Just thought I'd alert everyone to a great resource I've discovered on the internet. It's on the Monash Medical Centre's radiology registrar website and provides great alogorithms for determining whether patients' require imaging for various clinical presentations. Check it out at:
January 2008 Archives
Check out these radiation oncology FAQs from the US-based Student Doctor Network forums! Go there now...
Dr. Elliot Fishman, director of diagnostic radiology and body CT, and colleagues designed a test to determine which web resources best delivered accurate information to medical students most efficiently. Efficiency was based on the number of links one had to view. Students were randomized to complete the exam by using either Google or any other web resource. Participants repeated the exam with the alternative arm in two weeks. An analysis of the results from 86 medical students who completed the protocol showed that Google was more efficient compared with all alternatives (mean links 1.50 versus 1.94, p = 0.002). Following a Google search, 89% of end-sites identified that provided correct answers were medical websites. The most frequent alternatives used to initiate a search were the search engines Yahoo and Ask, and the encyclopedia Wikipedia. Yahoo yielded comparable correctness to Google (96% versus 97%) but was less efficient (mean links 1.90 versus 1.54, p<0.001).
From: http://www.dimag.com/showNews.jhtml?articleID=205901754
By default the My Medical Career community requires users to approve all colleague requests. This is a privacy setting to make sure that people cannot just add you as a colleague unless you allow this.
Adding colleagues allows you to talk to people addressing similar medical careers issues as you and see what they are up to.
In Edit my account there is an option to decide whether
- anyone can list you as a colleague
- colleagues must be approved by you
- nobody may list you
If you have set your account up so that you can moderate colleagues, the Colleague requests menu option allows you to manage this.
More suggestions about modernising medical careers, this time focussed on India.
Key suggestions:
ALL – INDIA PREMEDICAL SCREENING TEST - MANDATORY to get admission into Government or Private Medical Colleges –need to PASS [60%]. Results are notified as PASS or FAIL only
Exam conducted by CENTRAL BOARD – NEW DELHI
ADMISSION TO MEDICAL COLLEGES either by Entrance
Tests conducted by State Government or by Central Government Or through Management seats in Private Medical colleges.
Eligibilty : PASS in ALL – INDIA PreMedical Sceening test mandatory + HIGH SCHOOL completion certificate(+2)
MBBS Degree replaced by MD Degree in all medical colleges
MEDICAL LICENCING EXAM OF INDIA
[written or computer based]
STEP I [ preclinical + paraclinical subjects]
STEP II [ Clinical subjects]
STEP II Clinicals[ OSCE]
MEDICAL LICENCING EXAM OF INDIA
STEP 3 written or computer based [ MD style MCQ’s management of clinical conditions in Primary care and Urgent
care ] exam taken before completing INTERNSHIP
FULL REGISTRATION WITH MEDICAL COUNCIL OF INDIA with medical licence and relevant State medical council
DNB degree replaces all postgraduate courses [ MD,MS,MCH, Diplomas]
DNB Part 1 exam [ conducted by National Board of Examinations NBE ]
Specialty based exam [eg: Anesthesia, Surgery, Medicine..]
[written test or computer based ]
ELIGIBILITY for applying to this exam : 6 months of SHO post in that Specialty attached to a MCI recognized medical school and department
WORK AS A REGISTRAR for 36 months minimum with a Postgraduate Training number as applicable by National Board of Examinations
In that particular specialty where the candidate has passed the Part I DNB
DNB Part II exam [ Specialty exit exam ]
Part II written or computer based test
Part II Clinical + orals [ OSCE style]
Eligibility : 36 months completed in that Specialty as a Registrar , registered with National Board of Examinations and passed Part 1 DNB in that specialty
DNB degree holders could practice as Specialists in Government institutes and training Institutes , Private hospitals, clinics or take up further training in Subspecialties
DNB Part III Exam for Subspecialties conducted by National Board of Examinations
Part III written or computer based
Part III clinicals + orals [ OSCE style]
Eligibilty : 2 yrs as Senior Registrar post in MCI recognized teaching
Hospital and hold a DNB degree in that Broad specialty
Do you agree? Go to http://www.aippg.net/forum/viewtopic.php?p=198235to make your suggestions?
Post about the UK The Health Select Committee and the medical careers crisis in the UK
http://chezsams.blogspot.com/2008/01/health-select-committee-meeting-4.html
Blog post from paging dr jess about planning for the future
http://pagingdrjess.blogspot.com/2008/01/planning-future.html
As an intern, I take days one at a time. Once in a while, I'll actually look a few days ahead and plan to do something fun on my day off. However, I rarely look much further in the future. One of my medical students was bemoaning that the school was asking them to put in schedule requests for their rotations next year. It does seem difficult when you've only finished half a year to figure out what you want to do the next year, especially when these years are supposed to shape your future career. I told my medical student to suck it up because it doesn't end. I just submitted my schedule requests for the 2008-2009 year.
