Because of the snail's pace that education has developed at, most of us don't really know how to study because we've been told lectures and reading thousands of pages is the best way to go, and no one really wants to do that all day. That's not the only way to study. My first year of medical school... You know when you start the year so committed, then eventually you skip lectures once or twice... then you just binge on skipping? Kinda like breaking a diet "Two weeks in: oh I'll just have a bite of your mac n' cheese... oh is that cake? and doritos? and french fries? Give me all of it all at once." Anyways, when that happened in first year I started panicking after a while; but after studying with friends who had attended lectures, I found they were almost as clueless as I was. I'm not trying to say lectures are useless... What my fellow first years and I just didn't know was how to use the resources we had– whether we were keen beans or lazy pants, or somewhere in between. I still struggle with study habits, but I've formed some theories since and I'm going to share these with you. Reading While reading should not be the entire basis of your studying, it is the best place to start. Best to start with the most basic and detailed sources (ex.Tortora if it's a topic I'm new to, then Kumar and Clark, and Davidson's are where I usually start, but there are tons of good ones out there!). I do not feel the need to read every section of a chapter, it's up to the reader's discretion to decide what to read based on objectives. If you do not have time for detailed reading, there are some wonderful simplified books that will give you enough to get through exams (ICT and crash course do some great ones!). I start with this if exams are a month or less away. Later, it's good to go through books that provide a summarized overview of things, to make sure you've covered all bases (ex. Flesh and Bones, the 'Rapid ______" series, oxford clinical handbook, etc.). These are also good if you have one very specific question about a subject. Video Tutorials**** After all that reading, you want the most laid back studying you can find. This is where Meducation and Youtube become your best friend. (I can post a list of my favourite channels if anyone is interested).I always email these people to thank them. I know from the nice people that run this website that it takes a tremendous amount of effort and a lot of the time and it's just us struggling students who have much to gain. Everyone should use video tutorials. It doesn't matter if you're all Hermione with your books; every single person can benefit from them, especially for osce where no book can fully portray what you're supposed to do/see/hear during examinations. Some youtube channels I like https://www.youtube.com/user/TheAnatomyZone https://www.youtube.com/user/ECGZone https://www.youtube.com/user/MEDCRAMvideos https://www.youtube.com/user/awolfnp https://www.youtube.com/user/harpinmartin https://www.youtube.com/user/RadiologyChannel Lectures We're all thinking it, lectures can be boring. Especially when the speaker has text vomited all over their slides (seriously, If I can't read it from the back of the lecture hall, there's too much!. It's even worse when they're just reading everything to you, and you're frantically trying to write everything down. Here's the thing, you're not supposed to write everything down. If you can print the slides beforehand or access them on your laptop/ipad/whatever you use and follow along, do that. You're meant to listen, nod along thinking (oh yes I remember this or oooh that's what happens? or Oh I never came across that particular fact, interesting!). It's also meant to be a chance for you to discuss interesting cases from the a doctor's experiences. If you're lucky to have really interactive lecturers, interact! Don't be shy! Even if you make a fool of yourself, you're more likely to remember what you learned better. If you happen to be in a lecture you're completely unprepared for (basically 70% of the time?). Think of it as "throwing everything at a wall and hoping something sticks." Pull up the slides on your smart phone if you have one, only take notes on interesting or useful things you hear the speaker say. If all else fails, these lectures where tell you what topics to go home and read about. Tutorials My university has gradually increased its use of tutorials, and I couldn't be happier. Make the most out of these because they are a gift. Having the focused attention of a knowledgeable doctor or professor in a small group for a prolonged period of time is hard to lock down during hospital hours. Ask lots of questions, raise topics you're having trouble understanding, this is your protected time. Discussions In group study activities, this is particularly hard to make the most of when everyone in your group varies in studying progression, but even so, it can be beneficial. Other people's strengths might be your weaknesses and vise versa– and it's always helpful to hear an explanation about something from someone at your level, because they will neither under or over estimate you, and they will not get offended when you tell them "ok I get it that's enough." Myself and 3 of my medic friends would meet once a week the month or two leading up to exams at one of our houses to go through OSCE stations and concepts we didn't understand (food helps too). Besides peer discussions, you should take advantage of discussions with doctors. If the doctor is willing to give you their time, use it well. Practice Questions I am a practice question book hoarder. Practice questions book not only test and reaffirm your knowledge, which is often hard to find if your exams are cumulative and you have little to no quizes/tests. They also have concise, useful explanations at the back and, they tell you where the gaps in your studying are. For my neuro rotation, the doctor giving the first and last lecture gave us a quiz, it was perfect for monitoring our progress, and the same technique can be used in your studies. Practical Clinical Experiences If you freeze up during exams and blank out, and suddenly the only forms of text floating around your brain are Taylor Swift lyrics, these are bound to come to your rescue! "Learn by doing." Take as many histories as you can, do as many clinical exams in hospital, and on your friends to practice, as you can, see and DO as many clinical procedures as you can; these are all easy and usually enjoyable forms of studying. Teaching Have you ever had an experience where one of your peers asks you about something and you give them a fairly good explanation then you think to yourself "Oh wow, I had no idea that was actually in there. High five me." If there is ever an opportunity to teach students in the years below you or fellow students in your year, do it! It will force you to form a simplified/accurate explanation; and once you've taught others, it is sure to stick in your head. Even if it's something you don't really know about, committing yourself to teaching others something forces you to find all the necessary information. Sometimes if there's a bunch of topics that nobody in my study group wants to do, we each choose one, go home and research it, and explain it to each other to save time. If you're doing this for a presentation, make handouts, diagrams or anything else that can be used as an aid.
almost 8 years ago
This diagram was created to summarise my dissertation. It shows numerous methods of immune evasion methods of a cancer cell. I did a lot of research around this subject and never found a diagram that brought this number of methods together, so created one.
over 9 years ago
A bite size summary of Atheroma in 60 seconds I created this as part of a research project into the application of art and media in medicine. Its purpose is to give a quick and memorable visual summary of the pathological process of atheroma. Created by Cilein Kearns using Blender 2.5 beta All modelling, lighting, rigging, materials, texturing, animation etc is 100% my own work, please do not redistribute or host without my advance permission.
