The Winter is over Party / aka Welcome to Spring

For those of you whom this is the first spring: Welcome.

Details yet to come, i'll keep you posted,
but i thought it would be good to announce that :


with the vacation of winter

and with the advent of spring

i thought it would be a good idea to celebrate.

so any ideas, let me know.
poker, pool, movies, anything.



the
welcome to
spring
farewell
winter
party

time: TBA
date: TBA
place: i assume my place
reason: winter is over! spring is here

Definition, Incidence, and Prevalence of Disc Prolapse

hope ya'll enjoy the table, it is done with spaces:)
lotsa work for youse.

sleep tight.
much love,
tim

Spinal Disc Hernia (Slipped Disc, Disc prolapse, ruptured disc)

Definition
Against common misconception, the disc cannot actually slip, slide or do much. The bony structures generally keep it all pretty well secure, and the nucleus pulposus moves through a gap in the annulus fibrosis.

As with all hernias, the cause is a weakness in the wall of the enclosing compartment, allowing the contents to pass through. This generally happens with the bowel, as in when it enters the inguinal canal, or passes through the gap left in the diaphragm for the oesophagus.

Generally, the hernia occurs in either the cervical (19%) or the lumbar spine (80%): it is very rare to have a thoracic hernia (<2%).

Risk factors
Age, Nutrition, Obesity, Physical labour, Vibrating spine (ie driving), Male, Congenital defect in size and position of spinal cord, Smoking weakens cartilage.

Prevalence
Around 15 million people in the UK have back pain, and of that pain caused by physical problems, around one in 25 is attributed to disc prolapse.

Australian hospital admissions
Total admissions Admissions per 100,000 population
Males Females Males Females
0-4 3 1 0 0
5-14 9 15 1 1
15-24 263 127 19 10
25-34 1044 470 73 33
35-44 1543 955 110 68
45-54 1160 999 99 88
55-64 751 645 97 84
65-74 695 547 113 80
75+ 356 393 103 70
Total 5824 4152 64 45

http://en.wikipedia.org/wiki/Slipped_disc
http://www.spineuniverse.com
http://www.orthoinfo.org/fact/thr_report.cfm?Thread_ID=185&topcategory=Spine
Palmer KT, Walsh K, Bendall H et al, Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years. BMJ. 2000;320(7249):p.1577-1578.
http://72.14.235.104/search?q=cache:-zZQS2FYdXsJ:www.aihw.gov.au/bod/bod_yld_by_disease/q_musculoskeletal/q4_slipdisc.xls+prevalence+slipped+disc&hl=en&gl=au&ct=clnk&cd=3
(www.aihw.gov.au/bod/bod_yld_by_disease/q_musculoskeletal/q4_slipdisc.xls)
Choong, J. 2006, in the anatomy lab

Eye Testing

Testing Vision, Investigations, Symptoms and Signs

The most widely used test is the Snellen chart: a range of letters, starting large, and finishing small, designed to measure the ability to see one minute of arc (1/60 degree). A single minute arc equates to one inch over one hundred yards, for instance, or one pixel of Snellen’s 25 pixel optotype at 20/20 vision.

The ability to see these letters, and distinguish the pixels from each other is a reliable way to measure the patient’s ability to complete daily activities which require the use of sight. This test measures visual acuity. Visual acuity = Distance at which test is made / distance at which the smallest letter read subtends an angle of 5 arcminutes.

The measurement from the Snellen chart is given as a fraction comparing the patient’s eyesight to ‘standard’ eye sight: ie, a score of 20/40 indicated that the patient can see at twenty feet what a normal person could see at forty. It is said that normal vision is actually slightly better than 20/20, more like 20/16. In some countries, like Australia, eyesight is no longer measured in feet: it is now measured in metres. 6/6 is standard, worse than 60/6 (200/20) is considered legally blind, assuming it cannot be corrected with glasses. Hawks have 20/2 vision. 20/40 is considered the acuity required to drive.

