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@charmed-one-md
“Leave your worries behind and walk forward. Your dreams and aspirations are waiting ahead.”
Medicine is and will always be a long journey. There are a lot of hardships and obstacles that you will encounter along the way. But as long as you know your ultimate goal, you will always find a way to push yourself in to accomplish that.
What are the minor fallbacks if you know that someday, you will achieve that dream.
~charmedONEmd~ 041918
“Driven by a glimpse of light that leads to all possibilities. To all desires, what-ifs, and maybes.”
At last! An entry after a long time.
I completed my residency training just a few months a go. It was relieving at first because there is a sense of freedom. Freedom from a time bounding stage in a life of a doctor just to step on that elevation from your “basic” doctor which is a general physician.
There is a sense of accomplishment because of the additional learning that I gained from that 5 years of training. That comfort of knowing that your patients are somewhat managed properly using the accumulated knowledge and skills from the training.
Then I realized that I am now entering the realm of being an independent doctor. The moment that I was longing for the last 5 years of my life. And now that I am standing on ‘that moment’, I felt the fear. I will now face the uncertainty of my future. And I am now on my own in managing the patients. Of course I can still ask for the help of my mentors and seniors but this is different from when I was in residency.
Fear is one thing. Excitement is another. I now see that I am accomplishing my goals which I first thought of when I was in elementry. Looking back, I travel this path for a long time. But the journey that I have is overall an enjoyable one. I can say to my ten-year-old self, “you did a good job”.
Facing forward, this is a life long journey. And along the way, there are achievements that I am proud of reaching.
This every step is part of my self improvement. In my own little way, heal the world, one person at a time.
~charmedONEmd~ 041918
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Researchers use neuroimaging to explore reading deficits after left stroke
Researchers at Kessler Foundation and Rutgers University correlated neuroimaging data with reading deficits in patients with subacute left hemispheric stroke. Their findings add to our knowledge of the neural mechanisms of reading and may be useful in the development of reading interventions that address specific neurological deficits. The article, “Neurally dissociable cognitive components of reading deficits in subacute stroke” was published in Frontiers in Human Neuroscience. The authors are Olga Boukrina, PhD, Edward Alexander and William Graves, PhD, of Rutgers University, and A.M. Barrett, MD, and Bing Yao, PhD, of Kessler Foundation.
Although impaired reading can cause significant disability, few studies have focused on the cognitive components of reading. The objective of this study was to link each of the three components: visual form (orthography), sound (phonology) and meaning (semantics), with their neural substrates. In this study, 11 stroke patients underwent neuropsychological testing and neuroimaging, which enabled investigators to correlate their cognitive deficits with respect to lesion location.
Participants were studied during inpatient rehabilitation, within 5 weeks of left-sided stroke. All underwent functional magnetic resonance imaging, psychometric testing, neurological examination and tests for phonological, orthographic and semantic impairments. One interesting finding was the association between phonological deficits and lesions in the anterior temporal lobe and mid-fusiform gyrus.
“Although this lesion-deficit approach is not widely used, it offers a way to define impairments in reading in relation to specific cognitive deficits,” said Dr. Barrett, director of stroke rehabilitation research at Kessler Foundation. “This novel framework could provide the basis for targeted interventions for addressing acquired reading deficits. Research that advances our understanding of the cognitive processes involved in reading will improve the rehabilitative care of individuals with left-sided stroke, and benefit other populations with acquired reading impairments.”
We’re One Step Closer To Creating Artificial Skin With a Sense of Touch
Cutting-edge prosthesis are amazing, but they lack one very important feature: a sense of touch. Now a research team from Stanford University has developed artificial skin that can sense force exerted by objects—and then transmit those sensory signals to brain cells.
Inadequate sensory feedback is a serious limitation of current prosthetic limbs, whether they be artificial hands, arms, or legs. Users need to be able to sense how an object is responding to their touch in order to have optimal motor control. Otherwise, it’s difficult to know how much force is being exerted on an object, or sense things like temperature and texture. What’s more, the sense of touch—or even the illusion of it—can alleviate phantom limb pain, which affects some 80% of amputees.
We’re still a long ways off from being able to create artificial skin that feels and reacts the same way that natural skin does, but the Stanford team, led by electrical engineer Benjamin Tee, recently performed a proof-of-concept experiment that takes us a considerable step closer.