Filling out that form was mind boggling. When do I want to take vacation next year? I had to email all my engaged friends and ask if they were planning weddings before July 2009. When do I want to be in the ICU? Which ICU? What about electives? What do I want to be doing on July 1st? That's when I'm a brand new resident with brand new interns. I'll be a resident in less than six months!
Luckily, I'm on emergency coverage now with more than average free time. (Thank goodness my co-interns haven't been inflicted with that raging diarrhea that's going around.) So, I was actually able to step back and look at myself. I found that a lot of me is the same. I still want to spend vacations with my husband when he's on break from school. I'm still interested in outpatient medicine despite the copious amount of time I have spent in the hospital this year. And I'm still terrified that I will make a mistake and kill someone. Those were my guiding principles in filling out my requests.
What's changed about me? Less than I thought. While I'm on the wards or in the ICU, time is limited, so I don't get to indulge myself in my hobbies. Yes, spending time cooking or watching TV seems like an indulgence. (Luckily the writers' strike is making it easy for me to stay away from my television.) However, now that I have more free time, I have found happily that I am much the same person that I remember I was. And I'm relieved. Yes, I've changed as a clinician, but I'm still me.
Blog post about applying to medical school.
Introduction
I was speaking with a group of undergraduate pre-med students who asked me when I thought someone should “give up” on seeking admission into medical school. My first inclination was to say that if medical school and medicine is your “dream” you should never “give up”. I thought a bit about what might be behind the question and I thought it might make a good essay topic for my blogs.
“Should”
I have never been a person who dealt in “shoulds” in terms of what might be the best situation for anyone’s life and life pursuit. If you want something and if really desire something, then pursue that “something” and make sure that you are in the best possible situation to achieve your goal. Any realistic (and the emphasis here is on realistic) goal is achievable in taking small steps daily toward it. Certainly, you cannot possibly reach anything if your are not moving “toward” it.
Long-term
The pursuit of admission to medical school and medicine is a bit like having more than 100 pounds to lose. You have to be consistent with your work on a daily basis or you are not going to see results. This means that everything “counts” and you can’t afford to “slack” or you won’t reach your goals. Your undergraduate work is an opportunity to set yourself up with solid and disciplined study skills that can take you into medical school and beyond. It is also an opportunity to learn how to learn and master coursework. Just as daily exercise and diet modification will lead you closer to losing that 100 pounds (ounces at a time), daily preparation/study and mastery of your coursework will lead you closer to your goal (one semester at a time).
As you have probably heard, this is not a “sprint” but a “marathon” and like a marathon, you can’t just lace up your running shoes and expect to finish a 26.2 - mile race without some daily training and preparation. If you are not comfortable with long-term goal achievement, then use your undergraduate to obtain the characteristics that will make you comfortable with long-term goal achievement.
Overcoming difficulties
There are plenty of physicians out there who didn’t start off strong as an undergraduate. Perhaps they had some maturity problems or perhaps they just didn’t have the academic skills for the pre-med coursework but the important thing is that they kept their goals in mind. If something is not working for you in terms of getting your coursework mastered, then change it.
You can decide at this very minute -even if you are on the verge of dismissal- that you are going to turn your academics around “by any means necessary”. The process of doing this “turn-around” can be a huge asset in terms of making you competitive for medical school but you have to be successful. Just thinking about getting your academics together (like dreaming about losing 100 pounds) won’t make it happen but taking some active steps toward changing your methods will get results.
Many students have gone from extremely low undergraduate performances to getting themselves competitive but the process is not easy or short. Again, it’s back to the daily and consistent work with constant checkpoints to make sure that you are keeping on track. Enlist the assistance of any study skills courses at your school; enlist the help of peer tutors; enlist the help of a good academic adviser. In short, get help from any resources that you can find. Often, your school’s counseling service can help you identify resources at your school that can help you. You have to take the first steps and be willing to make some changes. Why not make the changes because what you are doing is either successful or it’s not?
Just remember, undergraduate “GPA damage control” is a long and expensive process. If you know this going in, then you can prepare yourself for the long haul. Again, medicine is not a sprint, it’s a long-term goal.
