Kuwait Medical Society, UK/Ireland

Career's day 2012 presentations.

2012-01-15T11:08:00.002Z

Please find the slides for the career's day in this folder.

Career's day 2012 presentations

«الصحة» توقف ابتعاث الأطباء لفرنسا وألمانيا

2011-05-06T02:31:00.000+01:00

الخميس 5 مايو 2011 الأنباء

تدرس وزارة الصحة بالتعاون مع ديوان الخدمة المدنية وإدارة التعليم العالي وقف ابتعاث الأطباء للدراسة في المانيا وفرنسا. وعزت مصادر صحية مطلعة في تصريح خاص لـ «الأنباء» هذا السبب لضعف المخرجات الدراسية للجامعات هناك في بعض التخصصات مما يجعل الطبيب غير مؤهل للعمل في مستشفيات وزارة الصحة. على صعيد آخر، طلبت وزارة الصحة 10 أجهزة جديدة للبصمة والتي ستصل قريبا، وستوزع على عدد من مرافق ديوان الوزارة لمنع حدوث الازدحام بين الموظفين ليصبح عددها 24 جهازا موزعة على جميع مرافق ديوان عام الوزارة. وذكرت مصادر أنه سيتم إعفاء فئة المستشارين في وزارة الصحة من البصمة ممن كانوا يشغلون وظائف مديري إدارة أو مراقبين سابقا في الوزارة، وذلك تقديرا لخدمتهم طوال الأعوام السابقة للوزارة والمساهمة في تطويرها.

Signup to the American Physician Scientist Association Conference April 15th-17th 2011; An opportunity to meet world-class physician scientists

2011-03-12T20:19:00.009Z

If you are a medical student interested in research, this meeting should be one of the items in your to-do list! The 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.

I went to APSA meeting on April last year and tremendously enjoyed it , and here is a 'summary' of the events and highlights from last year's meeting.

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 While summarizing unpublished data, he emphasized the advantage of being a physician scientist whereby the problem is identified in the clinic and taken to the laboratory for thorough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.’

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

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

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 meeting ; http://meeting.physicianscientists.org/

Ayoub Dakson

Membership Committee, Manchester University/UK rep

Please email Ayoubdakson@googlemail.com for further queries.

Support Kuwait University's Community Eye Health Initiative

2010-11-04T23:35:00.002Z

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

2010-07-24T18:06:00.001+01:00

Never be the brightest person in a room !

2010-07-24T01:10:00.004+01:00

''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 ?

2010-07-20T12:36:00.005+01:00

''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

2010-07-18T20:41:00.008+01:00

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

2010-06-21T16:43:00.000+01:00

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

2010-06-19T21:07:00.002+01:00

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

2010-06-07T17:07:00.002+01:00

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 physician²

¹University 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

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.
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.
Pangaro L. A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med 1999;74:1203-7.
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

2010-06-06T17:25:00.005+01:00

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?

2010-06-05T13:45:00.008+01:00

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

2010-06-05T00:54:00.004+01:00

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

2010-06-03T22:11:00.003+01:00

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

2010-05-30T10:10:00.022+01:00

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?

2010-05-20T14:08:00.002+01:00

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!

2010-05-18T20:24:00.000+01:00

First Near-Total Face Transplant Performed by Cleveland Clinic

2010-05-17T13:16:00.000+01:00

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

2010-05-10T16:50:00.005+01:00

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?

2010-05-07T11:32:00.005+01:00

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?

2010-05-05T17:24:00.010+01:00

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

2010-05-05T15:47:00.002+01:00

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

2010-05-05T12:06:00.000+01:00

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

2010-05-03T20:42:00.024+01:00

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.

E. Albert Reece

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

Jay Prtizker

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

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

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

New Irish Intern Recruitment Process

2010-05-02T12:32:00.003+01:00

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

2010-04-28T09:35:00.003+01:00

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

2010-04-27T17:34:00.008+01:00

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.

For more mental_floss articles, visit mentalfloss.com

Drugs!

2010-04-15T11:06:00.003+01:00

Drugs are a high yield topic in the USMLE Step 1 + 2. Some of their effects can be hard to remember if you're not a junkie. Do not despair, Sponge Bob is here to help (Nicked from His & Her Blog http://hishersq8.com/)

Medical Students that Changed the World

2010-04-14T17:12:00.005+01:00

There are many former medical students that achieved positions of great power and influence after graduating. Ex medical students include Che Guevara, Bashar Al-Assad, Bill Frist (Majority Republican leader) and Luke Johnson (founder of Pizza Express). More awe inspiring are medical students that began to influence the world before finishing medical school! Here's a snapshot of some of these medical students that changed the world during their time at medical school:

1. Stephen Bantu (Steve Biko)

Considered one of the most important politicians in South Africa's history. During his time at the University of Natal Medical School, he started the South African Student's Organisation (SASO) which provided legal aid and medical clinics to poor black communities. He founded the Black Consciousness Movement, which sparked the uprise against apartheid in South Africa. Due to his involvement in anti-apartheid politics he was expelled from medical school and 'banned' by the Apartheid government. In 1977, he was killed while in police custody and consequently became a symbol for resistance against Apartheid in South Africa.

2. Joshua Lederberg

Received a Noble Prize, aged 33, for work he did as a medical student at Columbia's College of Physicians and Surgeons. His research provided insight into the molecular mechanisms of gene action, and helped establish the field of molecular biology in the 1940s and 1950s. Instead of finishing medical school, he chose to accept an offer to become an assistant professor the University of Wisconsin-Madison.

3. Meles Zenawi

The current prime minister of Ethipoia and former president, interrupted his medical studies the University of Addis Ababa University for two years to lead the Ethiopian People's Revolutionary Democratic Front (EPRDF), who overthrew the Derg, a military junta. This ended the Derg's reign of Ethiopia, which caused up to 1.5 million Ethiopians to die from famine and the Red Terror.

4. Ernest Duchesne

Who discovered penicillin? If you said Alexander Fleming, you would be wrong! 32 years earlier, a French medical student noticed that moulds kill bacteria. This observation was made, when he noticed that Arab stable boys at the army hospital kept their saddles in a dark, damp room to encourage mould to grow on them. When he inquired they replied that the mould helped the saddle sores heal on the horses. Duchesne then made a solution out of the mould and injected it into diseases guinea pigs. They all recovered. As he was 23 and just a medical student, his findings did not receive recognition and his dissertation did not even get acknowledged by the Insitut Pasteur. His pleas for further research were ignored. He was honored after his death, 5 years after Alexander Fleming got the Nobel Prize for rediscovering penicillin.

All the information was acquired from Wikipedia!

Episode 2 - Interview with Dr Newton (Paediatric Neurology)

2010-04-11T23:12:00.008+01:00

We have interviewed Dr Richard Newton (pictured), a consultant in paediatric neurology at the Royal Manchester Children’s Hospital.

