- Julio Potenziani added an answer:When and to whom can urodynamics be used for overactive bladder (OAB) diagnosis?
There are are limited numbers of studies whether the urodynamics are superior to history alone or not for over active bladder. The diagnosis of OAB is mostly achieved by the history. I wonder your experiences about this topic in the light of literature.
When? When I have a bad evolution in the pharmacological treatment, when I think that can exist a change in the patient urodynamic profile, when the patient is operated in the pelvis (Obs, Gynec, Urological).
Whom? Patient with resistance an other treatments (medical o surgical)Following
- Desmond Brian Fernandes added an answer:Sun exposure, what is the cut-off to balance the beneficial effects (producing vitamin D) and prevent detrimental effects (skin cancer)?
Sun exposure, on the one hand, is beneficial to produce vitamin D and prevent many detrimental effects due to its deficiency. On the other hand, it may cause skin cancer, such as basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). How much daily exposure is suitable to balance these?! Is there any evidence-based cut-off guideline?
Thanks Jos. I think we will see trends but in humans we are never going to be able to do careful double blind studies but we are learning that regular (probably controlled would be better) sun exposure leads to less cancer but that brings us back to your original question: how much sunlight. The exact roles of vitamin D or other favorable molecules like melatonin may take many years to define.Following
- Dragica Pesut added an answer:What is the incidence of Tuberculosis in medical Residents?I have recently noted an upsurge in the incidence of tuberculosis (both pulmonary and extrapulmonary) in medical Residents. What precautions/ measures can prove effective in curtailing such an occurrence?
I fully agree that the measures of TB infection control should be in place at health care facilities. They usually are in place at TB departments. It is considered that health care providers working at triage are more exposed to TB. In 2013, a cross-sectional study from Japan involved HCWs from a hospital without TB-specific wards. The screening for latent tuberculosis infection (LTBI) has been performed by interferon gamma release assay (Quantiferon TB Gold in tube). LTBI prevalence rate was 11% and questionnaire revealed previous close contact of the staff with TB patients. Please find attached the paper.Following
- Arjyabrata Sarker added an answer:Can we think of different options as thyroid suppression?
Many drugs and metal ions in the plasma reduces the incidence of hormonal secretions i.e. Calcium supplements (Ca-citrate) can reduce the parathyroid secretion by 50 % more than the carbonates by PTH suppression. Can we think of this type of different medication strategy for cost effective manner only for the lower extent of suppression if needed?
Dear, Michaela Yakubovich-Dirks,
It seems the drug could have increased the effect of parathyroid suppression therapy if used simultaneously in my view.Following
- Aline Israel added an answer:Which form of Calcium is best for consumption as medicine??
In ayurveda following calcium sources are used in Bhasm form (Calx)
It is regarded as Conch Shell> Coral> Pearl calcium source us best according to the expert Physicians of Ayurveda. is there any scientific rationale?? plz explain with research evidences
IAccording to the data that I know and my experience, the calcium citrate complex is the only one that does not cause constipation at all.Following
- Surendra Mantoo added an answer:Is there a role of Geriatric Colorectal Surgery as a special service?
There is an increasing trend in the number of elderly patients with colorectal pathologies.
One of the important goals of surgery in elderly patients should be to restore them to the preoperative functional status after surgery. It is no point to operate on an 80y old patient and render him dependent for the rest of his life. Our results have shown that if there is good pre-operative optimisation, good intra-operative and postoperative care in collaboration with anesthetist, geriatric physicians, physiotherapists, pharmacists, dietiticians and others, a majority of elderly patients have a good functional recovery.Following
- Devin Hosea added an answer:What proportion of medicine is evidence-based?There is a high bar for introducing a new intervention (social/behavioral, drug, device, etc). However, I suspect that many interventions, treatments, and decisions in medicine do not have a high level of evidence base (i.e. no formal trials, decisions are based on experience, practice, etc). Have there been studies that estimate what proportion of medicine is evidence-based?