“Deal-breakers”
There are some things that are very, very difficult to overcome. I place things like academic dishonesty, felony convictions and substance abuse problems. Most medical schools, even if you are sitting there with a uGPA of 4.0 and an MCAT of 45, are not going to be very interested in you with these things in your background. If you have a substance abuse problem, get it taken care of long before you anticipate entry into medical school. There are excellent substance abuse programs out there and you can’t hide from your problems forever. Medical school on any pharmaceutical substance (other than pharmaceuticals prescribed by a physician within the guidelines of established medical practice) is expensive and heading for a crash either physically or legally. Neither of these are things that a prospective medical school would like to deal with. In short, take care of what you need to take care of and educate yourself so that you can handle life without drugs of any kind. If you “think” you have a problem with tobacco, alcohol, uppers, downers and any other illicit substances, then you have a “problem”. Get your “problems” solved as soon as they are identified.
Living in the “Real “World
You are going to read (and hear) stories out there about John or Jane X who got into Medical School A or B with a GPA of 2.5 and an MCAT or 20. Those John and Jane X’s are very, very unlikely to be real people. The average uGPA for medical school matriculants in 2007 was around 3.65 and the average MCAT was around 31. This means that the further from those average on the low side that you are, the lower your chances of admission. Admission to medical school with a uGPA of 2.5 is not impossible but it is improbable since the uGPA averages have been increasing every year. Get your uGPA as high as you can period. Get the highest MCAT score that you can period.
There are also folks out there who would believe that if you are an URM (Underrepresented Minority) in medicine, that you can get into medical school with drastically lower GPAs/MCAT. This is simply not the case because you have to have something in your application that shows you are capable of mastery of a challenging medical curriculum. If you are a URM and far below the uGPA/MCAT averages, then you likely don’t have a competitive application. Do what you have to do, to make yourself competitive and be prepared to take some years to get this done. I don’t care what your ethnicity/race is, you still have to be able to get through medical school if admitted. Admission is no guarantee that you will complete medical school. If you uGPA/MCAT is low, get yourself competitive by whatever means you have at your disposal.
But when do I “give up”?
You must answer this question for yourself. Preparation, application and matriculation in medical school is a very expensive process. How much time and money do you have? If you are a re-applicant, what you have you done to significantly improve your chances of admission? Just reapplying to medical school to “show them that you really, really want this” is not enough. You have to make some improvements on your application before you spend that money to reapply. Again, take a realistic look at what might have kept you out and get it improved.
If your application didn’t work this year, rework everything that you can rework before you submit for a future year. If you are reapplying to the same schools, you especially need to change and improve everything about your application that can be changed. Get fresh letters of recommendation, rewrite your personal statement (I don’t care how wonderful you believe it is, it didn’t work) and take more coursework if your uGPA is very low. Retake the MCAT if that is holding you back. (Beware though, retaking the MCAT and scoring lower can be a death blow). What ever you do, be sure to make it an improvement and not a change for the worse.
Looking at other career options
Some people believe that if they explore other career options such as physician assistant, nursing or physical therapy, that they are somehow giving up their dream. Nothing could be further from the truth. Explore other careers and have a realistic appraisal of how competitive you are for those careers. You may find that one of those careers better suits you in the first place from the standpoint of time of schooling to what your actual interests/motivation for medicine might be.
I am not advocating for anyone to seek to be a physician assistant, nurse or physical therapist because they “couldn’t get into medical school” but I am advocating that you should have a career back-up that you can love and pursue. You may not be competitive for physician assistant, nursing or physical therapist or you may not be interested in these great careers but you can’t make an honest decision without career exploration first. You may find again, that these careers are a great option for you and a better option than medicine.
Parting thoughts
Finally, be willing to let any of your advisers take a long and hard look at your competitiveness for medical school. If you don’t get in, get input from any and every excellent resource that you can find. Your goal is success on reapplication and you want to do everything that is within your grasp to ensure your success. Only you can tell when it’s time to move on to another career option and it’s YOUR life to live as you wish. Enlist any and all help that you can to get what you both need and want out of life.
The pursuit of becoming an excellent physician is a long goal. There will be people along the way who will tell you what you “can” and “cannot” accomplish. If you know yourself, and have faith in yourself, you know that you can accomplish anything that you want. You have to be willing to “run your own race” and take care of your own “needs”. There are as many routes into medical school as their are medical students.
If you should decide that you don’t want to pursue medicine, then that’s the best decision for you. Don’t let your life’s dream be anyone’s other than your own. It takes a fair about of courage to stand back, take a realistic appraisal of where you are and make the decision to move on to something else.
The other thing to consider is that getting into medical school does not have an age limit. Just because you decide not to continue with the pursuit next year does not mean that you can’t do something else and revisit medical school application three, four or even ten years down the line. As long as you have the desire, the stamina and are willing to earn competitive credentials, then give yourself a couple of years to decompress before you dive back into this process. If something doesn’t “click” for you in 2006, it might “click” in 2009 because you are a different person with a different perspective.
