Support Kuwait University's Community Eye Health Initiative

Fawzia Sultan Rehabilitation Institute (FSRI) has partnered with Agility to organize a RUN / WALK that will help support Kuwait University's Community Eye Health Initiative.

The Community Eye Health Initiative, developed by Kuwait University Assistant Professor and KHI board member Manal Bouhaimed, aims, through its different projects to achieve the following:

* Offer community eye health programs to raise public awareness about risk factors leading to vision impairment
* Organize educational activities for eye health professionals
* Facilitate population based research about blindness and visual impairment in Kuwait.


On Saturday, November 6, 2010 come support this initiative. Enjoy a fun day in the sun with family and friends.

WHERE: Scientific Center
TIME: 8:00AM
DETAILS: www.runq8.org

Orthopods Vs Anaesthetists

Never be the brightest person in a room !

''Getting out of intellectual ruts more often than not requires unexpected intellectual jousts. Nothing can replace the company of others who have the background to catch errors in your reasoning or provide facts that may either prove or disprove your argument of the moment. And the sharper those around you, the sharper you will become. It's contrary to human nature, and especially to human male nature, but being the top dog in the pack can work against greater accomplishments. Much better to be least accomplished chemist in a super chemistry department than the superstar in a lustrous department. By the early 1950s, Linus Pauling's scientific interactions with fellow scientists were effectively monologues instead of dialogues. He then wanted adoration, not criticism.''

from

Avoid Boring People

James Watson

Why did you choose medicine ?

''Thank you'', Mr S. replied to the consultant in charge as he started to recover from a debilitating neurological condition. I could see satisfaction and relief in his eyes and so did the consultant who looked at me with the following words ''this is what makes this job so worthwhile''. The consultant was not the tzar in managing such a condition, but he listened carefully to his patient, and he treated him with respect, dignity and kindness. He 'helped' him by providing a good service.

As medical students, sometimes we become so focused on passing exams and reading textbooks that we lose sight of what motivated us to become physicians or surgeons in the first place. Some of us are working very hard in the lab trying to figure out a scientific problem that would embark on better understanding of disease and treatment, and others investing their weekends in the wards looking after very ill people. Why do we do that? A very kind physician once said ''remember, we are here to help people''. This is the ultimate outcome to make people feel better as they leave.

This is not a matter of controversy, but it can be hard to pay attention to the individual as a whole and stop focusing entirely on treating his/her disease only. Sometimes all it needs is a touch of kindness and listening even though if this is all you can do.

Become a writer for KHI newsletter

Dear colleague,

We would like to invite you to participate in writing for the newsletter edited by the Kuwait Health Initiative (KHI) medical organization. It is a great pleasure to announce our affiliation with KHI which will help serve our members needs and improve medical student welfare.

KHI is an independent, non-profit and non-political organization of reformists dedicated to health policy research. Its members ascribe to a firm code of ethics and believe in the need for a rights-based approach to reform that targets customers of the health system, particularly destitute populations.

If you are interested in contributing to KHI newsletter, please email kmsnewsletter@hotmail.co.uk your interest in writing. A member of our team will contact you to offer more information and communicate any ideas that you might express as to the article you are writing.

We have attached a recent issue of KHI newsletter as an example accessible through the following link;

http://www.4shared.com/document/ETUyIYUJ/KHI_newsletter_June_2010.html

If you have any questions please contact us through our blog or by emailing us (kmsnewsletter@hotmail.co.uk)

