Christine Bowles takes on the big issue of Sex in critical care. In 2015, why is sexual equality in the workplace even an issue and how can we address it? Listen to the talk recorded live at SMACC Chicago.
Sex After Baby: Stop at 1 on 22 Sept 2014 for People's Association in Singapore by Eros Coaching
Dr Martha Tara Lee is Founder and Clinical Sexologist of Eros Coaching since 2009. She is a certified sexologist with ACS (American College of Sexologists), as well as a certified sexuality educator with AASECT (American Association of Sexuality Educators, Counselors, and Therapists). Martha holds a Doctorate in Human Sexuality as well as Certificates in Sex Therapy, Practical Counselling and Life Coaching. She was recognised as one of ‘Top 50 Inspiring Women under 40′ by Her World Singapore in July 2010 and ‘Top 100 Inspiring Women by CozyCot Singapore in March 2011. Website: http://www.eroscoaching.com.
Many people only require frequent baby makings in getting pregnant, but some people have to struggle to conceive, due to various problems including low sperm count. Do not distress, because with simple efforts, you can increase the chances in getting pregnant.
Sex After Baby: Stop at 1 on 22 Sept 2014 for People's Association in Singapore by Eros Coaching
Dr Martha Tara Lee is Founder and Clinical Sexologist of Eros Coaching since 2009. She is a certified sexologist with ACS (American College of Sexologists), as well as a certified sexuality educator with AASECT (American Association of Sexuality Educators, Counselors, and Therapists). Martha holds a Doctorate in Human Sexuality as well as Certificates in Sex Therapy, Practical Counselling and Life Coaching. She was recognised as one of ‘Top 50 Inspiring Women under 40′ by Her World Singapore in July 2010 and ‘Top 100 Inspiring Women by CozyCot Singapore in March 2011. Website: http://www.eroscoaching.com.
Many people only require frequent baby makings in getting pregnant, but some people have to struggle to conceive, due to various problems including low sperm count. Do not distress, because with simple efforts, you can increase the chances in getting pregnant.
Pregnancy Tips: Trying to Conceive or Trying to get Pregnant4pregnancy2parenting
For more information,
click here --> http://tinyurl.com/mhf2pr4
CONTENT
Healthy Diet
Vitamins
Healthy Weight
Body temperature
Caffeine
Know your cycle
Sex positions
Have sex frequently
Stress Management
Quality and Quantity of Sperm
Click here --> http://tinyurl.com/mhf2pr4
pregnancy rash, foods to avoid during pregnancy, pregnant woman, trying to conceive, ectopic pregnancy, pregnancy test results, prenatal care, male pregnancy, pregnancy headaches, zoloft and pregnancy, cramping during pregnancy, first trimester pregnancy, pregnancy hormones, pregnancy tips
What is secondary infertility and its solutionivfmeerut
The reason behind secondary infertility is associated with the natural process required to conceive. Your fertility condition may change after the first pregnancy.
If you are trying to get pregnant, here are important things to know about your ovulation day to get pregnant. You must be able to understand a woman’s menstrual cycle first
How to get Pregnant Faster – 7 Tips to Conceive QuicklyAvril Benton
How to get pregnant faster when you are in your late 30's or over 40 ? Find these 7 tips to conceive quickly and naturally even if you are not getting younger anymore.
How To Get Pregnant Quickly? If That’s Something You Keep Asking Yourself Then This Article Will Be The Most Important & Life Changing Thing You Will Read Today.
Fertility in Midlife: What are the Chances of Parenthood at Older Age?Dr Shivani Sachdev Gour
Midlife is defined as a central period of a person’s life that varies from 45 to 60 years. Like any other human efficiency, fertility also declines with the age. But these days many celebrities are seen conceiving at an older age around 35 or above.
Whether you’re trying to guess your own baby’s gender or looking for shower games for a friend, you must have referred to the old wives tales at one point of time. If you are a Pregnant with a Boy: 11 Noticeable Symptoms
look at
https://bit.ly/2KtXyOp
Please share/comment your experience.
Lactate has been viewed as a byproduct of anaerobic metabolism and an indicator of tissue hypoperfusion since the 1900s. This theory is still widely believed. Paul busts the myths surrounding lactic acidosis, anaerobic metabolism, tissue hypoxia and the role of lactate in sepsis.
Key take-away facts include:
- The production of lactate actually consumes hydrogen ions. Lactic acidosis is really lactic alkalosis.
- Lactate is produced physiologically and is a precursor for gluconeogenesis.
- During exercise, skeletal muscle exports lactate as the primary fuel for the heart and brain.
- At VO2max, intracellular oxygen stays the same. Anaerobic metabolism in cells only occur as a pre-terminal event. The exception is in complete arterial occlusion.
- Adrenaline promotes lactate production
- Lactate infusion has been shown to increase cardiac output in septic and cardiogenic shock
- Lactate is a survival advantage!