Although the measurement of visual acuity from Snellen does give a decent indication of ability to perform standard tasks, it fails to take into consideration a variety of other factors, and hence 20/20 vision may not be good. Examples of factors which contribute to vision impairment are colour blindness (generally measured with green and red dots creating a number), and the inability to track motion.

The Snellen chart has also been criticised on the fact that to read the top line, you only have to read one letter; compared to reading multiple at the lowest line. Thus factors such as isolation, cluttered space, the ability to distinguish between characters, not just pixels, and what not are not taken into consideration.

--------------------------------

The near vision test takes into account what font size of standard Times New Roman, can a person read at a distance of 40 cm (14 inches). N8-N10 is what most books and newspapers are. Occasionally, near vision is measured at both 40cm and 100cm, in which case the subject receives two scores, ie. N8 & N14. This is relevant for certain professions such as piloting aircraft. N10 is considered normal. Light conditions can affect the results of this test, as can tiredness.

--------------------------------------

Common symptoms of cataract include:

• a painless blurring of vision;
• glare, or light sensitivity;
• poor night vision;
• double vision in one eye;
• needing brighter light to read;
• fading or yellowing of colours.
• occassionally, a cataract can be painful, but it is rare.

The amount and pattern of cloudiness within the lens can vary. If the cloudiness is not near the centre of the lens, you may not be aware that a cataract is present.

-------------------------------------------------

To diagnose cataracts, visual acuity is measured, a pupil-dilation test is completed, and if necessary, a slit-lamp test is also conducted. In the pupil dilation test, the pupil is dilated using eye drops, then examined with an ophthalmoscope. In the slip test, a lamp which only allows a slit of light through, allows the doctor to determine the exact location of the cataract.

-------------------------------------------------

The Snellen Chart

Further reading: (melb uni, God bless them, have a decent site... worth checking out) :
http://en.wikipedia.org/wiki/Arc_minute
http://en.wikipedia.org/wiki/Visual_acuity
http://en.wikipedia.org/wiki/Image:Snellen06.png
http://en.wikipedia.org/wiki/Snellen_chart
http://www.lowvisiononline.unimelb.edu.au/Screening/acuityNear.htm
http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZSXEVUF4C&sub_cat=0
http://eye.upmc.com/Cataracts/Diagnosis.htm

Down with studiousness

so, in light of kara's message:

and with a little help from my friends,
the notion of a mid-winter pool party began to be discussed.
perhaps in jest, perhaps with laughter, perhaps ... perhaps... perhaps...

yet i took it in all seriousness.

thus:
The
Mid-Winter
Pool Party

will be held at my house this friday, 8pm onwards.

bring bathers/wetsuit.

pool table available, heater on, spa hot.
pool freezing.

see you there.
tim

group r and friends fun times?

lauren...

why do you build me up buttercup?
get my hopes up with smses and not follow through :p
lol


any news on friday?

let us know asap.

otherwise, i might have to sms you myself.

with much love

tim

The Exam

Hope all went well for all,
and if not, remember: only 5% :)

(it's going to be interesting what i say when it's not formative or worth like 80%, isn't it...)

Any problems/questions with 'a patient encounter' i guess should be discussed now.

Hope the PWE was good, and sorry i couldn't make it!
next time.

See you all monday though.

With love,
Tim

Come to Germany

Yes, you heard right:

rather than inviting all to germany, i've invited germany to all:

hence, monday 12th, in aid of australia's world cup effort, there shall be:

german sausage,
german bier,
german umm-pa-pa music,
german accents,
german spas (well, it's just a spa..)

and anything which sounds fun.

(oh, and when i say there'll be, i mean, that you should bring).

gates open around 8,
my house (if you don't where that is already, shame.)
kick off time for the match is 11ish.

feel free to stay at mine.

rsvp to tnfaz1, or 0439 918 804.

tschüß,

tim

Key features of major theoretical perspectives

1. Structural Functionalism
   Key theorists: Talcott Patson, Emile Durkheim, Robert Merton, Jeffrey Alexander.
   Key concepts: value consensus, functional prereequisites, sick role.
   Focus of analysis: Structuralist focus: shows how various parts of society function to maintain social order.
   Health example: The 'sick role' (social expectations of how doctors and patients should behave) exposes the management of illness as a social experience.
   
