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5
182

A Guide to Preeclampsia: Hand-drawn Tutorial

All credit for this video goes to professor May. If there is anything on it that sounds inspirational, it most likely came from her.  
YouTube
about 7 years ago
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1
11

Double throw hand tie filmed through GoogleGlass

More trials using #throughglass  
YouTube
almost 7 years ago
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1
7

Simple surgical hand tie filmed through GoogleGlass

Just an experiment to see what can be done with Google Glass for medical education but we thought we would share it. Feedback on the concept and other ideas ...  
YouTube
almost 7 years ago
Preview
1
12

How to tie a tie: Half Windsor

How to tie a Half Windsor knot. Be sure to check out my other videos: Four in hand knot: http://www.youtube.com/watch?v=hf90eRPhdjs Double Windsor: http://ww...  
YouTube
almost 7 years ago
Preview
1
14

How to tie a tie: Four in Hand knot

How to tie a Four in Hand Knot. Be sure to check out my other videos to learn different knots! Double Windsor: http://www.youtube.com/watch?v=lNqh_U8hJHc Hal...  
YouTube
almost 7 years ago
Preview
1
37

How to tie a tie: Double Windsor Knot

How to tie a double windsor knot. Be sure to check out my other videos for different knots! Four in hand knot: http://youtu.be/hf90eRPhdjs Half Windsor: http...  
YouTube
almost 7 years ago
Preview
1
16

Hook of Hamate Fracture - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing fracture of the Hook of Hamate bone in the hand. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on tw...  
YouTube
almost 7 years ago
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7
267

BBC Dissected The Incredible Human Hand

Dissecting a real hand, taking it apart layer by layer to reveal what makes it unique in the animal kingdom. We discover what gives our hands an unrivalled c...  
YouTube
almost 7 years ago
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1
5

Wrist Fractures

 
almostadoctor - free medical student revision notes
almost 7 years ago
Www.bmj
1
44

A sinister cause of shoulder pain, with numbness and weakness in the ipsilateral hand

A 41 year old patient with insulin dependent diabetes presented with a one month history of progressively worsening pain, numbness, and weakness of his right shoulder and arm. His history included peripheral vascular disease, chronic renal failure, and chronic pancreatitis. He was also a smoker with a 60 pack year history.  
bmj.com
almost 7 years ago
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7
141

Male Catheterisation OSCE Guide

There are generally two approaches to catheterisation, the two gloved technique and the clean hand / dirty hand technique. Please use the method taught at your medical school, this guide demonstrates the clean hand / dirty hand method.  
YouTube
almost 7 years ago
Preview
-1
16

Hands On | Arthritis Research UK

Read previous editions of Hands On, our publication for GPs.  
arthritisresearchuk.org
almost 7 years ago
13
0
82

Voluntary vs Automatic responses in the Somatic Nervous System.

This question is about the somatic nervous system (SNS). I read that this the SNS part of the peripheral nervous system (PNS) and that it controls skeletal muscle. It is therefore thought to be voluntary. In contrast, the autonomic nervous system controls smooth muscle, under involuntary control. What I'm wondering is if reflex arcs (or reflexes) are controlled by the autonomic nervous system, why is it making use of skeletal muscle? Take the example of the reaction of moving your hand away when it is placed on something hot. These motor commands come from the autonomic nervous system but control the arm muscles that are normally controlled consciously. In other words things normally controlled voluntarily. The response was activated by the ANS, and was therefore automatic, but the muscles supplied by these motor commands were skeletal muscles? Can someone explain this (contradition) or perhaps correct my wrong thinking?  
Alex Catley
over 9 years ago
5
0
35

How do we explain a patient having a normal finger to nose test but also having dysdiadochokinesia and romberg positive?

How do we explain a patient having a normal finger to nose test but also having dysdiadochokinesia and romberg' positive?  
malek ahmad
almost 9 years ago
5
0
14

Which exact parts of the hand are affected in carpal tunnel syndrome?

I'm asking only about sensitivity. Most pictures of carpal tunnel syndrome show that the thumb, index, middle and the adjacent half of the ring AND the related part of the hand are affected. But this image from fpnotebook.com clearly shows and says that the palm sensitivity is mediated by the branch of the median nerve that does not go through the carpal tunnel. So, I made a new image of carpal tunnel syndrome with only fingers colored. Can anyone who is certain of this say did I make it correct or not?  
Jan Modric
over 8 years ago
7
0
94

Guyon's canal syndrome - tingling in hand?

