Recently someone mentioned to me that medical school is a stressful experience to which I responded is the pope catholic, do bears poop in the woods....tell me something I don't know. Then I began to think of humor in the medical school curriculum. I love to laugh and if you google laughter and medicine there are thousands of responses. Without looking like I am losing it there is even laughter yoga that has become popular in North America. Now why do I bring this up? I think that as we fill these young brilliant minds in our school with myriads of facts and algorithms it’s important that they remember that there is an awful lot we don't know and we can't explain....here are some of the studies done on laughter....
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Although there are many clinical programs designed to bring humor into pediatric hospitals, there has been very little research with children or adolescents concerning the specific utility of humor for children undergoing stressful or painful procedures. Rx Laughter TM, a non-profit organization interested in the use of humor for healing, collaborated with UCLA to collect preliminary data on a sample of 18 children aged 7–16 years. Participants watched humorous video-tapes before, during and after a standardized pain task that involved placing a hand in cold water. Pain appraisal (ratings of pain severity) and pain tolerance (submersion time) were recorded and examined in relation to humor indicators (number of laughs/smiles during each video and child ratings of how funny the video was). Whereas humor indicators were not significantly associated with pain appraisal or tolerance, the group demonstrated significantly greater pain tolerance while viewing funny videos than when viewing the videos immediately before or after the cold-water task.
http://ecam.oxfordjournals.org/cgi/content/full/nem097?ijkey=vQVXkCN8QhDjDQe&keytype=ref%20
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In this study, researchers compared the humor responses of 300 people. Half of the participants had either suffered a heart attack or undergone coronary artery bypass surgery. The other 150 did not have heart disease. One questionnaire had a series of multiple-choice answers to find out how much or how little people laughed in certain situations, and the second one used true or false answers to measure anger and hostility. Miller said that the most significant study finding was that "people with heart disease responded less humorously to everyday life situations." They generally laughed less, even in positive situations, and they displayed more anger and hostility.
http://www.umm.edu/features/laughter.htm
Have a laughter filled day,
Maynard
Monday, January 18, 2010
Clinical Skills Pearl Vol 2 (#18): Diabetes
I have told the medical students that if you know nothing but diabetes and alcoholism you know more than most....this week is about diabetes....so here are the questions:
Is life expectancy altered by diabetes and by how much?
What is the prevelance of diabetes in the population?
Are all races at the same risk for diabetes?
What factors predispose for diabetes?
Diabetes Mellitus (DM) is a disease caused by deficiency or diminished effectiveness of endogenous insulin. It is characterized by hyperglycaemia, deranged metabolism and sequelae predominantly affecting the vasculature.
Life expectancy is reduced by 15 years in Type 1 diabetes; 5-7 years in Type 2 diabetes.
Prevalence models suggest the true prevalence is close to 5%. The incidence of diabetes is increasing in all age groups. Type 1 diabetes is increasing in children (especially <5 years), and type 2 diabetes is increasing particularly in black and minority ethnic groups.
People of South Asian, African and African-Caribbean and Middle-Eastern descent are at greater risk of type 2 diabetes, compared with the white population. People who are obese, are inactive or have a family history are also at increased risk of type 2 diabetes.
Other factors predisposing to DM, Gestational Diabetes and impaired glucose tolerance Drugs: steroids and thiazides
Pancreatic disease: acute and chronic pancreatitis (including surgery if 90% pancreas removed), haemochromatosis, cystic fibrosis. Endocrine disease: Cushing's, acromegaly, phaeochromocytoma, thyrotoxicosis.
Others: acanthosis nigricans, congenital lipodystrophy with insulin receptor antibodies, Wolfram syndrome (DIDMOAD),4 and glycogen storage diseases.
Reference:
http://www.patient.co.uk/showdoc/40000914/
Posted on behalf of Dr. M. Luterman
Is life expectancy altered by diabetes and by how much?
What is the prevelance of diabetes in the population?
Are all races at the same risk for diabetes?
What factors predispose for diabetes?
Diabetes Mellitus (DM) is a disease caused by deficiency or diminished effectiveness of endogenous insulin. It is characterized by hyperglycaemia, deranged metabolism and sequelae predominantly affecting the vasculature.
Life expectancy is reduced by 15 years in Type 1 diabetes; 5-7 years in Type 2 diabetes.
Prevalence models suggest the true prevalence is close to 5%. The incidence of diabetes is increasing in all age groups. Type 1 diabetes is increasing in children (especially <5 years), and type 2 diabetes is increasing particularly in black and minority ethnic groups.
People of South Asian, African and African-Caribbean and Middle-Eastern descent are at greater risk of type 2 diabetes, compared with the white population. People who are obese, are inactive or have a family history are also at increased risk of type 2 diabetes.
Other factors predisposing to DM, Gestational Diabetes and impaired glucose tolerance Drugs: steroids and thiazides
Pancreatic disease: acute and chronic pancreatitis (including surgery if 90% pancreas removed), haemochromatosis, cystic fibrosis. Endocrine disease: Cushing's, acromegaly, phaeochromocytoma, thyrotoxicosis.
