because you can make up for it in other areas. b. Work experience with any health care professional – ask to see what a nurse/ physio/ health care assistant/ phlebotomist/ ward secretary does. Any exposure to the clinical environment will give you an insight into what happens and gives you something to talk about during personal statements and interviews. c. Caring experience – apply to help out in local care homes, in disabled people’s homes, at charities, look after younger pupils at school. All these sorts of things help to show that you are dedicated, motivated and that you want to help people. 3. Be a fully rounded human being: a. Medical schools do not want robots! They want students who are smart but who are also able to engage with the common man. So hobbies and interests are a good way of showing that you are more than just a learner. b. Playing on sports teams allows you to write about how you have developed as a person and helps you develop essential characteristics like team work, fair play, learning to follow commands, learning to think for yourself, hand-eye co-ordination etc. etc. All valuable for a career in medicine. c. Playing an instrument again shows an ability to learn and the will power to sit and perfect a skill. It also provides you with useful skills that you can use to be sociable and make friends, such as joining student choirs, orchestras and bands or just playing some tunes at a party. d. Do fun things! Medicine is hard work so you need to be able to do something that will help you relax and allow you to blow off some stress. All work and no play, makes a burnt out wreck! 4. Have a basic knowledge of: a. The news, especially the health news – Daily Telegraph health section on a Monday, BBC news etc. b. The career of a doctor – how does it work? How many years of training? What roles would you do? What exams do you need to pass? How many years at medical school? c. The GMC – know about the “Tomorrow’s Doctor” Document – search google. d. The BMA e. The Department of Health and NHS structure – know the basics! GP commissioning bodies, strategic health authorities. f. What the Medical School you are applying to specialises in, does it do lots of cancer research? Does it do dissection? Does it pride itself on the number of GPs it produces? Does it require extra entry exams or what is the interview process? These 4 points are very basic and are just a very rough guide to consider for anyone applying to become a medical student. There are many more things you can do and loads of useful little tips that you will pick up along the way. If anyone has any great tips they would like to share then please do leave them as a comment below! My final thought for this blog is; READ, READ and READ some more. I am sure that the reason I got into medical school was because I had read so many inspiring and thought provoking books, I had something to say in interviews and I had already had ideas planted in my head by the books that I could then bring up for discussion with the interview panel when asked about ethical dilemmas or where medicine is going. Plus reading books about medicine can be so inspiring that they really can push your life in a whole new direction or just give you something to chat about with friends and family. Everyone loves to chat people – how they work, why they are ill, what shapes peoples' personalities etc and these are all a part of medicine that you can read into! Book Recommendations Must reads: Thought provokers: Final Final Thought: Just go into your local book shop or library and go to the pop-science section and read the first thing that takes your interest! It will almost always give you something to talk about.  
jacob matthews
about 8 years ago
Foo20151013 2023 1u6up6r?1444774235

Keep on Truckin’

Shattered. Third consecutive day of on-calls at the birth centre. I’m afraid I have little to show for it. The logbook hangs limply at my side, the pages where my name is printed await signatures; surrogate markers of new found skills. Half asleep I slump against the wall and cast my mind back to the peripheral attachment from which I have not long returned. The old-school consultant’s mutterings are still fresh: “Medical education was different back then you are dealt a tough hand nowadays.” I quite agree, it is Saturday. Might it be said the clinical apprenticeship we know today is a shadow of its former self? Medical school was more a way of life, students lived in the hospital, they even had their laundry done for them. Incredulous, I could scarcely restrain a chuckle at the consultant’s stories of delivering babies while merely a student and how the dishing out of “character building” grillings by their seniors was de rigeur. Seldom am I plied with any such questions. Teaching is a rare commodity at times. Hours on a busy ward can bear little return. Frequently do I hear students barely a rotation into their clinical years, bemoan a woeful lack of attention. All recollection of the starry-eyed second year, romanced by anything remotely clinical, has evaporated like the morning dew. “Make way, make way!...” cries a thin voice from the far reaches of the centre. A squeal of bed wheels. The newly crowned obs & gynae reg drives past the midwife station executing an impressive Tokyo drift into the corridor where I stand. Through the theatre doors opposite me he vanishes. I follow. Major postpartum haemorrhage. A bevy of scrubs flit across the room in a live performance of the RCOG guidelines for obstetric haemorrhage. They resuscitate the women on the table, her clammy body flat across the carmine blotched sheets. ABC, intravenous access and a rapid two litres of Hartmann’s later, the bleeding can not be arrested by rubbing up contraction. Pharmacological measures: syntocinon and ergometrine preparations do not staunch the flow. Blood pressure still falling, I watch the consciousness slowly ebb from the woman’s eyes. Then in a tone of voice, seemingly beyond his years, the reversely gowned anaesthetist clocks my badge and says, “Fetch me the carboprost.” I could feel an exercise in futility sprout as I gave an empty but ingratiating nod. “It’s the fridge” he continues. In the anaesthetic room I find the fridge and rummage blindly through. Thirty seconds later having discovered nothing but my general inadequacy, I crawl back into theatre. I was as good as useless though to my surprise the anaesthetist disappeared and returned with a vial. Handing me both it and a prepped syringe, he instructs me to inject intramuscularly into the woman’s thigh. The most common cause of postpartum haemorrhage is uterine atony. Prostaglandin analogues like carboprost promote coordinated contractions of the body of the pregnant uterus. Constriction of the vessels by myometrial fibres within the uterine walls achieves postpartum haemostasis. This textbook definition does not quite echo my thoughts as I gingerly approach the operating table. Alarmingly I am unaware that aside from the usual side effects of the drug in my syringe; the nausea and vomiting, should the needle stray into a nearby vessel and its contents escape into the circulation, cardiovascular collapse might be the unfortunate result. Suddenly the anaesthetist’s dour expression as I inject now assumes some meaning. What a relief to see the woman’s vitals begin to stabilise. As we wheel her into the recovery bay, the anaesthetist unleashes an onslaught of questions. Keen to redeem some lost pride, I can to varying degrees, resurrect long buried preclinical knowledge: basic pharmacology, transfusion-related complications, the importance of fresh frozen plasma. Although, the final threat of drawing the clotting cascade from memory is a challenge too far. Before long I am already being demonstrated the techniques of regional analgesia, why you should always aspirate before injecting lidocaine and thrust headlong into managing the most common adverse effects of epidurals. To have thought I had been ready to retire home early on this Saturday morning had serendipity not played its part. A little persistence would have been just as effective. It’s the quality so easily overlooked in these apparently austere times of medical education. And not a single logbook signature gained. Oh the shame! This blog post is a reproduction of an article published in the Medical Student Newspaper, February 2014 issue.  
James Wong
over 7 years ago