Drs. Eiser and Leibovitz make good points. However, I truly believe that Outcome-Based Medicine (OBM), driven by raw data, a form of "evidence", will actually make the clinician's job much easier, especially when making tough clinical decisions that can dramatically affect the probabilistic Px for a given Pt. Take a simple enough question in the psychiatric Tx for opioid use disorder (OUD, DSM Dx 304.xx). A clinical psychiatrist is often asked to decide whether to place a Pt with Dx 304 on maintenance medication (such as buprenorphine) or to instead hope they can sustain remission without such medication. This decision can have a huge impact on a patient's Px - in some cases, medicating the Pt saves her life, in others it can lead to morbidity or mortality -- and it is a binary decision that is hard to adjust during treatment (because of the extreme difficulty of discontinuing such medication).
As Dr. Eiser points out, it is too much to ask that the busy clinician be up-to-date with the academic literature, and even that source of "evidence" lacks consensus and tries to draw inductive conclusions, "e.g. one rule for all patients". What I am suggesting, instead, is that the clinician have access to statistical outcome data that apply to his Pt. This is not the "future", but is already happening in some specialties.
So, back to the example above - whether or not to prescribe buprenorphine to a patient with OUD. The current process is intuitive (to describe it kindly); there is little understanding of the etiology of addictive disorders; the academic/medical literature generally favors medicating but also highlights the risks in terms of morbidity and mortality. I think, in a case like this, a clinician would love to know that, empirically speaking, a statistically significant group of patients just like the Pt in question (in terms of Dx, Hx, gender, demographic, etc, etc, and all other relevant factors) had a better prognosis with (or without) medication. And a good clinical decision support system would show the clinician this personalized Px "forecast" that would inform his decision. Of course, the clinician could bring to bear intuition, what they have read, EBM synopses, etc, but I for one would be interested to know WHAT THE DATA SUGGESTS. Of course, one has to be careful in how these Tx suggestions are presented, and as Amarasingham, Patzer, et al explain in a recently published article entitled "Implementing Electronic Healthcare Predictive Analytics: Considerations and Challenges" (link below) there are a multitude of considerations.
Yet I would submit that it would be irresponsible for a clinician to ignore statistical outcome data when making a crucial Tx decision, especially if it is readily available and customized to the Pt, glowing on the nearby screen of an easy-to-use clinical decision support system. Outcome data, properly analyzed, will enable the busy clinician to make better Tx decisions in LESS TIME than any other method.
Furthermore, I believe that eventually Px will obviate Dx, which is to say, we should only care about optimizing prognosis. Assuming that prognosis is optimized (a big assumption, I'll admit), then diagnosis and etiology become academic (although they remain means to the end of an accurate Px) That, I'll agree with Dr. Eiser, is for the future, but it's my prognosis for EBM (please excuse all these puns), or whatever we eventually call data-driven medicine.Following
- Antonio R. Delgado-Almeida added an answer:Does anyone have any insight into what a magnesium bolus would do to vascular permeability in a patient taking a VEGF inhibitor?
Avastin can affect vascular permeability, normal BBB restrictions on Mg diffusion would thereby be bypassed opening the possibility of excitation and possibly seizures in those prone,
Before play chess you should known the pieces, and I probably help in the basic.
Magnesium ion has an ionized and intracellular fractions, being the 2nd largest intracellular cations in our body, critically important with potassium ions in most cell functions, as enzymes, at times being part of enzymes or protein structures. In fact, RBC magnesium is about 3 times of the plasma fraction.
In blood, similar to calcium, magnesium is found as bounded, ionized and intracellular fractions (RBC), in which bounded or Mg salt represents the reservoir to maintain ionized Mg, the only functional fraction, except when bounded to enzyme or proteins.
In pharmaceutical form, we usually refers as 100 mg of magnesium oxide or 600 mg of magnesium sulfate. Unfortunately, in 500 mg of Mg sulfate there is only 5 meq (10 mg) of Mg. In other ions as calcium: 1 g of IV calcium gluconate (FDA: 8 mg of calcium), very effective but tiny fraction as compared with calcium chloride.
Therefore, taking 800 mg of Mg sulfate = 6.4 mg (3.2 meq), half of RBC Mg/liter cell, is harmless from pharmacology and physiology aspects. However, 793 mg of oral sulfate after absorption may decrease blood ionized ions, thus cell function, while 793 mg of IV sulfate rapidly bounds ionized calcium leading to hypotension, seizures and bleeding in presence of surgery.