From: http://medicinefromthetrenches.blogspot.com/2008/01/when-hould-i-give-up-on-applying-to.html
About 70 medical students appointed to regional hospitals around Western Australia over the coming year will be arriving tonight in Kalgoorlie, in the south-east, for their orientation week.
The Rural Clinical School is made up of fifth year medical students from the University of Western Australia, as well as Notre Dame University.
The 69 students will spend their time in a practical medical environment in 10 regional hospitals.
http://www.abc.net.au/news/stories/2008/01/21/2142765.htm
At times, 57-year-old Christianne Bishop is keenly aware of the three decades separating her and fellow residents at Erlanger hospital. They are mostly a batch of ambitious, energetic twenty-somethings.
“Remember high school and the little cliques? It’s kind of like that,” she said. “I’m outside that since I’m married and older.”
But that doesn’t bother the Southern California native who, after 10 years as a court reporter and a career as a physical therapist, decided in her 40s to fulfill a lifelong dream to go to medical school, an ambition long delayed by marriage, motherhood and perceptions of what was socially acceptable.
“It was unheard of in 1980 to be outside of the traditional 22 to 25 (age range). Not only that, but very few women were accepted” to medical school, Dr. Bishop said.
The eldest members of the baby boomer generation — a demographic wave of Americans born after World War II — turn 62 this year. While surveys find that many are planning to work well into their retirement, either part time or volunteering, a large number also plan to go into new fields.
Less common is the baby boomer embarking upon a career in medicine, a venture that requires an enormous commitment of time, money — and guts.
“It requires not just physical stamina, but it requires courage to do this,” said Dr. Mack Worthington, chairman of the family medicine residency program at Erlanger and president of the Tennessee Medical Association. “Think about coming back to a very structured environment that has a high degree of stress in it.”
Dr. Worthington oversees the work of Dr. Bishop, a second-year resident in the program.
“She’s a high-energy person,” he said. “Many people don’t have the energy when they get on in their life, but there are others who continue to be very active people in their 50s and 60s. Some of them run circles around people in their 30s.”
The decision to go to medical school in his 40s was decidedly more capricious for Ringgold, Ga., native John Emberson, now 58 and an obstetrician-gynecologist in Chattanooga.
After 12 years as an agricultural extension agent for the University of Georgia and another dozen years as a farmer and construction worker, his wife one day offhandedly suggested he might try medicine.
“It wasn’t like I’d always wanted to be a doctor,” he said. “The odds of a 40-something-year-old farmer getting into medical school aren’t real good. You kind of have to figure there’s a little divine intervention along the way.”
It wasn’t all divine, however, said Dr. Emberson, who attended the Medical College of Georgia in Augusta.
“I’d hate to do it again, but I would definitely do it,” he said. “Medical school was pretty intimidating. ... The kids that you’re going to school with are the age of my children.”
new opportunities
A 2005 Merrill Lynch study of more than 3,400 baby boomers found that most of them plan to work in retirement and, of those who will continue working, 56 percent expect to work in a completely different field.
Anti-discrimination legislation and widespread acceptance of women in the medical field have broken down many of the barriers to embarking upon a new career late in life, boomers here said.
“When I applied to medical school I was 28 or 29,” Dr. Worthington said. “One of the schools I applied to wrote back and said sorry — they weren’t considering any applicants beyond the age of 26.”
In Chattanooga, Dr. Donna Hobgood, 59, said she saw doors open later in her life that she hadn’t seen when choosing her first career as a teacher.
“Around here you saw a lot of social change happen in the early ’70s,” said the obstetrician-gynecologist at Memorial Hospital. “I think the social changes had a lot of implications (and) certainly one of them was more a drive for personal freedom, which also spelled out that in the workplace you could pursue a job that you wanted to pursue.”
Liberated from what she termed a very traditional upbringing in Chickamauga, Ga. — “a sort of ‘Leave It to Beaver’ world,” she said — Dr. Hobgood left the teaching field for medical school in her 30s, finishing up an OB-GYN residency at Erlanger in 1988 at age 40.
“As the generations have gone on, it’s clear that it’s going to become more and more equal at work and at home,” Dr. Hobgood said.
Dr. Bishop said, “I do think the baby boom generation was the first to kind of protest and not follow the traditional (life plan of) the World War II generation. We’re more likely to challenge authority and say, ‘Why not?’”
About 10 percent of all applicants to U.S. medical schools — there were about 42,000 applicants in 2007 — are over age 28, said Gwen Garrison, associate vice president of student and applicant studies at the Association of American Medical Colleges. The median age of medical students over the last 20 years has hovered at about 24, she said.
“When they translate to who gets admitted, it ends up being a couple of handfuls spread throughout the medical schools,” she said.