Atul Gawande's Commencement Speech at Stanford's School of Medicine

Many of you have worked for four solid years—or five, or six, or nine—and we are here to declare that, as of today, you officially know enough stuff to be called a graduate of the Stanford School of Medicine. You are Doctors of Medicine, Doctors of Philosophy, Masters of Science. It’s been certified. Each of you is now an expert. Congratulations.
So why—in your heart of hearts—do you not quite feel that way?
The experience of a medical and scientific education is transformational. It is like moving to a new country. At first, you don’t know the language, let alone the customs and concepts. But then, almost imperceptibly, that changes. Half the words you now routinely use you did not know existed when you started: words like arterial-blood gas, nasogastric tube, microarray, logistic regression, NMDA receptor, velluvial matrix.
O.K., I made that last one up. But the velluvial matrix sounds like something you should know about, doesn’t it? And that’s the problem. I will let you in on a little secret. You never stop wondering if there is a velluvial matrix you should know about.
Since I graduated from medical school, my family and friends have had their share of medical issues, just as you and your family will. And, inevitably, they turn to the medical graduate in the house for advice and explanation.
I remember one time when a friend came with a question. “You’re a doctor now,” he said. “So tell me: where exactly is the solar plexus?”
I was stumped. The information was not anywhere in the textbooks.
“I don’t know,” I finally confessed.
“What kind of doctor are you?” he said.
I didn’t feel much better equipped when my wife had two miscarriages, or when our first child was born with part of his aorta missing, or when my daughter had a fall and dislocated her elbow, and I failed to recognize it, or when my wife tore a ligament in her wrist that I’d never heard of—her velluvial matrix, I think it was.
This is a deeper, more fundamental problem than we acknowledge. The truth is that the volume and complexity of the knowledge that we need to master has grown exponentially beyond our capacity as individuals. Worse, the fear is that the knowledge has grown beyond our capacity as a society. When we talk about the uncontrollable explosion in the costs of health care in America, for instance—about the reality that we in medicine are gradually bankrupting the country—we’re not talking about a problem rooted in economics. We’re talking about a problem rooted in scientific complexity.
Half a century ago, medicine was neither costly nor effective. Since then, however, science has combatted our ignorance. It has enumerated and identified, according to the international disease-classification system, more than 13,600 diagnoses—13,600 different ways our bodies can fail. And for each one we’ve discovered beneficial remedies—remedies that can reduce suffering, extend lives, and sometimes stop a disease altogether. But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures. Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive. And we’re struggling. There is no industry in the world with 13,600 different service lines to deliver.
It should be no wonder that you have not mastered the understanding of them all. No one ever will. That’s why we as doctors and scientists have become ever more finely specialized. If I can’t handle 13,600 diagnoses, well, maybe there are fifty that I can handle—or just one that I might focus on in my research. The result, however, is that we find ourselves to be specialists, worried almost exclusively about our particular niche, and not the larger question of whether we as a group are making the whole system of care better for people. I think we were fooled by penicillin. When penicillin was discovered, in 1929, it suggested that treatment of disease could be simple—an injection that could miraculously cure a breathtaking range of infectious diseases. Maybe there’d be an injection for cancer and another one for heart disease. It made us believe that discovery was the only hard part. Execution would be easy.
But this could not be further from the truth. Diagnosis and treatment of most conditions require complex steps and considerations, and often multiple people and technologies. The result is that more than forty per cent of patients with common conditions like coronary artery disease, stroke, or asthma receive incomplete or inappropriate care in our communities. And the country is also struggling mightily with the costs. By the end of the decade, at the present rate of cost growth, the price of a family insurance plan will rise to $27,000. Health care will go from ten per cent to seventeen per cent of labor costs for business, and workers’ wages will have to fall. State budgets will have to double to maintain current health programs. And then there is the frightening federal debt we will face. By 2025, we will owe more money than our economy produces. One side says war spending is the problem, the other says it’s the economic bailout plan. But take both away and you’ve made almost no difference. Our deficit problem—far and away—is the soaring and seemingly unstoppable cost of health care.
We in medicine have watched all this mainly with bafflement, even indifference. This is just what good medicine is like, we’re tempted to say. But we’d be ignoring the evidence. For health care is not practiced the same way across the country. There is remarkable variability in the cost and quality of care. Two communities in the same state with the same levels of poverty and health can differ by more than fifty per cent in their Medicare costs. There is a bell curve for cost and quality, and it is frustrating—but also hopeful. For those getting the best results—the hospitals and doctors measured at the top of the curve for patient outcomes—are not the most expensive. They are sometimes among the least.
Like politics, all medicine is local. Medicine requires the successful function of systems—of people and of technologies. Among our most profound difficulties is making them work together. If I want to give my patients the best care possible, not only must I do a good job, but a whole collection of diverse components must somehow mesh effectively.
Having great components is not enough. We’ve been obsessed in medicine with having the best drugs, the best devices, the best specialists—but we’ve paid little attention to how to make them fit together well. Don Berwick, of the Institute for Healthcare Improvement, has noted how wrongheaded this is. “Anyone who understands systems will know immediately that optimizing parts is not a good route to system excellence,” he says. He gives the example of a famous thought experiment in which an attempt is made to build the world’s greatest car by assembling the world’s greatest car parts. We connect the engine of a Ferrari, the brakes of a Porsche, the suspension of a BMW, the body of a Volvo: “What we get, of course, is nothing close to a great car; we get a pile of very expensive junk.” Nonetheless, in medicine, that’s exactly what we have done.
Earlier this year, I received a letter from a patient named Duane Smith. He was a thirty-four-year-old assistant grocery-store manager when he had a terrible head-on car collision that left him with a broken leg, a broken pelvis, and a broken arm, two collapsed lungs, and uncontrolled internal bleeding. The members of his hospital’s trauma team went swiftly into action. They stabilized his fractured leg and pelvis. They put tubes in both sides of his chest to reëxpand his lungs. They gave him blood and got him to an operating room fast enough to remove the ruptured spleen that was the source of his bleeding. He required intensive care and three weeks of hospital recovery to get through all this. The clinicians did almost every single thing right. Smith told me that to this day he remains deeply grateful to the people who saved him.
But they missed one small step. They forgot to give him the vaccines that every patient who has his spleen removed requires, vaccines against three bacteria that the spleen usually fights off. Maybe the surgeons thought the critical-care doctors were going to give the vaccines, and maybe the critical-care doctors thought the primary-care physician was going to give them, and maybe the primary-care physician thought the surgeons already had. Or maybe they all forgot. Whatever the case, two years later, Duane Smith was on a beach vacation when he picked up an ordinary strep infection. Because he hadn’t had those vaccines, the infection spread rapidly throughout his body. He survived—but it cost him all his fingers and all his toes. It was, as he summed it up in his note, the worst vacation ever.
When Duane Smith’s car crashed, he was cared for by good, hardworking people. They had every technology available, but they did not have an actual system of care. And the most damning thing is that no one learned a thing from Duane Smith. For we have since had the exact same story occur in Boston, with an even worse outcome. Indeed, I would bet you that, across this country, we miss the basic, unglamorous step of vaccination in probably half of emergency splenectomy patients.
Why does anyone receive suboptimal care? After all, society could not have given us people with more talent, more dedication, and more training than the people in medical science have—than you have. I think the answer is that we have not grappled with the fact that the complexity of science has changed medicine fundamentally. This can no longer be a profession of craftsmen individually brewing plans for whatever patient comes through the door. We have to be more like engineers building a mechanism whose parts actually fit together, whose workings are ever more finely tuned and tweaked for ever better performance in providing aid and comfort to human beings.
You come into medicine and science at a time of radical transition. You have met the older doctors and scientists who tell the pollsters that they wouldn’t choose their profession if they were given the choice all over again. But you are the generation that was wise enough to ignore them: for what you are hearing is the pain of people experiencing an utter transformation of their world. Doctors and scientists are now being asked to accept a new understanding of what great medicine requires. It is not just the focus of an individual artisan-specialist, however skilled and caring. And it is not just the discovery of a new drug or operation, however effective it may seem in an isolated trial. Great medicine requires the innovation of entire packages of care—with medicines and technologies and clinicians designed to fit together seamlessly, monitored carefully, adjusted perpetually, and shown to produce ever better service and results for people at the lowest possible cost for society.
When you are sick, this is what you want from medicine. When you are a taxpayer, this is what you want from medicine. And when you are a doctor or a medical scientist this is the work you want to do. It is work with a different set of values from the ones that medicine traditionally has had: values of teamwork instead of individual autonomy, ambition for the right process rather than the right technology, and, perhaps above all, humility—for we need the humility to recognize that, under conditions of complexity, no technology will be infallible. No individual will be, either. There is always a velluvial matrix to know about.
You are joining a special profession. Doctors and scientists, we are all in the survival business, but we are also in the mortality business. Our successes will always be restricted by the limits of knowledge and human capability, by the inevitability of suffering and death. Meaning comes from each of us finding ways to help people and communities make the most of what is known and cope with what is not.
This will take science. It will take art. It will take innovation. It will take ambition. And it will take humility. But the fantastic thing is: This is what you get to do.



Read more: http://www.newyorker.com/online/blog...#ixzz0rUyhYvRJ

Kuwait Health Initiative's First Newsletter

Kuwait Health Initiative's Inaugural Newsletter:

June Edition Includes:

In this edition:

Chairman's Welcome Address

KHI Introduction

Kuwait University Careers Day 2009

Green Hospital Workshop

Cancer Screening Practices Pilot Study

Guantanamo Bay and Medical Education: A Marriage of Convenience

Air Pollution in Umm Al-Hayman

Click on link below to read:

http://www.q8health.org/khi-newsletter/

Student BMJ: How to Present Clincal Cases

Education

How to present clinical cases

Presenting a patient is an essential skill that is rarely taught

• By: Ademola Olaitan, Oluwakemi Okunade, Jonathan Corne
• Published: 13 April 2010
• DOI: 10.1136/sbmj.c1539

Clinical presenting is the language that doctors use to communicate with each other every day of their working lives. Effective communication between doctors is crucial, considering the collaborative nature of medicine. As a medical student and later as a doctor you will be expected to present cases to peers and senior colleagues. This may be in the setting of handovers, referring a patient to another specialty, or requesting an opinion on a patient.

A well delivered case presentation will facilitate patient care, act a stimulus for timely intervention, and help identify individual and group learning needs.[1] Case presentations are also used as a tool for assessing clinical competencies at undergraduate and postgraduate level.

Medical students are taught how to take histories, examine, and communicate effectively with patients. However, we are expected to learn how to present effectively by observation, trial, and error.

Principles of presentation

Remember that the purpose of the case presentation is to convey your diagnostic reasoning to the listener. By the end of your presentation the examiner should have a clear view of the patient’s condition. Your presentation should include all the facts required to formulate a management plan.

There are no hard and fast rules for a perfect presentation, rather the content of each presentation should be determined by the case, the context, and the audience. For example, presenting a newly admitted patient with complex social issues on a medical ward round will be very different from presenting a patient with a perforated duodenal ulcer who is in need of an emergency laparotomy.

