themightymelatonin:

Branches of Facial Nerve (CN VII)

ucsdhealthsciences:

Q & A with Raul Coimbra: Treating Trauma as a Disease

Trauma. The word itself invokes images of an emergency: a car accident, heart attack, or bad fall. Something that cannot be anticipated but requires immediate action.

However, many causes of trauma can be prevented, and therefore, fit the criteria for disease, according to Raul Coimbra, MD, PhD, chief of Trauma, Surgical Care, and Burns for UC San Health System and co-director of the Injury Epidemiology, Prevention and Research Center. We’ve asked Coimbra several questions about how people can prevent trauma and why trauma needs to be treated as a preventable disease.

Question: It’s trauma awareness month – why is it important for the community to recognize this and understand their role in prevention?

Answer: Trauma is a disease that kills more people between one and 45 years of age than any other disease in the world. In addition, trauma leads to more years of life lost than any other disease, including cardiovascular diseases and cancer. Productive individuals are being taken away from their families, their jobs, and their environment because of injuries. Many die, and for every death, six individuals will be forever disabled. However, this is a completely preventable disease. The public has a responsibility in preventing injuries, as in most circumstances, it is human behavior that leads to injury.

Q: What are some simple prevention tips people can implement in their homes, yards, etc. that could save them a trip to the trauma center or even their lives?

A: For children at home, the most frequent causes of injury are drowning and burns. Therefore, the use of fences with alarms around swimming pools and constantly watching kids in the kitchen so they cannot reach out to frying pans or boiling liquids on the stove is very important. For the adult population, drinking and driving is a very common cause of injury. Avoiding driving after drinking, finding a designated driver, or catching a cab would be examples of preventive strategies. In the elderly population, securing rugs and furniture on the floor, as an example, will decrease the risk of injury at home. For all ages, wearing a seat belt while driving is key.

Q: Most people don’t think of trauma as a disease. Please explain this philosophy.

A: Trauma is a disease like any other. We know how to define it, we know how to treat it, and more importantly, we know how to prevent it, therefore, it is a disease like any other. Unfortunately, the public’s perception is that trauma is an accident that only happens to somebody else, but that is not the case.

Q: San Diego’s trauma system is used as a model worldwide. What makes it successful and what are your goals for future trauma systems?

A: San Diego has one of the most organized trauma systems in the world. The commitment of six trauma centers and the county EMS has been the same for the last 28 years. This is a model trauma system, and I would go even further to say that our system is a model for regionalized care applicable to any disease. Competing healthcare systems work together, in a very collegial way, to provide the best care possible to trauma patients. As a result, the San Diego trauma system has one of the lowest preventable death rates in the world. In our system, we do not compete with each other; we work together on behalf of the injured patient.

The trauma program at UCSD has provided guidance and help to many other systems in the world, and we plan to continue with those activities. We have received healthcare providers from several countries who spend three weeks with us learning the intricacies of the system and how to build an effective trauma center. This international outreach is very important in disseminating the concept of trauma as a disease. Just as an example, in August 2012, we will be presiding the first World Trauma Congress in Rio de Janeiro, Brazil, where we will be discussing a global agenda for trauma care, particularly focusing in middle and low income countries, where trauma is the most important health care problem.

Coimbra discussing state-wide trauma system

ucsdhealthsciences:

To Test or Not to Test? Three questions about the new PSA guidelines

A report published in Annals of Internal Medicine by the United States Preventive Services Task Force contained the following recommendation:  healthy men do not need an annual Prostate specific antigen blood test (PSA test). The recommendation is based on evidence that suggests these test do more harm than good as they often result in men undergoing aggressive and often unnecessary treatments.

However, many physicians, including the American Urological Association, aren’t happy with the new guidelines. We’ve asked Kellogg Parsons, MD, associate professor of Surgery at UC San Diego Moores Cancer Center and urologic cancer expert, three questions about the PSA test and what these new guidelines mean for men’s health.

Question:  How does a PSA test determine whether or not a man has prostate cancer?

Answer: PSA stands for “prostate-specific antigen.” It is a blood test that acts as an early warning system for prostate cancer. It can indicate that a man has prostate cancer years before symptoms develop. This is an important concept because, by the time a man develops symptoms, it is often too late to completely cure the cancer.

Q:  The article mentions that only men “exhibiting symptoms” should be screened.  What are symptoms of prostate cancer that men should be aware of?

A: Symptoms of prostate cancer are very non-specific.  A good resource is the American Urological Association web site.  More importantly, men should talk to their doctors about any concerns they may have.

Q: Men are notorious for skipping regular health checkups. By altering the PSA guidelines, do you think the new guidelines will do more harm than good?