When to stop resuscitation in probably the biggest question challenging Critical Care and it's a challenge that many of us face virtually every clinical shift. The main problem is that there is little good data to guide us, leaving us to navigate this situation with few coordinates to plot a path forward. When to stop resuscitation explores this problem and suggests some landmarks we can use to navigate by. It examines the inter-relationship between the pillars of our medical ethics Autonomy, Beneficence, Non-Maleficence and Justice. To better understand the clinical challenges we face, the talk also uses a framework provided by modern physics and the 'Space Time Continuum' theorem. Hence the title might more appropriately be – “The will to Live – The courage to die and the space-time continuum”.
If the thought of how Einstein’s theorem on ‘General Relativity’ can help us answer the question of, when to stop resuscitation interests you then don’t miss this.
Resuscitation legend John Hinds talks about the consequences of our actions in resuscitation.
He discusses resuscitative emergency thoracotomies and the philosophy and mindset required by the practitioner rather than the technicalities of how to perform it.
As John says, trying to find the fault in a wiring loom of a ZX10 is difficult. Opening a chest is not. But it has been built up to be such a heroic procedure that we're stopping people doing it.
John discusses a case and the way it was discussed in the ensuing mortality meeting. He breaks down the personalities you see in these meetings - the sycophants, supporters, the skeptics and coins the phrase #resuswankers.
The hardest part of a resuscitative thoracotomy is not making the first cut - it's dealing with the #resuswankers.
Using simulation, optimising logistics and training the team effectively John managed to change the culture in an institution. This translated into an incredible save.
Take home points include:
Prepare. Know the evidence.
Make your intentions honourable.
Do it.
Seek out the skeptics.
Never allow a wanker to bring you down.
He does this with his usual dry wit, genuine passion and refreshing modesty that have made him so popular.
To see how mating hippos and batman are of relevance, you'll have to watch the talk.
John will be dearly missed by our community and this talk shows you why.
Feeding in the Intensive Care - A trickle or a torrent, is a great summary of several key critical care nutrition trials and how we can apply the evidence from these to the ICU patient. Providing adequate nutrition to patients in the intensive care is an extremely complex therapy that must be carefully titrated on a daily basis. The evidence for how to provide nutrition to critically ill patients is largely lacking and what evidence there is is often contradictory. In this presentation I will look at four feeding trials conducted in the ICU setting and published over the last 3 years. While the results are somewhat conflicting, there are lessons from each that we can apply at the bedside.
Hazel Talbot gives her insights from working in neonatal and paediatric retrieval.
She delivers her talk with all the passion and dedication that she brings to her work as a neonatal and paediatric transport consultant.
Equipment failure, rapidly deteriorating children and miscommunication are all common challenges that Hazel and her team encounter in their line of work. This is on top of the challenge of caring for neonates and children.
How are children different? They differ in physiology, in disease profiles and even the way they make clinicians feel!
In this talk, Hazel focuses on physiology and disease. The large majority of young deaths in the UK, where Hazel works, are neonates – under 28 days old.
50% of these deaths are due to perinatal diseases. These include congenital malformations, prematurity, sepsis, and congenital heart conditions.
Children are small adults. Small airways, small necks, small lungs. Babies however are not small children. They use the majority of their physiological ability to survive.
When they breath they use most of their diaphragm, compared with an adult who will only use a small proportion. This leaves babies without much reserve. They have a high metabolic rate, and neonates have a right heart dominance with an inability to change their stroke volume.
Hazel urges you to consider this when faced with a sick baby. When thinking about neonatal and paediatric retrieval, Hazel has some key points. Practice, anticipation and knowing your environment and equipment is key to a success outcome.
Hazel drives this message home with a case presentation. This example highlights not only Hazel’s skill and knowledge, but also her ability of communication, leadership, and intuition.
Join Hazel as she gives an insight into her amazing work in neonatal and paediatric retrieval. Come along as she discusses her experiences and tells you how to ward of the Evil Transport Fairy!
For more like this, head to our podcast page. #CodaPodcast
Pregnancy Tips: Trying to Conceive or Trying to get Pregnant4pregnancy2parenting
For more information,
click here --> http://tinyurl.com/mhf2pr4
CONTENT
Healthy Diet
Vitamins
Healthy Weight
Body temperature
Caffeine
Know your cycle
Sex positions
Have sex frequently
Stress Management
Quality and Quantity of Sperm
Click here --> http://tinyurl.com/mhf2pr4
pregnancy rash, foods to avoid during pregnancy, pregnant woman, trying to conceive, ectopic pregnancy, pregnancy test results, prenatal care, male pregnancy, pregnancy headaches, zoloft and pregnancy, cramping during pregnancy, first trimester pregnancy, pregnancy hormones, pregnancy tips
What is secondary infertility and its solutionivfmeerut
The reason behind secondary infertility is associated with the natural process required to conceive. Your fertility condition may change after the first pregnancy.
If you are trying to get pregnant, here are important things to know about your ovulation day to get pregnant. You must be able to understand a woman’s menstrual cycle first
How to get Pregnant Faster – 7 Tips to Conceive QuicklyAvril Benton
How to get pregnant faster when you are in your late 30's or over 40 ? Find these 7 tips to conceive quickly and naturally even if you are not getting younger anymore.
How To Get Pregnant Quickly? If That’s Something You Keep Asking Yourself Then This Article Will Be The Most Important & Life Changing Thing You Will Read Today.