In this episode, we explore important themes such as communicating effectively with families in paediatrics, and how to break ‘unexpected’ news to parents of a child with a newly diagnosed condition. Dr Newton also explains the ingredients for a good paediatric consultation. We also talk about paediatric neurology as a rapidly evolving specialty with a mention of common diseases encountered and challenges facing the specialty locally and internationally.

In the beginning of the interview, Dr Newton explains the contribution of his department to research and helping children with neurological disease. Later, we discuss the spectrum of disorders commonly seen in paediatric neurology. The interview ends with a final note for medical students about to embark on their paediatric placement.

Previous episodes are also available on http://kmsukir.podbean.com/ or by searching for Kuwait Medical Society on iTunes.

We hope you enjoy listening to this episode. Please do not hesitate to contact us if you have feedback, or any other questions.

Case Study - Age No Barrier (from the Medical Protection Society, Case Reports)

2010-04-08T10:24:00.002+01:00

Age no barrier

A seven-year old girl, MA, complained to her mother of stomach ache. She was usually very stoical, but was complaining and not wanting to play. Her mother, Mrs A, was concerned and rang the surgery to speak to her GP, Dr G.

Dr G told her to give her daughter some paracetamol, but did not document the conversation in her notes. The next day, MA was still suffering so Mrs A requested a home visit. The GP went to their home and quickly diagnosed a UTI without examining the girl and prescribed trimethoprim. Dr G made only very brief notes, just mentioning the abdominal pain and the antibiotics prescribed.

According to her mother, Dr G did not stay very long, did not examine her daughter and did not ask for a urine sample to test. Mrs A asked Dr G whether it could be appendicitis, as the pain was on the right side. Her friend’s daughter had recently had appendicitis, which had been right-sided. Dr G said that MA was “too young for that”.

The following day, MA had started to vomit and seemed in much more pain, despite having taken paracetamol. She was also warm to the touch so Mrs A rang the surgery again. A different GP, Dr P, informed her that “antibiotics take time to start working” and to allow another couple of days to see if she improved. Again, the GP made no record in her notes of their discussion on the phone.

Three days after the pain began, Mrs A took her daughter to the Emergency Department (ED). By this time she looked very unwell. She was pale and was lying very still. She was in a lot of abdominal pain if she tried to move. She was vomiting and could not keep any food or drink down. The surgeons diagnosed acute peritonitis and took her straight to theatre where they found a perforated appendix. MA had a miserable stay in hospital, needing intravenous antibiotics, but she did make a good recovery.

MA got married when she was 29 and decided to try for a family. After two years of trying, she still was not pregnant and so went to discuss this with her GP. She was referred for tests and found to have blocked fallopian tubes and pelvic adhesions.

The specialist thought this was likely to have been caused by the perforated appendix and resultant pelvic adhesions years before. MA was very upset and made a claim against Dr G and Dr P. The claim was settled for a moderate sum. Although Dr G had died by this time, so was no longer in membership, the fact that he was a member of MPS at the time of the incident meant that MPS was able to respond to the claim.

Learning points

It is very important to examine a patient with abdominal pain. Doctors must adequately assess the patient’s condition, taking account of the history, the patient’s views and, where necessary, examining the patient.¹ Failure to examine the patient’s abdomen made the case indefensible.
Always be prepared to reconsider a diagnosis made by another doctor.
Some pathologies, such as appendicitis, are more common in certain age groups, but are still possible in others. Differential diagnosis needs to consider both the usual and the unusual.
Simple tests like dip-sticks are there to be used and are helpful in evaluating the likelihood of a diagnosis of UTI. Diagnosing a UTI with no evidence may not be safe.
Clear, comprehensive documentation is an invaluable way to ensure good communication with colleagues when patients are seen by different doctors.
A good defence is almost impossible without good documentation. Doctors must keep clear, accurate and legible records, reporting the relevant clinical findings, the decisions made, the information given to patients, and any drugs prescribed or other investigation or treatment.²
There may be long delays between the incident and a claim being made, which demonstrates the strength of occurrence-based indemnity. Claims can be brought years after a doctor has retired, or even died.

References

1. GMC Good Medical Practice 2006, good clinical care, paragraph 2a.
2. GMC Good Medical Practice 2006, good clinical care, paragraph 3f.

From: http://www.medicalprotection.org/ireland/casebook-january-2010/case-reports/age-no-barrier

Thanks to Marwan Al-Qenaie for sharing this case study!

HAPPY EASTER WISHES FROM KMS !!

2010-04-02T12:39:00.004+01:00

HAPPY EASTER FROM ALL OF US IN THE KUWAITI MEDICAL SOCIETY (UK/IRELAND)

Are Surgeons the Best Looking Doctors? Dr. Shepherd Vs. Dr. House!

2010-03-26T15:54:00.007Z

So I can across this study in the BMJ that compared the height and looks of surgeons and physicians (See below). Will have to agree with the study's conclusion that the film stars are better looking than either!

Phenotypic differences between male physicians, surgeons, and film stars: comparative study

Antoni Trilla, director of preventive medicine and epidemiology unit, Marta Aymerich, consultant, haemopathology unit, Antonio M Lacy, consultant, general and digestive tract surgery unit, Maria J Bertran, specialist, preventive medicine and epidemiology unit

¹ Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain

Correspondence to: A Trilla atrilla@clinic.ub.es

Abstract

Objectives To test the hypothesisthat, on average, male surgeons are taller and better lookingthan male physicians, and to compare both sets of doctors withfilm stars who play doctors on screen.

Design Comparative study.

Setting Typical university hospitalin Spain, located in Barcelona and not in a sleepy backwater.

Participants Random sample of12 surgeons and 12 physicians plus 4 external controls (filmstars who play doctors), matched by age (50s) and sex (all male).

Interventions An independentcommittee (all female) evaluated the "good looking score" (range1-7).

Main outcome measures Height(cm) and points on the good looking score.

Results Surgeons were significantlytaller than physicians (mean height 179.4v 172.6 cm; P=0.01).Controls had significantly higher good looking scores than surgeons(mean score 5.96 v 4.39; difference between means 1.57, 95%confidence interval 0.69 to 2.45; P=0.013) and physicians (5.96v 3.65; 2.31, 1.58 to 3.04; P=0.003). Surgeons had significantlyhigher good looking scores than physicians (4.39 v 3.65; 0.74;0.25 to 1.23; P=0.010).

Conclusions Male surgeons aretaller and better looking than physicians, but film stars whoplay doctors on screen are better looking than both these groupsof doctors. Whether these phenotypic differences are geneticor environmental is unclear.

Introduction

We finished our medical training at the Universityof Barcelona more than 25 years ago, and have enjoyed our workever since. At medical school we noted certain differences betweenmale trainees who selected either surgery or medicine as theirspecialty. The tallest and most handsome male students weremore likely to go for surgery, and the shortest (and perhapsnot so good looking) ones were more likely to become physicians(including doctors of internal medicine and its subspecialties).