over 10 years ago
Cultural change could be just what's needed All of us, at some time, will have experiences of being a patient. At such times we might feel vulnerable as we look to doctors, nurses and other healthcare professionals for help and advice. While most of our experiences will be positive, a significant minority of us will experience difficulties in our interactions with healthcare professionals. For example last year, following a spate of similar reports across the UK, the Older People's Commissioner for Wales found consistent issues concerning the lack of dignity and respect patients received in hospital. These situations can cause real distress for patients, undermine the effectiveness of clinical treatment and sometimes impacts on how fast we might recover. I am interested in how this state of affairs comes about within an NHS that promotes respect, dignity and compassion for all. My research examines what happens to healthcare students during their training in clinical settings that means they sometimes have to be reminded that the person in front of them is a human who deserves compassion and respect. Today's healthcare students are explicitly taught about what comprises professional values and behaviours. However, a large part of learning to become a healthcare professional occurs within the NHS as they observe their seniors – who act as powerful role models – interacting with patients. Sometimes these role models were trained many years ago and belong to a different culture of medicine with different ways of doing things. People who belong to the same cultural group tend to embrace common characteristics such as language, customs and values. In doing this they embrace a common "cultural identity" and achieve a sense of belonging. Likewise, healthcare students tend to embrace common characteristics of their chosen profession. They look to their seniors for guidance about how to behave. But what if their seniors belong to a different era where things that were acceptable then may no longer be acceptable now? One strand of my research examines professionalism dilemma situations. These are situations in which healthcare students find themselves witnessing or participating in something unethical or unprofessional. These include witnessing, and sometimes participating in, breaches of patient safety and dignity. Students often report experiencing distress in such situations as they know the right way to behave, but feel unable to do so for some reason. In their stories, students frequently report feeling unable to speak out for fear of receiving poor grades as their seniors are also their teachers, because they are low in the pecking order or because speaking out might hamper their future career. So how can we support tomorrow's healthcare students to become ethical and compassionate professionals? Revalidation for doctors is coming into force and involves patient and colleague feedback. But our research suggests that, by itself, this is insufficient to change behaviours. We urge healthcare schools to provide students with a safe place to share their stories with each other and with ethical role models so they can begin to make sense of their experiences, share good practice and ways to resist bad practice. Most of all, we suggest that cultural change should occur from within. Patients, patient advocates, students and healthcare professionals should join together to examine how language, practices and values occurring within clinical settings can be developed to improve patient safety and dignity for all.
Dr Lynn Monrouxe
almost 9 years ago
It is understandable why resume writing is daunting for most students – they haven’t achieved many significant things at such young age and they have difficulties to present usual things as something extraordinary. However, you shouldn’t give up on your efforts, because you will be surprised by all things your potential employers consider valuable. All you have to do is find the right way to demonstrate your achievements and relate them to the job you are applying for. The following tips will help you write a great resume that will represent you as an ideal candidate for every employer. 1. Start the process by listing your experiences. You cannot tackle the challenge right where it gets most difficult, so you should gradually work your way towards the precise professional language. Start with brainstorming and create a list of all experiences you consider significant. You can draw experiences from all life aspects, such as school, academic activities, internships, prior employments, community service, sports, and whatever else you consider important. Look at that list and distinguish the most motivating experiences that led you to the point where you currently are. 2. Target the resume towards the job. Sending the same generic resume to all potential employers is a common mistake students do. You should tailor a custom-written resume for each job application, representing experiences and skills that will be relevant for the position you’re applying for. 3. Present yourself as a dynamic person. Find the most active components of your experiences and present them in the resume. Focus on action verbs, because they are attention-grabbing and make powerful statements (trained, evaluated, taught, researched, organized, led, oriented, calculated, interviewed, wrote, and so on). 4. Mark the most notable elements of your experiences and use them to start your descriptions. An employer couldn’t care less about the mundane aspects of college or internships, so feel free to leave them out and highlight your persona as a professional who would be a great choice for an employee. 5. Show what you can do for the organization. Employers are only looking for candidates who can contribute towards the growth of their companies, so make sure to portray yourself as someone who can accomplish great things in the role you are applying for. You can do this by reviewing your experiences and highlighting any success you achieved, no matter how small it is. 6. Don’t forget that your most important job at the moment is being a student. While you’re a student, that’s the most important aspect of your life and you should forget to mention that you are an engaged learner in your resume. Include the high GPA and the achievements in your major as important information in your resume. 7. Describe the most important academic projects. At this stage of life, you don’t have many professional experiences to brag about, but your academic projects can also be included in your resume because they show your collaborative, critical thinking, research, writing, and presentation skills. 8. Present yourself as a leader. If you were ever engaged as a leader in a project, make sure to include the information about recruiting and organizing your peers, as well as training, leading, and motivating them. 9. Include information about community service. If all students knew that employers appreciate community service as an activity that shows that the person has matured and cares for the society, they wouldn’t underestimate it so much. Make sure to include information about your activities as a volunteer – your potential employers will definitely appreciate it. 10. Review before you submit! Your resume will require some serious reviewing before you can send it safely to employers. This isn’t the place where you can allow spelling and grammatical errors to slip through. The best advice would be to hire a professional editor to bring this important document to perfection. One of the most important things to remember is that writing a great resume requires a lot of time and devotion. Make sure to follow the above-listed steps, and you will make the entire process less daunting.
over 7 years ago
Maybe it’s just me, but I cannot get my head around pharmacology and antibiotics are certainly doing their best to finish me off! My group at uni decided that this was one area that we needed to revise, and the task fell on my hands to provide the material for a revision session. So, the night before the session I began to panic about how to come up with any useful tips for my group, or indeed anyone at all, to try to remember anything useful about antibiotics at all. If only Paracetamoxyfrusebendroneomycin was a real drug, it would make our lives so much easier. Come on Adam Kay and Suman Biswas, get the trials started and create your wonderful super drug. For the mean time I guess I will just have to keep blissfully singing along to your song. However, that is not going to help me with my task in hand. After a lot of research that even took me beyond the realms of Wikipedia (something I do not often like to do), I found various sources suggesting remembering these Top 10 Rules (and their exceptions) All cell wall inhibitors are ?-lactams (except vancomycin) All penicillins are water soluble (nafcillin) All protein synthesis inhibitors are bacteriostatic (aminoglycosides) All cocci are Gram positive (Neisseria spp.) All bacilli are Gram negative (anthrax, tetanus, botulism, diptheria) All spirochetes are Gram negative Tetracyclines and macrolides are used for intracellular bacteria Pregnant women should not take tetracyclines, aminoglycosides, fluroquinolones, or sulfonamides Antibiotics beginning with a ‘C’ are particularly associated with pseudomembranous colitis While the penicillins are the most famous for causing allergies, people may also react to cephalosporins If those work for you, then I guess you can stop reading now… If they don’t, I can’t promise that I have anything better, but give these other tips that I found a whirl… Alternatively, I have created a Page on my own blog called Rang and Dale’s answer to Antibiotics, which summarises their information, so please take a look at that. Most people will suggest that you can categorise antibiotics in three ways, and it’s best to pick one and learn examples of them. Mode of action: bactericidal (kill) bacteriostatic (stop multiplying) 2 mnemonics to potentially help you remember examples: We’re ECSTaTiC about bacteriostatics? Erythromycin Clindamycin Sulphonamides Tetracyclines Trimethoprim Chloramphenicol Very Finely Proficient At Cell Murder (bactericidal) - Vancomycin Fluroquinolones Penicillins Aminoglycosides Cephalosporins Metranidazole Spectrum of activity: broad-spectrum (gram positive AND negative) narrow (gram positive OR negative) Mechanism of action Inhibit cell wall synthesis Inhibit nucleic acid synthesis Inhibit protein synthesis Inhibit cell membrane synthesis If you have any more weird and wonderful ways to remember antibiotics, let me know and I will add them! As always, thank you for reading.