Others: acanthosis nigricans, congenital lipodystrophy with insulin receptor antibodies, Wolfram syndrome (DIDMOAD),4 and glycogen storage diseases.
Reference:
http://www.patient.co.uk/showdoc/40000914/
Posted on behalf of Dr. M. Luterman
Monday, January 11, 2010
PBL Pearl Vol 2 (#17): Traits of successful teachers
What makes a good teacher? A study was done at the San Diego School of Pharmacy to identify faculty characteristics and teaching methods that initiate and maintain student attention and engagement throughout the classroom experience.
Current 3rd and 4th professional year Doctor of Pharmacy students were invited to complete a web-based survey regarding their perceptions of faculty attributes and teaching techniques that maintain or enhance engagement. Each questionnaire consisted of 23 multiple choice questions using a 1-4 rating scale from strongly disagree to strongly agree and 5 open ended questions. Preferences of teacher characteristics, active learning techniques and lecture structure were examined.
Ninety eight questionnaires were completed (48%). Students strongly agreed that enthusiasm (73%), genuine interest in student learning (71%) and preparation/organization (69%) were engaging faculty attributes. Strong agreement was also observed for techniques including multiple examples/patient cases per subject (71%) and end of class summaries (72%).
Reference:
http://www.allacademic.com/meta/p_mla_apa_research_citation/1/1/8/2/0/p118208_index.html
Posted on behalf of Dr. M. Luterman
Current 3rd and 4th professional year Doctor of Pharmacy students were invited to complete a web-based survey regarding their perceptions of faculty attributes and teaching techniques that maintain or enhance engagement. Each questionnaire consisted of 23 multiple choice questions using a 1-4 rating scale from strongly disagree to strongly agree and 5 open ended questions. Preferences of teacher characteristics, active learning techniques and lecture structure were examined.
Ninety eight questionnaires were completed (48%). Students strongly agreed that enthusiasm (73%), genuine interest in student learning (71%) and preparation/organization (69%) were engaging faculty attributes. Strong agreement was also observed for techniques including multiple examples/patient cases per subject (71%) and end of class summaries (72%).
Reference:
http://www.allacademic.com/meta/p_mla_apa_research_citation/1/1/8/2/0/p118208_index.html
Posted on behalf of Dr. M. Luterman
Clinical Skills Pearl Vol 2 (#17): Adrenal Insufficiency Part 2
Part 2.....how much of the adrenal gland needs to be destroyed for you to become Addisonian? Here's a dandy...what happens to the following blood tests..Na, Cl, Bicarb, K, Urea, Glucose,LFTs, Ca,Hb, WBC diff,
BONUS TIME>>>>test to distinguish primary from secondary Addison disease?
Pathogenesis:
Addison disease is characterized by progressive destruction of the adrenal glands. This is usually autoimmune based and most likely the result of cytotoxic T lymphocytes, although 50% of patients have circulating adrenal antibodies. Clinical and biochemical insufficiency only occurs once >90% of the gland is destructed.
In the early period of adrenal insufficiency, investigations may be normal however, patients have no reserve when faced with stress.
Laboratory abnormalities in adrenal insufficiency:
Sodium - reduced
Chloride - reduced
Bicarbonate - reduced
Potassium - increased
Uraemia
Hypoglycaemia
Abnormal liver function tests
Calcium - increased in 10-20%
Normocytic anaemia
Lymphocytosis
Moderate eosinophilia
Distinguish between primary and secondary insufficiency by measuring the ACTH level
Primary insufficiency - ACTH increased; Secondary insufficiency - ACTH decreased.
Reference:
http://www.patient.co.uk/showdoc/40024894/
Posted on behalf of Dr. M. Luterman
BONUS TIME>>>>test to distinguish primary from secondary Addison disease?
Pathogenesis:
Addison disease is characterized by progressive destruction of the adrenal glands. This is usually autoimmune based and most likely the result of cytotoxic T lymphocytes, although 50% of patients have circulating adrenal antibodies. Clinical and biochemical insufficiency only occurs once >90% of the gland is destructed.
In the early period of adrenal insufficiency, investigations may be normal however, patients have no reserve when faced with stress.
Laboratory abnormalities in adrenal insufficiency:
Sodium - reduced
Chloride - reduced
Bicarbonate - reduced
Potassium - increased
Uraemia
Hypoglycaemia
Abnormal liver function tests
Calcium - increased in 10-20%
Normocytic anaemia
Lymphocytosis
Moderate eosinophilia
Distinguish between primary and secondary insufficiency by measuring the ACTH level
Primary insufficiency - ACTH increased; Secondary insufficiency - ACTH decreased.
Reference:
http://www.patient.co.uk/showdoc/40024894/
Posted on behalf of Dr. M. Luterman
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