Now, after all these years we hypothesise that,on average, surgeons are taller and better looking than physicians.We conducted a comparative study to test this hypothesis.

Methods

We selected a random sample of senior staffsurgeons and physicians working at the University of BarcelonaHospital Clinic (a 700 bed public hospital), matched by age(52 ±7 years) and sex (all men), from the staff payrollof the surgical and medical departments. We contacted all eligibleparticipants by email. If they agreed to participate, theirheight (in cm) was recorded and they were asked to submit adigital picture. Age (in years) was registered and checked againstthat recorded in the payroll database. The external controlswere four well known film stars, mostly in their 50s—HarrisonFord as Dr Richard Kimble (a neurosurgeon in the film The Fugitive),George Clooney as Dr Doug Ross (a paediatrician in the televisionseries ER), Patrick Dempsey as Dr Derek Shepherd (a surgeonin the television series Grey's Anatomy), and Hugh Laurie asDr Gregory House (a nephrologist and infectious disease specialistin the television series House).

We randomly organised the pictures of all surgeons,physicians, and external controls and showed them to an independentgroup of eight female observers—three doctors and fivenurses from our hospital. All observers were in the same agegroup as the participants (no further checking of this informationwas attempted). We decided to avoid (for the time being) maleobservers, because of potential bias. Observers used the "goodlooking score" to classify each participant. This score measuresthe degree of handsomeness on a seven point Likert scale (1,ugly; 7, very good looking).

We discarded the highest and lowest score (outliers)for each participant and used the six remaining scores for ourstudy. Mean scores, differences in means with 95% confidenceintervals, and standard deviations were used to compare thethree groups. We used the standard t test to compare age andthe non-parametric (Mann-Whitney U) test to compare height andmean good looking scores.

Results

We contacted 14 surgeons and 16 physicians (24surgeons and 38 physicians were eligible). Only two surgeonsand two physicians did not answer the questionnaire or senda picture (their out of office auto reply was switched on).Two additional physicians were dropped from the final analysisbecause of the poor quality (technical, of course) of theirpictures. The final analysis therefore comprised 12 physiciansand 12 surgeons plus four external controls.

The mean age of physicians was 50.6 years (SD4.02) and of surgeons 51.1 years (SD 4.11) (P=0.76). The meanheight of physicians was 172.6 cm (95% confidence interval 170.2to 175.4) and of surgeons 179.4 cm (175.1 to 184.0) (P=0.01).

Film stars (external controls) had significantlyhigher good looking scores than surgeons (5.96 v 4.39; differencebetween means 1.57, 95% confidence interval 0.69 to 2.45; P=0.013)and physicians (5.96 v 3.65; 2.31, 1.58 to 3.04; P=0.003). Surgeonshad statistically significantly higher good looking scores thanphysicians (4.39 v 3.65; 0.74, 0.25 to 1.23; P=0.010). We foundsmall, non-significant differences between film stars who playedeither surgeons or physicians. Incidentally, we noted a higherproportion of baldness (surrogate marker) among physicians.

The figure shows a control, a surgeon, and aphysician from our study (the physician and surgeon are by chanceauthors of this study) to provide a snap shot summary of themain study findings.

Sample of participants. Left, surgeon; middle, physician; right, control (George Clooney)

We did not make individual results public. However,widespread rumours, discussions, polls, and illegal bets arosethroughout the institution as a by-product of our study. Ifthey requested, participants were privately told about theirpersonal score compared with the average score of the relevantgroup.

Discussion

Our study shows that, on average, senior malesurgeons are significantly taller and better looking than seniormale physicians. It also shows that film stars who play doctorsare significantly better looking than real surgeons and physicians.

Differences between surgeons and physicians
Perhaps because of their training, surgeonshave a different attitude and approach to the practice of medicinecompared with physicians. The surgeon's image is that of competence,trust, expertise, and compassion.¹ Surgeons are the only doctorswho practise what has been called "confidence based medicine,"which is based on boldness.² They are often practical and fastacting, and they exert tight control on their natural turf—theoperating theatre. Being taller and better looking has severalevolutionary advantages for surgeons. Their extra height makesthem more likely to be masters and commanders, and gives thema better view of the operating room, including the patient lyingon the table. Also, as the senior male surgeon is normally surroundedby junior surgical staff, training fellows, nurses, anaesthetists,and the like, his height and appearance make him easily identifiableas their leader.

How do surgeons become taller and better looking than physicians?
There are several potential explanationsfor the phenotypic changes between surgeons and physicians.Firstly, surgeons spend a lot of time in operating rooms, whichare cleaner, cooler, and have a higher oxygen content than theaverage medical ward, where physicians spend most of their time.Furthermore, surgeons protect (but not always properly) theirfaces with surgical masks, a barrier to facial microtrauma,and perhaps an effective anti-ageing device (which deservesfurther testing). They often wear clog-type shoes, a confoundingfactor that adds 2-3 cm to their perceived height. The incidentalfinding that fewer surgeons are bald might be related to theseenvironmental conditions and to the use of surgical caps.

In contrast, senior physicians are surroundedby fewer people in their habitat (the patient's bedside andthe office), and they therefore have less need to be easilyidentified or spotted by families and nurses in the middle ofa swarm. Physicians tend to hang heavy stethoscopes around theirnecks, which bows their heads forward and reduces their perceivedheight. They also complain of a (clearly abnormal) need to endlesslyupdate their knowledge in accordance with the current evidencebased approach to medicine by reading and studying heaps ofmedical journals; this overload of information further grindsthem down. Although a prospective study found that doctor'swhite coats decrease in weight with increasing seniority, nosignificant difference was found between the mean weight ofphysicians' coats and surgeons' coats (1.4 v 1.5 kg).³

Limitations and future studies
Firstly, we did not independently assessthe height of the study subjects. However, we trust in theirhonesty and believe that any potential bias would always pointin the same direction, as people tend to overestimate ratherthan underestimate their height. Secondly, we did not checkif the submitted photographs had been improved using the latesttechnology. The members of the evaluating committee know allthe study subjects well, and would easily have spotted any grossattempt at cheating (such as submitting photographs taken whenthe subject was younger or photographs of another person). Thirdly,the evaluation process of the good looking score is subjective,but we have no reliable alternative. The best known alternativepublished in the literature (asking a mirror, "Mirror, mirroron the wall, who is the fairest of them all?") works only forqueens, a notable shortcoming of this test.⁴ Although it iswidely known that the mirror always spoke the truth, at presentwe do not have access to this device (not currently suppliedby the Spanish national health system).

Further studies are needed to assess whetherour findings also apply to junior male surgeons and physicians,as well as to senior and junior female staff. Currently thenumber of female surgeons in their 50s at our institution issmall, and we cannot enrol enough study subjects, a situationthat will change no doubt over the next five to 10 years. Webelieve also that a non-crossover design deserves further testing(good looking score of men evaluated by men and a similar systemfor women).