Mrs Malaika Smith
almost 8 years ago
What is Problem Based Learning? During my time at medical school, I enjoyed (at times) a curriculum delivered through the traditional model. As the name suggests, this is an approach experienced by the majority of doctors to date. The traditional model was first implemented by the American Medical College Association and American Academy of Medicine in 1894 (Barr, 2010) and has been used by the majority of medical schools. It traditionally consists of didactic lectures in the initial years covering the basic sciences followed by clinical years, where students learn clinical medicine while attending hospital placements. Is It Better? A few years after my graduation I found myself teaching at a university which had fully adopted the use of problem based learning (PBL) in the delivery of their curriculum. PBL is a philosophy of teaching that has increasingly been used in medical education over the past 40 years. It has rapidly been replaced or supplemented in medical education as opposed to the traditional model. PBL seeks to promote a more integrated and active approach to learning right from the first year with less reliance on didactic lectures. Having been involved in these two different approaches to medical education, I was interested to explore what the evidence was for and against each. For the purposes of this blog, I have looked at four specific areas. These include student attitudes, academic achievement, the academic process of learning and clinical functioning and skills. Student Attitudes Student attitudes to PBL have been highly featured in studies and many show that there is a clear favourability towards this philosophy of teaching. Blumberg and Eckenfel (1988) found that students in a problem based preclinical curriculum rated this three times higher than those in the a traditional group in terms of what they expect to experience, what they would like, and what they actually experienced. Heale et al (1988) found physicians in the problem-solving sessions rated a Continuing Medical Education short course higher compared to others who attended traditional lectures and large-group sessions. Vernon and Black (1993) performed a Meta analysis on 12 studies that looked at attitudes and towards PBL and found PBL was favored in some way by all studies. PBL appears to be preferred by the majority of students at a range of academic levels. However, Trappler (2006) found that converting a conventional curriculum to a problem based learning model for part of a psychopathology course did not show complete favourability. Students preferred the conventional lectures given by experts, rather than PBL groups run by mentors and not experts. They did however show preference towards PBL small group sessions run by experts Academic Achievement Academic achievement is an important factor to assess. Vernon and Blake (1993) compared a number of studies and found that those, which could be compared, showed a significant trend favouring traditional teaching methods. However, it was felt this might not be reliable. When looking at the heterogeneity of the studies there was significant variation that could not be accounted for by chance alone. Interestingly, they found that there was significant geographical variation across the United States such that New Mexico showed consistently negative effects and Michigan State showed consistently positive. Other studies have shown that the traditional method may show a slightly better outcome when assessing academic achievement. Schmidt et al (1987) looked at the same progress test taken among students in six different Universities in the Netherlands and found that those taught by a traditional approach showed slightly better outcomes. Baca et al (1990) compared performances of medical students in two separate tracks, one PBL the other a traditional model. Baca et al found that PBL students scored slightly lower in the National Board of Medical Examiners (NBME) examinations. Dochy et al (2003) conducted a meta analysis comparing 43 studies and found that when considering the effect of PBL on the knowledge of students the combined effect size is slightly negative. The academic process of learning It is important in medical education to enable people to continue life long learning, to overcome problems and fill in knowledge gaps. Coles (1990) and Entwistle (1983) found that PBL students would place more emphasis on understanding and meaning compared to just rote learning, seen more in those taught by a traditional approach. Students on a PBL course also place more focus on using resources such as the library and online sources rather than those taught in a traditional approach (Rankin, 1992). Students taught by a traditional model place more emphasis on the resources supplied by the faculty itself. It has also been shown that students who learn through a process of problem solving, are more likely to use this spontaneously to solve new problems in the future compared with those taught in a traditional way (Bransford et al, 1989). Clinical functioning and skills Clinical competence is an important aspect in medical education and has been measured in studies comparing PBL and traditional methods. The traditional model focuses acquisition of clinical competence in the final years of a program with hospital placements. In a PBL course it may be more integrated early on. There are however, only a few studies that look at clinical competence gained in undergraduate PBL courses. Vernon and Blake (1993) compared some of these studies and found that students obtained better clinical functioning in a PBL setting compared to a traditional approach. This was statistically significant, however there was still significant heterogeneity amongst studies and for conclusive results to be made 110 studies would have to be compared, rather that the 16 samples they were able to use. They also found that in contrast to the NBME I giving better results in the traditional model, PBL students score slightly higher in NBME II and federation licensing examination which related more on clinical functioning than basic sciences. On reflection, this evidence has indicated to me that PBL is a very valuable approach and it has a number of benefits. The traditional model in which I was taught has provided a good level of academic education. However, it may not have supported me as well as a PBL course in other areas of medical education such as academic process, clinical functioning and satisfaction. On reflection and current recommendations are for a hybridisation of the PBL and traditional approach to be used (Albanese, 2010) and I would support this view in light of the evidence. References Baca, E., Mennin, S. P., Kaufman, A., and Moore-West, M. A Comparison between a Problem-Based, Community Orientated track and Traditional track Within One Medical school. In Innovation in Medical Education; An Evaluation of Its Present Status. New York: Springer publishing Barr D. (2010) Revolution or evolution? Putting the Flexner Report in context. Medical Education; 45: 17–22 Blumberg P, Eckenfels E. (1988) A comparison of student satisfaction with their preclinical environment in a traditional and a problem based curriculum. Research in Medical Education: Proceedings of the Twenty-Seventh Annual Conference, pp. 60- 65 Bransford, J. D., Franks, J. J., Vye, N. J., & Sherwood, R. D. (1989). New Approaches to Instruction: Because Wisdom Can't Be Told. In S. Vosiadou & A. Ortony (Eds.), Similarity and Analogical Reasoning (pp. 470 297). New York: Cambridge University Press. Coles CR. (1990) Evaluating the effects curricula have on student learning: toward a more competent theory for medical education. In: Innovation in medical education: an evaluation of its present status. New York: Springer publishing; 1990;76-93. Dochy F., Segersb M., Van den Bosscheb P., Gijbelsb D., (2003) Effects of problem-based learning: a meta-analysis. Learning and Instruction. 13:5, 533-568 Entwistle NJ, Ramsden P. Understanding student learning. London: Croom Helm; 1983 Heale J, Davis D, Norman G, Woodward C, Neufeld V, Dodd P. (1988) A randomized controlled trial assessing the impact of problem-based versus didactic teaching methods in CME. Research in Medical Education.;27:72-7. Trappler B., (2006) Integrated problem-based learning in the neuroscience curriculum - the SUNY Downstate experience. BMC Medical Education 6: 47. Rankin JA. Problem-based medical education: effect on library use. Bull Med Libr Assoc 1992;80:36-43. Schmidt, H G; Dauphinee, W D; Patel, V L (1987) Comparing the effects of problem-based and conventional curricula in an international sample Journal of Medical Education. 62(4): 305-15 Vernon D. T., Blake R. L., (1993) Does Problem-based learning work? A meta-analysis of evaluated research. Academic Medicine.