In brief, don't worry about our metal ions, our body has a lot, take care of the ionized and intracellular fractions (iron in Hb) which maintain us alive!Following
- Niroshan Sivathasan added an answer:Are medical errors a sign of incompetence among physicians or can it be reduced through change in medical culture or attitude of the medical professionals?Patient safety is high on the agenda both nationally and internationally.
Agreed, Anthony! A spin on the old adage, 'familiarity breeds contempt' - in this case, 'familiarity predisposes to oversight' - is something that all, including experts, should be aware of!Following
- Roberto Maffei added an answer:Is there existing scientific literature about vitreous humour and its correlated diseases and therapies?
My aim is a survey on what seems to be a very scarcely studied subject and points to evaluate the possibility to outline the state of the art about such matter.
This is a preliminary study related to a possible methodological research about semi-neglected subjects in medicine and biology.
Many thanks to you!
- Zoltan Sandor added an answer:Why isn’t nutrition a bigger part of conventional medical school education?Diet is arguably the single most important preventive measure for healthy aging because it affects the functioning of every organ in the body and is a factor both in the development of disease and in recovery.
Wrong. OK, You are not a chemist. 2 mol Na+ equivalent with 1 mol Mg2+ .
3 mol Na+ equivalent with 1 mol Cr3+.
In this (reversible) cation exchange process:
LNa2 + Mg2+ <--> LMg + 2 Na+
the counter ion of (for) magnesium is sodium. In an ion exchange process the ions and counterions has the same charge + with + in cation exchange processes, and - with - in anion exchange processes. (This eqiuvalency = maximum economy, L= ligand with 2- charge.) Molar equivalent ratio is not = molar ratio.
Read this article: http://padre.uw.hu/ekvis/eqlaw.htm
Pálinka OK, it's a medicine.
The “science” of salt, nutrition science, health science = three monkeys.
Hear no truth, see no truth, speak no truth!
- Sinna Shan added an answer:How can I treat azetatsolamid-resistent CME in retinitis pigmentosa?
17 years old Usher patient, po azetatsolamid (growing dose, now 500 mg x2) used since 12/2013. CME is getting worse, but BCVA is still about 0.5-0.6 oa. I read that intravitreal corticosteroid gives only limited and transient response - so maybe not so good idea? Anti- VEGF?? Something else?
I have not had much success with diamox. Since it has been going on for quite some time chances of it clearing is slim. You could repeat FFA and OCT(HD-OCT is fine) and have an idea of the progress. I find, in the early stages, it responds well for Acular (ketorolac trometamol 0.5%) t.i.d for at least 4/52 and preferably continue for 2 or 3 months. If there is no response in 4 weeks, I would give sub-tenon dexamethasone or triamcinolone before considering intravitreal agents (-ozurdex/ ranibizumab /bevacizumab/ or aflibercept in that order.)Following
- Hristina Petrova added an answer:Are you familiar with the history of the food diary? Is there any specific research or works in literature and art on the food diary or journal?
Have you read any articles on the history of food diary/journal in relation to its use in medicine? Where can I find any interesting stories, books or articles written by physicians, medical administrators or librarians, patients? I would also be interested if there are any documented stories in medical anthropology, medical humanities or even literature.
Here is an article by Maria Popova on diarists in art and literature http://www.brainpickings.org/2014/09/04/famous-writers-on-keeping-a-diary/
I didn't see anything interesting in it or things related to food and health but some of you might not share my opinion and find other clues.Following
- Noliwe Lebani added an answer:Can you diagnose this?
A 78-year-old Caucasian women presented fever (39°C) and a large, moderately painful ulceration on her right breast which had begun about 10 days ago after quadrantectomy and extended rapidly. Wound and blood cultures yielded negative results. Laboratory investigations: erythrocyte sedimentationrate was 73mm/h, WBC was 22890 mmc; C-reactive protein (CRP) was 25 mg/dl; Protein electrophoresis showed a increase in alfa 2 globulin 15.6%. No clinical response with different antibiotics (imipenem plus teicoplanin; daptomicin + levofloxacin; piperacillin/tazobactam + trimetoprim/sulfamexazole + tigecicline + fluconazole. What is your diagnosis? What do you suggest?