Whether you’re presenting on a busy ward round or during an objective structured clinical examination (OSCE), it is important that you are concise yet get across all the important points. Start by introducing patients with identifiers such as age, sex, and occupation, and move on to the complaint that they presented with or the reason that they are in hospital. The presenting complaint is an important signpost and should always be clearly stated at the start of the presentation.

Presenting a history

After you’ve introduced the patient and stated the presenting complaint, you can proceed in a chronological approach—for example, “Mr X came in yesterday with worsening shortness of breath, which he first noticed four days ago.” Alternatively you can discuss each of the problems, starting with the most pertinent and then going through each symptom in turn. This method is especially useful in patients who have several important comorbidities.

The rest of the history can then be presented in the standard format of presenting complaint, history of presenting complaint, medical history, drug history, family history, and social history. Strictly speaking there is no right or wrong place to insert any piece of information. However, in some instances it may be more appropriate to present some information as part of the history of presenting complaints rather than sticking rigidly to the standard format. For example, in a patient who presents with haemoptysis, a mention of relevant risk factors such as smoking or contacts with tuberculosis guides the listener down a specific diagnostic pathway.

Apart from deciding at what point to present particular pieces of information, it is also important to know what is relevant and should be included, and what is not. Although there is some variation in what your seniors might view as important features of the history, there are some aspects which are universally agreed to be essential. These include identifying the chief complaint, accurately describing the patient’s symptoms, a logical sequence of events, and an assessment of the most important problems. In addition, senior medical students will be expected to devise a management plan.[1]

The detail in the family and social history should be adapted to the situation. So, having 12 cats is irrelevant in a patient who presents with acute appendicitis but can be relevant in a patient who presents with an acute asthma attack. Discerning the irrelevant from the relevant is not always easy, but it comes with experience.[2] In the meantime, learning about the diseases and their associated features can help to guide you in the things you need to ask about in your history. Indeed, it is impossible to present a good clinical history if you haven’t taken a good history from the patient.

Presenting examination findings

When presenting examination findings remember that the aim is to paint a clear picture of the patient’s clinical status. Help the listener to decide firstly whether the patient is acutely unwell by describing basics such as whether the patient is comfortable at rest, respiratory rate, pulse, and blood pressure. Is the patient pyrexial? Is the patient in pain? Is the patient alert and orientated? These descriptions allow the listener to quickly form a mental picture of the patient’s clinical status. After giving an overall picture of the patient you can move on to present specific findings about the systems in question. It is important to include particular negative findings because they can influence the patient’s management. For example, in a patient with heart failure it is helpful to state whether the patient has a raised jugular venous pressure, or if someone has a large thyroid swelling it is useful to comment on whether the trachea is displaced. Initially, students may find it difficult to know which details are relevant to the case presentation; however, this skill becomes honed with increasing knowledge and clinical experience.

Presenting in an exam

Although the same principles as presenting in other situations also apply in an exam setting, the exam situation differs in the sense that its purpose is for you to show your clinical competence to the examiner.

It’s all about making a good impression. Walk into the room confidently and with a smile. After taking the history or examining the patient, turn to the examiner and look at him or her before starting to present your findings. Avoid looking back at the patient while presenting. A good way to avoid appearing fiddly is to hold your stethoscope behind your back. You can then wring to your heart’s content without the examiner sensing your imminent nervous breakdown.

Start with an opening statement as you would in any other situation, before moving on to the main body of the presentation. When presenting the main body of your history or examination make sure that you show the examiner how your findings are linked to each other and how they come together to support your conclusion.

Finally, a good summary is just as important as a good introduction. Always end your presentation with two or three sentences that summarise the patient’s main problem. It can go something like this: “In summary, this is Mrs X, a lifelong smoker with a strong family history of cardiovascular disease, who has intermittent episodes of chest pain suggestive of stable angina.”

Improving your skills

The RIME model (reporter, interpreter, manager, and educator) gives the natural progression of the clinical skills of a medical student.[3] Early on in clinical practice students are simply reporters of information. As the student progresses and is able to link together symptoms, signs, and investigation results to come up with a differential diagnosis, he or she becomes an interpreter of information. With further development of clinical skills and increasing knowledge students are actively able to suggest management plans. Finally, managers progress to become educators. The development from reporter to manager is reflected in the student’s case presentations.

The key to improving presentation skills is to practise, practise, and then practise some more. So seize every opportunity to present to your colleagues and seniors, and reflect on the feedback you receive.[4] Additionally, by observing colleagues and doctors you can see how to and how not to present.

Top tips

• Remember the purpose of the presentation
• Be flexible; the context should dictate the content of the presentation
• Always include a presenting complaint
• Present your findings in a way that shows understanding
• Have a system
• Use appropriate terminology

Additional tips for exams

• Start with a clear introductory statement and close with a brief summary
• After your summary suggest a working diagnosis and a management plan
• Practise, practise, practise, and get feedback
• Present with confidence, and don’t be put off by an examiner’s poker face
• Be honest; do not make up signs to fit in with your diagnosis

Ademola Olaitan, medical student¹, Oluwakemi Okunade, final year medical student¹, Jonathan Corne, consultant physician<sup>2

1</sup>University of Nottingham, ²Nottingham University Hospitals

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

See “Medical ward rounds” (Student BMJ 2009;17:98-9, http://archive.student.bmj.com/issues/09/03/life/98.php).

References

1. Green EH, Durning SJ, DeCherrie L, Fagan MJ, Sharpe B, Hershman W. Expectations for oral case presentations for clinical clerks: Opinions of internal medicine clerkship directors. J Gen Intern Med 2009;24:370-3.
2. Lingard LA, Haber RJ. What do we mean by “relevance”? A clinical and rhetorical definition with implications for teaching and learning the case-presentation format. Acad Med 1999;74:S124-7.
3. Pangaro L. A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med 1999;74:1203-7.
4. Haber RJ, Lingard LA. Learning oral presentation skills: a rhetorical analysis with pedagogical and professional implications. J Gen Intern Med 2001;16:308-14.

Cite this as: Student BMJ 2010;18:c1539

Thanks Joe for sharing the article!

Free OSCE Revision Videos

Click here to access OSCE revision lectures. They are by delivered by the guy who wrote the Pastest OSCE book. Apparently, they are easygoing and good for quick revision if you have spare time.

Thank you Noura for sharing the link and good luck with your exam!

What does a complex partial seizure look like?

This video illustrates what a complex partial seizure looks like. But what does this even mean? well let's have a close look !

Seizure (fit) is a transient neurological event caused by abnormal electric discharge of neurons within the cerebral hemisphere manifesting as a group of motor/sensory symptoms/signs known as seizure semiology. An individual is said to have epilepsy if he/she has ≥ 2 seizures. Epilepsy is a symptom of an underlying disease process rather than a disease on its own right.

Did you know that about 5% of the population has a single seizure at some point of their lifetime, and if we are to look at every 100,000 people in the UK, about 500 of them will have a diagnosis of epilepsy.

Seizures are often mistaken for syncope or fainting which might be accompanied by general jerkiness just like some seizures. Therefore, it is important to clearly and accurately describe what exactly happened during the event. A witnessed account of what happened is essential since seizures almost always result in memory impairment or loss of consciousness.