Dr Alastair Buick
over 8 years ago
In a recent article in the BMJ the author wonders about the reasons beyond the rising trend diagnosing Attention Deficit Hyperactivity Disorder (ADHD). The article attempts to infer reasons for this. One possible reason was that the diagnostic criteria especially DSM may seem for some to be more inclusive than ICD-10. The speculation may explain the rise of the diagnosis where DSM is used officially or have an influence. In a rather constructive way, an alternative to rushing to diagnosis is offered and discussed in some details. The tentative deduction that the Diagnostic Statistical Manual (DSM) may be one of the causes of rising diagnosis, due to raising the cut-off of age, and widening the inclusion criteria, as opposed to International Classification of Diseases, 10th revision (ICD-10), captured my attention. On reading the ICD-10 diagnostic criteria for research (DCR) and DSM-5 diagnostic criteria, I found them quite similar in most aspects, even the phraseology that starts with 'Often' in many diagnostic criteria, they seem to differ a bit in age. In a way both classification, are attempting to describe the disorder, however, it sounds as if someone is trying to explain a person's behaviour to you, however, this is not a substitute to direct clinical learning, and observing the behaviour, as if the missing sentence is 'when you see the person, it will be clearer'. El-Islam agrees with the notion that DSM-5 seems to be a bit more inclusive than ICD-10. A colleague of mine who is a child psychiatrist and she is doing her MSc. thesis in ADHD told me, that DSM-5 seems to be a substantial improvement as compared to its predecessor. The criteria - to her - though apparently are more inclusive, they are more descriptive with many examples, and she infers that this will payback in the reliability of the diagnosis. She hopes gene research can yield in biological tests for implicated genes and neurotransmitters in ADHD e.g. DRD4, DAT, gene 5,6,11 etc. One child psychiatrist, regretted the fact that misdiagnosis and under-diagnoses, deprive the patient from one of the most effective treatments in psychiatry. It is hoped the nearest forthcoming diagnostic classification (ICD-11), will address the issue of the diagnosis from a different perspective, or else converge with DSM-5 to provide coherence and a generalised newer standard of practice. The grading of ADHD into mild, moderate, and severe seem to blur the border between disorder and non-disorder, however, this quasi-dimensional approach seems realistic, it does not translate yet directly in differences in treatment approaches as with the case of mild, moderate, severe, and severe depression with psychotic symptoms, or intellectual disability. The author states that one counter argument could be that child psychiatrists are better at diagnosing the disorder. I wonder if this is a reflection of a rising trend of a disorder. If ADHD is compared to catatonia, it is generally agreed that catatonia is less diagnosed now, may be the epidemiology of ADHD is not artefact, and that we may need to look beyond the diagnosis to learn for example from environmental factors. Another issue is that there seems to be significant epidemiological differences in the rates of diagnosis across cultures. This may give rise to whether ADHD can be classified as a culture-bound syndrome, or whether it is influenced by culture like anorexia nervosa, or it may be just because of the raising awareness to such disorders. Historically, it is difficult to attempt to pinpoint what would be the closest predecessor to ADHD. For schizophrenia and mania, older terms may have included insanity, for depression it was probably melancholia, there are other terms that still reside in contemporary culture e.g. hypochondriasis, hysteria, paranoia etc. Though, it would be too simplistic to believe that what is meant by these terms was exactly what ancient cultures meant by them, but, they are not too far. ADHD seems to lack such historical underpinning. Crichton described a disorder he refers to as 'mental restlessness'. Still who is most often credited with the first description of ADHD, in his 1902 address to the Royal College of Physicians. Still describes a number of patients with problems in self-regulation or, as he then termed it, 'moral control' (De Zeeuw et al, 2011). The costs and the risks related to over-diagnosis, ring a warning bell, to enhance scrutiny in the diagnosis, due to subsequent stigma, costs, and lowered societal expectations. They all seem to stem from the consequences of the methodology of diagnosis. The article touches in an important part in the psychiatric diagnosis, and classifications, which is the subjective nature of disorders. The enormous effort done in DSM-5 & ICD-10 reflect the best available evidence, but in order to eliminate the subjective nature of illness, a biological test seems to be the only definitive answer, to ADHD in particular and psychiatry in general. Given that ADHD is an illness and that it is a homogeneous thing; developments in gene studies would seem to hold the key to understanding our current status of diagnosis. The suggested approach for using psychosocial interventions and then administering treatment after making sure that it is a must, seems quite reasonable. El-Islam, agrees that in ADHD caution prior to giving treatment is a recommended course of action. Another consultant child psychiatrist mentioned that one hour might not be enough to reach a comfortable diagnosis of ADHD. It may take up to 90 minutes, to become confident in a clinical diagnosis, in addition to commonly used rating scales. Though on the other hand, families and carers may hypothetically raise the issue of time urgency due to scholastic pressure. In a discussion with Dr Hend Badawy, a colleague child psychiatrist; she stated the following with regards to her own experience, and her opinion about the article. The following is written with her consent. 'ADHD is a clinically based diagnosis that has three core symptoms, inattention, hyperactivity and impulsivity in - at least - two settings. The risk of over-diagnosis in ADHD is one of the potentially problematic, however, the risk of over-diagnosis is not confined to ADHD, it can be present in other psychiatric diagnoses, as they rely on subjective experience of the patient and doctor's interviewing skills. In ADHD in particular the risk of under-diagnosis is even more problematic. An undiagnosed child who has ADHD may suffer various complications as moral stigma of 'lack of conduct' due to impuslivity and hyperactivity, poor scholastic achievement, potential alienation, ostracization and even exclusion by peer due to perceived 'difference', consequent feelings of low self esteem and potential revengeful attitude on the side of the child. An end result, would be development of substance use disorders, or involvement in dissocial behaviours. The answer to the problem of over-diagnosis/under-diagnosis can be helped by an initial step of raising public awareness of people about ADHD, including campaigns to families, carers, teachers and general practitioners. These campaigns would help people identify children with possible ADHD. The only risk is that child psychiatrists may be met with children who their parents believe they might have the disorder while they do not. In a way, raising awareness can serve as a sensitive laboratory investigation. The next step is that the child psychiatrist should scrutinise children carefully. The risk of over-diagnosis can be limited via routine using of checklists, to make sure that the practice is standardised and that every child was diagnosed properly according to the diagnostic criteria. The use of proper scales as Strengths and Difficulties Questionnaire (SDQ) in its two forms (for parents SDQ-P and for teachers SDQ-T) which enables the assessor to learn about the behaviour of the child in two different settings. Conner's scale can help give better understanding of the magnitude of the problem. Though some people may voice criticism as they are mainly filled out by parents and teachers, they are the best tools available at hands. Training on diagnosis, regular auditing and restricting doctors to a standard practice of ensuring that the child and carer have been interviewed thoroughly can help minimise the risk of over-diagnosis. The issue does not stop by diagnosis, follow-up can give a clue whether the child is improving on the management plan or not. The effects and side effects of treatments as methylphenidate should be monitored regularly, including regular measurement height and weight, paying attention to nausea, poor appetite, and even the rare side effects which are usually missed. More restrictions and supervision on the medication may have an indirect effect on enhancing the diagnostic assessment. To summarise, the public advocacy does not increase the risk of over-diagnosis, as asking about suicidal ideas does not increase its risk. The awareness may help people learn more and empower them and will lead to more acceptance of the diagnosed child in the community. Even the potential