Stretchable skin with flexible artificial mechanoreceptors (Credit: Bao Research Group/Stanford University
By using flexible organic circuits and an innovative new pressure sensor, Tee’s team developed a kind of artificial skin that can sense the force of static objects. What’s more, this sensory data was then transmitted to cultured, i.e. in vitro, brain cells of mice using optogenetic technology. They have published the results of their work in the journal Science.
Tiny Pyramids of Touch
The system, called DiTact (Digital Tactile System), is based on a low-power, flexible organic transistor circuit that transforms the feeling of pressure into the same kind of signals generated naturally by natural skin’s mechanoreceptors. These signals were in turn converted to a series of voltage pulses.
The DiTact System (Credit: Tee et al., 2015/Science)
To get the sensors to record the wide dynamic range of pressure, the researchers used carbon nanotubes molded into pyramidal structures.
“Our sensor was made of tiny pyramids of rubber with carbon nanotubes distributed in it,” noted study co-author Alex Chortos in an email to Gizmodo. “This structure was very useful because it allowed us to easily change a few things, like the distance between the pyramids, the size of the pyramids, and the concentration of carbon nanotubes in order to get the ideal pressure sensing characteristics in the right range.”
These microstructures allowed to researchers to maximize the sensitivity of the sensors in a way that closely approximates the sensitivity of natural skin’s cutaneous receptors.
Transferring Signals
On their own, these signals do nothing. In order for them to be experienced as sensory feedback, they have to be transmitted to a brain. To that end, the researchers took these signals, which ranged between 0 to 200 hertz, and transmitted them via optical fibres to the cortical neurons of mice. DiTact is still in an early phase of development, so the researchers transmitted the signals to cultured cells in vitro, rather into the brains of live mice.
The DiTact System (Credit: Tee et al., 2015/Science)
This technique, referred to as optogenetics, could eventually be used on live subjects. Through this process, neurons are stimulated to fire or stop firing by genetically-engineering neurons that respond to light. A transgene from algae makes neurons fire when they’re exposed to blue light, and a bacterial transgene causes them to respond to yellow light.
But for this experiment, the researchers had to use an alternative optogenetic solution to account for the rapid rate at which sensory information is processed by neurons.
“Biological mechanoreceptors are able to produce signals as fast as several hundred electrical pulses per second,” says Chortos. “Previous optogenetic technologies were only capable of stimulating brain cells much slower than we need to mimic real mechanoreceptors.”
Chortos points to the work of Andre Berndt and Karl Deisseroth who developed a new type of optogenetic treatment that allows brain cells to be stimulated very rapidly so that they’re compatible with the speed of real mechanoreceptors.
Tee’s research team shows that the new optogenetic proteins were able to accommodate longer intervals of stimulation, which is a strong indication that the system might be compatible with other fast-spiking neurons—including peripheral nerves. In other words, DiTact will likely work in live mice, and possibly humans. And indeed, the researchers told Gizmodo that the next step in their research will be to use their sensor to stimulate the nerve of live mice.
From Science Fiction to Reality
Given that the signals were transmitted to clumps of cells in a petri dish and not a live animal, how could they be sure their signals were of the right nature and intensity?
“We could validate that our sensor is conveying the correct information to [a live] animal by using behavioral cues, i.e. how the animal behaves in response to pressure,” said Chortos. “The ultimate test will be to attach the sensor to a human and ask them what they feel. In order to get truly natural touch sensing, we may need to modify and tweak our design.”
Indeed, the ultimate goal is to imbue human prosthetics with touch-sensitive artificial skin.
“We envision our artificial mechanoreceptors making the greatest impact via integration for sensory feedback with prosthetic systems in development by other groups,” noted co-author Amanda Nguyen. “As our sensor would be mounted alongside artificial limb systems, the primary safety concerns are centered around nerve stimulation patterns and interface.”
Nguyen says that early work involving sensory feedback with neuroprosthetics in humans has been promising, but there is a need for larger and more involved human studies to understand how to effectively and safely stimulate nerves to provide sensory feedback.
“As a greater understanding of stimulation parameters is gained, the output of our artificial mechanoreceptor will be tuned to follow these stimulation paradigms,” she said. “With demonstrated efficacy and safety, the potential for improving the quality of life for individuals with tactile impairments can be balanced with the ethical concerns raised by neuroprosthetics. Accessibility of this type of technology in humans will grow as both our understanding of neuroscience grows and prosthetic technology advances to provide nuanced sensory perceptions.”