So, how can you describe a seizure? let's dissect the event:

PRODROME = alteration of behaviour/mood preceding the attack by hours.

AURA = symptoms occurring immediately before the attack (this is important to indicate a seizure and trace its origin within the brain. For example, unusual sudden strange smell and gut rising feeling localizes to the temporal lobe).

ICTUS = the event itself might present as violent jerky movement affecting the limbs to sudden attacks looking vacant.

POST-ICTUS = this is the period immediately after seizure symptoms. A seizure is often associated with slow recovery (> 5 min) leaving the individual confused and muddled for few minutes even after recovery.

Now we know how to describe seizures, we can move to the next part - classification of seizures. The type of seizure you saw in the video is described as 'partial'. Why is that?

The International League Against Epilepsy (ILAE) classifies seizures according to their origin of onset within the brain. A seizure can be 'generalized' or 'partial'. Generalized seizures arise from a subcortical structure and are associated with synchronized generalized abnormal neuronal firing involving BOTH HEMISPHERES and resulting in impairment of consciousness and bilateral motor manifestations. On the other hand, partial seizures arise from a FOCAL origin within the CEREBRAL CORTEX that may either remain localized or spread more generally to result in a secondary generalized seizure.

A partial seizure can be further classified into 'simple' and 'complex' based on the degree of consciousness. Patients filmed in the video are said to have complex partial seizures because they can't remember what happened and lost awareness of their surroundings. This is due to seizure activity originating in the temporal lobe involving the hippocampus and spreading to the contralateral temporal lobe resulting in amnesia. So, 'complex' means accompanied by alteration of consciousness.

The behavioural features illustrated in the video are involuntary and known as 'automatism' which occurs in 90% of complex partial seizures. As shown above, they present as fumbling movement, rubbing and chewing or as semi-purposeful limb movement (eg opening the curtins and putting on cloths) - other people won't even guess the individual is suffering from a seizure. However, patients experiencing a complex partial seizure often appear distant, staring and unresponsive.

I hope this brief article helped to explain the pattern of symptoms and signs shown in the video, and provided some clarification. Please do not hesitate to ask any questions related to the topic.

Marmots can teach us about obesity

Marmots Can Teach Us About Obesity

ScienceDaily (June 2, 2010) — A nutrient that's common to all living things can make hibernating marmots hungry -- a breakthrough that could help scientists understand human obesity and eating disorders, according to a new study by a Colorado State University biologist.

The study appears in the current issue of the Journal of Experimental Biology.

Professor Greg Florant discovered he could slowly release a molecule called AICAR into yellow-bellied marmots that activates a neurological pathway driving food intake and stimulates appetite. The pathway, which shuts down during hibernation, relies on an important balance between two energy molecules -- ATP and AMP. The lower the ratio between the two cellular molecules, the lower the energy in the cell and the more the appetite is stimulated.

Without this artificial stimulation, awake, hibernating marmots do not eat -- even when researchers place food in front of them.

"The experimental group started to feed because they thought they had this energy deficit," Florant said. "Then when the pumps dispensing the molecule finally stopped, the animals went right back into hibernation. That suggests to us that the animals are still sensing energy levels within cells during the hibernation period."

Tissue samples taken from marmots in Florant's lab allow researchers to identify biochemical processes and genes that are active during hibernation -- as opposed to genes that are active when they're feeding or engaging in other behaviors.

The American Physiological Society has called hibernators such as marmots, bears, woodchucks, hedgehogs and lemurs "medical marvels" because they can turn off their appetites and slow their breathing to a point that would be lethal to other animals.

Marmots typically hibernate for as many as six or seven months.

"You can't eat if you're asleep," Florant said. "We've discovered that perhaps nutrients within the brain, such as fatty acids, can alter the food intake pathway, which normally shuts down when marmots hibernate. The perceived drop in energy nutrients (i.e. low ATP) makes the animals think they've got an energy deficit and want to eat."

Florant said he'll conduct additional research this summer to determine whether the reverse is true: Can he stop the animals from eating when they're not hibernating?

His team will also identify neurons in the particular areas of the hypothalamus that are involved in food intake in animals. The hypothalamus is one of the master regulator areas of the brain and controls such activities as food intake, sex and temperature regulation.

"We know which neurons are driving this process," he said. "We're just trying to identify them within the marmot and distinguish what's different about the neurons in a marmot compared to a rat or other animal that does not go into hibernation."

G. L. Florant, A. M. Fenn, J. E. Healy, G. K. Wilkerson, R. J. Handa. To eat or not to eat: the effect of AICAR on food intake regulation in yellow-bellied marmots (Marmota flaviventris). Journal of Experimental Biology, 2010; 213 (12): 2031 DOI: 10.1242/jeb.039131

KIMS plans a meeting for interns

In light of changing the new regulations describing the pathway of specialty training in Kuwait, the Kuwaiti Institute of Medical Specialties (KIMS) arranged a meeting for the interns in order to address concerns regarding their future career plans (see pictures).

I thank Ali Mohsen for forwarding the above pictured documents from the facebook page of one of the junior doctors working in Kuwait.

Article in Today's Al Qabas about the new KIMS rules

13291 - 30/05/2010, Al Qabas (see below for English version)

لوزير الصحة إلغاء القرار الجائر بحق الأطباء


لكم تمنينا ان يرى النور اقتراحنا بإنشاء «سوبر هاي واي» للاطباء الكويتيين، لتحفيزهم على التخصص والابداع، كما حدث في السبعينات في اميركا، عندما اقترحه الرئيس نيكسون، فكان من بين الاسباب التي جعلت اميركا من اكثر دول العالم تطورا في مجال الطب. ولكننا للأسف سمعنا، من خلال شكوى تقدم بها لنا اطباء متدربون، انه بدلا من ان يكون هناك «سوبر هاي واي»، فإن الوزارة اصدرت قرارا يعتبر «حفرة داون واي» في الشارع الضيق الذي يسير عليه ابناؤنا وبناتنا من الاطباء!
لقد صدر قرار جائر منذ ثلاثة اسابيع من معهد الكويت للتخصصات الطبية التابع للوزارة، الذي يترأسه دكتور ليس طبيبا، يلزم الاطباء المتدربين قبل تاريخ 10 يونيو بأن ينقبلوا في تخصص من بين ثلاثة تخصصات فقط في البورد الكويتي، من غير ان يسمح لهم بالانتقال الى درجة الطبيب المساعد حتى يمارسوا هذه التخصصات لمدة كافية! فكيف يا معالي الوزير يختار هذا الطبيب المتدرب تخصصا غير مقتنع به تماما بسبب ضيق الوقت؟ كما يقول طبيب في شكواه: كيف أختار ولم يمض على تدريبي سوى اسبوعين فقط؟! كيف ولم يعرف الاطباء حتى الآن مدى توافق هذه التخصصات مع ميولهم المهنية؟ ان توافق التخصص مع الميول المهنية هو سر الابداع لدى الطبيب يا معالي الوزير، فجاء قرار الوزارة جائراً محبطاً لا يراعي مصلحة الاطباء.
لقد كان الطبيب في السابق يعطى سنة من التدريب لينتقل بعدها ليكون طبيبا مساعدا، وله ان يبقى طبيبا مساعدا، اما اذا اراد الترقية فعليه ان ينقبل في اي بورد سواء كان الكويتي، غير المعترف به عالميا، او اي بورد خارجي، فتكون للاطباء فرصة للممارسة قبل ان يقرروا تخصصهم وبأي بورد يلتحقون.
ما زاد الطين بلة ان القرار، الذي قيل انه صدر لتوفير اموال عن كل رأس طبيب متدرب للوزارة! قد نُقل للاطباء شفهيا، وبطريقة غير لائقة لا تخلو من الصراخ احيانا عندما يتقدمون للسؤال عن تفاصيل القرار التي يبدو ان رئيس المعهد الذي اصدرها لا يعرفها جيدا، فلا تعميم مكتوب ولا لائحة تنفيذية بالشروط والضوابط، وما زاد الطين بلة، فصار «صبخة»، ان هذا القرار قد ألغى مكانة مصداقية اختبار MRCP المعترف به عالميا، حيث قال المسؤول لطبيبة حاصلة على درجة الاختبار «بلّيها واشربي ماءها»! لان شرط الترقية والبعثة هو دخول البورد الكويتي فقط! فما هذا التخبط يا وزارة الصحة؟! هل يصدق معالي الوزير انه عندما سأل احد الاطباء احد المسؤولين بالوزارة: من سيؤدي العمل اذا صارت درجة الطبيب المساعد فارغة بالمستشفيات بسبب هذا القرار؟ اجاب ببرود: «نجيب هنود من بره يشيلون الشغل بربع معاشكم»!‍!! فيا معالي وزير الصحة ويا سعادة الوكيل الموقر، هذا القرار فيه اجحاف بحق مستقبل أهم مهنة في البلد، مما يستدعي إلغاؤه، لأنه جائر بحق الاطباء.
***
إن أصبت فمن الله وإن اخطأت فمن نفسي والشيطان.