risk of having more case loads for doctors to assess for ADHD may help give more exposure of cases, and reaching more meaningful epidemiological finding. From my experience, it is quite unlikely to have marked over-representation of children who the families suspect ADHD without sufficient evidence. ADHD remains a clinical diagnosis, and it is unlikely that it will be replaced by a biological marker or an imaging test in the near future. After all, even if there will be objective diagnostic tests, without clinical diagnostic interviewing their value will be doubtful. It is ironic that the two most effective treatments in psychiatry methylphenidate and Electroconvulsive Therapy (ECT) are the two most controversial treatments. May be because both were used prior to having a full understanding of their mechanism of action, may be because, on the outset both seem unusual, electricity through the head, and a stimulant for hyperactive children. Authored by E. Sidhom, H. Badawy DISCLAIMER The original post is on The BMJ doc2doc website at http://doc2doc.bmj.com/blogs/clinicalblog/#plckblogpage=BlogPost&plckpostid=Blog%3A15d27772-5908-4452-9411-8eef67833d66Post%3Acb6e5828-8280-4989-9128-d41789ed76ee BMJ Article: (http://www.bmj.com/content/347/bmj.f6172). Bibliography Badawy, H., personal communication, 2013 El-Islam, M.F., personal communication, 2013 Thomas R, Mitchell GK, B.L., Attention-deficit/hyperactivity disorder: are we helping or harming?, British Medical Journal, 2013, Vol. 5(347) De Zeeuw P., Mandl R.C.W., Hulshoff-Pol H.E., et al., Decreased frontostriatal microstructural organization in ADHD. Human Brain Mapping. DOI: 10.1002/hbm.21335, 2011) Diagnostic Statistical Manual 5, American Psychiatric Association, 2013 Diagnostic Statistical Manual-IV, American Psychiatric Association, 1994 International Classification of Diseases, World Health Organization, 1992
Dr Emad Sidhom
over 7 years ago
In equatorial Africa, a region of the globe known as the “lymphoma belt,” children are ten times more likely than in other parts of the world to develop Burkitt’s lymphoma, a highly aggressive blood cancer that can be fatal if left untreated. That area is also plagued by high rates of malaria, and scientists have spent the last 50 years trying to understand how the two diseases are connected.
about 6 years ago
Introduction This post describe the creation of a Stroke Summary video. The aim of this project was to assess the attitudes of medical students towards the use of video animation in medical education. An educational tutorial was produced outlining the basic principles of stroke. This aimed to provide a summary of different aspects relating to stroke, outlined in the Bristol University curriculum. This intended to be a short, concise animation covering stroke presentation, definition and recognition, with an overview of the blood supply to the brain and the classification of stroke presentation used in clinical practice. This was followed by some key facts and a summary of different management stages. After the video animation was produced an assessment of student’s attitudes using an online questionnaire was undertaken. This consisted of ten short questions and an open text feedback for additional comments. The video was then edited with reference to feedback given by students and the results analysed. This report will outline relevant research and project work that lead to this assignment being undertaken. A description of the method followed to generate the video animation and to collect feedback on students will be outlined followed by analysis of results. This will then be discussed in relation to previous work and research. Background There are a number of reasons this project has been undertaken. On a personal level, I have a long-standing interest in teaching and medical education. As part of a previous project I created a series of audio tutorials in cardiovascular medicine and assessed student attitudes to audio learning. The findings of this report showed that a large number of students found these audio tutorials useful and would like more of these available to supplement their learning. One of the questions given to students at this time assessed how useful they found different types of educational material. This project showed students reporting audio tutorials more useful than previously thought, while also reporting that they were not readily available. Although a video tutorial was not provided to them at this time, feedback questions assessed attitudes to video tutorials as a learning resource. Students reported low availability and felt they would be more useful than audio tutorials. Some results from this project are shown in figure 1. Figure 1. Results from previous research by Buick (2007), showing attitudes of students towards different learning tutorials. The majority of students report audio tutorials to be ‘quite useful’ or ‘very useful’. Video tutorials are thought by students to be more useful that audio tutorials, however there is a large proportion that do not have access to these learning resources. As a number of students reported an inability to access to video tutorials, it was thought that creating a video animation tutorial followed by assessing students attitudes would be a useful follow up project. If this is found to be a useful resource, other students may generate video tutorials in the future. Therefore student feedback also assessed attitudes towards authenticity, relating to who generates the tutorial and whether they find the ability to feedback a useful tool. Medical education is widely researched globally, although it is not often a consideration for those studying medicine. Those involved in teaching and educating future doctors have looked at different methods of passing on knowledge. A high quality medical education given to future healthcare professionals is important. It is widely accepted that a better knowledge results in better care for patients and education is at the centre of any healthcare system. This is reflected in the cost of educating medical students and training doctors in the UK. In the 1997 it was reported by the Department of Health that estimates of 200 million pounds would be spent per year for an increase in 1000 medical students being trained in the UK. This suggests that the cost of training a medical student is in the region of £200,0001. Medical education in the UK is split in two halves, with undergraduate and postgraduate training. The Department of Health has recently invested millions of pounds into the development of online tutorials for postgraduate training posts in a number of different specialities. Justification for is given by reducing the cost of training through the use of standardised online tutorials. This will be a more cost effective method than the standard in hospital teaching. This approach has not been undertaken for undergraduate medical education. Universities are seen as primarily responsible for undergraduate training. Many of these institutions have used the Internet to aid teaching and have produced video tutorials. However, as reflected in the previous project (Buick, 2007), resources are often limited and students do not feel they have ready access to these educational tutorials. The benefits of different types of learning resource have been researched. These include online audio downloads (Spickard et al, 2004), practice exam questions and interactive tutorials (Hudsen, 2004). Research showing the benefit of video was shown by Balslev et al (2005) comparing video and written text while teaching a patient case. Balsley et al (2005) found those who learnt using a video presentation rather than those given written text showed a significant increase in data exploration, theory evaluation and exploration. However, there is little research looking specifically at video animation for explaining conditions. Animation software is now available on personal computers and is also possible using Microsoft PowerPointTM, which is the most widely used presentation software. It is clear that recent trends show training can benefit from this type of learning resource. Generation of high quality video tutorials can help students learn while reducing the cost of training. It is for this reason that more material is likely to become available, either from funded production supported by external organisations or by the trainers and trainees themselves who have technology able to produce material such as this on their home computer. Ethical and Legal Issues During the development of this video some ethical and legal issues arose that had to be addressed before a final video could be made. When considering what imagery would be used in the video, I wanted to include pictures of clinical signs relevant to the audio narration. However, taking images from the Internet without prior consent was not thought to be ethical and therefore clinical signs were displayed graphically through drawings and diagrams. Plagiarism and copyright were some of the legal issues surrounding the presentation of medical information. Narrated information was generated using a number of information