Fertility in Midlife: What are the Chances of Parenthood at Older Age?Dr Shivani Sachdev Gour
Midlife is defined as a central period of a person’s life that varies from 45 to 60 years. Like any other human efficiency, fertility also declines with the age. But these days many celebrities are seen conceiving at an older age around 35 or above.
Whether you’re trying to guess your own baby’s gender or looking for shower games for a friend, you must have referred to the old wives tales at one point of time. If you are a Pregnant with a Boy: 11 Noticeable Symptoms
look at
https://bit.ly/2KtXyOp
Please share/comment your experience.
Lactate has been viewed as a byproduct of anaerobic metabolism and an indicator of tissue hypoperfusion since the 1900s. This theory is still widely believed. Paul busts the myths surrounding lactic acidosis, anaerobic metabolism, tissue hypoxia and the role of lactate in sepsis.
Key take-away facts include:
- The production of lactate actually consumes hydrogen ions. Lactic acidosis is really lactic alkalosis.
- Lactate is produced physiologically and is a precursor for gluconeogenesis.
- During exercise, skeletal muscle exports lactate as the primary fuel for the heart and brain.
- At VO2max, intracellular oxygen stays the same. Anaerobic metabolism in cells only occur as a pre-terminal event. The exception is in complete arterial occlusion.
- Adrenaline promotes lactate production
- Lactate infusion has been shown to increase cardiac output in septic and cardiogenic shock
- Lactate is a survival advantage!
When to stop resuscitation in probably the biggest question challenging Critical Care and it's a challenge that many of us face virtually every clinical shift. The main problem is that there is little good data to guide us, leaving us to navigate this situation with few coordinates to plot a path forward. When to stop resuscitation explores this problem and suggests some landmarks we can use to navigate by. It examines the inter-relationship between the pillars of our medical ethics Autonomy, Beneficence, Non-Maleficence and Justice. To better understand the clinical challenges we face, the talk also uses a framework provided by modern physics and the 'Space Time Continuum' theorem. Hence the title might more appropriately be – “The will to Live – The courage to die and the space-time continuum”.
If the thought of how Einstein’s theorem on ‘General Relativity’ can help us answer the question of, when to stop resuscitation interests you then don’t miss this.
Resuscitation legend John Hinds talks about the consequences of our actions in resuscitation.
He discusses resuscitative emergency thoracotomies and the philosophy and mindset required by the practitioner rather than the technicalities of how to perform it.
As John says, trying to find the fault in a wiring loom of a ZX10 is difficult. Opening a chest is not. But it has been built up to be such a heroic procedure that we're stopping people doing it.
John discusses a case and the way it was discussed in the ensuing mortality meeting. He breaks down the personalities you see in these meetings - the sycophants, supporters, the skeptics and coins the phrase #resuswankers.
The hardest part of a resuscitative thoracotomy is not making the first cut - it's dealing with the #resuswankers.
Using simulation, optimising logistics and training the team effectively John managed to change the culture in an institution. This translated into an incredible save.
Take home points include:
Prepare. Know the evidence.
Make your intentions honourable.
Do it.
Seek out the skeptics.
Never allow a wanker to bring you down.
He does this with his usual dry wit, genuine passion and refreshing modesty that have made him so popular.
To see how mating hippos and batman are of relevance, you'll have to watch the talk.
John will be dearly missed by our community and this talk shows you why.
Feeding in the Intensive Care - A trickle or a torrent, is a great summary of several key critical care nutrition trials and how we can apply the evidence from these to the ICU patient. Providing adequate nutrition to patients in the intensive care is an extremely complex therapy that must be carefully titrated on a daily basis. The evidence for how to provide nutrition to critically ill patients is largely lacking and what evidence there is is often contradictory. In this presentation I will look at four feeding trials conducted in the ICU setting and published over the last 3 years. While the results are somewhat conflicting, there are lessons from each that we can apply at the bedside.
Hazel Talbot gives her insights from working in neonatal and paediatric retrieval.
She delivers her talk with all the passion and dedication that she brings to her work as a neonatal and paediatric transport consultant.
Equipment failure, rapidly deteriorating children and miscommunication are all common challenges that Hazel and her team encounter in their line of work. This is on top of the challenge of caring for neonates and children.
How are children different? They differ in physiology, in disease profiles and even the way they make clinicians feel!
In this talk, Hazel focuses on physiology and disease. The large majority of young deaths in the UK, where Hazel works, are neonates – under 28 days old.
50% of these deaths are due to perinatal diseases. These include congenital malformations, prematurity, sepsis, and congenital heart conditions.
Children are small adults. Small airways, small necks, small lungs. Babies however are not small children. They use the majority of their physiological ability to survive.
When they breath they use most of their diaphragm, compared with an adult who will only use a small proportion. This leaves babies without much reserve. They have a high metabolic rate, and neonates have a right heart dominance with an inability to change their stroke volume.
Hazel urges you to consider this when faced with a sick baby. When thinking about neonatal and paediatric retrieval, Hazel has some key points. Practice, anticipation and knowing your environment and equipment is key to a success outcome.
Hazel drives this message home with a case presentation. This example highlights not only Hazel’s skill and knowledge, but also her ability of communication, leadership, and intuition.