Ms. Garrison said there does not seem to be any increase in recent years in the number of older medical students. As the country has experienced a physician shortage, medical schools today often are hesitant to take on students who may not be able to work as practicing physicians for a significant amount of time, she said.
“When you start getting older and older, the medical schools talk very specifically with older students about, ‘Can you commit to a career for the next 10 years?’ With the doctor shortage right now, I think this is putting more pressure on that conversation. ... We really want to be very productive about training and educating people to meet the demands of our population.”
benefit of experience
The decisiveness that can come with age is an asset when going into the field of medicine, Dr. Worthington said.
“Looking at people who’ve done other things and who have had a lot of life experiences ... their goals become even sharper and clearer at that point, as far as making decisions about what they want to do for the remainder of their life,” he said.
Dr. Bishop, who intends eventually to specialize in geriatrics, said she often can relate to her patients’ conditions, particularly when working in gynecology.
“I’ve been through menopause, and I know what hormones are like,” she said.
She also said she has confidence in her interactions with her superiors.
“I’m not intimidated by the older attending (physicians) who are my age or younger,” she said. “I don’t feel hesitant to ask questions, because I’m very willing to humiliate myself. Maybe the younger people would be hesitant to do that, because they don’t want to look like an idiot.”
Dr. Emberson said he feels he can understand his patients on a different level than doctors who have known only the medical field.
“It kind of gives you a little different view of life, knowing there are people who work just as hard as we do and don’t get the recognition,” he said. “And it kind of gives you an appreciation for your patients’ position. Sometime you know they can’t do everything we advise them to do. ... Maybe it gives me a little more empathy.”
retirement?
Dr. Bishop said she does not intend to retire — ever.
“It would drive me crazy. What are you going to do, golf all day?” she said. “I want to be able to work until I’m pushing my walker down the hall.”
Dr. Hobgood said she doesn’t have any definite plan to leave the work force, either.
“Certainly in the job I’m doing now I like it and really don’t see that I want to retire,” she said.
With a healthy lifestyle, age does not have to be a limitation in the medical field, Dr. Worthington said.
“I think excitement and passion about what you’re doing and having the health to do it are the most important factors,” he said.
Dr. Emberson’s retirement plans still are up in the air, but he expects to take it easier eventually.
“Who knows? I’m 58, and I don’t see retiring at any time particularly soon,” he said. “I’ve always wanted to hike the Appalachian Trail, and I think that might be one of the things I’ll do when I retire.”
E-mail Emily Bregel at ebregel@timesfreepress.com
http://timesfreepress.com/news/2008/jan/21/midlife-career-moves/
ELEMENTS
- Average age of U.S. medical school student: 24 years old
- Total number of medical school applicants in 2007: 42,315
- Percentage of applicants over age 28: 10
Source: Association of American Medical Colleges
There's been an awakening in the medical community to how important good sleep is to our bodies. Here's some of the latest pillow talk.
By CATHY FRISINGER
Special to the Star-Telegram
http://www.star-telegram.com/health/story/422447.html
Know somebody who likes to brag that he can get by on six hours of sleep a night?
Tell him that men who sleep less than seven hours a night have a 26 percent greater death rate over two decades than men who sleep seven to eight hours a night.
And children who don't get enough sleep are more likely to be overweight and have behavioral problems.
And people who do rotating-shift work have lower levels of the hormone serotonin, low levels of which are associated with anxiety and depression.
These findings, all published in the journal Sleep within the last six months, are part of a rapidly expanding body of knowledge about the physiology of sleep and the importance of adequate sound sleep to good health.
"Shift work was just added to the list of risk factors for cancer by the CDC [Centers for Disease Control and Prevention]," says Dr. Jerrold Kram, a member of the board of directors of the National Sleep Foundation. "It just suggests the increasing recognition of how profoundly sleep affects our lives."
And it's not just arcane statistics about risk factors and sleep that are accumulating. There are 83 recognized sleep disorders, including sleep apneas, insomnias, circadian-rhythm disturbances, narcolepsy, restless leg syndrome and plain old wake-the-neighborhood snoring. Physicians like Kram are putting this knowledge to use, making sleep medicine one of the fastest-growing medical specialties over the past decade.
The American Academy of Sleep Medicine accredited the first clinical sleep lab in 1977. The idea of community medical centers where patients would be hooked up to monitors while they punched their pillows, snored and dreamed about showing up for college exams naked, grew slowly at first -- by 1996 there were just 300 AASM-accredited sleep centers -- but the concept has exploded in the past decade, resulting in more than 1,000 accredited centers today and many more unaccredited centers.