sources, none of which were exclusively quoted. Therefore an end reference list was generated showing all supporting information sources. Images used in the animation were either self generated or taken from sources such as Wikipedia.org. This resource supplies images under a free software license such as GNU general public license2. This allows anyone to freely use and edit images while referencing the original source. Skills Needed To Develop This Video Animation To generate the video a number I had to develop a number of new skills. Unlike previous work that had been undertaken this media was generated using animation software. To use this effectively I had to research the different functions that were available. To do this I combined reading books aimed to teach beginners such as Macromedia Flash 8 for Dummies (Ellen Finkelstein and Gurdy Leete, 2006) and online sources such as www.learnflash.com . To generate voice narration, another program was used that allowed editing and splicing of audio tracks. This was then split up into a number of narrated sections and added to the animation. Method Script To produce the tutorial the first stage was to construct a script for narration. This involved outlining the areas to be covered. The main headings used were: Stroke definition This gave a clinical definition and a lay person recognition mnemonic called FAST which is used to help members of the general public recognise stroke. Pathophysiology This covered blood supply to the brain. This combined diagrams of the circle of Willis, with images of the brain. Arterial blood supply were then displayed over the brain images while relating this to the arterial vessels leaving the circle of Willis Classification Students at Bristol university are asked to understand the Oxford / Bamford classification. This was covered in detail with explanations of clinical signs that may be seen and graphical representation of these. Prevalence This section covered prevalence, national impact and cost of stroke in the UK. Management In this section management was split up it to immediate management, medical management, in hospital care and some of the procedures considered for different cases. Risk factors for stroke and research into this was also written up and narrated. However at a later stage this was not included due to time constraints and video length. Narration An audio narration was generated using software called ‘Garage Band’ which allows audio tracks to be recorded and edited. The narration was exported in 45 sections so that this could then be added to the animation at relevant points. Animation The animation was made using Adobe Flash. This software is used for making websites and animations used for Internet adverts. It has the facility to export as a ‘flash video format’, which can then be played using a media player online. This software generates animation by allowing objects to be drawn on a stage and moved around using command lines and tools. This was used as it has the ability to animate objects and add audio narration. It also is designed for exporting animations to the Internet allowing the material to be accessed by a large number of people. Feedback A short questionnaire was generated which consisted of ten questions and placed online using a survey collection website (www.surveymonkey.com). Students were directed to the feedback questionnaire and allowed to submit this anonymously. Adapting the tutorial Some feedback constructively suggested changes that could be made. The video was updated after some concern about the speed of narration and that some of the narrative sections seemed to overlap. Analysis and Report The results of the feedback were then collected and displayed in a table. This was then added to the report and discussed with reference to research and previous project work. Results Students were allowed to access to the video animation through the Internet. After uploading the video an email was sent to students studying COMP2 at Bristol University. These students are required to know about aspects of stroke covered in this tutorial to pass this section of the course. The email notified them of the options to view the tutorial and how to give feedback. In total 30 students completed the feedback questionnaire and out of these 4 students provided optional written feedback. The results to the questions given were generally very positive. The majority of students showed a strong preference to video animations as a useful tool in medical education. The results are displayed in Table 1 below. TABLE 1 shows the ten question asked of the students and to what extent they agreed with each statement. Results are given in the percentage of students who chose the relevant category. Written Feedback Four written comments were made: "Really useful presentation!! Would be much better if someone proof read the whole thing as there are some spelling mistakes; also if the pauses between facts were longer it would be more easier to take in some facts. Overall, really nicely done!!" "Some of speech went too quickly, but good overall" "Very clearly written with excellent use of images to match the text and commentary!" "The Video was excellent." Discussion Student attitudes to this video tutorial were very positive. This was in contrast to the attitudes previously shown in the audio tutorial project (Buick, 2007) where video tutorials were not thought to be a useful resource. These results support recent developments in the generation of online video training for doctors by the Department of Health and previous research by Balsley et al (2005). Question one showed that the majority of students strongly agreed that the stroke video would be a useful resource. Questions two, three and four aimed to establish what aspects of a disease were best outlined using a video animation. Results showed that students agree or strongly agreed that defining the condition, pathophysiology and management were all well explained in this format. Interestingly, a large majority of students (70%) felt pathophysiology was best represented kinaesthetically. This may be due to the visual aspect that can be associated with pathophysiology. Disease processes are often represented using diagrams in textbooks with text explaining the disease process. Using computer technology it is possible to turn the text into audio narration and allow the user to view dynamic diagrams. In this way, students can better conceptualise the disease process, facilitating a more complete understanding of disease and its clinical manifestations. Question five aimed to highlight the benefit of visual stimulation as well as audio narration as a positive learning method. All students agreed or strongly agreed that the combination of these two aspects was beneficial. Question six showed a very strong response from students wanting access to more video tutorials, with 70% of students strongly agreeing to this statement. It is often the case that students take part in generating teaching material, and some students may be concerned that this material is inaccurate. However, many students do not think that this is a significant problem. This is reflected by the spread of student’s opinion seen in question 7, where there was no clear consensus of opinion. It may be that as students learn from a number of different resources, that any inaccuracies will be revealed and perhaps stimulate a better understanding through the process of verifying correct answers and practicing evidence based medicine. Question nine and ten show that most students value resources that allow sharing of educational material and feel they could help others learn. They would also value the option to feedback on this material. The written feedback showed positive responses from students. However there was feedback on some aspects of the video that they felt could be changed. The narration was delivered quickly with few gaps between statements to keep the tutorial short and concise, however this was thought to be distracting and made it less easy to follow. Following this feedback the narration was changed and placed back on the Internet for others to review. Further research and investigation could include the generation of a larger resource of video animations. My research has suggested that using animation to cover pathophysiology may be most beneficial. The software used to make this video also allows for the incorporation of interactive elements. The video produced in this project or other videos could have online menus, allowing users to select which part of the tutorial they wish to view rather than having to watch the whole animation, or they include interactive questions. Reflections Strength and weaknesses Strengths of this project include its unique approach to medical education. There have been few animated videos produced for undergraduate medical students that use this advanced software. This software is used by professional web developers but can be used effectively by students and doctors for educational purposes to produce video animation and interactive tutorials. For these reasons, I passionately believe that this