I suggest you go for a biopsy and see if it is not cancerFollowing
- Jill Snow added an answer:White vinegar craving - any thoughts?I have a patient who is craving vinegar (not pregnant). Is there any significance to this?
Will add this to knowledge base, many thanksFollowing
- Tommy Berglund added an answer:Do Radiology residents require personal dosimeters in present scenarios?Personal dosimeters (viz. TLD) are used for monitoring radiation exposure. As in the current Radiology curriculum, residents hardly work in an environment where radiation monitoring would be required (except DSA), what is the current guideline for personal dose monitoring?
In general terms one shall wear a personal dosimeter when you are working within radiation exposed areas at least one time each working day. In other words if you are exposed to radiation minimum 5 times a week you should wear a dosimeter. BUT you can also choose to do a test period were you have your radiation exposure measured, 3-6 months for example. If your workload is normal in the testperiod and you have no or negligible dose readings you can make a qualified judgement of not using any dosimeter device further.Following
- Ulyana B Lushchyk added an answer:Is there evidence that staged ICA stenting in severe ICA stenosis reduces post-op hyperperfusion syndrome risk ?
I am researching into hyperperfusion syndrome and prevention, specially in carotid stenting.
Is there any evidence that a staged procedure is more beneficial than a single stage procedure in severe ICA stenosis (80% or higher)
Have you experienced cases with hyperperfusion syndrome following carotid stenting ?
Due to the laws of hemodynamic, the ICA stenosis is the most frequent place for stenosis according the laws of various diameter of bifurcation branches. The phenomenon of postoperative hyperperfusion is closely connected with deep and longtime status of arteriovenous disbalance. Such patients need the preoperative course of vascular correction of the abnormal disproportion in total arterial-capillary-venous tube system for the prophylactic of arterial hydraulic stroke. More- http://angio-veritas.com/technologies/vascular-innovations/?lang=enFollowing
- Imran Shuja Khawaja added an answer:What are the effects of stimulants on REM sleep?Do stimulant medications reduce the amount of REM sleep?
- Maddali V S Murali Krishna added an answer:Should we question the credibility of international conferences?
We see most of international conferences accept more than 90 percent of the papers that they receive regardless of the quality of the papers or plagiarism possibilities. Shall it make us think that the conferences are only business?
In the Academics point of view, conducting International Conferences has more weightage rather than attending the conference. We get opportunity of meeting experts in their own field and sharing knowledge with them on common platform so as to know recent advances or latest techniques taking place in their field in International scenario. Conducting international conference is not a business but it is a wonderful experiene or an opportunity. It depends on your talent, how you can utilize this opportunity.Following
- Aaron Brady added an answer:How can we estimate the level of various monoamine neurotransmitters in a biological sample?
I want to detect various neurotransmitters in various biological samples. Please suggest a simple, accurate and economic method for determination of these neurotransmitter. like UV method.
It is very important in my research work. Please.
If you don't get consistent or low enough levels of detection with HPLC try LC-MS or perhaps, more easily, an ELISA-based method.Following
- Eliab Z. Opiyo added an answer:What criteria should be taken into account to find the best supplier?
What should be considered as criteria to find the most appropriate supplier?
In addition to what has been mentioned, trust is also one of the key considerations. The supplies often have access to important process or product knowledge, and it is therefore imperative to do business with one that can be trusted.Following
- Madelaine Lawrence added an answer:What is the scope of liberal forms of power characteristic of modern systems of governance?
Patients are expected to demonstrate their will to be empowered and to act as user participants. On an organizational level, various systems of self-regulation have been introduced, such as quality assurance systems, self-evaluations, and different documentation practices. There is a need to explore whether self-regulation and the will to be empowered has become a prerequisite for receiving effective health care and the possible implications of such an ideology.
I totally agree with Brenda. Healthcare institutions do not endorse patient self-determination. The magnet hospital movement and its evaluation requirements have helped a little toward achieving that end. Even though patients fill out evaluation forms, they generally are already use to being in a submissive role to care givers. They believe that is normal and reflect that in their evaluations.
There is a growing movement toward billing doctors if patients wait too long for them to see you. I waited for one doctor for over an hour. I was told by the receptionist I was next to be placed in the exam room. I knew that was another 30 minute wait in that room. I walked out never to return. I should have billed him for my time.
