Recently I was visited by a very good friend who had just returned from a long walk in the woods, and I asked her what she had observed. 'Nothing in particular,' she replied. I might have been incredulous had I not been accustomed to such responses, for long ago I became convinced that the seeing see little.

How was it possible, I asked myself, to walk for an hour through the woods and see nothing worthy of note? I who cannot see find hundreds of things to interest me through mere touch. I feel the delicate symmetry of a leaf. I pass my hands lovingly about the smooth skin of a silver birch, or the rough, shaggy bark of a pine. In spring I touch the branches of trees hopefully in search of a bud, the first sign of awakening Nature after her winter's sleep. I feel the delightful, velvety texture of a flower, and discover its remarkable convolutions; and something of the miracle of Nature is revealed to me.

-Helen Keller, Three Days to See (1933)
NB: Helen Keller was deaf-blind.

Sunday, 20 November, 2011

Psychological Origin of Anxiety

"One's perception of a given situation is distorted which causes one to believe it is threatening in some way."
-Toronto Notes 2011

Facundo Cabral

"Una bomba hace más ruido que una caricia, pero por cada bomba que le destruye hay millones de caricias, que alimentan la vida."
http://www.amarseaunomismo.com/no-estas-deprimido-estas-distraido/

Friday, 8 April, 2011

denial is bliss?

http://www.cbc.ca/news/health/story/2011/04/08/alcohol-cancer-deaths-europe.html

Many cancers avoidable with less drinking: study

Lack of warning labels in Canada 'scandalous'

Posted: Apr 8, 2011 9:53 AM ET 

Last Updated: Apr 8, 2011 5:30 PM ET 

A waitress carries a load of one litre beer mugs to thirsty customers at the start of the Oktoberfest beer festival in Munich in 2010. German researchers say a 'considerable proportion' of the most common and most lethal cancers can be attributed to drinking alcohol.A waitress carries a load of one litre beer mugs to thirsty customers at the start of the Oktoberfest beer festival in Munich in 2010. German researchers say a 'considerable proportion' of the most common and most lethal cancers can be attributed to drinking alcohol. (Matthias Schrader/Associated Press)

Drinking too much alcohol is blamed for a "considerable proportion" of cancer cases, a large new European study suggests.
The study in this week's issue of the medical journal BMJ said current or former alcohol consumption could be blamed for as much as 10 per cent of cancer cases in men and three per cent in women.
The conclusions were based on following more than 100,000 men and 250,000 women aged 37 to 70 in Britain, France, Italy, Spain, Greece, Germany, the Netherlands and Denmark from 1992 to 2005.
"A considerable proportion of the most common and most lethal cancers is attributable to former and current alcohol consumption," wrote lead author Manuela Bergmann of the Institute of Human Nutrition Potsdam-Rehbruecke in Nuthetal, Germany.
"This strongly underlines the necessity to continue and to increase efforts to reduce alcohol consumption in Europe, both on the individual and the population level."
Too much drinking was also blamed for seven per cent of breast cancers in German women and 28 per cent of colorectal cancers in Spanish men, the results show.
"The effect was greater for certain cancers which we already know there's a causal relationship between alcohol and certain cancers like liver, mouth, throat, esophagus and breast cancer as well," said Dr. Karl Kabasele, CBC's medical commentator.

Standard drink labels

Canada has a national alcohol strategy that covers alcohol pricing and availability. But labelling alcohol bottles better with specific warnings about cancer risk would help reduce its adverse health effects, said Prof. Tim Stockwell of the University of Victoria's Centre for Addictions Research.
"It's a citizen's right-to-know issue," Stockwell said in an interview. "I think it's scandalous that vested interest groups have persuaded governments that it's not necessary to inform consumers about the risks of things like cancer from this product that most of use and love."
People are warned about the risks of tanning salons for example but alcohol's risks are not clearly spelled out, Stockwell.
The Canadian Cancer Society acknowledged that cancer risks of drinking have received little attention.
"There is a misconception about the safety of alcohol, " said Gillian Bromfield, a policy analyst with the Canadian Cancer Society in Toronto.
Alcohol labels could also carry more useful information about how many standard drinks of alcohol are found in a bottle of wine or spirits, Stockwell suggested. That way, it would be easier for people to translate upcoming national guidelines on quantity and frequency of drinking that are considered low risk to their personal behaviour.
In the study, researchers used a mathematical model to take factors such as smoking, diet and exercise into account in calculating the number of cancers attributed to drinking more than recommended.
The research was funded by several European health authorities.

Saturday, 2 April, 2011

J’aimerais vous parler de l’art

J’aimerais vous parler de l’art – non pas l’art de la médecine, mais l’art, muse de l’esprit. Son appréciation est universelle, et pourtant on s’aventure rarement dans sa discussion, on ne s’interroge point sur son sens.

Feu Anatole Broyard, ancien essayiste et éditeur du New York Times Book Review, écrivit de ses interactions avec les médecins qui le soignaient pendant qu’il était atteint d’un cancer de la prostate métastatique :

Pour le médecin typique, ma maladie est un incident routinier durant sa tournée, tandis que pour moi c’est la crise de ma vie. Je me sentirais mieux si j’avais un médecin qui du moins percevait cette incongruité… Je voudrais seulement qu’il… me donne son esprit entier qu’une seule fois, qu’il s’attache à moi pour une brève espace, qu’il étudie mon âme ainsi que ma chaire, pour atteindre maladie, car tout homme est malade de sa propre façon.

Son éloquence est touchante, n’est-ce pas ? Artistique même. Malheureusement, ce n’est pas comme ça que les patients communiquent avec nous. Si c’était le cas, l’empathie du médecin serait un acquis. Or, malgré la parole plutôt terne qu’il employait sans doute quand il voyait ses médecins, M. Broyard ressentait surement les émotions qui sont si évidentes dans cette citation.

