One of the new initiatives in healthcare reform is called the Affordable Care Act (ACA) which requires that all participating hospitals and clinics be reimbursed by Medicare based on the quality of care they provide.
Scientists have been mystified by thepinealgland for centuries. As the brain and central nervous and endocrine systems were progressively unravelled by the anatomists, physiologists and biochemists, the pineal gland resolutely refused to yield up its secrets. Until recently the scientific community regarded it as having no function in man, being but a vestigial remnant from an earlier stage in evolution. However, in the last few years interest in the gland has reached a climax when no fewer than ten national and international conferences devoted entirely to unravelling the secrets of the mysterious pineal have been held around the world.
Physically, the pineal is perhaps the smallest organ of the body. Such a minute structure has rarely, if ever, caused so much curiosity and commotion. It is a tiny grey white structure approximately inch long, weighing about 100 milligrams, and shaped like a pine-cone. It is located directly at the top of the spinal cord within the brain at the level where the head and neck are joined. It lies attached to the roof of the third ventricle (fluid filled canal) of the brain directly in line with the point between the eyebrows. It is the only structure in the brain, apart from the pituitary gland, which is not bilaterally symmetrical, lying right in the midline. This means that, except for these two glands, the two halves of the brain when it has been cut from front to back, are mirror images of each other, with each structure being duplicated, one for each half.
It is interesting to trace the scientific history of the pineal gland to the present day.
Halloween. The word conjures up wonderful memories for most people, and children often rate it as one of their favorite days of the year. However, it is also one of the 4 most likely days of the year that children will make trips to the emergency department. Injuries in both adults and children can run the gamut from trips and falls, as a consequence of ill-fitting costumes, to motor vehicle accidents resulting from excessive alcohol use. What are the factors that lead to the increase in risk? And what are the specific injuries and events seen in both adults and children on this often very frightening night?
A few weeks ago, the Bourne series returned to the theaters, and we’re all revisiting our memories of the original trilogy. Jason Bourne starts out as a man with very convenient amnesia — the kind that wipes out all your memories but leaves your ability to break out of an embassy intact. Could you really have a case of amnesia that erases your identity but leaves the skills in place?
Here’s the weird real-life science of amnesia.
Discussing amnesia is a little like discussing cancer, in that it’s hard to sum up because there are so many different causes and kinds. Basically, there are three types of amnesia — one that wipes out past memories, one that makes it impossible to make new memories, and one that does a little bit of both. All of these can last for an hour (or for life), happen with different degrees of severity, and can be the result of different things.
It seems to me that physicians, more than most other professionals, carry egos the size of watermelons on their shoulders. In a sense, this is the type selected for by the career itself — confident, successful, achievement-driven people are the ones admitted to medical schools. As a group, we are predisposed to pride from the start.
Then we struggle fervently through training, each day acquiring another fragment of the physician’s fabled knowledge. The frenzy continues for several years until a day comes when we are considered capable of functioning independently, and this is a great triumph.
But when we finally arrive at our objective, the nature of our pride has evolved. We have now fulfilled the most monumental achievement of our lives, and we’ve obtained knowledge so powerful that many people will trust us with their lives.
So maybe our arrogance is justified. Maybe we’re entitled to some arrogance. Don’t you think?
Major medical and consumer groups are coming together to question the carte blanche use of many commonly ordered tests and procedures, including MRI for low back pain and exercise EKG tests in people with no symptoms and low risk for heart disease.
Sometimes these tests can be lifesavers. Other times they are unlikely to do anything except increase costs and anxiety and expose people to unnecessary risks.
At graduations across the country, students are walking across the stage, receiving their diplomas and beginning the next chapter of their lives. These graduates are equipped with a wealth of new tools. However, nearly all are forced to leave behind one of the most important: their library card.
Students’ library cards are a passport to the specialized knowledge found in academic journal articles — covering medicine and math, computer science and chemistry, and many other fields. These articles contain the cutting edge of our understanding and capture the genius of what has come before. In no uncertain terms, access to journals provides critical knowledge and an up-to-date education for tomorrow’s doctors, researchers and entrepreneurs.