One major research center I know of uses gray, shroud colored gowns for cancer patients awaiting mammograms. I have asked on numerous occasions for over 3 years that someone change the color of those depressing gowns. No action has been taken. If something that simple can't be done, what hope is there for a full program of self determination for patients?Following
- Flavio Tonelli added an answer:Shall we trust our suppliers?
There are sometimes no choices, but to disclose the protected process or product knowledge to the suppliers. How can we handle it?
I'll try to provide you a "industrial applicable" answer since I've faced the problem recently. Besides common and correct considerations as provided by Prem and Eliab, there are software application capable to HANDLE effectively the supplier relationships yet guaranteeing IPR or knowledge, allowing a real supervised, authorised collaboration process. One of these, I didn't know till several months ago, is Arena Solution a SaaS based application for Bill of Material (but also Recipe) Management System. You can find it easily on the web and download/install a fully working demo.
There is also an interesting book written by Shaun Snapp entitled "The Bill of Materials in Excel, Erp, Planning and Plm/Bmms Software", Amazon link: http://www.amazon.it/Bill-Materials-Excel-Planning-Software/dp/098371553X
A useful link from Shaun is: http://www.scmfocus.com/billofmaterials/2012/01/26/plm-vs-bom-management-software-or-the-bms/
See also this you tube link: https://www.youtube.com/watch?v=RTg31zEIrHk reporting an interview from Arena Solutions directly
Sorry if I could seem very practical but if you really need to handle this relationships these resources can be very useful and is not efficient to repeat what other researchers already expressed well.
On the other hand if your interest is more on the philosophical perspective I'll be very glad to answer you on this specific aspect.
- Parviz Parvin added an answer:Is there any attempt to model "Physics of Cancer"?Cancer consists of a series of diseases based on undesired cell proliferation. The cancerous cells are continuously formed in infectious organs whereas the human immunity system regularly identifies and destroys the unhealthy cells. When the defense system fails to demolish these malignant cells because its mal-function then the proliferation takes place in a definite rate (constant or increasing).
In this case, the patient needs to be treated by chemo-therapy to hinder (or slow down) the peroliferation rate. This may be done by using vaious techniques available such as employment of the nanostructures, novel bio-clusters, bio-stimulation, thermal therapy and laser techniques or hybrid methods of treatment accompanied by traditional chemo-drugs to enhance the efficiency.
A Chinese research team: a type of virus can hinder the canceous cell proliferation.Following
- Ian Leader-Elliott added an answer:Looking for help: What's the distinction between self-deception and self-concealment?
We (me and my research partner Thomas Waanders) have interviewed 20 Dutch Olympic Gold Medal winners about coping with extreme fatigue. At the moment we're analyzing the results and writing a book about the topic.
We asked athletes questions about many different topics (e.g. pacing, self-regulation, coping strategy, culture, environment, personality and many more) related to the subject.
Concerning the topic of coping strategy. One of the strategies athletes use is self-deception. Lately I've been reading more about self-concealment though. It got me thinking. At the moment I'm trying to better understand self-deception and self-concealment. I hope someone is willing to help me out with my thought processes..
Self-deception is lying to yourself. An important strategy used by athletes (e.g. lying to themselves about the distance of the race or telling themselves their SRM system is broken). The thing I like. The person who lies and who's been lied to are the same. Interesting, because how does your mind work in such cases? Do you focus attention to certain information? Do you conceal (negative) information to the self (e.g. just like a trauma and clinical psychology)? What's the role of perception?
Another strategy athletes use is 'self-concealment'. To explain. Athletes use small cues of tiredness from close competitors to give themselves a boost and keep pushing forward during a race (e.g. a marathon runner thinking: 'Do you see him breathe, he's almost done. Just keep pushing for one more bit and you will beat him.'). Because of this, athletes conceal (negative) information about oneself to competitors. If you show any 'signs of weakness', the opponent will see a chance for success and will be more willing to keep spending energy.
Besides endurance athletes, think of a K1 fighter concealing pain in his left leg, to avoid having an opponent focusing on exactly that weakness. Sometimes they even smile to give their opponents the feeling their punches aren't having any effect. Just to give them a feeling of powerlessness.