The same question as with carpal tunnel syndrome. Are only the fingers (the pinky and adjacent half of the ring finger) affected or also the related part of the hand? Acoording to my research until now, there can be paresthesia in the pinky side of the hand but only about halfway toward the wrist. Most other pictures show altered sensitivity beyond the wrist.  
Jan Modric
over 8 years ago
3
0
18

ulnar nerve injury- finger extension

I understand that one would lose motor function of the hypothenar muscles and lumbricals III and IV. Therefore when asking the patient to straighten their fingers their would be the characteristic ulnar claw. However, i'm having difficulty understanding why this would be the case since the extensor muscles are still fully functionally. Would there a decreased ability to straighten the fingers as opposed to total loss? Therefore the patient could slightly straighten finger III and IV but not with full extension? Thanks in advance  
Khalil Ali
about 8 years ago
Foo20151013 2023 riytde?1444773947
3
99

Reflection

Just as a bit of an intro, my name is Conrad Hayes, I'm a 4th year medical student studying in Staffordshire. My medical school are quite big on getting us into the habit of writing down reflections. It's something I feel I do subconsciously whilst I'm with patients or in teaching sessions, but frankly I suck at the written bit and I feel on the whole it's probably because there's nobody discussing this with us or telling me I'm an idiot for some of the things I may think/say! So I think if I'm going to attempt to complete a blog then I am going to do it in a reflective style and I do look forward to peoples feedback and discussions. I'll try to do it daily and see if that works out well, or weekly. But hopefully even if it doesn't get much response it can just be a store for me to look back on things! (Providing I keep up with it). So I'll start now, with a short reflection on my career aspirations which have been pretty much firmed up, but today I gave a presentation that I felt really galvanised me into this. So I want to do Emergency Medicine and Expedition Medicine (on the side more than as my main job). Emergency Medicine appeals to me as I love primary care and being the first to see patients, but I want to see them when they're ill and have a role in the puzzle solving, as it were, that is their issues. Possibly more to the point I want to do this in a high pressure environment where acutely ill individuals come in, and I feel (having done placements in A&E and GP and AMU) A&E is the place for me to be. Expedition Medicine on the other hand is something I accidentally stumbled upon really. In 2nd year I was part of a podcast group MedHeads that we tried to set up at my medical school. I interviewed Dr Amy Hughes of Expedition & Wilderness Medicine, a UK company, and I got really excited about the concepts she was talking about. Practicing medicine in the middle of nowhere, limited resources and sometimes only personal accumen and ingenuity to help you through. It sounded perfect! And since then I've wanted to do it, particularly being interested in Mountain Medicine and getting involved with some research groups. Today in front of my group I gave a presentation on the effects of altitude on the brain (I'm on Neurology at the moment and we had to pick a topic that interested us). I spoke for 15 minutes, a concept that usually terrifies me truth be told, and I thoroughly enjoyed myself. Now I've given a fair number of presentations but this was the first time I was actively excited and really happy about talking! It seems to me that if that isn't the definition of why you should go for a job, then I need to talk to a careers advisor. This experience has definitely ensured I pursue this course with every resource I have available to me! I would be interested in hearing how other people feel about their careers panning out and what got them into it so feel free to leave a comment!!  
Conrad Hayes
almost 9 years ago
Foo20151013 2023 7owyf5?1444773963
3
158