L’appréciation de l’art, c’est la perception de l’émotion - du sens - d’un collage de pigments, d’un assemblage de sons, d’une séquence de lettres. Et même si une œuvre est représentative – tel un portrait – le sujet nous est d’habitude étranger. Cette appréciation ne se fait pas par une analyse assidue des détails sensoriels; au contraire une telle approche peut nuire à l’expérience pure de l’art dans le moment. L’apparition du sens d’une œuvre dépend plutôt d’un certain recul analytique et d’une véritable ouverture de l’esprit. En filtrant les faits de notre bouillie phénoménale, on isole un élixir d’émotion et de symbolisme capable de pénétrer même dans le cœur d’un soldat drapé d’épaisses d’armures.

Experts par nécessité dans le processus contraire, l’art (ainsi que l’amour et les enfants) est une muse indispensable aux médecins pour garder une vision humaine des êtres patients.

Wednesday, 24 November, 2010

epidurals

whether or not you recommend an epidural, remember what really counts:
http://www.ncbi.nlm.nih.gov/pubmed/12011880

Saturday, 20 November, 2010

Multiple Choice Question Strategies: Getting Them Right Even When You Don't Deserve To

It’s often said that those who get good grades in medical school (and in other disciplines) are not necessarily the ones who will make the best doctors. In fact, some go as far as to say that many who get below average grades are those who will excel in practise. I believe there is much truth to this.
Keywords: multiple choice test strategies, mcq, improve, grades
Unfortunately, though, nobody enjoys having grades floating around the 60s. So, in solidarity with all those who don’t think their grades reflect their knowledge, I’m writing this post to address one of the root causes of this: multiple choice testing. This is a compilation of a few multiple choice strategies that allow people who know them to do well despite mediocre understanding. Moreover, since profs subconsciously expect students to know and apply these, those who haven’t picked them up over the years can do more poorly than is reflective of their understanding. Hope you find them helpful!


Before you start

Remember that you are looking for the best answer, NOT one which must be entirely true all of the time, in all cases, and without exception.


When reading the question/stem

Look for grammatical clues. If the stem ends with the indefinite article "an," for example, then the correct response probably begins with a vowel.

Try to anticipate the correct response before you are distracted by seeing the options provided. Then uncover the responses and select the option that most closely matches your answer. Do NOT confuse this with the myth that your first answer is usually correct! Change your first answer when you are fairly sure of the correction, or when other cues in the test prompt you to change it.

Know if you are allowed to select more than one response per question/stem (e.g. Clinical Decision Making Questions). If so, select the maximum number of responses.


When considering the options

Question responses that are totally unfamiliar to you. Profs have no problem including terms/concepts that have never been discussed as long as they are part of INCORRECT responses.

You can often rule out responses that contain absolute terms like "always" or "never." Responses that contains generalizations like "usually" or "mostly" are more likely to be correct.

Look alike options: If they have different meanings (e.g. back pain, chest pain, abdominal pain), one is probably correct; if they have practically the same meaning (e.g. chest pain, torso pain), neither one can be correct.

When faced with double negatives consider the equivalent positive statement.

If two options are opposite (e.g. increases heart rate, decreases heart rate) one of them is probably correct.

Favour options that contain qualifiers (e.g. ...often presents with intense chest pain which radiates to the left arm or neck). The prof usually puts more effort (and words) into composing the correct answer.

If two alternatives seem correct, compare them for subtle differences and then refer back to the stem to find your best answer.

"All of the above" is often a correct response. If you suspect that more than one of the other responses is probably correct, then choose "All of the above."

"None of the above" is usually an incorrect response (used when the instructor has run out of ideas), but this is less reliable than the "All of the above" rule. Be very careful not to be fooled by double negative options when “None of the above” is also an option (e.g. ... rarely decrease blood pressure – this is probably the correct response but would have been taught as “usually increases blood pressure”).

Look for verbal associations. A response that repeats key words that are in the stem is likely to be correct.

If all else fails, choose b) or c). Many profs subconsciously feel that the correct answer is more "hidden" if it’s surrounded by distracters. Apparently, response a) is usually least likely to be the correct one.

Don't worry about the pattern of the answers. If you answer b) to four questions in a row, you might be right (especially when you consider the previous point).


A particular case:
Which are classic symptoms of lupus?
a) photosensitivity and acromegaly
b) angiomas and oral ulcers
c) oral ulcers and photosensitivity
d) photosensitivity and claudication

Profs like their answer to be ambiguous. In this sort of question with multiple elements in each response, profs achieve ambiguity by having one correct element and one incorrect element in each incorrect response. Since the correct elements also usually appear in the correct answer, elements that appear most often are most likely to be correct. In this case “photosensitivity” appears three times and “oral ulcers” appears twice, so the correct answer is probably “c”.


Applying the same logic to the following question:
Which of the following statements is most true with regards to Crohn’s?
a) it is an inflammatory disease that is worsened smoking.
b) it is worsened by smoking and has an increased incidence in Hispanics
c) it is an inflammatory disease that affects the ileum exclusively
d) it is a genetic disease that accounts for 60% of the global prevalence of constipation

“a” is most likely.


Finally:
Which is the proper sequence of events in mitosis?
a) 3-4-2-1
b) 3-2-4-1
c) 1-2-3-4
d) 2-3-4-1

Consider the most common position of each element (more correct positions means more ambiguity):
1 in 4th
2 in 2nd
3 in 1st
4 in 3rd
There’s your answer (b)! You didn’t even need to know that
3=prophase 2=metaphase 4=anaphase 1=telophase.