technology could be used to revolutionise the way students learn medicine. If done effectively this could provide a more cost effective and engaging learning experience. This will ultimately benefit patients and doctors alike. This material can be place online allowing remote access. This is increasingly important for medical students studying on placements who are often learning away from the university setting. Weaknesses of this project include that of the work intensity of generating animated video. It is estimated that it takes around 6 to 9 hours to produce a minute of animated video. This does not include the research and recording of narration. The total sum of time to generate material and the additional skills needed to use the software makes generation of larger numbers of videos not possible by a small community of learners such as a university. Although it was done in this case, it is difficult to edit the material after it has been created. This may mean that material will become inaccurate when new advances occur. The feedback sample collected was opportunistic and the response rate was low. These factors may bias the results as only a subsection of opinions may have been obtained. These opinions may not be representative of the population studied or generalisable to them. It was difficult obtaining a professional medical opinion about the video in the time that I was allocated. However this has been organised for a later time. Knowledge and skills gained During this project I was able to learn about stroke its presentation, classification, management and risk factors. I read texts, which summarised stroke and research into risk factors and management of stroke. The challenge of usefully condensing a subject into a short educational tutorial was a challenging one. I feel I improved my skills of summarising information effectively. I gained knowledge of some of the challenges of undertaking a project such as this. One of the largest challenges included how long it took to produce the animation. In the future I will be aware of these difficulties and allow for time to gather information and generate the material. I also learnt the benefit of gaining feedback and allowing for adaption to this. It took more time to respond to feedback but this resulted in a better product that other students can use. I also reflected on the impact of stroke itself. Stroke has a major impact on patients, health care and carers. Much can be done in the recognition classification and management. A better understanding benefits all areas and I have gained a better knowledge and the importance of helping others gain a good understanding of stroke. I learned how to generate a video animation for the use of teaching in medicine and combine this with audio presentation. I learned how long it can take to generate material like this and the skill of organising my time effectively to manage a project. I can use this skill in the future to produce more educational material to help teach during my medical career. I also gained skills in learning how to place material on the Internet for others to access and will also use this in the future. Conclusions Previously evidence has shown the use of videos in medical education to be beneficial. It has normally been used to demonstrate clinical examination and procedures this study suggest there is a place for explanation of pathophysiology and disease summaries. However, there has been little research in to its use for graphically representing condition summaries. Computer technology now allows people to generate animation on their personal computer. It is possible that over time more students and doctors will start producing innovative visual and audio teaching material. This project indicates that this would be well received by students. References Planning the Medical Workforce: Medical Workforce Standing Advisory Committee: Third Report December. 1997 Page 40. The GNU project launched in 1984. Balslev T, de Grave W S, Muijtjens A M and Scherpbier A J (2005) Comparison of text and video cases in a postgraduate problem-based learning format Medical Education; 39: 1086–1092 Buick (2007) Year 3 External SSC. Bristol University Medical School. Spickard A, Smithers J, Cordray D, Gigante J, Wofford J L. (2004) A randomised trial of an online lecture with and without audio; Medical Education 38 (7), 787–790. Hudson J. N., (2004) Computer-aided learning in the real world of medical education: does the quality of interaction with the computer affect student learning? Medical Education 38 (8), 887–895. Ellen Finkelstein and Gurdy Leete, (2006) Macromedia Flash 8 for Dummies. Wiley publishing Inc. ISBN 0764596918
Dr Alastair Buick
almost 12 years ago
Dr Danielle Reddi is a Pain Research Fellow and Speciality Registrar in Anaesthesia at University College London Hospital, London, NW1 2BU, Dr Natasha Curran is Consultant in Pain and Anaesthesia, UCLH and Dr Robert Stephens is Consultant in Anaesthesia, UCLH.
about 6 years ago
Children's palliative care in Wales needs more "strategic attention" by ministers and the NHS, a new report says.
about 6 years ago
Introduction to Epidemiology and public health Epidemiology is the study of the patterns, causes, and effects of health and disease in defined populations. It is the cornerstone of public health, and informs policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive medicine. Epidemiologists help with study design, collection and statistical analysis of data, and interpretation and dissemination of results (including peer review and occasional systematic review). Epidemiology has helped develop methodology used in clinical research, public health studies and, to a lesser extent, basic research in the biological sciences. Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" (1920, C.E.A. Winslow). It is concerned with threats to health based on population health analysis. The population in question can be as small as a handful of people or as large as all the inhabitants of several continents (for instance, in the case of a pandemic). The dimensions of health can encompass "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity", as defined by the United Nations' World Health Organization. Public health incorporates the interdisciplinary approaches of epidemiology, biostatistics and health services. Environmental health, community health, behavioral health, health economics, public policy, insurance medicine and occupational health (respectively occupational medicine) are other important subfields. From Wikipedia, the free encyclopedia. http://en.wikipedia.org/wiki/Epidemiology
over 7 years ago
This is a review of 'Research Skills for Medical Students' 1st Edition (Allen, AK – 2012 Sage: London ISBN 9780857256010) Themes – Research Skills, Critical Analysis Medical Students Thesis – Research and critical analysis are important skills as highlighted by Tomorrow’s Doctors Detailed Review Allen, drawing on many years’ experience as a researcher and lecturer in the Institute of Education, at Cardiff University has bridged the gap in Research methodology literature targeted at medical students. Pushing away from comparative texts somewhat dry and unengaging tones, this book encourages student interaction, empowering the student from start to finish. Not so much a book as a helpful hand guiding the student through the pitfalls and benefits of research and critical analysis from start to finish. Part of the Learning Matters Medical Education series, in which each book relates to an outcome of Tomorrow’s Doctors, this book is written from the a lecturers standpoint, guiding students through making sense of research, judging research quality, how to carry out research personally, writing research articles and how to get writings published. All of these are now imperative skills in what is a very competitive medical employment market. This concise book, through its clarity, forcefulness, correct and direct use of potentially new words to the reader, Allen manages to fully develop the books objectives, using expert narrative skills. With Allen’s interest in Global health, it is little wonder why this books exposition is clear and impartial, Allen consistently refers back to the Tomorrows doctors guidelines at the beginning of each chapter, enabling students to link the purpose of that chapter to the grander scheme. This enables Allen to argue the relevance of each chapter to the student before they have disregarded it. Openly declared as a book aimed at medical students (and Foundation trainees where appropriate) the authors style remains formal, but with parent like undertones. It is written to encapsulate and involve the student reader personally, with Allen frequently using ‘you’ as if directly speaking to the reader, and useful and appropriate activities that engage the reader in the research process, in an easy to use student friendly format. This book is an excellent guide for all undergraduate health students, not limited to medical students, and I thank Ann K Allen for imparting her knowledge in such a useful and interactive way.' This was original published on medical educator.