A: Many, if not most, prostate cancer experts agree that these new guidelines will do more harm than good. PSA is not a perfect test. It can be abnormal in men who do not have cancer. However, if used in a responsible way, PSA screening can significantly reduce a man’s chances of dying from prostate cancer, especially in men younger than 65 years of age. Over 30,000 men die each year of prostate cancer in the U.S. Men should talk to their doctor about what PSA testing can and cannot do for them as individuals.

Photo from the American Urological Association

cupcakern:

Diabetes Insipidus.

Caused by a lack of ADH which stimulates the re-absorption of water and sodium. This diabetes has nothing to do with blood sugar. 

ucsdhealthsciences:

In pill health
           
Half of all American adults take one or more dietary supplements, mostly multivitamins. Selling these supplements is a $30 billion-a-year industry in the United States, comparable to the National Institutes of Health’s entire budget for all medical research.
           
Yet, with very few exceptions, nutritional deficiencies in the United States are rare. Americans might not necessarily eat right, but they are not nutritionally deprived.
           
So why do most people take them? Their answer: “They’re healthy. They can’t hurt.”
           
Most people are wrong.

In a recent commentary in the Journal of the National Cancer Institute, Maria Elena Martinez, PhD, a professor in the department of Family and Preventive Medicine at the UC San Diego School of Medicine and Co-leader of the Reducing Cancer Disparities program at the Moores UCSD Cancer Center, and colleagues discuss the benefits and risks of dietary supplements, particularly when taken to “prevent cancer.”
           
Their conclusion, after reviewing existing scientific literature on the subject: There is little empirical evidence to support the widely held and widely advertised notion that popular supplements like beta-carotene, folic acid, vitamin D and calcium reduce cancer risk.

Indeed, the opposite may be true.
           
That’s not what people want to hear, of course. Axioms like “an apple-a-day” and “we are what we eat” have a sort of enduring resonance. They may be true, write Martinez and colleagues in their JNCI paper, but the nutritional supplement industry exploits it to excess, suggesting in often misleading fashion that if a little bit of a nutrient is good, then a lot must be better.
           
This is not just another case of economic exploitation in the marketplace. While there is little compelling evidence that nutritional supplements significantly prevent cancer, there is growing proof that too much might cause it.
           
For example, some studies have found that exogenous or added antioxidants like beta-carotene might, in fact, promote oxidative stress linked to carcinogenesis. Other trials have found that long-term folic acid supplementation boosts the risk of colorectal tumor growths. Several observational studies support an association between higher calcium consumption and reduced breast cancer risk, but higher calcium intake also appears to increase the chances of contracting prostate cancer.
           
The situation is, in a word, confounding. The observational studies that nutritional supplement-makers most often cite as evidentiary proof (along with testimonials utterly bereft empirical value) are inherently limited. They lack the standardized treatment regimens and controls required to scientifically prove or disprove efficacy and safety. They have value in terms of involving large numbers of test participants – the proverbial big picture – but the devil is usually in the details: Cancer risk is different in different tissues. Personal characteristics, from genetics to behaviors, are massively influential. What is the effect, for example, of taking many supplements at once? How do they interact with each other? How well do they work if the person is a smoker, drinker, obese or all three?
           
These are factors that must be – and are – addressed in the gold standard of scientific experimentation: the randomized controlled trial (RCT), which is rigorously designed to produce precise data without bias. Unfortunately, RCTs of nutritional supplements are relatively few in number, and their conclusions thus far have been mixed.

Cancer does not give up its secrets easily. RCTs are expensive. It often takes decades for cancer to manifest itself, much longer than most RCTs attempting to reveal the cancer prevention benefits or cancer-causing dangers in nutritional supplementation.
           
Nonetheless, Martinez and colleagues argue in their commentary that more, longer and better-designed RCTs are needed, indeed essential to determining the benefits and risks of supplements.

In the meantime, they call for improved oversight of the manufacture and marketing of dietary supplements, which has a short and sketchy history of regulation. The U.S. Food and Drug Administration only began attempting to regulate these substances in the 1960s. Its efforts have been significantly and repeatedly constrained by a well-funded supplement industry and its political advocates.
           
Today, dietary supplements exist in a sort of legal limbo somewhere between foods and drugs. Manufacturers cannot make bold, direct assertions of cancer prevention benefits. The high-profile deaths from the supplement ephedra helped end that, but they can – and do – advertise the cancer prevention powers of supplements by implication.

Take Pill X, which research has been found to reduce the growth of prostate cells in culture. Makers of Pill X advertise that it “supports prostate health.” They cite stories of real people who took Pill X and didn’t get prostate cancer. For the casual consumer, it’s easy to conclude that Pill X has anticancer properties, despite the lack of any real science to support that conclusion.
           