Indeed, this avenue of research will become safer and less ethically dubious over time. In order for optogenetics to work properly and safely in humans, for example, researchers will have to figure out a way to get optogenetics to work without resorting to invasive fibre optic wires and the viral delivery of transgenes to patients.
According to Polina Anikeeva, a professor of Materials Science and Engineering at MIT, it may soon become possible to use stem cells from the patient and enable their sensitivity to a particular wavelength of light through genetic manipulation outside the body. She said that these cells can then be potentially reintroduced into the peripheral nerve of the patient allowing the latter to be optically stimulated. No wires, no ethically dubious trans-genes. Anikeeva says it may also be possible to use neural stimulation to enhance the ability of the nerve to regenerate themselves or even form intimate interfaces with synthetic sensors.
Suffice to say, we won’t see these sorts of technologies for years, if not decades. But thanks to the work of Tee and his team at Stanford, the path to reaching this goal is getting increasingly clearer.
Read the entire study at Science: “A skin-inspired organic digital mechanoreceptor”.
Source
*above is the drawing that my mentor suggested to be included in the report to better explain the intra-operative finding. The drawing is not good but a commended one. Not for its apearance but for its use.* ~charmedONEmd~ 110515
Positive Reinforcement
“Truly, I am very happy with the presentation and how the patient was managed.”
Such a simple statement but resulted to a major boost of confidence. This is part of the message sent by one of our mentors after a post-operative case presentation.
Psychology, as part of my knowledge from my major in college, is embedded to the way I see things. It influence my interpretation and how I address people and situations.
All of us give feedbacks to every incident that happens around us. But how many of us emphasizes on positive reinforcement? As what B.F. Skinner formulated in his theory, operant conditioning, positive reinforcement will strongly influence a person to do well in the next task given.
We usually say our thought without screening them. It is usual to see the negative result and we make comment that may further lower the confidence of the person involved. Furthermore, we sometimes forget to say positive feedbacks once we see good results. We usually accept it as it is; as a common fact; as an expected result. Hence, no acknowledgement.
Not saying positive feedbacks on good results and saying negative feedbacks on mistakes will lead to a disaster. This disaster may not manifest immediately or will be visible but it will definitely nick the confidence of that person.
Will it be degrading if we commend someone who deserves it? No. It is not a sign of weakness to acknowledge the job well done that you have witnessed. It will boost a person’s confidence and this may result to a postive perspective; to the person recieving the positive reinforcement and also to the source of feedback.
May we see positively the people and the situation that we encounter in our daily life. Fear not to give positive feedback to someone who deserves it. Because this will push a person to do better and will respect you more.
“For a positive thought given will not make you a lesser person.” -hmpu
~charmedONEmd~ 110415
Reblog if you’re a Pharmacy/Med School Studyblr!
I’m looking for some new studyblrs to follow specifically in the pharmacy or health care field! Reblog if you’re one of them!
how to start studying after school
clean up your desk: it’s hard to concentrate when there’s a pile of rubbish on your desk. the chance of you fiddling with things is also higher! you’ll get more done by cleaning your desk! if you’re looking for an easy way to organise your desk, check out these handy organisers!
get your books: get out all the books you need to study that particular subject. if it’s geography, an atlas might be handy.
get a notebook: if you’re in uni or college it’s a good idea to re-write all your notes for your classes that day. make them look clean and tidy. if you’re in secondary school and you’re studying for a test, summarize everything you have learned. in any case, it’s best to have a few notebooks on your desk too. here’s a 4 pack of spiral notebooks for $7.04!
grab some pens: seems self explanatory! i recommend you having an ordinary pen, a highlighter and a pencil on hand. (a.k.a. the basics!) here are some super cute gel pens!
turn off your phone: by turning off your phone, you will get less distracted by social media. sure, people won’t be able to reach you but you’ll get some peace and quiet. obviously leave it on if you’re expecting an important call!
look for a study playlist: if you easily get distracted by your laptop too, skip this step. i personally find it harder to get distracted by my laptop than my phone, so i leave it on and look for some music to study to. here’s a masterpost of some good playlists to listen to!
get a glass of water: you really need your h2o, everyone. grab a large glass or fill up a water bottle. some super cute ones: i ii iii
get a healthy snack: if you’re like me and you love snacking on things while your studying, the best thing to do is to grab something healthy. cut up some apples and sprinkle some cinnamon on them (try it. it’s amazing.), grab some hummus and some celery or carrots or cucumber to dip in it, fill a little bowl with nuts, treat yourself to a square of dark chocolate! if you’re studying during dinner time or lunch time, make yourself a nourishment bowl to nibble on. for more study snack ideas, go to pinterest and snoop around the study snack tag for a while. try out my favourite smoothie bowl too!
take a deep breath: i know from personal experience that sometimes the workload can be really scary and freak you out. the most important thing to do is to take a deep breath and to tell yourself you can get through all your work. you can do anything if you try hard enough!
get cracking: now that you’ve done steps 1-9, you can actually start studying! good luck!