Medical students are used to being at the bottom of the totem pole. However, there is one area in which they surpass residents and attending physicians: the art of communication.
Unfortunately, as you gain training and experience in medicine, your communication skills may worsen. Although there are obvious reasons why this occurs (eg, time constraints curtail communication), the trend can be stopped.
The ability to communicate well is not innate. Think of communication as another procedure you must learn in medical school, perhaps one of the most important in the long run — given that most of what you do is talk to patients.
Research shows that the patients of physicians who communicate well are more adherent to therapies, more satisfied with care, and less likely to file malpractice suits. Just like you need to learn how to diagnose strep throat, you need to learn how to communicate effectively.
How well we learn communication depends on how it’s taught. Few of us learn well when we sit in lecture halls and listen to didactic presentations. “And before you tell the patient the bad news, ask the patient what she knows first…” The main problem with this format is that none of the information is individualized to the learner. It is easy for the learner to see the technique and think, “I already do that, so I don’t need to improve,” or “I don’t do that with my patients, so this is not relevant to me.”
It’s not news that sleep is tied to learning — even a 90-minute nap can significantly help boost your brain power — but if you want to cement new knowledge in your brain, recent sleep research demonstrates that a good night’s sleep shortly following your studies has a significant impact on your ability to retain information.
The study in question asked participants to memorize related word pairs (e.g., circus – clown) and unrelated word pairs (e.g., cactus – brick). Some participants learned the words at 9am, some at 9pm. The 9pm crowd went to sleep shortly after learning the words. The 9am crowd did not.
The results: Sleep made no difference when participants were asked to recall the related words, but when participants were asked to recall unrelated word pairs, the 9pm group — the group that slept right after learning — did significantly better. So where your brain already has a strong semantic roadmap for learning (as is the case with the related word pairs), sleep doesn’t have a major effect. Where it’s forming new connections, sleep makes all the difference.
Stick that in your mind pipe next time you need to do some serious cramming.
It’s an old joke: a long line of people waits at the Pearly Gates as St. Peter slowly checks them in, taking an eternity. Little guy in a white coat shows up, carrying a leather bag, stethoscope around his neck. St. Peter waves him through. “What the hell was that?” someone asks. “Why does that doctor get cuts?” “Oh, that wasn’t a doctor,” Pete says. “It was God. He just likes to play doctor once in a while.”
But it’s no joke. Whereas I don’t buy the “playing God” aphorism, I’ve had to make life-and-death decisions on occasion, and I don’t like it. I mean “life and death” literally: this person lives. That one dies. Saving a life is nice, and part of the job; failing to save one is horrible, yet inevitable. But deciding in advance — looking at a situation and concluding it best to let things go, or choosing to render help when the outcome might be regrettable — is a responsibility beyond understanding. Maybe it also comes with the territory, but who has the roadmap?
Bowel infarction is a good example. Dead bowel happens for a lot of reasons. Untreated, of course, it’s fatal. In operating, one may find — depending on the cause and the anatomy — a small segment of intestine the removal of which is not only life-saving but free of side effects; or you might find essentially the entire gastrointestinal tract dead and black. Removal in that case is possible, too, leaving the person entirely dependent upon permanent intravenous feedings. Or there might be enough small and large intestine remaining to handle oral intake with or without intractable diarrhea, with or without the need for complicated supplemental nutritional support.
And there you are, in the operating room at three in the morning, looking into a belly. No crystal ball, no outcome-prediction software; no moral counseling or ethics committee with two-cents worth of advice. What resources do you marshall; how do you decide whether to close up and deliver the bad news to the family, or to go ahead? Can you make a decision without interjecting your own moral values? Should you? Surely it’s conceivable that two people might make different decisions; ergo, it’s subjective. Who, then, has the right? Rarely, you may know enough about the patient to have an idea of what he/she would want. But how can you apply that when you’re not sure what kind of life will result from going ahead? Wrongful death? Wrongful life?