Benchmarking Outpatient Referral Rates

Introduction GPs for a little while have been asked to compare each other’s outpatient referrals rates. The idea is that this peer to peer open review will help us understand each others referral patterns. For some reason and due to a natural competitive nature of human behaviour, I think we have these peer to peer figures put to us to try to get us to refer less into hospital outpatients. It’s always hard to benchmark GP surgeries but outpatient referral benchmarking is particularly poor for several reasons It's Very Difficult to Normalise Surgeries Surgeries have different mortalities morbidities ages and other confounding factors that it becomes very hard to create an algorithm to create a weighting factor to properly compare one surgery against another. There Are Several Reasons For The Referral I’ll go into more detail on this point later but there are several reasons why doctors refer patients into hospital which can range from: doctors knowing a lot about the condition and picking up subtle symptoms and signs lesser experienced doctors would have ignored; all the way to not knowing about the condition and needing some advice from an expert in the condition. We Need To Look At The Bigger Picture The biggest killer to our budget is non-elective admissions and it’s the one area where patient, commissioner and doctor converge. Patients want to keep out of hospital, it’s cheaper for the NHS and Doctors don’t like the lack of continuity when patients go in. For me I see every admission to hospital as a fail. Of course it’s more complex than this and it might be totally appropriate but if we work on this concept backwards, it will help us more. Likewise if we try to reduce outpatient referrals because we are pressurised to, they may end up in hospitalisation and cost the NHS £10,000s rather than £100s as an outpatient. We need to look at the bigger picture and refer especially if we believe that referrals will lead to less hospitalisation of patients further down the line. To put things into perspective 2 symptoms patients present which I take very seriously are palpitations in the elderly and breathlessness. Both symptoms are very real and normally lead to undiagnosed conditions which if we don’t tackle and diagnose early enough will cause patients to deteriorate and end up in hospital. Education, Education, Education When I first went into commissioning as a lead in 2006 I had this idea of getting to the bottom of why GPs refer patients to outpatients. The idea being if we knew why, we would know how to best tackle specialities. I asked my GPs to record which speciality to refer to and why they referred over a 7 month period. The reason for admission was complex but we divided them up into these categories: 2nd care input required for management of the condition. We know about the condition but have drawn the line with what we can do in primary care. An example of this is when we’ve done a 24 hour tape and found a patient has 2sec pauses and needs a pace maker. 2nd care input required for diagnosis. We think this patient has these symptoms which are related to this condition but don’t really know about the diagnosis and need help with this. An example of this is when a patient presents with diarrhoea to a gastroenterologist There could be several reasons for this and we need help from the gastroenterologist to confirm the diagnosis via a colonscopy and ogd etc. Management Advice. We know what the patient has but need help with managing the condition. For example uncontrolled heart failure or recurrent sinusitis. Consultant to Consultant Referral. As advised between consultants. Patient Choice. Sometimes the patient just wants to see the hospital doctor. The results are enclosed here in Excel and displayed below. Please click on the graph thumbnail below. Reasons For Referrals Firstly a few disclaimers and thoughts. These figures were before any GPSI ENT, Dermatology or Musculosketal services which probably would have made an impact on the figures. There are a few anomalies which may need further thought eg I’m surprised Rheumatology for 2nd input for diagnosis is so low, as frequently I have patients with high ESRs and CRPs which I need advise on diagnoses. Also audiology medicine doesn’t quite look right. The cardiology referral is probably high for management advise due to help on ECG interpretation although this is an assumption. This is just a 7 month period from a subset of 8-9 GPs. Although we were careful to explain each category and it’s meaning, more work might need to be done to clarify the findings further. In my opinion the one area where GPs need to get grips with is management advice as it’s an admission that I know what the patient has and need help on how to treat them. This graph is listed in order of management advice for this reason. So what do you do to respond to this? The most logical step is to education GPs on the left hand side of this graph and invest in your work force but more and more I see intermediary GPSI services which are the provider arm of a commissioning group led to help intercept referrals to hospital. In favour of the data most of the left hand side of the graph have been converted into a GPSI service at one point. In my area what has happened is that referrals rates have actually gone up into these services with no decline in the outgoing speciality as GPs become dis-empowered and just off load any symptoms which patients have which they would have probably had a higher threshold to refer on if these GPSI services were not available. Having said that GPSI services can have a role in the pathway and I’m not averse to their implementation, we just have to find a better way to use their services. 3 Step Plan As I’m not one to just give problems here are my 3 suggestions to help referrals. To have a more responsive Layered Outpatient Service. Setting up an 18 week target for all outpatients is strange, as symptoms and specialities need to be prioritised. For example I don’t mind waiting 20 weeks for a ENT referral on a condition which is bothering me but not life threatening but need to only have a 3 week turn over if I’m breathless with a sudden reduction in my exercise tolerance. This adds an extra layer of complexity but always in the back of my mind it’s about getting them seen sooner to prevent hospitalisation. Education, education, education It’s ironic that the first budget to be slashed in my area was education. We need to education our GPs to empower them to bring the management advice category down as this is the category which will make the biggest impact to improving health care. In essence we need to focus on working on the left hand side of this graph first. Diagnose Earlier and Refer Appropriately The worst case scenario is when GPs refer patients to the wrong speciality and it can happen frequently as symptoms blur between conditions. This leads to delayed diagnosis, delayed management and you guessed it, increased hospitalisation. The obvious example is whether patients with breathlessness is caused by heart or lung or is psychogenic. As GPs we need to work up patients appropriately and make a best choice based on the evidence in front of us. Peer to peer GP delayed referral letter analysis groups have a place in this process. Conclusion At the end of the day it's about appropriate referrals always, not just a reduction. Indeed for us to get a grip on the NHS Budgets as future Clinical Commissioners, I would expect outpatient referrals to go up at the expense of non-elective, as then you are looking at patients being seen and diagnosed earlier and kept out of hospital.  
Raza Toosy
almost 9 years ago