Conclusions
Male surgeons are taller and better lookingthan physicians, but whether these differences are genetic orenvironmental is unclear. However, most surgeons and physiciansare pleased with their career choices and even with their looks(personal communications).

Thanks to all participants in our study whoprovided a breath of fresh air and a touch of humour. Thanksalso to the members of the evaluating committee for taking therisk and having some fun together. Finally, thanks to SarahLafuente and Beatriz Serrano for help in the statistical analysis.

Contributors: All authors designed the study.MA and MJB designed the good looking score. AT and AML are guarantors.

Funding: None

Competing interests: AT is a physician and AMLis a surgeon. AT and MA have been happily married for 25 years.MA's good looking score for AT was not requested to avoid anyproblems at home for Christmas.

Ethical approval: Submitted to the institutionalreview board (IRB) but transferred for approval by the institutionalbeauty review (IBR), an ad hoc subcommittee of our institution.

References

Rowland PA, Coe NPW, Burchard KW, Pricolo VE. Factors affecting the professional image of physicians. Curr Surg 2005;62:214-6.[CrossRef][Medline]
Isaacs D, Fitzgerald D. Seven alternatives to evidence based medicine.BMJ 1999;319:1618.[Free Full Text]
Gordon PM, Keohane SG, Herd RM. White coat effects. BMJ1995;311:1704.[Free Full Text]
Wikipedia. Snow White. http://en.wikipedia.org/wiki/Snow_White.

(Accepted 20 October 2006)

The Best Way to Search the Literature for Clinical Trials on Dementia !!

2010-03-19T17:07:00.008Z

This is a dead easy way of searching the literature for studies looking at effective treatments for dementia and accurate diagnostic tests.

HIGHLY RECOMMENDED !!

This searchable register has been developed recently in Oxford by Noel-Storr and other keen colleagues as part of the Cochrane Collaboration. The project is named ALOIS representing a comprehensive register of dementia studies, with an excellent engine tool that allows users to search the study quoting author name, study design, study aim, drug name...

It is simply the most convenient way of finding information about clinical trials in dementia.

So if you're starting a literature review or interested in dementia clinical research .. you will need to click on the following link;

www.medicine.ox.ac.uk/alois

Good News..Coffee Drinkers..It Can Reduce Your Risk for Arrhythmia !!

2010-03-15T13:23:00.011Z

Picture from www.reallynatural.com/ archives/Coffee%20Lover.jpg

We sometimes hear about the negative tales of coffee increasing your risk of getting atrial fibrillation, a very common form of irregular heart beat. But is it true?

Well.. a research team in San Francisco gave questionnaires to 130,000 people asking them about coffee intake and other lifestyle habits.

The results are good news for coffee lovers. The study showed that coffee drinkers had lower incidence of admission to hospital for heart arrhythmia. Furthermore, this protective effect was considered additive. For example, men and women who drank more than 4 cups of coffee aday had 18% reduction of arrhythmia risk. This result was generated after adjusting for other potential confounding variables such as body mass index, total cholesterol, blood pressure ... ext. The effect was seen consistent across smokers and non-smokers as well as in different ethnic groups.

Dr Klatsky, team leader, suggests that double blinded randomized control trials would be a better test of this effect, although it might be tricky to convince people off coffee and persuade others to drink coffee.

Nonetheless... if you're a medic, would you discourage your patients with atrial fibrillation or other forms of arrhythmia from drinking coffee?

Leaving you with this thought .. I better go now to make my lovely afternoon cup of coffee !

Have a Healthy Day :-)

The Magic of Placebo

2010-03-12T18:04:00.002Z

We posted previously about the placebo effect. Here is Eric Mead demonstrating the placebo effect using magic! Warning: this video is not for the quesy.

A Cartoon Guide to Becoming a Doctor

2010-03-11T12:09:00.003Z

Find this and other silly medical school cartoons from http://doccartoon.blogspot.com/

The Neurobiology of a Wedding

2010-03-07T22:46:00.001Z

Interview with Prof David Neary (Neurology)

2010-02-28T16:29:00.009Z

David Neary is a Professor of Neurology at the University of Manchester, UK, specializing in dementia. He started the Cerebral Function Unit (CFU) in Manchester with a multidisciplinary team of neurologists, neurospychiatrists, neuropathologists, radiologists and biochemists in order to tackle clinical and scientific research into the diagnosis, molecular pathology, pathogenesis and management of dementia. Prof Neary has authored more than 150 publications and three books, two of which are on dementia. In this podcast, we talk about dementia, its subtypes and general management. Finally, we address future challenges facing dementia research and patient care.

Listen to KMS's interview with him (conducted by Ayoub Dakson and Ali Mohsen) now by clicking on the play button in the podbean player below, checking out the podcast on http://kmsukir.podbean.com or searching for the 'Kuwait Medical Society' podcasts on iTunes (where you can subscribe to future podcasts).

Find out more about dementia and its impact on the individual, family, society and scientific research by exploring the following sites;

http://www.hbo.com/alzheimers/

(The Alzheimer's Project contains lots of interesting educational videos about Alzherimer's dementia, the most common of all dementias)

http://alzheimers.org.uk/

(The Alzheimer's society is a large UK organization committed to support patient care and research in dementia, with a wealth of information in their website about the condition)

Selected publications and reading

David Neary.1999. Classification of the dementias. Reviews in clinical gerontology. 9; p 55

(Excellent review the clinical phenotypes and pathology of different dementias from a clinical point of view - highly recommended read)

H. Quefurth and F. LaFerla. 2010. Mechanisms of disease: Alzheimer's Disease.NEJM. 363: p329

(A recent reader friendly review of science's recent advances in understanding the pathogenesis and treatment of Alzheimer's disease)

Subscribe to KMS's Video Podcasts on iTunes!

2010-02-27T13:46:00.005Z

We now have all KMS's videos available on iTunes to view/download for free. Just search for 'Kuwait Medical Society' on iTunes or visit http://kmsukir.blip.tv and click on the link below the video that say 'subscribe to iTunes'.

The videos are formatted so they can watched on your iPods/iPhones or offline. You can subscribe to the podcast to receive our latest offerings. We will use this service to provide more educational material so keep watching this space!

Video Coverage from the Careers Days

2010-02-26T15:39:00.001Z

In addition to photos from the Careers Days (see previous post), we also have... wait for it... VIDEOS of all that took place on Careers Days! So for all KMS's friends in the UK/Ireland who couldn't be home for Christmas to attend, we are sorry you couldn't be there but at least now you can watch all the proceedings from the comfort of your sofa at home. We would be immensely grateful if after watching the videos you e-mail us at kmsukir@gmail.com to let us know what you liked/didn't like about the conference and if you have any suggestions (if you're interested in becoming an active KMS member, or to to learn about future events, let us know in the e-mail).