You need all five stages of sleep
"We used to think that sleep was a dormant period of time, and we're finding out that there are a whole lot of things that go on during sleep," says Dr. David Ostransky, a Fort Worth pulmonology and sleep-medicine specialist.
Saying "a whole lot" goes on during sleep is like saying that war is "unpleasant."
There are five stages of sleep, according to the National Sleep Foundation, four non-REM stages and REM (rapid eye movement) sleep, and sleepers cycle through the stages about every 90 to 100 minutes.
Stage 1 is the transitional stage, when you're between waking and sleep. Your brain waves and muscle activity slow. Sometimes people's bodies jerk just before they fall asleep.
Stage 2 is a light sleep stage. Eye movements cease. Body temperature drops, and heart and brain activity slows. National Sleep Foundation material says there are periods of muscle tone and muscle relaxation, and that occasional brain-wave spikes, called sleep spindles, occur during this stage.
Stages 3 and 4 are called delta sleep. These are the deep sleep stages when body restoration and repair occurs. Temperature drops even further during this phase, brain waves are slow and there is decreased muscle tone. Fibromyalgia may be associated with poor delta sleep, Ostransky says. People woken during delta sleep are often groggy and disoriented. Night terrors occur during this sleep stage.
Stage 5 is REM sleep, a period of fast brain waves; rapid, shallow breathing; and the rapid eye movements it's named for. Dreaming, believed to be a way of organizing the day's experiences, Ostransky says, occurs during REM sleep. Have you ever wanted to scream during a nightmare and been unable to? Muscles become temporarily paralyzed during REM.
These stages of sleep are repeated four to six times during the night, but not in exactly the same ratio. The first REM sleep is short, just seven minutes or so, but REM sleep takes up a larger and larger portion of the cycles as the night goes on, Ostransky says, which is why you're often dreaming when your alarm clock goes off.
And it's not just the amount of sleep, but the distribution of sleep stages, that's important for health. People who don't get adequate delta sleep, or REM sleep, wake up feeling unrestored, Ostransky says.
Don't mess with your circadian rhythm
On March 9, when daylight-saving time goes into effect, don't forget to reset your clock -- your internal clock, that is.
The suprachiasmatic nucleus, a region in the hypothalamus, regulates the body's sleep/wake cycle, or circadian rhythm, and it needs to be kept in adjustment, just like the alarm clock beside your bed needs to be kept adjusted.
Cycles of light and dark are what keep the suprachiasmatic nucleus properly set so that you will go to sleep at 11 and wake up at 7. The human body, deprived of clues like sunlight and clocks, wouldn't naturally keep a 24-hour schedule. Many people who are totally blind, in fact, have a circadian rhythm disorder, continually advancing their sleep/wake schedule forward.
Teenagers are particularly prone to circadian-rhythm problems, and their night-owl tendencies are at least partly biological, says sleep foundation spokesman Kram.
Light is the chief, but not the only clue for the body's inner clock, according to the American Association of Sleep Medicine Web site. Zeitgebers are the name for other circadian-rhythm influences, and they include meals, exercise and routine activities.
People with chronic insomnia may be helped by sticking to regular times for meals, exercise and bedtime routines.
Without sleep, your hormones get out of whack
Have you ever been inside the cockpit of a plane? So many dials.
The human body is a far more complicated piece of machinery than a plane, and it has a complex system of hormones that are constantly being adjusted to keep endocrine, metabolic and other body systems functioning properly.
Many of these regulatory hormones are secreted at night or during periods of sleep, and sleep disorders or life situations such as shift work can affect the proper sequence of hormone release, the sleep foundation says.
Melatonin, a hormone secreted by the pineal gland in the brain in reaction to darkness, helps promote sleep, but has other functions as well. Disruptions in melatonin production may be the reason shift work is associated with an increased risk of cancer.
Growth hormone, necessary for growth in children, is released during the deep delta sleep stages, Ostransky says. Growth hormone is important for adults, too, who require it to repair the body and regulate muscle mass.
The stress hormone cortisol varies during the night, Kram says. It falls as the body enters sleep and then before waking.
Hormones involved in the reproductive cycle, including luteinizing hormone and follicle-stimulating hormone, are released during sleep, the foundation says.
And medical researchers now believe that the hormones ghrelin and leptin, which help signal hunger and satiety, are affected by sleep. Low levels of leptin in children and adults who get inadequate sleep may be the reason for the link between insufficient sleep and obesity. Kram says people with interrupted sleep are more likely to develop insulin-resistance because the balance of these hormones is off.
TIPS FOR GETTING BETTER SLEEP
So you're convinced that you need seven to eight hours of sound sleep a night, but your body just doesn't want to cooperate. Here's how to start solving the problem:
For temporary insomnia: For this kind of sleeplessness, caused by extreme stresses in life, don't be afraid to use a sleeping pill. Jerrold Kram of the National Sleep Foundation says he'd rather see a patient use a sleeping pill for two or three nights during a period of difficulty than develop chronic insomnia. "The newer sleeping pills are quite effective and quite safe," he says.