Join Hazel as she gives an insight into her amazing work in neonatal and paediatric retrieval. Come along as she discusses her experiences and tells you how to ward of the Evil Transport Fairy!
For more like this, head to our podcast page. #CodaPodcast
Selective Aortic Arch Perfusion -
Summary by: Jim Manning
Selective Aortic Arch Perfusion (SAAP) is an endovascular-extracorporeal perfusion resuscitation technique designed specifically to treat cardiac arrest. SAAP involves the blind insertion of a large-lumen balloon occlusion catheter into the descending thoracic aortic arch via a femoral artery. With the SAAP catheter balloon inflated in the thoracic aorta, the heart and brain are relatively isolated for resuscitative perfusion through the SAAP catheter lumen with an oxygen-carrying fluid (such as blood, hemoglobin-based oxygen carrier or fluorocarbon emulsion). SAAP promotes restoration of spontaneous circulation (ROSC) by the heart while protecting the brain from further ischemic insult. SAAP can be used to treat both hemorrhage-induced traumatic cardiac arrest and medical, non-traumatic cardiac arrest.
In traumatic cardiac arrest, SAAP provides the combination of (1) thoracic aortic balloon occlusion for control of hemorrhage below the diaphragm, (2) rapid volume replacement in hemorrhage-induced hypovolemia to restore normovolemia and (3) perfusion of the heart and brain in an effort to achieve ROSC. SAAP also allows titration of small doses of intra-aortic adrenaline or other medications to achieve ROSC.
In medical cardiac arrest, SAAP catheter balloon occlusion of the thoracic aorta limits the distribution of oxygenated perfusate toward the heart and brain. Since medical cardiac arrest patients are not typically hypovolemic, SAAP with an exogenous oxygen-carrier is a volume loading intervention that can only be used for a short time period (5-10 min). If ROSC is not achieved with the limited volume of exogenous oxygen-carrier, femoral venous access during initial SAAP infusion allows venous blood withdrawal for continued SAAP support to promote ROSC without further volume loading (autologous blood SAAP or, essentially, aortic arch ECMO). Intra-aortic adrenaline and anti-reperfusion agents can also be used. Even if ROSC is not rapidly achieved, SAAP serves as a bridge that limits hypoperfusion until cannulation for full body ECMO can be achieved.
Martin Smith persuades you that controversies in brain death should not, and do not, exist.
Almost fifty years since the concept of brain death was first introduced, some individuals and whole nations still struggle with its concept and justification.
Many controversies continue to surround brain death, although there is broad consensus that human death is ultimately death of the brain.
Martin provides a history of the concept of brain death. He describes how advances in modern medicine have made the concept of death, and specifically brain death, muddled. This has broad implications on the diagnosis of brain death – and provides the basis to the controversies that exist.
The concept of death as a process is explored.
The idea, and in fact the truth, is that death does not happen at a discrete moment in time.
Alive or dead may be the only two states an organism can be in. However, the transition from one to the other is not instantaneous.
Martin contends that the process and the nomenclature has little practical relevance. What is important is the point of irreversibility.
He explains how we, as a medical community, can be confident of this point.
The main points are 1) fulfilment of essential preconditions, 2) exclusions of reversible causes and 3) clinical evaluation.
In his talk Martin elaborates on each and provides some important teaching points. As he explains, this is an important concept to grasp as it has implications for your patients as well as broader societal implications in the context of organ donation.
Martin’s talk will discuss the history and development of the concepts and diagnosis of brain death internationally. He examines current challenges and controversies and makes the case for an international consensus.
For more like this, head to our podcast page. #CodaPodcast
Huy Tran is a lab and clinical haematologist at Peninsula Health. He has research interests in haemostasis and thrombosis and is a member of the Australasian committee for anticoagulation reversal. Here he presents on the new oral anticoagulants and what can be done when they cause critical bleeding
Steve Bernard speaks at a meeting on 4/2/14 in Sydney on the reality of ECMO CPR at The Alfred in Melbourne, Victoria, and the upcoming CHEER study.
Exciting times!
See Intensive Care Network for the talk and more.
How to manage conflict in Critical Care: Ronan O’LearySMACC Conference
In this entertaining talk, Ronan O’Leary discusses conflict in critical care.
Ronan explains how to make a team decision about whether or not to perform a decompressive craniectomy.
Undertaking a decompressive craniectomy is perhaps one of the most challenging decisions we face within critical care.
Ronan contends that we do not know if we should do the operation. As he explains, even if we think we should do it, we don’t know when, or even how.
Perhaps more importantly, intensivists do not perform the operation, the neurosurgeons do. However, we frequently put them in the position of doing the operation when we are at our wits end. Alternatively, they do the operation without asking us when we still feel we have space to play.
Ronan poses the question - how can we resolve this, in a workplace environment which is already fraught with competing interests, beliefs, values and approaches?
Evidence based medicine is not going to provide an answer soon and it is unlikely that a superficial approach to improving teamwork will either.
An important component will be the future structure of clinical training. Our current systems reflect the way hospitals worked decades ago and the specialties we now have exist almost independently of the training which leads to consultant posts.
