IVLine

The Haydom Health Experience

2013-03-19T11:02:00.003+10:00

He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all. Willliam Osler

The sails are set, the end coordinates are locked in and the journey begins. This is the start of my adventure to Haydom Lutheran Hospital in rural Tanzania. It will not be a particularly long one, amounting to two months in total. But I will be truly letting go of a technology-centric world, and heading back to the basics of medicine and of life. It's time to set sail, with my trusted chart in hand (Oxford Handbook of Clinical Medicine & Oxford Handbook of Tropical Medicine - turns out I need two charts) and explore the sea that awaits in rural Tanzania.

About Haydom Lutheran Hospital
Haydom Lutheran Hospital (HLH) is situated in North-East Tanzania, only a stones throw away from Arusha (5 hours by Public Land-cruiser). It was built by the Norwegian Lutheran Mission in 1953, and originally had a little over 40 beds.

In 2013, it now has over 400 beds, several departments (surgical, medical, paediatric), outreach clinics and a school of nursing. To find out more about HLH go to their official website.

Finally because I'm largely a visual learner, I've included a little video to provide you with some more information about HLH.

HAYDOM HOSPITAL OF ARUSHA, TANZANIA, AFRICA from michal venera on Vimeo.

HaydomHealth.org
To chronicle this journey, and not dull or bore my traditional IVLine readership, I've set up (quickly over the weekend) HaydomHealth.org. HaydomHealth will also be used to raise awareness about some of the challenges facing the hospital, but also the heart-warming stories of it's workers, volunteers and patients. I will also share some of my experiences on some of the more leisurely activities to do whilst in Africa. Finally to act as another starting point for those interested in volunteering at HLH in the future.

So I hope that a few of you, will jump ship for a bit and take part in the HaydomHealth blog. People's support is truly appreciated.

How you can help
Finally there are number of ways you can help both me and Haydom Hospital. I'm looking to give back as much as I can to the Haydom community.

Donation
Donations are important stream of support for the hospital. As such I've set-up an paypal donation account, so that you can send some spare change their way.

Every person who donates $10 or more to this account will have there name listed at the end of my HaydomHealth Documentary (which will be released upon my return to Australia). A lump-sum donation will be made to HLH on June 1st 2013 from all your individual contributions.

You can also donate directly to HLH via their own donation page. HLH also needs a lot of equipment and will gladly accept a lot of it (anything from computers to ultrasound machines) - see a full list of things they would like here.

Get involved and spread the word
One person can only do so much, and I believe with the help of each of you I can get the word out about Haydom Lutheran Hospital, and ensure their survival as a hospital in the coming years.

The SMACC Wrap

2013-03-18T22:06:00.001+10:00

The Social Media and Critical Care Conference or SMACC2013 as it is otherwise known, was an adrenalin (or epinephrine for Scott Weingart @EMCrit ) rushing, mind changing experience. It was an opportunity to hear from world leaders in critical care, and finally meet some people face to face.

Unfortunately, I can't do the conference complete justice (been busy packing for Africa). Luckily, there has been a multitude of other attendees reliving the dream, and sharing some of the highlights of the conference.

Check out some of the tales and wrap-ups below.

Keep Caring: Getting Personal by Tamara Hills
Intensive Care Network: What a SMACCing
Intensive Care Network: SMACC: Med Student Review
Injectable Orange: Talking SMACC a nurse eye view
LifeintheFastLane: SMACC, Down But Not Out by Chris Nickson
PHARM: SMACC 2013 My thoughts by Minh Le Cong

I will share one of my favourite moments, which was the Allergen Connection performance by
Gerard Fennessy.

And just in case you missed it, you can checkout the presentation by myself and Dave Townsend (@futuregp) on the Interncrisis Social Media Campaign (minus our witty jokes and long-winded tales)

SMACC2013 Interncrisis Presentation from Aaron Sparshott

And that's my SMACC Wrap.

Antibiotics and Streptococcal Pharyngitis

2013-02-26T23:23:00.002+10:00

Wikipedia

Group A β-hemolytic streptococcus (Streptococcus pyogenes, or GAS) is a form of β-hemolytic Streptococcus bacteria. It is a gram positive bacteriaum responsible for a wide range of both invasive and non-invasive infections. Wikipedia

In this post, I just wish to highlight the power of FOAM to answer and discuss a clinical question. What started off as a post on Diagnostics and Likelihoods ratios for Streptococcal Pharyngitis, transgressed on to a discussion about treatment and management.