2. Marxism
   Key theorists: Karl Marx, Friedrich Engels, Vincente Navarro, et al.
   Key concepts: class conflict, capitalism, medical-industrial complex, commodification of heal care
   Focus of analysis: Structuralist focus: shows how the unequal distribution of scarce resources in a capitalist society is based on class division and highlights 'who benefits' and who is disadvantaged.
   Health example: Analyses the links between class and health status, and between class, medical power, and profit-maximalisation.
   
3. Weberianism
   Key theorists: Max Weber, George Ritzer, et al
   Key concepts: beueaucracy, ideal type, rationalisation, McDonaldisation
   Focus of analysis: Combines a primary focus on agency, with structuralist tendencies: shows how the increasing regulation of social life takes place and may stifle human creativity; also explains the multiple forms of social inequality and social conflict.
   Health example: Examines how health professionals are increasingly subject to regulation and managerial control, producing greater efficiency and uniformity in health care delivery, but potentially decreasing the effectiveness of patient care.
   
4. Symbolic interactionalism
   Key theorists: George H. Mead, Erving Goffman, Howard S. Becker, et al.
   Key concepts: the self, lbaelling theory, stigma total institutions, negotiated order.
   Focus of analysis: Agency focused: emphasises how individual and small-group interaction construct social meaning in everyday settings to construct and change social patterns of behaviour.
   Health example: Uncovers how and why certain forms of behavious are treated as deviance, exposing the stigma, negative consequences, and biased treament of social groups whose behaviour is deemed 'obnormal' (eg homosexuality).
   
5. Feminism
   Key theorists: Germaine Greer, Ann Oakely, Naomi Wolf, et al women.
   Key concepts: patriarchy, gender, sexual division of labour.
   Focus of analysis: Consists of a range of strands that are either structuralist or agency focused; seeks to explain and address the unequal position of women in society.
   Health example: Exposes sexism, biological determinism, and gener inequality in health research, theory and treatment.
   
6. Post-structuralism/Post-modernism
   Key theorists: Michael Focault, David Armstrong, Nicholas Fox, Rosemary Pringle, Elizabeth Grosz.
   Key concepts: Discourse, panopticon, bio-power, power-knowledge, surveillance.
   Focus of analysis: Agency focused: critques theories based on universal truths and structuralist assumptions; concentrates on subjectivity, diversity, and fragmentation.
   Health example: Examines how certain discourses of normality and panoptic effects serve to discipline and control various social groups.

Hope you enjoy it all:

perhaps consider asbestos access to treatment, the beaconsfield mine incident, HIV drug testing on men not women, and many other fun things.

happy studying, i'll be back home at 11 for any questions.

tim

Management of Cardiovascular Disease

Management of Cardiovascular Disease

Prevention is the best cure, and this is put into practice both before and after a heart attack: lifestyle changes, including a focus on diet, nutrition and smoking are a step in the treatment of all cardiovascular diseases.

Depending on the severity and outcome of the disease, various other treatments can be put into place:

Drugs used to treat CHD include[i]:
· Aspirin – Aspirin helps to lower the risk of a heart attack for those who have already had one. It also helps to keep arteries open in those who have had a previous heart bypass or other artery-opening procedure such as coronary angioplasty.
· Digitalis – makes the heart contract harder and is used when the heart's pumping function has been weakened; it also slows some fast heart rhythms.
· ACE (angiotensin converting enzyme) inhibitor – stops the production of a chemical that makes blood vessels narrow and is used to help control high blood pressure and for damaged heart muscle. It may be prescribed after a heart attack to help the heart pump blood better. It is also used for persons with heart failure, a condition in which the heart is unable to pump enough blood to supply the body's needs.
· Beta blocker – slows the heart and makes it beat with less contracting force, so blood pressure drops and the heart works less hard. It is used for high blood pressure, chest pain, and to prevent a repeat heart attack.
· Nitrates (including nitroglycerine) – relaxes blood vessels and stops chest pain.
· Calcium channel blocker – relaxes blood vessels and is used for high blood pressure and chest pain.
· Diuretic – decreases fluid in the body and is used for high blood pressure. Diuretics are sometimes referred to as "water pills."
· Blood cholesterol-lowering agents – decrease LDL cholesterol levels in the blood.
· Thrombolytic agents–also called "clot busting drugs," they are given during a heart attack to break up a blood clot in a coronary artery in order to restore blood flow.
‘statin’ medication
angioplasty, to reopen/repair damaged blood vessels
bypass surgery
nitro-glycerine can prevent myocardial infarction from progressing[ii]

Cardiac Rehabilitation has 4 main areas[iii]:
§ Medical evaluation. A thorough evaluation helps your health care team assess your physical abilities, medical limitations and other conditions you may have. Your team explores what risk factors you may have for such cardiovascular diseases as stroke or high blood pressure. All of these findings help your team tailor a cardiac rehabilitation program to your individual situation, making sure it's safe and effective.
§ Physical activity. No longer is bed rest recommended if you have serious heart problems — it just won't improve your fitness. Cardiac rehabilitation improves your cardiovascular fitness through walking, cycling, rowing or even jogging and other endurance activities. You may also do strength training to increase your muscular fitness. Don't worry if you've never exercised before. Your cardiac rehabilitation team will make sure the program moves at a pace you're comfortable with.
§ Lifestyle education. Guidance about diet and nutrition helps you shed excess weight and learn to make healthier food choices aimed at reducing fat, sodium and cholesterol. You receive tips on breaking unhealthy habits, such as smoking. You also learn how to manage pain or fatigue that may accompany your heart condition. Cardiac rehabilitation also gives you ample opportunity to ask questions about such issues as medications and sexual activity.
§ Psychosocial support. Adjusting to a serious health problem often takes time. You may experience depression or anxiety, lose touch with your social support system, or have to stop working for several weeks. Counseling or vocational or occupational therapy shows you healthy ways to cope.


[i] http://www.nhlbi.nih.gov/actintime/hdm/hdm.htm
[ii] http://en.wikipedia.org/wiki/Cardiovascular_disease/
[iii] http://www.nlm.nih.gov/medlineplus/heartdiseases.html

Syndicate Session – May 11, 2006

Scenario One
a) What is the likely diagnosis?
Scurvy.
b) What measures were taken to prevent these problems?
Dietary measures: increase in fruit and vegetable intake, and hence intake in vitamin C. Citrus fruits in particular had a long life and good effect.
c) How did Captain Cook avoid this problem on his ships?
Captain Cook used ‘portable soup’, vinegar and malt, along with Sauerkraut. This was believed to combat the problem of gaining vitamins without fresh fruit.
d) What is the chemical basis for this problem?
Normal collagen synthesis depends upon the hydroxylation of proline and lysine. These are non-standard amino-acids and are found abundantly in collagen and hence confer strength to collagen fibrils. The enzymes which catalyse these reactions require vitamin, and therefore, without ascorbic acid, hydroxyproline and hydroxylysine are not formed, and the collagen fibrils are considerably weaker than normal.

Scenario 2
a) What are the underlying principles which must be considered in the management of a compound fracture?
The most important principle is the aiding of the inflammatory response, by the removal of infection and foreign matter.
b) The fracture does not heal, and a chronic inflammation occurs. Pus is constantly discharged, and after seven months it has not healed. What is the likely diagnosis?
Due to the nature of the wound, and the underlying tissue being exposed to the environment, due to penetration of the skin, a foreign body is likely to be causing chronic infection.