Ronan posits that training should involve exposure to collegiate decision making and consensus building.
However, this will be difficult to achieve within our current nationally co-ordinated training schemes.
For more like this, head to our podcast page. #CodaPodcast
Emergency management of agitation: Reuben StrayerSMACC Conference
Rueben Strayer provides a masterclass in droperidol for emergency management of agitation. He discusses sedation in three patient groups.
Agitated but cooperative
If the patient is agitated but cooperative there is no concern for a dangerous condition. They respond well to some company and a sandwich. Drug therapy in this group is relatively straightforward.
Disruptive without danger
You can converse and engage with this group; however, they are not responsive to suggestion. They are loud and disruptive and need to be sedated. You can do a history and exam and be fairly confident that there is no dangerous underlying condition.
There is no threat to themselves or others. They can be managed by observation in an unmonitored bed. So, you can sacrifice speed of sedation to ensure safety. Simple and well worn, tried and tested methods of mixed medical sedation are fine in this situation. And Reuben stresses this… it is fine. To be better than fine, consider a single agent - droperidol. Droperidol is the most effective and safest agent for undifferentiated agitation.
If droperidol is unavailable the next best choice is midazolam intramuscularly. Be careful. Dosage is trickier in this situation. You need to monitor for respiratory depression and ne prepared to manage it. It works quickly but has a narrow therapeutic window. As such, for unmonitored patients, Reuben combines drugs to get away with smaller doses. Listen in to learn how!
Excited delirium
This patient is rare. But this is a dangerous situation. A few clues are the patients who are thrashing, angry, incoherent, un-engageable. They may have a fluctuating level of consciousness. Have a low threshold if you are not sure – err on the side of caution and treat as excited delirium.
How do you treat this person? Five strong people are needed (not including those administering care), one for each limb plus one at the head. Administer high flow oxygen via a mask immediately. Do not wait for sats or vitals. This stops spit and provides oxygen! Get the patient out of dangerous positions such as the “hogtie” position and ensure no one is applying pressure to the chest or neck.
Next chemical restraint – IM shot as soon as possible. This is as opposed to any mechanical restraints. The priority is immediate control. This allows you time to properly assess and treat the patient whilst ensuring their safety and the safety of the treating team.
Join Reuben for a no nonsense run through of managing the agitated patient.
Ah, but you don't look like a professor! A recent statement from a (female) patient says it all, doesn't it?
Since the first women were admitted to medical schools – quite a while ago in most countries, the participation of women in clinical and academic medicine has increased steadily. Overall, women represent the majority of health care workers and also medical students in most countries of the world today. SMACC audience is almost 50% female.
However, only few women make it to the top, and with each step up the career ladder, the proportion of women decreases substantially, a phenomenon called the “glass ceiling” or the „leaky pipeline“. This is particularly true for some medical specialties such as critical care or trauma surgery, as opposed to specialties like endocrinology, pediatrics or gynecology. Although often subtle, gender discrimination against women continues to be a problem – for instance, it has been shown that a ficticious student named “John” would receive a higher salary and find a mentor easier than “Jennifer”. A manuscript written by “John” is judged more favourably than one that is authored by “Joan”, and female grant applicants with the same scientific productivity are given substantially lower scores than male applicants by reviewers (men and women). Sheryl Sandberg’s statements are as true in clinical and academic medicine as in other areas.
This talk will definitely raise your awareness for the topic.
Learning Objective: Examine methods for working women to live stronger, longer, and healthier lives
Many women only dream of having it all, the family, the job and the social life. Empowering women is the key to building a better, more healthy life and career that impacts their family and communities. Too many people are living small, staying in jobs they don’t like, settling for unfulfilling relationships, living where they don’t feel at home, and maintaining less-than-ideal health. Some people are too scared to make a change; others aren’t sure how to begin. This seminar will inspire you to make the change and follow through, shake off the fear of not taking a chance, and live up to your greatness. Join us as we discuss how women can strategically use your strengths and abilities—your competitive edge—to master the career and family while being able to live longer and healthier.
At the end of this seminar, participants will be able to:
a. Explore reasons why women are holding themselves back.
b. Examine ways to rekindle your passion and purpose in life in a healthier format.
c. Discuss healthier solutions and lifestyle changes.
d. Find the courage to conquer your fear and live life to the fullest.
Thinking Differently about the Complexity of Unmet Need for Family Planning a...CORE Group
Fall Global Health Practitioner Conference 2017
Thinking Differently about the Complexity of Unmet Need for Family Planning and Improving Maternal & Child Health Outcomes: Why Understanding Your Body Matters
Sandra Chipanta, Gabrielle Nguyen, Shannon Pryor, Lauren VanEnk
What is the Pregnancy Miracle System?
Pregnancy Miracle is a revolutionary clinically proven 5-step holistic and ancient Chinese system for getting pregnant in 60 days (Even if you're on your 30's or late 40's).
It's backed by nearly 14 years and 65,000 hours of intense research and has been developed, refined and perfected over 5 years of experimentation.
A presentation to assist women in considering birthing options and choices that suit themselves and make them feel they have an active choice, role in their birthing options
How, and in what ways, are rates of contraceptive use and induced abortion linked? What reasons do women give for contraceptive (non-)use for a terminated pregnancy?