To watch Careers Day visit our page on blip.tv

http://kmsukir.blip.tv

You can also watch the videos embedded in this blog if you scroll down to previous posts

Coverage includes:

Day 1: Getting into a Speciality - 4 videos

Day 2: The Specialties Panels + Dean's Speech

(Specialties covered = Medicine, Pediatrics, Surgery and Other Specialties)

The careers event took place at Kuwait University on the 29th-30th December 2009. KMS would like to repeat its appreciation for all the help it received from KuMSA, Kuwait University, Dr. Altayyeb Yousef and his fellow speakers who deserve full credit for Day 1 and the panelist for taking part.

Photos from the Careers Days

2010-02-26T15:38:00.001Z

Below is the link to the photostream on Flicker

http://www.flickr.com/photos/47820201@N08/

Finally we have coverage from 2009's Careers Days!

Here's a photo of us at the start of the conference:

And at the end of the conference... It seemes like the stress got to some of us:

Many many many many many heartfelt thanks to all the Kuwait University staff, the speakers/panelists, Dr. Altayyeb Yousef and his fantastic four and KuMSA who without this event would not have been possible. We are very grateful for all the support, which made this conference a fun project to work on (special mention to KuMSA's medical education and media committees. You guys rock!)

Careers Day 1-1 of 4

2010-02-26T15:37:00.000Z

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Introduction by Sarah Al Youha from KMS and Fahad Al Hassan from KuMSA. Postgraduate Training Canada Vs USA by Dr. Altayyeb Yousef. The application process: valuable time-saving tips by Dr. Mohammad Al-Bader and Dr. Mohammad Ibraheem. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Careers Day 1 - 2 of 4

2010-02-26T15:36:00.008Z

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The USMLE and MCCEE: when to do them? How to ace them by Dr. Ali Al-Ali. After the exams: how to ensure your application gets you the most number of interviews and what different program directors are looking for in your CV by Dr. Altayyeb Yousef and Dr. Mohammad Ibraheem. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Careers Day 1 - 3 of 4

2010-02-26T15:35:00.002Z

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The big interview day: what to expect? what are they looking for? (good/bad examples) by Dr. Sadikah Behbehani and Dr. Mohammad Al-Bader. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Careers Day 1 - 4 of 4

2010-02-26T15:34:00.006Z

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Making up your mind: after doing great in the interview and getting many acceptance letters, which institutions and programs will you choose? by Dr. Altayyeb Yousef. Question and answer session and closing. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Introduction and Dean's Speech

2010-02-26T15:33:00.000Z

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Introduction by Sarah Al Youha from KMS, followed by a talk by Professor Fuad Al Ali, Dean of Kuwait University's medical school. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Medicine Panel 1 of 2

2010-02-26T15:31:00.000Z

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The 'Medicine Panel' was co-ordinated by Waleed Al Duaij a medical student from Manchester University and Dr. Yasser Hassan a graduate of Manchester University. The panel was comprised of Dr. Jabir Al-Ali, Gastroenterology; Dr. Salem Al-Shemmeri, Hematology; Dr. Talal Al-Taweel, Medicine; Dr. Kefaya Abdulmalek, ICU; Dr. Mohammad Shamsah, ICU; Dr. Ibrahim Al-Rashdan, Cardiology; Dr. Raed Al-Hashemi, Emergency Medicine; Dr. Ebaa Al-Ozairi, Diabetology. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Medicine Panel 2 of 2

2010-02-26T15:29:00.000Z

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Other Specialties Panel

2010-02-26T15:28:00.000Z

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The 'Other Specialities' panel was co-ordinated by Ayoub Dakson, a medical student from St. Andrews and Manchester University and Dr. Mohammad Ganbar graduate of St. Andrews and Manchester University. The panel was comprised of Dr. Ibrahim Hadi, Anesthesiology; Dr. Asmahan Al Mulla, Pain Management; Dr. Jehad Al Harmi, Obstetrics and Gynecology; Dr. Renu Gupta, Radiology; Dr. Mohammad Al Seaidan, Public Health; Dr. Adel Al Zayed, Psychiatry; Dr. Osamah Al-Baker, Neurology. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Surgery Panel

2010-02-26T15:26:00.000Z

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The 'Surgery Panel' was co-ordinated by Dr. Yousef Al Muhanna, a graduate of Kuwait University, Sarah Al Youha, a medical student from Manchester University and Dr. Talal Al Qaoud, a graduate of Manchester University. The panel was comprised of Prof Adel Ayed, Thoracic Surgery; Dr. Jamal Al Fadhli, Cardiac Surgery; Dr. Fahad Al Asfar, Laproscopic Surgery; Dr. Hisham Burezq, Plastic Surgery; Dr. Manal Bouhaimed, Opthalmology; Dr. Haitham Al-Khayat, Trauma Surgery; Dr. Khalid El Enezi, Trauma Surgery; Dr. Hisham Al-Khayat, Neurosurgery. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Pediatrics Panel

2010-02-26T15:25:00.000Z

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The 'Pediatric Panel' was co-ordinated by Jacob Mathew a medical student from Kuwait University and Dr. Nawal Akbar a graduate of Kuwait University. The panel was comprised of Dr Maitham Hussain, Immunology; Dr. Majeda Abdul-Rasoul, Diabetology Dr. Nawal Makhseed, Metabolic Diseases; Dr. Entisar Hussain, Infectious Diseases; Dr. Eman Mattar, Hemato-Oncology; Dr. Eman Buhamrah, Gastroenterology; Dr. Marzouq Al-Azmi, Emergency Medicine. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

How can sugar pills cure diseases?

2010-02-21T17:42:00.002Z

Ben Goldacre, doctor and author of 'Bad Science', explains what the placebo effect is and describes its role in medical research and in the pharmaceutical industry.

For more about this subject, you can buy the bestselling book, 'Bad Science' by Ben Goldacre, from Amazon

Philosophy and Medicine

2010-02-19T17:58:00.000Z

The word philosophy means “Love of Wisdom”. It’s the study of general and fundamental problems concerning matters such as existence, knowledge, values, reason, mind, and language (taken from Wikipedia). Philosophy is also involved in providing ethical frameworks that outline people’s lives and the tools that one can use to dissect arguments using reason and logic.

In medical school the topic of philosophy is often applicable to ethical principles that outline the day to day dealings of doctors and their patients. But there is much more to philosophy than that, I’m not saying that ethical principles are bad or anything. It’s that philosophy is incredibly undercooked in Medical schools and if taught properly it could aid medical students in critical thinking which in turn is useful in writing literature reviews, performing research and debating people.

My main theme is going to be “arguments” and how to differentiate between “bad” arguments and “good” arguments. A good argument is one that relies on reason, end of story. Sounds easy, you’d think everyone builds arguments on reason but that is not the case. A lot of arguments are fallacious, and do not appeal to reason. I’ll provide some examples, whilst not inclusive of all that critical thinking offers it serve as an introduction into the discipline.

Ad Hominem Argument:

The word Ad Hominem means “the person”. So it is an argument against the person rather than what they’re saying. Unfortunately, this is very common even in day to day arguments. I’ll illustrate this fallacy in a medical context.