Of course, maybe Pill X does reduce cancer risk – and maybe it increases it. No one knows. The scientific data are lacking. Think about that next time you take a nutritional supplement you probably don’t need.

lostinretrosynthesis:

Gram Staining technique

Some tips for a proper Gram staining:

• Before starting with the staining, you have to make sure that the bacterial sample is properly fixed to the slide. First, apply a drop of water on the slide. Then rub the bacteria sample against it. Wait for it to dry. After that you must apply heat to fix the cells on the surface of the slide; otherwise they will wash away the first time you rinse the crystal violet. To apply heat, run the slide through a Bunsen lighter flame (yes I mean THROUGH a flame!) very quickly 4 or 5 times. DO NOT let the slide linger for longer than 1 or 2 seconds too close to the flame or the cells will be destroyed! Press the slide against the back of your hand. If it’s slightly warm, but not too warm, then you can assume cells are sufficiently fixed.

• Be extremely careful with the timing. Each coloring chemical requires a different amount of time to work:

1. Crystal violet: wait for 60 seconds for it to work. Seriously, I’ve read some online “papers” saying that it only takes 10 seconds for it to color the cells. BULLSHIT.   If you wait for too long nothing will go wrong because crystal violet is not an irreversible coloring complex. If you wait for too little, on the other hand, you will get a false negative in your staining.
2. Iodine: it is advisable to wait for 60 seconds; but its sole purpose is to be a mordant, which means it helps cells absorb crystal violet, so it’s not neccessary to be extremely careful here.
3. Decolorization: alcohol decolors bacteria. Gram positive bacteria have thicker peptidoglycan walls and alcohol makes their pores to shrink, so the crystal violet does not exit the cell. In Gram negatives, alcohol disorganizes the outer wall and washes away the crystal violet. You can either use ethanol 95% or a solution 3:1 of alcohol:acetone. If you use ethanol, you must wait approximately 30 seconds. If you use the alcohol-acetone solution, DO NOT WAIT LONGER THAN 7 OR 8 SECONDS before washing. If you wait for too long, this strong solution can even cause the decoloration of Gram positive bacteria (again, false negative).
4. Safranin: wait for 60 seconds before washing.

And a generic tip: do not put too much sample on the slide. Even if you can’t see any purple stains or dots when you finish the staining, believe me, you will see the cells under the microscope. Why? Because if there are too many cells, and they are too close to each other, the alcohol can’t reach all of them equally and some of them won’t bleach even if they are Gram negative  (giving a false positive result).

dorasnursing:

I’ve posted this before but it’s a good one so worth a reblog. Happy Nurses Day to all my fellow nurses, student nurses and want to be nurses :)

Candle Ceremony of Nursing (by DrPhotoMoto)

Candle Ceremony of Nursing

There is something sacred about nursing.

As a doctor I can’t say enough about the importance of nurses and the nursing profession. I remember little about them as a child except that they were the ones that gave the shots. By my teens I had been hospitalized several times so I had seen a lot of nurses and held them in high regard. It wasn’t till medical school that I really learned about nursing.

Nurses are the front line of medical care. They triage patients in the battlefield. They institute emergency life saving measures. Their manner paints the first impression that the patient sees.

Nurses sift information for relevance. They clean wounds and stop bleeding. They assist the doctor in examination and treatment. They gather specimens and administer medication. They also screen and administer orders of the doctor. In this role they often help the physician by clarification and correction of these orders. I can’t begin to count the number of times a nurse has gently asked me if I really meant to give a patient a medicine to which they were allergic. Nurses are often the first to evaluate treatment effectiveness.

Nurses have to walk a razor sharp line. They know when to reassure and when to call the doctor. When a nurse calls me to see a patient I come as quickly as possible. They know the value of time and rest and even making a dollar, so when they call I usually drop everything and am grateful they are watching the patients for me. They know when urgent intervention
is called for.

Nurses give of themselves despite the hardships, adversity and danger of the profession. Nurses witness some of the most inappropriate human behavior, and it is not always from patients. Demands flow from patients, family, doctors and administrators. Then there are the insurance companies. And yet through it all, somehow, nurses maintain a degree of compasionate professionalism that is a constant source of amazement to me.

Medicine without nursing would be a violin without bow and rosin. They are the contact point of caring.

Medicine without nursing would be breath without air. They are the breath of medicine.

Medicine without nursing would be like trying to fly with one wing. Nurses provide balance to medical care.

Medicine without nursing would be like trying to fly without radar. They are the watchful eye of medicine.

Medicine without nursing would be body without soul. Nurses are the spirit of healing.

I take my stethescope off to nurses.

__________________________________________

“I may be compelled to face danger, but never fear it, and while our soldiers can stand and fight, I can stand and feed and nurse them.” Clara Barton

“After two days in hospital, I took a turn for the nurse.” W.C. Fields

“Nursing would be a dream job if there were no doctors.” Gerhard Kocher

“O sleep, O gentle sleep,
Nature’s soft nurse.” William Shakespeare


Link to Nursing Set: www.flickr.com/photos/drphotomoto/sets/72157624274469905/…