بدر خالد البحر
bdralbhr@yahoo.com

English Version

To the Minister of Health: Cancel the Unjust Decision Towards Doctors

We were hoping that our suggestion, to create a "super highway" career path for Kuwaiti doctors would see light, to encourage Kuwaiti doctors to specialize and innovate. When President Nixon made the same suggestion in America, in the seventies; it became one of the drivers for the advancement of healthcare there. Unfortunately, recent decisions made by the Kuwait Institute of Medical Specialization (KIMS) are the equivalent of digging holes in the career paths of junior doctors, instead of building 'super highways' to help them on the already narrow road of medical specialization

The unjust decision was passed three weeks ago by KIMS, which is headed by a doctor who's not even a physician himself. This decision reads, that all doctors must select three choices for a specialty to pursue in the Kuwaiti board before the 10th of June, of which they'll be accepted into one only. In addition, doctors won't be promoted to the level of assistant registrar without spending a set amount of time in their selected specialty. We pose the question to the Minister of Health, how can a doctor be forced to choose a specialty they are unsure they want to pursue, as is likely to happen when doctors are not given adequate time to think this decision through? A young doctor complained to me, "How can I choose a specialty when I've only been training for two weeks?".

How can doctors choose a specialty when they are yet to figure out which one agrees with their career inclinations? A doctor's innovation is closely tied with the synchrony of his or her career inclinations and the specialty they are enrolled into. I would like to voice my concerns to the Minister of Health that this decision is unjust and goes against the interests of physicians. In the past, a trainee doctor spent one year in training. Next, he or she was promoted to the grade of assistant registrar. Then, the doctor had the right to remain an assistant registrar or seek promotion via the Kuwaiti board, which is not internationally accredited, or any other foreign accredited board. As such, physicians were given an entire year to choose which board and which specialty they would like to be enrolled into.

What makes things worse, is that a trainee doctor was told that this decision was brought in place to decrease the amount of money spent on doctors. It was delivered in an inappropriate manner and questions regarding the minutiae of the decision were met with rude and loud responses. It appears that even the head of the institute is not aware of all the details of the decision. The decision was not put in writing and there are no clear rules and regulations that must be followed. Also, it appears that the MRCP (internationally accredited membership) has been rendered useless, as the only road to a promotion and scholarship is through the Kuwaiti board. What is with all this incompetence? A Kuwaiti doctors asked, "Who will cover the workload delegated to assistant registrars if no Kuwaitis are enrolled in it because of this decision?" The reply from the head of the institute was, "We'll bring Indians from abroad who will work for a quarter of your pay!"

Finally, I say to the Minister of Health; this decision is prejudiced towards the most important profession in the country and it is unjust towards the future generation of physicians; it should be revoked!

By: Bader Khaled Al Bahar
Published: Al Qabas Newspaper

bdralbhr@yahoo.com

(Kindly translated by Mohammad Hassan)

KIMS's new rules?

So word's been going around that KIMS are changing the scholarship rules for people who would like to specialize abroad. To be honest, I'm not well versed on the issue but what I can gather from people (which may not be entirely accurate so don't quote us!):

-High GPA
-High TOEFL score
-You need to get into the Kuwaiti board and pass their exam
-You don't get to choose which country you go to
-You don't get to choose which specialty you get into

I guess what's more frustrating than having new rules is not having a system in place where these regulations are spelt out (on KIMS's website or another regulatory body). Things are a bit murky for junior doctors at the moment with little guidance from administrators to help them plan their future.

Anyway, for interested parties, apparently there's going to be a meeting at Kuwait Medical Association's HQ at 8pm today, Kuwait time.

More information is available if you join this facebook group: http://www.facebook.com/group.php?gid=118389084868775#!/group.php?gid=118389084868775&v=wall

Let us know if you are in possession of any more information!

Dancing Arrythmias!

First Near-Total Face Transplant Performed by Cleveland Clinic

Fever Series (Challenge 2): 'high temp after travel' What's the diagnosis?

26 year-old female presents to the ER with fever and rigors. Her symptoms are particularly troublesome every 2 days. While taking bloods, the resident asks her about a recent holiday or travel abroad. She mentions being in West Africa for some period of time for voluntary work.

O/E she has elevated temperature of 39 C.

What is the working diagnosis?

What signs would you look for?

( A bonus mark for explaining the pathophysiology !! )

Nature Book Reviews: The Vanishing Physician Scientists?

The USA is the birthplace of many prominent physician-scientists and even there, it appears that the numbers of practicing physician-scientists are dwindling. This book, reviewed by the journal Nature, offers possible explanations for the drop in physicians who practice science.

The academic niche for physician-scientists has been degenerating for over three decades. In 1979, the director of the US National Institutes of Health (NIH), James Wyngaarden, initially highlighted an alarming drop-off in the number of physician-scientists and their success rates in NIH funding. Since then, the combined burdens of an increasingly stringent overall NIH budget, educational loans on young physicians (often in the six figures), the procedure-driven nature of modern clinical medicine, and the financial vise of managed care and its follow-on effects on the academic environment have created an increasingly ablative force on the necessary environment to maintain a proper balance in the numbers of physician-scientists. In The Vanishing Physician-Scientist?, edited by Andrew I. Schafer, currently chairman of the Department of Medicine at Weill Cornell Medical College, the fate of the physician-scientist is revisited from multiple angles: renewal versus extinction, the evolution of diverse lineages (MD-PhD, late bloomers with MD degrees alone, PhDs in clinical departments), implications for biotechnology and drug discovery, gender imbalance, pipeline versus attrition effects, role models, financial and modern lifestyle concerns and the fragile microenvironmental niche of academic medicine in general. The result is a fascinating must-read for those of us with a deep interest in the subject that goes beyond conjecture and anecdotal personal experience to recent academic survey data, population analyses, current NIH funding trends, outcome analyses of MD-PhD trainees and, most importantly, onward toward a series of cogent, specific and implementable suggestions for regeneration. As the last page is turned, a more sanguine view of the problem emerges, along with a few surprises.