Person A: Prescribing medication that has not been proven to work is unethical and resource draining.

Person B: Look who’s talking! Weren’t you the one who cheated on his wife? It’s ironic that you’re talking about ethics.

Explanation: This is an ad hominem argument. It does not matter whether Person A cheated on his wife or not. That’s irrelevant to the argument offered.

Ad nauseum argument:

This means to repeat the argument again and again and again. Just to convince people of it rather than offering evidence of the argument’s validity. This is often encountered in advertisements for products in day to day life.

Person A: Smoking causes heart disease. Smoking causes heart disease. Smoking causes heart disease.

Explanation: Even though smoking has been linked to coronary artery disease. This person presents no evidence to substantiate his argument. He’s just repeating it over and over again.

Strawman fallacy:

This is a hard one to understand. What it means though is that your opponent diverts themselves from the original argument and they create one of their own i.e. “a strawman” and then they proceed to destroy it.

Person A: Abortion should be legalized for the sake of the benefit of patients.

Person B: This legalization of murder shows complete disregard for the sanctity of life and will only lead to the corruption of society.

Explanation: the word “Abortion” does not equal “murder” and so the opponent diverted the argument from the original point and said opponent defeated the strawman.

False Dichotomy Fallacy:

This is one when one offers two choices for one matter when there are actually many.

Person A: We can either have a PBL course or a traditional course. PBL is much better, you don’t want to be spoon fed now, do you?

Explanation: Person A didn’t offer us the third option which is an integrated course i.e. a mix of PBL and lectures thus creating a false dichotomy fallacy.

Appeal to ignorance:

This is when a person tries to persuade us of something due to our ignorance regarding a topic.

Person A: Palates are the best treatment option for Meralgia paraesthetica.

Person B: Where is your proof for that?

Person A: There have been no studies conducted but that doesn’t mean it’s not the best treatment.

Explanation: Absence of evidence is not evidence of absence. But since Person A made that statement the burden of proof falls on them to back it up. If they can’t then we must not take them at face value.

Appeal to Novelty:

Person A: This device is brand new! The company says it uses the latest technology to get rid of varicose veins without the need of an operating theatre. It’s new so it must be good.

Explanation: You’ll see this in the medical world on numerous occasions. Just because a product is new doesn’t mean it’s good. Where is your evidence?

Appeal to Authority:

This is when someone tries to win an argument by saying that their particular statement has been made by someone who is an authority and thus it should be taken at face value.

Person A: In the case of massive pulmonary embolus the patient might get a chest bruise. The consultant told me!

Person B: First of all, it’s an infarct, not a hemorrhage. Why would blood seep out? Second of all how would the blood seep out through all the muscular layers to the superficial layers of the chest?

Person A: Are you calling the consultant a liar? He told me that’s a sign of a PE!!!!

Explanation: Just because someone is in a position of authority doesn’t mean they can make unsubstantiated claims. If anything, they’ve got a higher responsibility of backing their claims with evidence.

That’s all I’m going to talk about for now. It just serves as an introduction to logic and reason. You can Google “logical fallacies” if you want to learn more.

What Happens When You Overwork Yourself... Take a Little Break!!!

2010-02-16T18:56:00.004Z

Sex and its Problems... A Crash Course!! Part 2

2010-02-15T17:53:00.013Z

Psychosomatic Sex Cycle (adapted from Bancroft (2009))

So we've briefly touched on the components of the sexual response. Let's explore now the problems and their prevalence in males and females.

1/ DISORDERS OF SEXUAL DESIRE

Impairment of sexual desire can occur in both men and women; however lack of desire most commonly affects females with 60-70% prevalence rate.

Sexual desire correlates with the testosterone:oestrogen ratio in both genders so that a higher ratio is associated with increased sexual desire. Inhibition or lack of interest is broadly either psychogenic or organic in origin. Psychological factors include early parental problems, society or past experiences eg rape/incest. Organic causes include hyperprolactinaemia due to a pituitary adenoma (if impaired sexual response co-exists with symptoms of headache and impairment of peripheral vision- think pituitary adenoma!!). Diminished testosterone:oestrogen ratio may lead to lack of desire.

Management includes assessment for an underlying organic problem. Psychological problems are far more common, and a good history taker would be able to identify how patient attitudes of past and current relationships, any guilt or indication of early childhood problems contribute to the problem. Relationship therapy and taught focus exercises might be of benefit.

2/ DISORDERS OF SEXUAL AROUSAL

This is represented by erectile difficulties in men and by lack of lubrication and of general sexual responsiveness in women.

IN MEN

About 85% of cases with erectile dysfunction are organic in origin. Risk factors include obesity, lack of exercise smoking, high cholesterol, hypertension and diabetes.

- organic causes;

VASCULAR= atherosclerotic change in penile blood vessels (accounts for half of cases)

NEUROLOGICAL= can be either central (eg in Parkinson's, MS, spinal cord syndrome) or peripheral in origin (eg peripheral neuropathy like diabetic neuropathy or GBS, alchoholism, uraemia).

HORMONAL= Hypoganadism, Cushing's and thyroid diseases, hyperprolactinaemia

ANATOMICAL= Peyronie's disease

DRUGS = beta blockers, diuretics, Cu channel blockers, hormonal agents eg cyptotenone acetate,LH releasing analogues, H2 antagonists eg cimeetidine, ranitidine.

2/Psychogenic causes

- psychosexual factors (can be general due to a disorder of sexual intimacy and lack of arousability or situational due to partner or stress)

-Psychiatric illness ( Generalized anxiety disorder, depression, alcohol dependency)

Management - involves

- history taking ( ask about current/past sexual relationships, current emotional status, erectile symptoms eg onset and duration, arousal ejaculation and orgasmic difficulties). don't forget drug and social history. Latter is important to look for drinking problems, smoking, home situation, difficulties at work/marriage.

-Investigations - blood glucose, U&Es, urinarlysis, LFTs if indicated. If patient also has reduced sexual drive or abnormal sexual characterization, check testosterone levels, LH/FSH, prolactine (especially in young men).

Treatment - correct the underlying cause whether organic or psychological. First line symptomatic treatment is with phosphodiesterase inhibitors (sidenafil, tadafil, vardarefil) or vacuum devices eg external cylinder - one study reported that 23% asked for a prescription after a 2-week trial and 52% reported satisfaction (suitable for older patients).

IN WOMEN

Lack of arousal may be caused by inability to respond to sexual stimulation with dilatation of venous vaginal plexuses and lubrication to reach orgasm.

The causes are;

1/psychosexual;

- inhibitions from learned attitudes, past experiences or marriage difficulties.

- situational anxiety eg about a baby, in parental house

- inadequate stimulation from an inexperienced lover is often a cause of early difficulties

2/ organic

- Causes include drug side effects, neurological problems (MS), vascular disease (Diabetes), postmenopause (low oestrogen).