over 8 years ago
So you're sitting in a bus when you see a baby smile sunnily and gurgle at his mother. Your automatic response? You smile too. You're jogging in the park, when you see a guy trip over his shoelaces and fall while running. Your knee jerk reaction? You wince. Even though you're completely fine and unscathed yourself. Or, to give a more dramatic example; you're watching Titanic for the umpteenth time and as you witness Jack and Rose's final moments together, you automatically reach for a tissue and wipe your tears in whole hearted sympathy ( and maybe blow your nose loudly, if you're an unattractive crier like yours truly). And here the question arises- why? Why do we experience the above mentioned responses to situations that have nothing to do with us directly? As mere passive observers, what makes us respond at gut level to someone else's happiness or pain, delight or excitement, disgust or fear? In other words, where is this instinctive response to other people's feelings and actions that we call empathy coming from? Science believes it may have discovered the answer- mirror neurons. In the early 1990s, a group of scientists (I won't bore you with the details of who, when and where) were performing experiments on a bunch of macaque monkeys, using electrodes attached to their brains. Quite by accident, it was discovered that when the monkey saw a scientist holding up a peanut, it fired off the same motor neurons in its brain that would fire when the monkey held up a peanut itself. And that wasn't all. Interestingly, they also found that these motor neurons were very specific in their actions. A mirror neuron that fired when the monkey grasped a peanut would also fire only when the experimenter grasped a peanut, while a neuron that fired when the monkey put a peanut in its mouth would also fire only when the experimenter put a peanut in his own mouth. These motor neurons came to be dubbed as 'mirror neurons'. It was a small leap from monkeys to humans. And with the discovery of a similar, if not identical mirror neuron system in humans, the studies, hypotheses and theories continue to build. The strange thing is that mirror neurons seem specially designed to respond to actions with clear goals- whether these actions reach us through sight, sound, smell etc, it doesn't matter. A quick example- the same mirror neurons will fire when we hop on one leg, see someone hopping, hear someone hopping or hear or read the word 'hop'. But they will NOT respond to meaningless gestures, random or pointless sounds etc. Instead they may well be understanding the intentions behind the related action. This has led to a very important hypothesis- the 'action understanding' ability of mirror neurons. Before the discovery of mirror neurons, scientists believed our ability to understand each other, to interpret and respond to another's feeling or actions was the result of a logical thought process and deduction. However, if this 'action understanding' hypothesis is proved right, then it would mean that we respond to each other by feeling, instead of thinking. For instance, if someone smiles at you, it automatically fires up your mirror neurons for smiling. They 'understand the action' and induce the same sensation within you that is associated with smiling. You don't have to think about what the other person intends by this gesture. Your smile flows thoughtlessly and effortlessly in return. Which brings us to yet another important curve- if mirror neurons are helping us to decode facial expressions and actions, then it stands to reason that those gifted people who are better at such complex social interpretations must be having a more active mirror neuron system.(Imagine your mom's strained smile coupled with the glint in her eye after you've just thrown a temper tantrum in front of a roomful of people...it promises dire retribution my friends. Trust me.) Then does this mean that people suffering from disorders such as autism (where social interactions are difficult) have a dysfunctional or less than perfect mirror neuron system in some way? Some scientists believe it to be so. They call it the 'broken mirror hypothesis', where they claim that malfunctioning mirror neurons may be responsible for an autistic individual's inability to understand the intention behind other people's gestures or expressions. Such people may be able to correctly identify an emotion on someone's face, but they wouldn't understand it's significance. From observing other people, they don't know what it feels like to be sad, angry, surprised or scared. However, the jury is still out on this one folks. The broken mirror hypothesis has been questioned by others who are still skeptical about the very existence of these wonder neurons, or just how it is that these neurons alone suffered such a developmental hit when the rest of the autistic brain is working just dandy? Other scientists argue that while mirror neurons may help your brain to understand a concept, they may not necessarily ENCODE that concept. For instance, babies understand the meaning behind many actions without having the motor ability to perform them. If this is true, then an autistic person's mirror neurons are perfectly fine...they were just never responsible for his lack of empathy in the first place. Slightly confused? Curious to find out more about these wunderkinds of the human brain? Join the club. Whether you're an passionate believer in these little fellas with their seemingly magical properties or still skeptical, let me add to your growing interest with one parting shot- since imitation appears to be the primary function of mirror neurons, they might well be partly responsible for our cultural evolution! How, you ask? Well, since culture is passed down from one generation to another through sharing, observation followed by imitation, these neurons are at the forefront of our lifelong learning from those around us. Research has found that mirror neurons kick in at birth, with infants just a few minutes old sticking their tongues out at adults doing the same thing. So do these mirror neurons embody our humanity? Are they responsible for our ability to put ourselves in another person's shoes, to empathize and communicate our fellow human beings? That has yet to be determined. But after decades of research, one thing is for sure-these strange cells haven't yet ceased to amaze and we definitely haven't seen the last of them. To quote Alice in Wonderland, the tale keeps getting "curiouser and curiouser"!
over 7 years ago
Itraconazole is an antifungal drug used widely to treat fungal infections and is active against Aspergillus, Candida and Cryptococcus. It is effective and now much cheaper as it has passed out of the period of time granted to its inventor to exclusively sell it - there are now several competing manufacturers. It seems to be an increasingly useful and used drug now it has become more accessible which is a good thing in the main but this makes it increasingly important that this drug is properly understood and its very severe potential side effects appreciated and guarded against. These are the warnings published by the World Health Organisation Risk of congestive heart failure The agency says that while the available evidence suggests that the risk of heart failure with short courses of itraconazole is low in healthy, young patients, prescribers should exercise caution when prescribing the drug to at-risk patients. Amendments to the product information of all itraconazole formulations have been made to reflect this information. Risk to pregnant women By April 2000 the UMC had received 43 case reports from 5 countries regarding the use of itraconazole by pregnant women. 25 of these pregnancies ended in embryonic or foetal death. The remaining 19 reports described a variety of congenital malformation or neonatal disorders. In the 38 reports in which the route of administration was specified the drug was taken orally. The data suggested that: inspite of the approved recommendations and warnings itraconazole is being taken by pregnant women for minor indications, reported human experience seems to lend support to the experimental evidence that itraconazole is teratogenic, there is a predominance of abortion, and more firm warnings may be needed in the product information.Although not apparent from the UMC reports, a further question of interest was if itraconazole might decrease the reliability of oral contraceptives and so lead to unintended exposure in pregnancy. Care thus needs to be taken about which patients are prescribed itraconazole, adequate monitoring needs to be put in place if needed and sufficient advice given with the drug to ensure the patient is aware of the risks involved and the signs & symptoms to look out for.
over 8 years ago