Congratulations to the Dux

Congratulations to the other Tim,

for duxing the 5%er.

Sadly, all he receives is a PGO on his report card.

Mummy will be happy.

With love,

Tim

Group R Ethics Legal Debrief

Hey All.

I will post under comments what Jackie emailed me, as promised.

If anyone wants the word file, just drop me a line.

For non group R people, our theme 4 tutor wanted to give us these... could be fun.

much love,
Tim

Week 9 PCL: Aidan's Mole

Hey all.

Aidan's Mole is almost diagnosed.

But, any questions regarding cancer, causes, effects, diagnosis, prognosis, and any other '-oses', feel free to post.

I'll post my research for this week.

Have fun, and enjoy your thursday night.

With love,
Tim

Once again, due to a lack of enthusiasm from Monash staff, the PCL for this week was not available online at time of publishing. I reserve the right to add it later! xx

Syndicate: Thurs 4 May

Syndicate Session: Thursday, May 4

Question One
Rather than merely treating the anaemia, the doctor should have pursued working out the reasons behind this. Given that the patient had a family history of bowel cancer, she is at increased risk of developing bowel cancer. Given also the fact that she is post menopausal, the standard associated of anaemia with dietary iron-deficiency could not be made.
An assumption was made by the attending physician that her anaemia was not caused by anything significant, when really, further investigations were required.

Question Two
What is radical mastectomy?
It is a surgical procedure in which the breast, underlying chest muscle and lymph nodes of the underarm are removed.

What were the underlying assumptions of this form of surgery?
That it would prevent breast cancer. An assumption was made that the cancer was localised, and by removing it, it would remove all problems. Given that cancer can spread through the lymphatic system, removing lymph nodes would remove a primary cause of metastasis. The assumption is also made that the cancer has not already progressed and metastasised.

What were the complications?
It is very invasive. Emotional complications need also to be considered: identity, and self-esteem need to be considered. Aseptic technique 100 years ago was not as advanced, and the risks of infection from surgery were considerably high.

Sometime after about 1970, radical mastectomy began to be abandoned, and replaced by simple mastectomy or even lumpectomy. What were the conceptual changes that led to this change in surgical practise?
Conceptual changes include early diagnosis, advances in oncopharmocology, for instance chemotherapy or radiotherapy. Targeted tyrosine-kinase receptor treatments have also been discovered.

What effects has this change had on the prognosis and complications of surgery for breast cancer.
Less complication will arise as the surgery is less invasive: the chance of complications arising from septicaemia will be lowered. Through the use of advanced imaging and diagnosis (mammography), cancer which has not progressed to such an extent can be removed. As this cancer can be diagnosed early, a radical mastectomy is generally not required. From early detection, the prognosis has improved dramatically.

WOW 102

Due to extreme lack of WOW factor in recent monash medical courses,
Marina and I have decided to backlog a few Words of the Week, and perhaps add a few extras, just for shits and giggles.

so,

in no particular order:

Cholesteatoma

Pseudohypoparathyroidism

Xanthopsia

Quinquagenarian

And to start off the definition process, we decided to help you out with one of the words:

quinquagenarian: a person in their fifties.

Much fun, and as much love

Marina and Tim

Week 8 PCL: Nobody is Immune

Anybody have any good ideas on why we shouldn't immunise our kids?
I'm intrigued and ready to listen.

As for DFA: can anybody tell me how the process actually works. (direct immunofluorescent assay)?

Token Theme 2 mention, let me think... nope, i'm over it.

Cheers,
Tim

(oh, and apologies for the lack of 'Sharon's dilemma'. it can be added if required)

no text currently available online for Part A.
if it happens to come online, i shall put it here.
ciao!

The Exam

If anyone wants to discuss things that they had no idea about on the exam, I thought it might be a good idea to do so here.

Possible inclusions include:

• Sick role concept
• Questioning about beliefs
• Ethics behind medicine

etc.

Ciao for now.

Tim

(ethics = beneficence, non malificence, autonomy, justice :) )