- Inadequate stimulation or lack of arousal may accompany dyspareunia, which is pain during a sexual intercourse. Fear of pain with intercourse causes anxiety with or without sexual reponse leading to vaginismus (contraction of pelvic muscles resulting in failure of penetrative sex) and more painful intercourse thus creating a vicious cycle.

For medical students reading this, dyspareunia is not an uncommon history station in your OSCE. You have to think of a differential. This depends on the site of the pain, which classifies dyspareunia into introital, midvaginal or deep.

Introital dyspareunia is caused by

-inadequate lubrication or vaginitis (eg due to STI)

-vaginismus

Midvaginal caused by

- urethritis, congenital vaginal abnormalities

Deep dyspareunia caused by

- endometriosis (ectopic bleeding uterine tissue outside uterus), adenomyosis (bleeding uterine tissue within uterine muscle layer), leiomyomata (benign uterine cancer), pelvic inflammatory disease, uterine retroversion or ovarian cyst.

Management

- Take a good history; if patient reports painful intercourse, ask about onset, duration and site of pain, and whether pain occurs with arousal or at penetration. Ask about associated symptoms eg rash, irritation, smell (local aetiology), vaginal discharge (STI), heavy periods and menstrual irregularities (endometriosis) and menopausal symptoms and any dragging sensation (prolapse).

- pelvic and speculum examination

-treatment; to correct the underlying cause. The cycle of fear must be broken in order to stop the pain if no evidence of organic aetiology and anxiety/vaginismus induced dyspareunia is suspected. A specialized Kegel exercise of the pelvic muscle is taught to the patient to learn how to relax pelvic muscles during an intercourse. Lubricants may be used in case of indequate lubrication.

3/ ORGASMIC DYSFUNCTION

5-10% of females report anorgasmia, which can either be primary (never been able to achieve orgasm under any circumstances) or secondary (diminished ability to active orgasm despite previous successful attempts). A study by Kinsey in 1953 found that 9% remain unable to experience orgasm throughout their lives.

Psychosexual factors include fear from momentary loss of control experienced during orgasm and unable to relax and let go. Vaginismus can cause orgasmic dysfunction as well as impaired arousal. Other physical factors include lack of normal bulbo-cavernous reflex which causes failure to reach orgasm.

I hope this brief post made a useful introduction into medical problems affecting sexuality, which is normally a big and complicated area. For further reading, please explore the references below.

Information was adapted from;

- www.patient.co.uk (highly recommended for non-medical readers)

- John Bancroft, human sexuality and its problems. 3rd edition. 2009

- David Goldberg, Linda Gask and Richard Morris. Psychiatry in medical practice. 3rd edition. 2008

Sex and its Problems... A Crash Course!!

2010-02-14T20:49:00.013Z

Sexual problems are badly taught in medical school curricula despite their common prevalence, which represent the top of the ice-burg since many choose not to seek medical advice out of embarrassment or lack of awareness.

For example, one large US survey found that 43% of women and 31% of men between the ages of 18-59 complained of some form of sexual problems during the preceding 12 months. Whereas 2/3rds of men referrals were due to erectile dysfunction, women complained of loss of desire and impaired sexual interest, which commonly co-existed with relationship problems and other problems with arousal.

Hence the purpose of this brief report is to raise educational awareness of these problems and outline a general framework for a differential. First, we illustrate how 'sex' normally works in this post followed by an exploration of related problems in a second post later. So keep tuned!!!

The sexual response consists of 4 essential steps as shown in the diagram;

1/ DESIRE; it is the energy that allows an individual to initiate a response to sexual stimulation

2/ AROUSAL; this is the physical and emotional stimulation leading to breast and genital vasodilatation and clitorial enlargement.

3/ ORGASM; Physical and emotional stimulation maximized allowing the individual to relinquish their sense of control

4/ RESOLUTION; most of congestion and tension resolves within seconds. Complete resolution may take up to 60 minutes.

If you look at the diagram - The frontal cerebral cortex, the thinking part of your brain, feeds positive cognitive stimuli into the limbic system, the seat of your emotions!! ie this loop is where sexual DESIRE is coordinated and governed by individual's attitudes fears and experiences. Through spinal neuronal circuits, the limbic system exerts its stimulating/inhibiting influences on sexual AROUSAL represented by peripheral arousal (respiratory and cardiovascular effects) and genital responses. In order for the individual to know that arousal has taken place, a sensory feedback system sends information to the brain establishing that physical effects of arousal occurred. Tactile/sensory stimulation stimulates the limbic system through spinal centers, and that contributes to ORGASM. Therefore, functional availability of the limbic system and spinal centers are prerequisite for orgasm.

Now, it's easier to think of sexual disorders generally as problems of desire, arousal or orgasm. We'll explore this part next.

Reference

John Bancroft. Human sexuality and its problems. 3rd edition. 2009. Edinburgh

Learn How to Beat Jet Lag!

2010-02-14T14:59:00.020Z

(Picture from http://www.jetlagtips.com/j0202148.jpg)

Did you once travel across 6-8 time zones and developed the following symptoms;

Insomnia

Daytime sleepiness

Diminished physical performance

Cognitive impairment

GI disturbances

That's right! Jet lag is a sleep disorder, although medically benign and self limited within 1-2 days, symptoms can continue until the biological clock in your brain is adjusted to time in the new destination. Jet lag can cause 'serious misjudgments in business or professional dealings' and knowing how to deal with it will make your life less of a 'sleepy' one!!!

So is there an actual clock ticking in your brain? of course there is!!!

Located in the suprachiasmic nucleus in the hypothalamus, right above your inner nose cavity, is where the 'circadian' clock lies. Circadian is derived from latin for 'around the day'.

The Circadian clock responds to the on-and-off cycles of solar light so that it helps you go to bed during night and increases alertness during daytime. It does that cleverly by special nerve cell pathway which starts from the back of your eyes and goes to the hypothalamus, where circadian cells live. Circadian nerve cells can develop a specific pattern of releasing electrical nerve impulses that is specific to length of day and night. In other words, they memorize when night is going to fall. So, they send messages to another tiny structure in your brain called 'pineal gland', which release the hormone melatonin at night to make you feel sleepy.

The problem with jet lag now is that this clock is very old fashioned and needs lots of time to adjust to time of day and night in the new destination. I am sure you're asking now a very intelligent question; can we make it adjust faster? Yes you can!!!

The simple way is to do the opposite of vampires - get as much bright light exposure in the best time of the day as you can. This is recommended in the morning after eastward travel and in the evening after westward travel. I am afraid readjusting the timing of your sleep does not reset the clock.

However, changing your bedtime before flight can shorten the jet lag; it's recommended to shift your sleep time 1-2 hs in accordance to destination time before take off.