Looking for signs of weakness themselves and knowing their opponents do too, learns athletes that it's important to conceal negative information about their level of fatigue and pain.
But what about semantics? When do we talk about self-concealment? Is it when you conceal (negative) information during self-deception (to the executive system?) about the self (is this even possible, think of a trauma and putting the memory away)? Or is it when you temporarily try to conceal negative information about your level of fatigue or pain, in order to don't 'give energy' and influence opponents 'costs-reward model' for pushing on. Or do we have another word for this?
To make matters worse in my head :-) A side note. Self-concealment is also something that's been talked about in a more cultural perspective (e.g. think about social media and only sharing positive information and concealing to the public the negative information about the self) and health (e.g. coping with trauma). Or is self-concealment just like the term self-regulation. Having a different meaning in different fields?
If you have an interesting viewpoint about the topic or some relevant literature, I would love to hear from you!
Thank you in advance!
Fascinating enquiry. The answer above, from Hans van Laake, that self deception might have to do with directing one's attention to a current project does have at least one support from a well known, earlier scholar of SD. Herbert Fingarette published a monograph, called 'Self Deception', in 1969, with an update essay in 1998, which can be found in the Philosophical Quarterly (vol 47) for that year. Fingarette argues that there is no paradox about SD It is an essential mechanism of one's mind in setting oneself to do a task, or pursue a course in life. His sad little vignette of 'Harriet', the self deceiving would-be academic who never quite makes the cut is memorable. Self concealment is very different. It may be accompanied by self deception - one may 'put on a good front' for oneself as well as for others. But self concealment can be quite calculated. I have seen boxers feign hurt in order to gain the opportunity to administer a sucker punch. Self concealment seems essentially communicative in a way that SD is not.Following
- Maritha Purperhart added an answer:How to teach? What are the qualities that should be present in a teacher (lecturer) ? Please share your own experience for effective teaching.There are many experienced prof. on this network. I need your guidance for effective teaching . Hope your sharing experience will helps not only me but also many lecturer.
Effective teaching is engaging. The instructor is obligated to provide resources, exercise guided learning and model content knowledge and skills. School district these days are more engaged in providing research based best practice activities in which learning is student centered and active learning is taking place in all core subjects. The technology age requires instructors to entertain, balance reading, writing, speaking and active listening with hands -on activities.Following
- Alan Hawk added an answer:Why so many physicians joined the Nazi party?50 percent of physicians joined the Nazi party. For some reason, they were more enthusiastic than other professions to collaborate with Nazis. Other professions did not have such high representation in the Nazi party.
I wonder about the possible reasons for that enthusiasm.
As much as progressives don't like to admit it, the roots of National Socialism are in progressive (i.e. socialist) ideology. There is a very strong correlation between single payer systems and death panels used to cull the population of an increasing pool of sicker individuals. Although single payer is premised on efficiency, centrally-planned institution are notoriously inefficient (remember Soviet Union) since bad decisions have very broad impact. The only way for a single payer healthcare system to save money is to kill the sick. Once you get that concept and power into the hands of government agency, it is a very short leap to expand the mandate. Terminating the life of a patient with terminal cancer begins to morph into terminating the life of those susceptible to cancer. What about patients with chronic conditions such as mental illness or cerebral palsy? What about people who make undesirable life choices? What about certain ethic groups? Each decision makes the next one more plausible. Suddenly decisions are being made that were completely unthinkable a generation earlier.
Single player healthcare systems are an extremely dangerous game since the risk of either bad or unethical decisions can have a very broad impact.
The real question you need to ask is not why physicians embraced Nazism, but why were they ready for the Nazi ideology before Hitler came along?Following
- Puppala Vijaya Kumar added an answer:Does the responsibility of researchers end with the scientific publication of their findings?Or should he or she also ensure that these findings find a way to a) non-scientific public and b) the implementing authorities / institutions (a practical reference provided)? I have made it my habit to any scientific contribution to compose another layman's contribution and to publish in order to create the possibility of practical implementation. All non-academic partners are extremely grateful for it. Without access to databases they would probably know nothing about these results and findings. Other ways to make research applicable?
Trying new channels for effective communication of results will be a good thing.Following