For chronic insomnia: Sleep doctors will recommend lifestyle changes that fall under "sleep hygiene," including getting exposure to sunlight, avoiding caffeine, exercising in the morning or afternoon and establishing a bedtime routine. For more on this subject, go to www.sleepfoundation.org and search for "healthy sleep tips."
For sleep apnea: If you have a problem such as sleep apnea, which affects 5 percent of adults, you might be able to cure it by dieting down to your college weight. What is obstructive sleep apnea? A sleeping disorder in which your breathing "is briefly and repeatedly interrupted during sleep," according to the National Sleep Foundation. Or consider getting a polysomnograph evaluation at a sleep center (go to www.sleepfoundation.org to find a center near you). Sleep apnea can be effectively treated, Kram says, with a CPAP (continuous positive airway pressure) device, a mask that fits over the sleeper's nose and delivers fresh air, keeping the throat open at night.
Dr. Barry Eppley serves as Medical Advisor in Plastic Surgery for EMMI Solutions
Emmi solutions of Chicago is a company that provides an online patient education program for a wide variety of medical and surgical procedures. Through this program, Emmi helps increase patient satisfaction, helps physicians manage patient expectations, helps patients prepare for and recover from medical procedures, and engages patients in quality and safety initiatives. EMMI programs are currently available in 16 medical specialties including Anesthesia, Ophthalmology, Oral Surgery, Cardiothoracic Surgery and Cardiology, Gastroenterology, Pulmonary, General Surgery and Oncology, Plastic Surgery, Ob/Gyn, ENT, Orthopedic Surgery, Neurology and Spine Surgery, and Urology.
In Plastic Surgery, programs are currently available for saline breast augmentation, silicone breast augmentation, facelift, liposuction, breast reduction, breast reconstruction, and abdominoplasty. Dr. Barry Eppley, plastic surgeon in Indianapolis, will work with other advosry members in updating these programs as well as expanding to include other plastic surgery procedures.
Emmi solutions provides these programs through physician office enrollment. Once a physician is enrolled, his office provides a website and access code for the patient to review the program related to their upcoming procedure. The program documents whether the patient reviewed the program, the length of time and extent that the program was reviewed, and forwards any questions asked to the physician’s office. The program enjoys high patient satisfaction with 96% of patients surveyed saying that EMMI improved their understanding of what to expect before their procedure. Over 90% of patients say they were more comfortable about their upcoming procedure after viewing Emmi. Dr Eppley’s experience over the past year supports these statistics and feels it is a valuable asset to his practice. Emmi helps provide another layer of procedure information beyond what the physician’s office normally does.
http://exploreplasticsurgery.com/2008/01/20/dr-barry-eppley-of-indianapolis-and-emmi-solutions/
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First of all, nice site guys, good work.
...While entrenched in the meyhem of a busy emergency department with new grad nurses and interns starting out at the same time, it was hard to find time to think with any sort of clarity. In a rare moment however, I was wondering if the meyhem and work load would be relieved if the interns and grad nurses began their commencement of work at different times of the year.
This would mean that the new intake of grad nurses could start half way through the year, say June/July, and the interns would maintain their current cimmencement date of around January.
This potential study would aim to achieve less medication errors, a higher level of care, better communication between staff, less stressors in the workplace and an overall improvement in patient care. It would also enable the two working bodies, (interns & grad nurses) to support each other more in these difficult times.
Thoughts people???
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BMJ rapid response: http://www.bmj.com/cgi/eletter-submit/336/7635/DC1
The BMJ would like to hear from you. Do you want to know what’s in store for junior doctors’ training?
Or are you wondering why MTAS seemed to go horribly wrong? In the first broadcast between the
BMJ and both the BMA and Remedy UK, we put your questions to Ram Moorthy, chair of the Junior
Doctors’ Committee, and Chris McCullough from Remedy UK. Please send us your question as a
rapid response.
Interesting post on medical blogspot.
Open Question: Do you need to have good vision to become an optometrist? I was reading a book on medical careers and its says one of the things you should have to be an optometrist is to have good vision. What does that have to do with anything? One of the reasons I want to become an optometrists is BECAUSE I have bad vision.
Any help from the community on this one?
Independent Inquiry into Modernising Medical Careers
The Royal College of Anaesthetists warmly welcomes the publication today of the Final Recommendations of Sir John Tooke’s panel. We are delighted that the overall support given to the original recommendations, strongly supported by this College, was so substantial.