The book is comprised of 15 chapters written by over twenty leading physician-scientists who offer a number of penetrating insights into the crux of the problem of regenerating a new cadre of leaders in academic medicine. For example, as noted in the book by Tim Ley, a former president of the American Society of Clinical Investigation, the demographics of physician-scientists have been relatively stable since 1990. The bulk of these researchers hold an MD degree alone, and their success rates for NIH funding are similar to others with PhD or MD-PhD joint degrees. A surprising trend of combined MD-PhD trainees moving away from scientific careers is also evident in survey analyses. Interestingly, a case can be made to enhance our focus on designing strategies for renewing the population of physician-scientists. Also, as noted by Ley, the pool of physician-scientists is still overwhelmingly male, despite the near equal number of females in medical school today, indicating a need to address gender-specific issues.

'Translational medicine' has become the mantra for every medical school dean in the US and elsewhere, and, as presented by Barry Coller, the physician-in-chief of Rockefeller University, in his chapter, regenerating the pool of physician-scientists is clearly central to this goal. Increasingly, scientific centers of excellence are forging close networks with leading medical institutions, creating an interactive, nurturing microenvironment for physician-scientists. In this new era, in which humans themselves are models for human disease, technological barriers are rapidly breaking down, as higher-throughput human genotyping, whole exome or genome sequencing and high-content chemical screening on human stem cell model systems are becoming customary. The major discoveries in genomics research coming out of the Broad Institute at the Massachusetts Institute of Technology, in close collaboration with physicians at Massachusetts General Hospital and elsewhere, come to mind. Finding the extreme and rare clinical phenotypes of major interest, and having the capability of calling back the patient for additional information, will be increasingly important going forward. However, as Coller clearly documents, academia must recalibrate how young physicians are recognized, protected and promoted as essential components of these large interdisciplinary teams.

The crucial role of the environmental academic niche for physician-scientists, and the need for its substantial modification, is a major point of discussion in many chapters. In terms of mentoring, the needs for earlier exposure to research in the core medical curriculum, as well as in post-graduate MD training, the inclusion of off-site mentors and exposure to successful physician-scientists that have managed to balance the scientific and medical demands of their profession with personal family goals are mentioned throughout the book. The need for the institution itself to create a more nurturing infrastructure is also highlighted.

Finally, as noted by the preeminent physician-scientist David Nathan, the former president of the Dana-Farber Cancer Institute and also the physician-in-chief of Children's Hospital in Boston, there has never been a more exciting time to be a physician-scientist. “They must not and will not vanish,” he writes. “Indeed, their future can be as bright as ever if we proactively fashion it with creativity, foresight, and vision.” This future is clearly being empowered by annotated digital medical records, expanding databases on genotype-phenotype disease correlations from global collaborations, and research centers and networks funded by major philanthropic organizations and individuals. Likewise, the ability to study human disease in a dish, offered by recent advances in human stem cell biology, are extraordinary, offering the possibility of studying extremely rare and highly differentiated human cells from people with specific, rare and/or common diseases. Clearly, a resurgence in human physiology is on the horizon, and this need alone is likely to lead to a new breed of physician-scientists. The future of biology might be summed up in three words: human, human and human. Stethoscope, anyone?

You can buy this book from Amazon here.

Fever Series (1st Challenge): 'A neck lump, high temp and loose pants' What's the diagnosis?

23 year-old British Caucasian university student felt some gland swelling at her neck. Upon further questioning, she reports on and off fever with overnight sweating, and noticed 7 kg weight loss. She travelled to Malaysia, Thailand and Hong Kong 6 months previously. BCG vaccination has been obtained. On examination, there is palpable rubbery cervical lymphadenopathy. Subsequent chest X ray uncovers increased mediastinal opacity and enlargement.

What is the differential diagnosis and course of action?

US Hospital Rankings

The new USNews rankings have been out for a while so here's the link for those of you who missed it:

USNews:

http://health.usnews.com/best-hospitals

Here is also Thompson Reuters' rankings which is divided into teaching/community hospitals:

Thompson Reuters Top National Hospitals:

http://www.100tophospitals.com/top-national-hospitals/

Neurosurgeons Go Paperless at Annual Meeting With iPod Touch in Their Pockets

From Medscape Medical News
Daniel M. Keller, PhD

May 3, 2010 (Philadelphia, Pennsylvania) — Using the iPod Touch isn't brain surgery, but when 1 neurosurgeon saw what his young daughter could do with it, he got a brainstorm. The American Association of Neurological Surgeons (AANS) was looking for something more to offer its members at its annual meeting than the same old shoulder bag filled with weighty program and abstract books.
Michael Oh, MD, associate professor of neurosurgery at Drexel University, Philadelphia, Pennsylvania, and West Virginia University, Morgantown, said his daughter "zooms around [the iPod Touch], and she has access to so much information that it would be a perfect thing to have at a medical meeting." He proposed the idea to AANS president Troy Tippett, MD, who wanted to find a way to make the association's annual meeting more creative in a way that would offer more benefits to members. Dr. Oh then became the chair of the AANS iPod Touch Taskforce Committee.
"The whole purpose of those meetings is to transmit and communicate new information," Dr. Oh said. The idea of adopting the iPod Touch was to make the 2010 scientific meeting "more in your pocket and always available and on demand."
So at this year's AANS annual meeting, held May 1-5 in Philadelphia, attendees are all given an iPod Touch loaded with an AANS application, abstracts, the meeting program, podcasts, videocasts, electronic versions of posters, and clinical guidelines.
They will also be able to instant message their colleagues via Wi-Fi, participate in interactive audience polling during courses and scientific sessions, schedule which sessions to attend, and see maps to find rooms in the convention center and vendor booths on the exhibit floor. If a room number or presentation time changes, their schedules will be automatically updated via dynamic links. They can see a city guide and even make restaurant reservations through the Open Table online service.
This year, the more than 400 posters appear only in electronic form as an abstract and slides, and there are no actual poster sessions. Attendees can search for posters by author name or keyword. If a viewer wants to talk with an author he or she can send an instant message with a question or arrange a time to meet. In the future, Dr. Oh said, viewers may be able to leave comments about each poster.
Getting Up to Speed
Communications director Betsy van Die said AANS has ordered 3500 iPod Touches to be given to all paying attendees. Because the use of this technology is new to them, the AANS has done a year-long program of education through biweekly newsletters and online tutorials. In addition, “marshals” wearing distinctive armbands will be available at the conference to help any attendees with their devices.
Dr. Oh said that once the AANS started planning uses for the iPod Touch devices, "We realized it wasn't just going to be for the meeting. It will probably transform how our membership really communicates with each other and with the organization.
"It offers...new ways to look at information, transmit information, communicate with our peers...[and] be that sort of common device that transforms our membership into a community. I think that's the long-term exciting part of this project." He expects people to bring their iPod Touches to next year's meeting to have them loaded with new content.