One of the biggest challenges women face in medicine is being taken seriously. Fair or not, we have to work harder than our male colleagues to show patients, nurses, and consultants that we know what we’re talking about. In today’s SlideShare, two experienced physician leaders offer practical tips on communicating confidently and assertively … without losing yourself in the process.
CORTICAL SPREADING DEPOLARISATION IN NEUROLOGICAL DISEASE – AN INTRODUCTION
By Toby Jeffcote
Cortical spreading depolarization (CSD) is a spreading loss of ion homeostasis, altered vascular response, change in synaptic architecture, and subsequent depression in electrical activity following an inciting neurological injury.
It was first described by Leão in 1944, a disturbance in neuronal electrophysiology has since been demonstrated in a number of animal studies, and recently a few human studies that examine the occurrence of this depolarizing phenomenon in the setting of a variety of pathological states, including migraines, cerebrovascular accidents, epilepsy, intracranial hemorrhages, and traumatic brain injuries. The onset of CSD has been demonstrated experimentally following a disruption in the neuronal environment leading to glutamate-induced toxicity. This initial event leads to pathological changes in the activity of ion channels that maintain membrane potential. Recovery mechanisms such as sodium-potassium pumps that aim to restore homeostasis fail, leading to osmolar shifts of fluid, swelling of the neuron, and ultimately a measurable depression in cortical activity that spreads in the order of millimeters per minute. Equally important is the resulting change in vascular response. In healthy tissue, increased electrical activity is coupled with release of vasodilatory factors such as nitric oxide and arachidonic acid metabolites that increase local blood flow to meet increased energy expenditure. In damaged tissue, not only is the restorative vascular response lacking but a vasoconstrictive response is promoted and the ischemia that follows adds to the severity of the initial injury. Tissue threatened by this ischemic response is then at elevated risk for CSD propagation and falls into a vicious cycle of electrical and hemodynamic disturbance. Efforts have been made to halt this spreading cortical depression using N-methyl-D-aspartate receptor antagonists and other ion channel blockers to minimize the damaging effects of CSD that can persist long after the triggering insult.
Celia Bradford takes us through the latest on the management of subdural haemorrhage (SDH). She covers acute SDH, chronic SDH and middle meningeal artery embolisation, a novel treatment for chronic SDH management in certain circumstances.
Andy Neill - More neuroanatomy pearls for neurocritical careSMACC Conference
Andy Neill shares some more neuroanatomy wisdom that's highly practical for anyone working with neuro emergencies. This time he covers brain herniation syndromes, hydrocephalus, extradural vs subdural haematomas, cervical spinal imaging, vertebral artery dissection and "things you read on CT reports but don't know what they mean"!
Andrew Udy talks about Brain Tissue Oxygen Monitoring:
It’s Not What You’ve Got It’s What You Do With It
The BONANZA Trial
Andrew Udy talks about the ongoing BONANZA Trial which is assessing whether an algorithm that incorporates both ICP and brain tissue oxygen (PbTO2) can improve outcomes after traumatic brain injury (TBI). Like with all monitoring, how the PbTO2 is interpreted and managed is critical and the devil is in the detail!
More on BONANZA here
More on BOOST3 here
R. Loch Macdonald, M.D., Ph.D.
Community Neurosciences Institute
Fresno, California, USA
Angiographic vasospasm and more accurately, delayed cerebral ischemia, continue to contribute to morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). It is known that angiographic vasospasm is common after SAH, occurring in two-thirds of patients. Cerebral infarctions that developed days after the SAH have been attributed to angiographic vasospasm, occuring in about a third of patients, although this has always been controversial. Angiographic vasospasm theoretically can only damage the brain by restricting blood flow but there is no easy, accurate, widely available method to measure cerebral blood flow and this is not the measurement we need. Blood flow depends on metabolic demand so what we need to know to determine if angiographic vasospasm is causing ischemia is oxygen extraction fraction in the brain tissue supplied the the spastic artery. Without this measurement, the attribution of ischemia to vasospasm is subjective. Since angiographic vasospasm is essentially the only detectable delayed phenomenon after SAH, we focus on it and apply tremendous resources to preventing or reversing the vasospasm. Undoubtedly angiographic vasospasm can cause cerebral infarctions, but it has to be severe and flow limiting. But SAH is a complex disease. There are many other causes for cerebral infarctions after SAH, the most common being due to the aneurysm repair procedure. And a given degree of vasospasm may cause infarction in a volume-depleted patient with poor collateral blood supply but not in a patient without these things. There also are hypodense brain lesions after SAH that are due to intracerebral hemorrhages. There can be hypodensities in the brain directly under usually thick SAH where the brain dies. This observation in particular supports a role for cortical spreading depolarizations/ischemia as a cause of infarction after SAH. Other macromolecular processes that are hypothesized to cause brain damage after SAH include microthromboembolism, changes in the microcirculation, delayed brain cell apoptosis and capillary transit time heterogeneity. Determining the importance of these things is hindered by the lack of an easy way to detect them in patients. It is also known that poor grade patients, who presumably have more early brain injury and ischemia than good grade patients, are more prone to delayed cerebral ischemia, suggesting increased sensitivity to secondary insults of the already injured brain. We also assume delayed neurological deterioration when attributed to vasospasm or delayed cerebral ischemia, is purely due to ischemia. While knowledge about what happens pathophysiologically after SAH is increasing, management of delayed cerebral ischemia still focuses on detecting angiographic vasospasm and then augmenting the blood pressure to improve cerebral blood flow or dilating the spastic arteries with balloons or drugs.