Over the next days we will consider the updated recommendations in detail but wish in particular to record our support for the new recommendation 47. We will give our full professional support, with others, to the establishment and work of the new body NHS Medical Education England (NHS.MEE). This arms length co-ordinating body gives an opportunity for all involved in promoting excellence in medical training to work together to deliver the vision set out by the Inquiry.
We eagerly await a positive response to this final report from the Department of Health and look forward to the early appointment of a Director of Medical Education.
08 Jan 2008
Physicians contact us from around the country—indeed from around the world—to serve as a sounding board for their careers. Here are some of their remarks, disguised to protect confidentiality. These are not complaints, per se, but pleas for help and guidance toward a new future. The comments come from East, West, North, and South, from all medical specialties, and from residents as well as established practitioners. Hopefully, as you read, you will feel a sense of kinship with the writers—and you will realize you are not alone in the pursuit of your dreams.
ThePhysicianCareerNetwork™ is your ally.
http://www.careerlab.com/pcn_dyspepsia.htm
Problems with the 2008 junior doctor recruitment process in England have already started to emerge, the BMA said. Last week it alerted the Department of Health to the fact that many NHS trusts block external emails, preventing junior doctors from being notified of job offers.
Today it is investigating reports that some doctors in the North of England are being refused application forms, even though posts are still open to applications. The BMA has written to the Conference of Postgraduate Medical Education Deaneries raising the issue.
Mr Ram Moorthy, chairman of the BMA Junior Doctors Committee, says:
"This is outrageous. Doctors are being denied vital career opportunities. It's utterly bizarre to be told you can't have an application form for a job before the deadline has passed. We're concerned that this is a cynical attempt to reduce numbers of applications."
Last Monday, the BMA wrote to the Department of Health and the Modernising Medical Careers Programme Board, raising concerns that many junior doctors would not find out they had been offered jobs because their trusts block access to popular email providers. The Department of Health agreed to write to NHS trusts, but many doctors have reported to the BMA that their trusts are still blocking access. Meanwhile the MMC Programme Board for England has notified all Deaneries, at the request of the BMA, who will take the matter up directly through local HR networks.
Mr Moorthy adds:
"Junior doctors need to be able to check their e-mail regularly, especially when their careers depend on it. We hope trusts will show some understanding and remove blocks on access. The artificially short limits on advertising and accepting jobs are causing major concerns that the process this year will again be unfair."
The RCGP has welcomed extending GP training in the UK from three to five years, as recommended by the Tooke Report.
Professor Sir John Tooke's review of Modernising Medical Careers (MMC) called for GP training to be as thorough as specialty training in other disciplines.
RCGP chairman Professor Steve Field said he was 'delighted' with the outcome, which was a result of the RCGP's work on the GP training curriculum.
'The RCGP supports the division of training into new core specialty training programmes in family medicine,' he said.
But Professor Field said that the RCGP has concerns over the recommendation to abolish the Foundation Year 2.
'Specialists might not have the opportunity to spend time in general practice during their first year of core specialty training,' he said.
URL: http://www.healthcarerepublic.com/news/GP/LatestNews/776867/Review-backs-GP-training-extension/
The Australian Medical Students’ Association (AMSA) released a report urging stakeholders in medical education to recognize the importance of Indigenous Health in medical school curricula.
The report, based on the proceedings of the Leaders in Indigenous Medical Education (LIME) conference in late 2007, outlines areas of key importance in Indigenous Health education.
AMSA President Michael Bonning said, “The long standing inequity between the health of Indigenous and non-Indigenous Australians is completely unacceptable.”
“Improving Indigenous Health outcomes requires a medical workforce with a sound understanding of the issues involved in the provision of health care to Indigenous Australians.
“Producing medical graduates of this calibre requires Indigenous Health curricula which address the social, cultural and medical factors which contribute to the poor health of Indigenous Australians,” Mr. Bonning said.
“To do this Indigenous Health curricula must be developed in consultation with Indigenous Australians, health professionals and students.
“The curriculum must also emphasise the potential for healthier Indigenous communities, rather than focusing too heavily on negative historical aspects of Aboriginal Australia.
“Furthermore, an understanding of Indigenous health must be fostered early and continue throughout a student’s medical education,” Mr. Bonning said.
“In this way, we can take steps towards closing the gap between the health of Indigenous and non-Indigenous Australians.
The Leaders in Indigenous Medical Education (LIME) conference report can be accessed at http://www.amsa.org.au.
Australian Medical Students’ Association
Universities should take over the work co-ordinating postgraduate medical training in England, a report on modernising medical careers has recommended.
Sir John Tooke's paper says that new graduate schools could be set up to take over the work currently done by National Health Service deaneries. It says they should b