The AANS has budgeted for a 3-year program of using the iPod Touch devices. "Even in a down economic year, we were able to meet and exceed our budget for sponsors," Dr. Oh said, "so we're very pleased with that. I think that it helped that we had something new and novel to offer sponsors."
The cost of the devices is offset by an additional $100 being added to the registration fee. Gone are the old "door drops" of promotional materials from exhibitors. Instead, the AANS has offered exhibitors several forms of advertising on the iPod Touch, ranging in cost from $1000 to $10,000, plus the cost of product give-aways or services (eg, video production for videocasts).
Opportunities include blast emails, splash ads, banner ads, exhibitor Website listings, podcasts, videocasts, iPod Touch cases, AC chargers, iTunes cards, and individual custom applications. Ms van Die said 40 company-sponsored email blasts are scheduled for the meeting.
"Some of them have action items in them, like 'Come to our booth for a raffle drawing.' So there's been a huge amount of enthusiasm from the sponsors on this, and they're very excited that it's more interactive," Ms van Die explained. She said many other medical societies are interested in using the iPod Touch at their meetings, and they have contacted the AANS to see how it has implemented the technology and are waiting to see the outcome.
Dr. Oh and Ms van Die have disclosed no relevant financial relationships.
American Association of Neurological Surgeons (AANS) 2010 Annual Meeting.

A Brilliant Meeting for Medical Students with Passion and Interest in Science

The joint meeting of the American Association of Physicians and American Society of Clinical Investigators (AAP-ASCI) synchronized and coordinated by by the American Physician Scientist Association (APSA) takes place in the beautiful city of Chicago every year. I have been lucky to attend this year’s meeting despite extensive disruption of airline services due to the ‘volcanic ash’!!

If you are a medical student interested in research, this meeting should be one of the items in your to-do list! The AAP-ASCI-APSA meeting provides exceptional opportunity for medical students undertaking research or considering a science career in medicine. You get to meet up with first-class physician scientists and important policy makers in medical science.

The meeting started with a keynote lecture by Professor E. Albert Reece (pictured), Dean of the University of Maryland Medical School. His research team is trying to figure out the mechanism of birth defects in fetuses born to mothers with type 2 diabetes mellitus. While summarizing unpublished data, he emphasized the advantage of being a physician scientist whereby the problem is identified in the clinic and taken to the laboratory for thorough investigation.

E. Albert Reece

The Noble Laureate in Medicine and Physiology, professor Joseph Goldstein (pictured) from UT Southwestern Medical Centre inspired the audience as he explained the ingredients of being a good physician scientist. In order to get his message across, he used quotes from noble laureates and other notable scientists. For example, one of the interesting quotes were for Sir Peter Medawar (pictured); ‘the intensity of a conviction that a hypothesis is true has no bearing over whether it is true or not.’

Joseph Goldstein

Professor Goldstein also emphasized the following for those about to embark on science research;

1/ Have focused research strategy

2/ Don’t become wedded to a technical gimmick

3/ Don’t confirm a finding that no longer needs reconfirmation

Sir Peter Medawar

Following the publication of recent figures reflecting inequalities between male and female doctors in respect to a number of features including income and professorship positions, the meeting invited a panel of speakers to address the roots of this happening and how to change it. Deans of New York and Johns Hopkins were among the audience and contributed to the discussion in different ways.

Day 1 ended with a number of science talks on areas of cancer biology, mechanism of vascular disease, neurodegeneration and cell biology. Conference delegates were invited for dinner followed by drink receptions with live Jazz music at the Jay Pritzker stage in Chicago’s lively Millennium park.

Jay Prtizker

The Highlight of Day 2 was a speech given by the director of the National Institute of Health (NIH), Francis Collins (pictured) who was nominated by President Barack Obama in July 2009. Professor Collins supervised the Human Genome Project. If you don’t know him, I recommend Google; otherwise you might be able to see few clips of him playing guitar on Youtube !! He described four opportunities for the NIH to contribute to research in the US and worldwide;

1/ Using high throughput technologies to understand basic biology and uncover causes of diseases

2/ Translating basic science discoveries into better treatments

3/ Putting science to work for the benefit of health care

4/ Encouraging a greater focus on global health

Professor Collins PPP slides are available through the following link;

http://www.nih.gov/about/director/04242010presentation_aapasci.pdf

Francis Colllins with President Obama during a visit to the NIH

During dinner, He reflected on his experience as an MD/PhD student facing a high degree of uncertainty and feeling challenged in a lab that no one spokes English very well to offer some help !! Nonetheless, it was one of Winston Churchill’s quotes hanging on the lab wall that kept his enthusiasm going despite negative results and technical difficulty – ‘’ Success is made by moving from failure to failure to failure’’!!! Keeping this in mind, together with a motivating mentor, Collins research made it to shores with a discovery of genetic locus responsible for sickle cell anaemia. Reflection does not stop at this point for Collins as he pulls out his guitar (with a symbol of the DNA helix imprinted on it) and starts singing with talent !

Later talks focused on how a study of worm biology can yield a therapeutic potential in worms, the mechanism of degenerative disease in muscle disorders and genetic strategies to modify disease pathophysiology.

We were broken into three seminars of ‘how to write a grant’, ‘residency planning’ and ‘the transition from being a medic into a scientist’. I attended the later meeting attended by MD/PhD directors of Rochester University and Stanford University. Directors spoke of perseverance as a quality to cultivate in the beginning of one’s academic career. ‘Two important points you need to remember; select a suitable lab and have perseverance’’, one of the speakers said. Choosing a lab depends on the personality of the student and their supervisors – other important points are whether you prefer working in a lab where you prefer to be left alone to do your own experiments and present whenever you have data, or else a lab where you get monitored constantly and shown what to do. Selecting the appropriate supervisor should be an informed decision of the student following a meeting with the supervisor and exploration of what other students thought of the lab.

Exchange of research ideas and critical feedback of one’s own work take place mostly in the poster session. I have been lucky to have breakfast with Dr Germino, Deputy Director of the National Institute of Diabetes and Digestive and Kidney Diseases. He came afterwards to look at my poster and provided very helpful feedback. It got more exciting when I had another prolific discussion with Prof Marcus, a distinguished scientist from Cornell University. The beauty of the meeting is that you get a chance to meet up with successful and bright physician scientists.

The last day of the conference was highlighted by talks from important physician scientists such as John Niederhuber, Director of the National Cancer Institute, and a noble laureate Ferid Murad, the director of the institute of molecular medicine at the University of Texas. In addition, I had opportunity to listen to elegant presentation of interesting science on stem cell research.

The meeting ended with a lunch with residency directors and directors of MD/PhD programmes across the US.

Even though I travelled by myself to the meeting, I felt very welcomed and accommodated by APSA members including very respectable and approachable MD/PhD colleagues. This made my stay in Chicago even more exciting !!

In short, the meeting is highly enjoyable, very educational, mind broadening and full of opportunities for collaboration and exchange of thoughts, scientific criticism and feedback, but most importantly a great way to make friends !!

So you better watch out for the next AAP-ASCI-APSA meeting ; http://meeting.physicianscientists.org/

New Irish Intern Recruitment Process

For Irish graduates who are keen on doing an intern year, the application deadline is May 6th for jobs starting in July.