Avoidance.
Avoidance. It's a term used by a lot of people in medical field. Usually as a reminders to the patients. Avoidance of this kind of food, this lifestyle. This medications. In a way, this is a good thing. It's a prevention. An avoidance to have a worse situation. However, avoidance is also a harmfull trait that may worsen someone's situation. Avoidance of responsibility is one of this. For a person in medical field, this avoidance is sometimes automatic in some situation. A person might not realize it but this avoidance can affect not only the patient but also the people involved. A situation happened today that is gull of avoidance from a lot of people involved. It may not be a good example but a good learning for anyone. Some junior residents with some problems as per the point of view of some senior resident had an operation in which they are the main surgeons. At some point, the operation became complicated and the most senior of the surgeons askthe help of the most senior. And because the senior felt that he wanted to teach his juniors their lesson. He did not help them in the operation which resulted to a prolonged procedure. We, as humans, can be carried away by our feelings and personnl agenda. That it may block our sense of judgement and may forget ang primary goal in the medical field. "To serve humanities is the main purpose in life" is a cliche for the people in medical field. But let us not forget this a our drive to strive ang heal people. Not just their body but also their other aspect of life. Our feelings may be our instruments give us the 'push' that we want to help others but this may also hinder our judgement which may be a disadvantage for the patients. With this, let us set aside our own feelings and do the things for the improvement of the patient. "To serve humanity, and heal the world." ~charmedONE_MD~ 101115
Frozen Poop Pills Fight Life-Threatening Infections
Fecal transplants can be life-saving for people with stubborn bacterial infections, but they’re not for the faint of heart. So doctors have come up with a way to make them more palatable – the frozen poop pill.
Twenty people with recurrent C. diff infections took 15 pills a day, about the size of a large multivitamin, for two days. Fourteen of them were free of diarrhea almost immediately, with no recurrences. The other six tried the treatment again; that did the trick for four of them. The two people who failed to get results were in poorer health overall, the study found. But the treatment worked for people from age 11 to age 89.
The Mass General group has since treated another 21 people with the pills, with similar success. The results were announced Saturday at the IDWeek meeting in Philadelphia and published in JAMA, the journal of the American Medical Association.
"Hey, I'll just take my poop and lets have a meal..."
Yeah!!!
I’m so so scared. Everyone thinks that I can do it but I can’t. Not with this attitude. I’m just dreading the day the results come out and I receive a ton of phone calls from friends, family, just everyone all asking how I did. They’ll expect me to do better. Much better. I do too.
studdiction It's ok for you to expect. Just don't let your fear eat you. Have a conversation with those you love and explain to them that you did your best. So that they would understand whatever the results are. You yourself will know how much effort you gave in that examination. Whatever the result, its the knowledge that you gain from all those studying. Remember, exams are only hurdles that we doctors should pass. Our main goal is to treat patients based on the knowledge and training that we had. Just to you're best in everything that you do. And remember yo enjoy at the same time. Medicine is not a task. Its a journey. Ok?
That awkward moment when you walk outside and see the sun for first time all week and your eyes actually burn.
Oh medicine.
mddiaries I can relate. Residency training just get the most of your time. Seems like a life of a vampire... you go in the hospital prior to sunrise...the you go out the next day (when you're benign enough) after sunset. But what really drives you to conginue is your passion to take the path that you really want. Let's finish this residency with a contented heart.
Conscience
You can reason all you want. Some will believe Others won't. But God will see And also yourself Will know the truth. CharmedONE 071714
45 female 1 year prior to consult, noted with grafually enlarging mass on the occipital area. Associated with tolerable pain and hair loss.
42 male Allegedly shot by an unknown assailant GCS 15
Now you see it... and its on me.... An arrow on my thigh.... Cause pain that's high.... ER consult of a 14 year old female