By Catherine Bell and Andrew Udy
Catherine Bell takes us through how to troubleshoot problems commonly encountered when looking after patients who have an external ventricular drain (EVD) in situ. Issues with using brain tissue oxygen monitors are also discussed. A highly practical session aimed at bedside clinicians.
There is no such thing as mild, moderate and severe TBI - by Andrew UdySMACC Conference
Part 2 of a debate over the classification of TBI. Andrew Udy then argues that this classification is fundamentally flawed. He discusses the issues with the Glasgow Coma Scale, and therefore the follow-on issues in TBI classification, including all the confounders to the GCS, the issues with timing of the score as well as GCS not taking baseline function or specifics subtypes of TBI into account. He makes teh argument that biomarkers may better categorise the diffuse entity we call TBI.
TBI Debate - Mild, moderate and severe categories workSMACC Conference
Andrew Chow, Intensivist with a neurosurgical background, argues that the current categorisation system for traumatic brain injury (TBI) works, and makes sense! He tackles us through the history of this system, and why it’s important to differentiate different types of TBI. The arguments in favour of this categorisation include the consistency and benefits of a universal language, the implications for triage and management, and the fact that this system has been endorsed by all major organisations
Dr Nick Little is an experienced Neurosurgeon who's looked after patients with traumatic brain injury for his whole career. Here he discusses the difficulties of prognostication following traumatic brain injury (TBI). He talks about the statistics of outcomes following mild, moderate and severe TBI and then goes on to tackle the harder topic of how we try to work out what an individual would want if they knew the spectrum of outcomes that they may face. The issues with the clinical examination findings we use to prognosticate are covered, as well as which imaging findings he finds most helpful. He also mentions the difficulties with current prognostic calculators.
Historically, when it came to brain injury, ketamine had a bad rap. Much of that dogma was dispelled in the last decade, and ketamine is now frequently used as an induction agent in acute brain injury, especially traumatic brain injury, due to it’s favorable effects on haemodynamics.
However a new application of ketamine is now being explored - whether ketamine may be able to reduce secondary brain injury.
Managing Complications of Chronic SCI by Bonne LeeSMACC Conference
20 million people around the world are living with a spinal cord injury (SCI). The medical issues they develop over the years differ to any other patient cohort.
These complications include autonomic dysreflexia, management of pressure areas, specific infections, nuanced peri-operative care and highly specific issues such as baclofen pump management and syringomyelia
Do look at the NeuroResus section on this and listen to Spinal Rehab Specialist Bonne Lee talk about this side of SCI care.
Keywords
SCI, spinal, spinal cord injury, autonomic dysreflexia, pressure areas, infection, peri-operative care, baclofen pump, syringomyelia, chronic SCI, spinal trauma, spinal rehab, incomplete SCI
Tania is a neurologist and epileptologist with expertise in continuous EEG (cEEG) and status epilepticus (SE). This talk covers what a seizure is, what status is, including focal and generalised status epilepticus.
So why do we do cEEGs for patients with suspected SE?
To confirm the diagnosis
To see if patient just post ictal or still seizing
To establish that the clinical and electric seizures have stopped
To see if burst suppression is achieved
To exclude other differential diagnoses
She makes a good argument for why cEEG is such an important tool in managing SE.
In the questions after the talk, the issue of availability of cEEG in the Australian setting was discussed. Limited montage EEGs are discussed including their pros and cons.
Stuart Browne is a Neuro Rehab specialist from Sydney. These slides accompany a talk he gave at the Brian Symposium in 2023. He discusses what "severe disability" really means.
Severe disability is more common than many realise - about 6% of the Australian population.
Stuart discusses how health is more than simply physical recovery and how it is a multidimensional construct. He covers how permanent disability doesn't necessarily equate to a poor quality of life. He also discusses the long timespan of recovery, which is often much longer than appreciated.
He specifically discusses "Locked-in Syndrome" and how the survivors have surprisingly positive self-reported health-related quality of life and well-being.
Stuart also covers how severely disabled people face various forms of discrimination.
Shree Basu is a Paediatirc Intensivist in Sydney. These slides from the Brain Symposium 2023 accompany the talk she gave. She discusses how Paediatric stroke presents, what neuroimaging is required and what interventions are available, including thrombolysis and the role of endovascular thrombectomy.
Hypertensing Spinal Cord Injury - gold standard or wacky?SMACC Conference
After spinal cord injury (SCI), there aren’t many interventions we have available that actually make a difference.
Augmenting blood pressure to increase spinal cord perfusion pressure is an attractive concept that may improve neurological outcomes following SCI. We know that hypotension can make SCI worse. Clinical studies looking at blood pressure augmentation are mostly old, retrospective and flawed in various ways.