You can access all the relevant information here: http://www.hse.ie/eng/staff/jobs/Interns_SHOs_Registrars/Intern_Doctors/

My Personal Tips for the Step 1 by CartoonDoc

This was posted by CartoonDoc (A Cartoon Guide to Becoming a Doctor: http://doccartoon.blogspot.com/) on studentdoctor.net's forum.

1. Your worst subject which will comprise 50% of the exam. The other 50% of the test will be on the female pelvis.

2. Most exam takers will bring ear plugs to protect themselves against noisy people in the room. It is also recommended to bring nose plugs to protect against smelly people in the room. You might also want to blindfold yourself to protect against ugly people in the room.

3. When in doubt, the answer is priapism (the painful prolonged male erection).

4. Regardless of chief complaint or symptoms, every African-American female on the exam has sarcoidosis or possibly lupus. Every Caucasian female has either pelvic inflammatory disease or thyroid dysfunction. The rest of the spectrum of disease is represented in men. Just like in real life.

5. If it's any comfort, nothing you're about to be tested on or have killed yourself learning for the past two years will be at all relevant to your future career. Do you feel better now?

6. The same #1 basic guideline applies as to every other exam you've ever taken: Never fall in love.

7. If you do badly the exam, you can always build a time machine, go back in time, and fix your score. If you do so, just make sure your mom doesn't fall in love with you because it'll, like, disrupt the space time continuum or something.

8. Due to increasing incidence of cheating, proctors have been instructed to perform randomized body cavity searches during the exam. So you may want to rethink some of your old hiding places from the MCATs.

9. Statistically it's been shown that students' scores on Step 1 are reflective of their performance over the past two years, so any studying you're about to do for the exam will statistically be a waste of time. But, you know, don't let that stop you.

10. If all else fails, there's always Plan B: Hide under a pile of coats and hope that everything turns out OK.

Hope that helps!!!

A Cartoon Guide to Becoming a Doctor: http://doccartoon.blogspot.com/

Mental Floss: The Men Behind Famous Diseases

The men behind famous diseases

By Ethan Trex, Mental Floss

(Mental Floss) -- Having a disease named after you is a decidedly mixed bag. On the one hand, your scientific developments are forever commemorated. On the other hand, though, you're stuck with the knowledge that no patient will ever be happy upon hearing your name. Who are the scientists and doctors behind some of our most famous diseases and conditions, though? Here are a few of the physicians and their eponymous ailments:

1. Crohn's disease

The inflammatory digestive disease could just have easily ended up with the name Ginzburg's disease or Oppenheimer's disease. In 1932, three New York physicians named Burrill Bernard Crohn, Leon Ginzburg, and Gordon Oppenheimer published a paper describing a new sort of intestinal inflammation. Since Crohn's name was listed first alphabetically, the condition ended up bearing his name.

2. Salmonellosis

Yes, the salmonella menace that haunts undercooked chicken is named after a person. Daniel Elmer Salmon was a veterinary pathologist who ran a USDA microorganism research program during the late 19th century.Although Salmon didn't actually discover the type of bacterium that now bears his name -- famed epidemiologist Theobald Smith isolated the bacteria in 1885 -- he ran the research program in which the discovery occurred. Smith and his colleagues named the bacteria salmonella in honor of their boss.

3. Parkinson's disease

James Parkinson was a busy fellow. While the English apothecary had a booming medical business, he also dabbled in geology, paleontology, and politics; Parkinson even published a three-volume scientific study of fossils. Following a late-18th-century foray into British politics where he advocated a number of social causes and found himself briefly ensnared in an alleged plot to assassinate King George III, Parkinson turned his attention to medicine. Parkinson did some research on gout and peritonitis, but it was his landmark 1817 study "An Essay on the Shaking Palsy" that affixed his name to Parkinson's disease.

4. Huntington's disease

George Huntington wasn't the most prolific researcher, but he made his papers count. In 1872, a fresh-out-of-med-school Huntington published one of two research papers he would write in his life. In the paper, Huntington described the effects of the neurodegenerative disorder that now bears his name after examining several generations of family that all suffered from the genetic condition.

5. Alzheimer's disease

In 1901, German neuropathologist Alois Alzheimer began observing an odd patient at a Frankfurt asylum. The 51-year-old woman, Mrs. Auguste Deter, had no short-term memory and behaved strangely. When Mrs. Deter died in 1906, Alzheimer began to dissect the patient's brain, and he presented his findings that November in what was the first formal description of presenile dementia.

6. Tourette syndrome

Credit George Gilles de la Tourette for his modesty. When the French neurologist first described the illness that now bears his name in 1884, he didn't name it after himself. Instead, he referred to the condition as "maladie des tics." Tourette's mentor and contemporary Jean-Martin Charcot renamed the illness after Tourette. Tourette didn't have such great luck with patients, though. In 1893, a deluded former patient shot the doctor in the head. The woman claimed that she lost her sanity after Tourette hypnotized her. Tourette survived the attack.

7. Hodgkin's lymphoma

British pathologist Thomas Hodgkin first described the cancer that now bears his name while working at Guy's Hospital in London in 1832. Hodgkin published the study "On Some Morbid Appearances of the Absorbent Glands and Spleen" that year, but the condition didn't bear his name until a fellow physician, Samuel Wilks, rediscovered Hodgkin's work.

8. Bright's disease

The kidney disease bears the name of Richard Bright, an English physician and colleague of Hodgkin's at Guy's Hospital. Bright began looking into the causes of kidney trouble during the 1920s, and in 1927 he described an array of kidney ailments that eventually became known as Bright's disease. Today, doctors understand many of the symptoms historically clumped together as Bright's disease are in fact different maladies, so the term is rarely used.

9. Addison's disease

Guy's Hospital was apparently the place to work in the 19th century if you wanted to have a disease named after you. Thomas Addison, a colleague of Bright and Hodgkin at Guy's Hospital, first described the adrenal disorder we call Addison's disease in 1855. On top of this discovery, Addison also published an early study of appendicitis.

10. Tay-Sachs disease

Although both of their names are attached to this genetic disorder, Warren Tay and Bernard Sachs didn't work together. In fact, they didn't even work in the same country. Tay, a British opthalmologist, first described the disease's characteristic red spot on the retina in 1881. In 1887 Bernard Sachs, a colleague of Burrill Crohn at Mount Sinai Hospital, described the cellular effects of the disease and its prevalence among Ashkenazi Jews.

11. Turner syndrome

The chromosomal disorder got its name from Oklahoma doctor Henry Turner, who first described the condition in 1938.

12. Klinefelter's syndrome

The genetic condition in which males have an extra X chromosome bears the name of Harry Klinefelter, a young Boston endocrinologist who published a landmark study while working under the tutelage of endocrinology star Dr. Fuller Albright in 1942. Albright pushed his young protégé to be the lead author of the paper that described the condition, so the young Klinefelter's name is forever associated with the syndrome.

13. Asperger's syndrome

Austrian pediatrician Hans Asperger first described the syndrome that now bears his name in 1944 after observing a group of over 400 children who suffered from what Asperger described as "autistic psychopathy". Interestingly, since Asperger's research was all written in German, his contributions to the literature went unrecognized until much later. The term "Asperger's syndrome" didn't come into widespread usage until 1981.

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