If you're getting an overnight flight, like I always do, then you will feel inevitably sleepy during the first 1-2 days in your destination and might need extra recovery sleep to compensate. It is best to avoid longer naps during daytime because they do no good to your nighttime sleep and will reduce your chance of getting some good quality light exposure necessary for resetting your brain clock. So, 'short' naps are better and more effective in order to make you feel less sleepy during daytime.

Early this month in a review in the New England Journal of Medicine, Dr Robert Sack, a psychiatrist specialized in sleep problems from Oregon University, Portland, suggested an alternative way into reseting your brain clock. He discusses the evidence of using melatonin as a night signal. So you can take 0.5-3 mg melatonin at local bedtime nightly if you're going eastward until you get adapted, or 0.5 mg slow short acting dose in the second half of night if you're going westward.

Another option is to sleep in the plane, which I personally can't do to be honest, unless of course if you force yourself into reading a book of medical statistics - what a powerful hypnotic!!! Of course, you don't have to do this torture to yourself! You can take zaleplon, a sleep pill that has 2-3 hr duration of action. If you want to sleep more, then zolpidem and eszopiclone are preferred- a word of warning though, these two can cause grogginess on arrival and can make you feel grumpy rather than shinny!!

You should avoid alcohol if taking these pills. Also if you're at risk of deep vein thrombosis (a condition where blood in leg veins is prone to clotting) eg had a knee surgery, previous history or pregnant, then avoid them.

Table below is from Sack (2010), and summarizes the different approaches one can entertain.

We wish you a safe and comfortable journey wherever you're going!!

Reference;

R. Sack. Jet lag. 2010. NEJM.(362); 440-7.

Queen's University Belfast Scrubs EM Conference BOOKING NOW

2010-02-12T11:19:00.004Z

Dear Medical Student,

Just to let you all know that the medical and surgical society QUB Scrubs is now taking bookings for our Emergency Medicine Conference on Tuesday and Wednesday 9th & 10th March. The conference is going to be held at the Medical Biology Centre at Queen's University Belfast.

The conference is the highlight of our calendar- it's a national conference tailored specifically for undergraduates. It is a 2 day event, with delegates coming from all over the UK and the Republic of Ireland as well as from Queen's. It's not just for students in their clinical years either...it is a fantastic learning opportunity for students from all years, so why not come along to learn, to present your research and have some great craic with other medical students from all over the country?!

FULL DETAILS CAN BE FOUND ON OUR WEBSITE BUT HERE IS A BRIEF SUMMARY BELOW!

WHAT'S INCLUDED?
Day 1 of the conference focuses on expert seminars- a huge number of specialties are covered from paediatrics to trauma surgery, and from management of oesophageal varices to acute poisoning. Day 2 is much more hands on- it is the practical skills workshop, focusing on things like ABGs, immediate life support, suturing, radiology (perfect OSCE preparation).

* Food is provided on both days
* Delegates will receive conference bags with goodies from Scrubs, Wesleyan and MPS who will be attending
* Spot prizes throughout both days

WHAT ELSE?

* If you have done an intercalated degree/original research/audit/literature review and wish to come along to present you work you can do so- just submit an abstract to us via email by Tuesday 9th February. Points are awarded on the UKFPO application for presenting work at conferences so why miss out? We are planning to have our conference party on the first night this year, so that anybody travelling won't miss it if they have to dash off for flights after the second day. We are planning to have the meal/party in Victoria Square on the night of the 9th March- all delegates are invited as well as the speakers.

HOW TO BOOK
If you like the sound of that you can book online via our website; the 2010 Conference page at www.scrubs.society.qub.ac.uk has all the details and info on how to book. We have kept the prices the same as last year- £15 for members and £20 for non-members.
However, we now have double the number of members than we had last year, so with limited places it would be a good idea to book quickly. We know not everybody will want to present research or go to the dinner, so you can opt out of those. At the bottom of the 2010 Conference page on the website just follow the simple instructions.

* In the first box select whether you are a member or non-member, and you can add the evening meal ('dinner') for an additional £10, or add a research presentation ('RP') for an additional £5, or both. * Please fill in the second box (just stick in QUB). * Regardless of whether or not you are having the evening dinner put any special dietary requirements in, because we'll be providing lunch on both days.

Payment is via PayPal, which is totally secure. Information about where to stay can be found on the conference page of our website!

If you have any general queries, or any problems booking just send us an email and we'll get back to you as soon as possible.

We'd love to welcome you to Belfast in March!

Luke Boyle
President, QUB Scrubs

Thanks to Yaqoub Al Qattan for the information

Don't miss; Psych, Neuro and Ophthalmology this weekend in London

2010-02-11T16:41:00.006Z

The Royal Society of Medicine in London is planning a medical student revision day on Sunday 14th Feb for the three tricky specialties...

Neurology Ophthalmology Psychiatry

If you feel you are not confident in these areas, then I promise that you won't regret spending the weekend in London! The clinical lectures are of high standard and handouts with power point slides are provided.

http://www.rsm.ac.uk/students/sta16.php

Addicted to Video Games? Find out about Video Game Dependency or VGD!!

2010-02-10T15:25:00.008Z

(Picture from http://s3.hubimg.com/u/271610_f520.jpg)

Three German scientists conducted a psychological survey of more than 15,000 ninth graders in which 3% of male and 0.3% of female students were found eligible for a diagnosis of Video Game Dependency (VGD).

The authors described students with VGD to have high levels of psychosocial stress including increased truancy, less sleeping hours, lower academic performance in school and less leisure activities. In addition, students also reported increased thoughts of committing suicide.

The study suggests VGD as a clinical phenomenon calling for further descriptive research. This is good news for those who play more often as VGD is considered by authors distinct from excessive playing!!!

Reference;

Florian Rehbein, Matthias Kleimann, Thomas Mößle. Cyberpsychology, Behavior, and Social Networking. -Not available-, ahead of print. doi:10.1089/cpb.2009.0227.

Edward Cullen's Disease

2010-02-04T22:22:00.000Z

Since people have recently gone vampire mad, I thought I'd share some vampire medical trivia.

Some historians claim that the vampire/werewolf folklore emerged from the symptoms of a certain disease. Can anyone guess what condition is linked with tales about vampires?

Castration to Stop Criminal Behaviour Dominated by Hypersexuality - should doctors get involved as agents of social control?

2010-02-02T16:17:00.015Z

medical castration with LHRH agonists (diagram from www.patienthealthinternational.com)

[Prizzi Zarsadias & Josephine Hayes wrote in BMJ Group mailings];

'There are many ways to increase your sex drive, from aphrodisiacs to Viagra. But what about people who need to reduce it? Many European countries and several US states are considering, or already use, chemical castration of sex offenders as part of rehabilitation. Antiandrogenic drugs are used to stop offenders being dominated by sexual thoughts and drive. Some offenders request physical castration to control their sexual urges. But there are questions about doctors' involvement in the process and the side effects of the treatments'

Don Grubin, professor of forensic psychiatry and Anthony Beech, professor in criminological psychology wrote an interesting editorial article in BMJ supporting this case.