Aiming for a MAP of > 85 for 5-7 days is recommended by guidelines but why this pressure and duration are good questions.
Hypertensive therapy is relatively safe and easy to implement but not without risk.
Tessa discusses the pros and cons, how this is managed practically and what the future may hold in this area.
Mark Weedon takes us through the increasingly utilised concept of an optimal cerebral perfusion pressure (CPPopt) for each unique patient. He discusses the background to CPPopt, including intrcranial pressure (ICP), the Monroe Kelly hypothesis, neurovascular coupling, and cerebral autoregulation in health and following brain injury. He shows how intracranial pressure is affected by intracranial compliance and how this affects ICP waveforms. Cerebral perfusion pressure in relation to the Brain Trauma Foundation guidelines is covered including management of elevated ICP (EICP). The currently recommended tiered approach to managing cerebral perfusion pressure and EICP is mentioned citing recent guidelines. He uses a clinical case of a TBI to illustrate how the CPPopt can be ascertained and used to guide therapy, including the easy to perform “MAP Challenge”. Mark also describes the Pressure Reactivity Index (PRx) and how it can be used as a target for therapy. Finally, he covers the exciting results of the preliminary COGiTATE pilot study.
Social Worker Victoria Whitfield and Bereavement councilor Louise Sayers discuss the power of words when health professionals are communicating topics around of death and serious injury with relatives and patients in critical care. They use role plays to bring theories to life.
Sepsis and Antimicrobial Stewardship - Two Sides of the Same CoinSMACC Conference
Appropriate use of antimicrobials is primarily a patient safety issue, and is the key aim of an effective antimicrobial stewardship program. We discuss the challenges in the management of a patient with sepsis, and how decision-making is usually done in the absence of effective diagnostics. Time dependent protocols and the knowledge that undertreatment of a patient with sepsis will lead to poor outcomes will lead to prescribing that may be driven by fear. Antimicrobial resistance is associated with over-use of antimicrobials but is usually not the immediate concern. Antimicrobial stewardship programs should work closely with sepsis teams to ensure that sepsis pathways are implemented across the whole hospital, and that key principles of judicious use are embedded within the clinical pathway.
Being able to prognosticate in the aftermath of a traumatic brain injury (TBI) is important as it assists with counselling patients and families. Moreover, it helps rationally allocate healthcare resources.
However, due to the heterogenous nature of TBI and variable pre brain injury patient factors and post brain injury course, this has proven to be a difficult task.
Large cohort studies have enabled improved accuracy in the prediction of 6 month mortality and unfavourable outcome.
Furthermore, many of the factors that contribute to long-term outcome have also emerged. However, it is not yet possible to use them in prediction algorithms or mathematical models.
There is emerging evidence that pre injury psychosocial and demographic factors may be of more relevance than injury severity. Moreover, that 'outcome' becomes increasingly subjective and complex as the post injury duration increases.
We end with three brief vignettes which highlight the fraught nature of long term outcome prediction.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
7. Women Are Hopeless.
• There aren’t enough women with the right
experience
• Women have kids and drop out
• Women are no good at leadership
• Women don’t speak up
8. Men Are Awful.
• Men are sexist
• Men promote men
• Men are better at self-promotion
• Workplaces are structured to suit men
• Men think they know everything
17. The Bowles Manifesto
• Men- stand up for your right to be a father
• Women- stand up for your rights
• Recruit with equality
• Limit short and zero hours contracts
• Create decent conditions for pregnant health care workers
• Create equal access to paid parental leave
• Equal pay for equal work
• A paradigm shift
18. References
• ASMOF (2014) Submission to the Pregnancy and Return toWork National Review www.humanrights.gov.au/
• Australian Human Rights Commission (2014) Pregnancy and Return toWork Review www.humanrights.gov.au
• Calder, L and Cwinn, A (2014) Accommodating pregnant emergency physicians CJEM 16(4):259-261
• Crabb,A. (2014) TheWife Drought. Random House
• Khan, M (2012) Medicine- a woman’s world? BMJ Careers
• Medscape (2015) Emergency Medicine Physician Compensation Report www.medscape.com
• Rimmer, A (2014) Why do female doctors earn less money for doing the same job? BMJ Careers
• Sandberg,S. (2013) Lean In:Women, Work, and theWill to Lead.WH Allen
• Wolf, N. (2001) Misconceptions. Anchor
25. Maternity leave
• Australia- 14 weeks on full pay, plus up to 12 months of unpaid leave from
the actual date of birth
• UK- 12 months as a combination of 8 weeks on full pay, 18 weeks at half
pay, 13 weeks at SMP, and 13 weeks unpaid
• US- no guaranteed paid leave
• Finland- 4 months paid leave
26. Parental/paternity leave
• Australia- 1 week of paid leave and 51 weeks of unpaid leave
• UK- 2 weeks of paid leave and 26 weeks of ASPP
• US- nothing guaranteed
• Finland- 54 days of paid leave and then EITHER parent can take
paid leave until the baby is nine months old
27. Women- A Disruptive Innovation?
• Women able to dominate in some areas eg general
practice
• Women still not taking leadership roles in other areas eg
cardiology
• Men modelled as the mainstream