View the story "Antibiotics and Streptococal Pharyngitis" on Storify Antibiotics and Streptococal Pharyngitis Storified by Aaron Sparshott· Tue, Feb 26 2013 05:13:18 The Post that started the conversation.
Does this patient have strep throat? And I might ask: who cares if they do? http://www.thennt.com/lr/streptococal-pharyngitis/ H&P components not helpful by themselvesGraham Walker Streptococal Pharyngitis | TheNNTQuick Summaries of Evidence-Based Medicine @grahamwalker I love LRs...but the challenge is determining where to start. I.e., what's the pretest in our selected ED peds population?Ryan Radecki Antibiotics for Strep.
@grahamwalker I work in an extremely high strep community with lots of Rheum heart disease. Still unconvinced that rx with ABs make any diffCasey Parker @broomedocs @grahamwalker what?! You dont think Bicillin prophylaxis works?Minh Le Cong @rfdsdoc @grahamwalker bicillin works as secondary prophylaxis But throwing ABs at every sore throat doesn't prevent RhHD in my readingCasey Parker @broomedocs @rfdsdoc @grahamwalker EMRAP this month has excellent piece on facts & myths of strep; all of which Dr. Neuman has stated 4 yrsHaney Mallemat

Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis.

@broomedocs @grahamwalker http://www.ncbi.nlm.nih.gov/pubmed/15927077Minh Le Cong Acute Renal Failure
@rfdsdoc @broomedocs @grahamwalker some compelling argument that strains in modern/hygienic places don't lead to ARFSeth Trueger @EMtraveller @rfdsdoc @broomedocs @grahamwalker ARF is terrible- but if abx don't help in some areas they can only hurtSeth Trueger @MDaware @EMtraveller @broomedocs @grahamwalker have you actually seen ARF and a 4 yo kid needing heart valve repair? Me seen too many..Minh Le Cong @rfdsdoc @MDaware @broomedocs @grahamwalker I never forget 13yo ATSI at clinic, routine check *woosh woosh*, only 100m flat walk b4 fatigueChris Edwards @MDaware @rfdsdoc @broomedocs @grahamwalker have my 'city' centor criteria then my rural ATSI 'script already written' methodChris Edwards @rfdsdoc @emtraveller @broomedocs @grahamwalker it's pretty terrible but doesn't really happen here outside of select at risk populationsSeth Trueger @rfdsdoc @emtraveller @broomedocs @grahamwalker do abx prevent PSGN? I thought no. also pcn doesn't prevent spider bites.Seth Trueger @MDaware @EMtraveller @broomedocs @grahamwalker ok getting bit off topic but yes some studies to suggest pcn to contacts can prevent PSGNMinh Le Cong @MDaware @rfdsdoc @emtraveller @broomedocs @grahamwalker what's the point of trying to prevent a benign self-limited (v rare) disease? PSGNmovinmeat @MDaware @EMtraveller @broomedocs @grahamwalker http://health.nt.gov.au/library/scripts/objectifyMedia.aspx?file=pdf/10/84.pdf&siteID=1&str_title=Acute%20Post-Streptococcal%20Glomerulonephritis.pdfMinh Le Cong @rfdsdoc @movinmeat @emtraveller @broomedocs @grahamwalker yes strep is PCN sens but more PCN-> other resistenceSeth Trueger @MDaware @movinmeat @EMtraveller @broomedocs @grahamwalker well what do you propose for secondary prevention of ARF then?Minh Le Cong @rfdsdoc @movinmeat @emtraveller @broomedocs @grahamwalker modern hygiene?Seth Trueger @rfdsdoc @movinmeat @emtraveller @broomedocs @grahamwalker if at risk population (developing world, recent immigrant, Queenslander) then PCNSeth Trueger @rfdsdoc @broomedocs @grahamwalker NZ guidelines support 1˚ prev of ARF with pcn 4 GAS in high risk regions. Some towns swab & rx asympt GASRochelle @rfdsdoc @broomedocs @grahamwalker abx for ARF also disputed (from http://rhdaustralia.org.au) http://pic.twitter.com/Vzwu11UeLWWilliam Sargent

Some Further Reading

Australian Therapeutic Guidelines

The therapeutic goals used to justify antibiotic treatment for pharyngitis/tonsillitis are:

to prevent nonsuppurative complications (eg acute rheumatic fever, acute glomerulonephritis)

to prevent suppurative complications (eg acute otitis media, quinsy, acute sinusitis)

to shorten the illness.

Strep.Pyogenes
phenoxymethylpenicillin 500 mg (child: 15 mg/kg up to 500 mg) orally, 12-hourly for 10 days.

Short-term late-generation antibiotics versus longer term penicillin for acute streptococcal pharyngitis in children - The Cochrane Library - Altamimi - Wiley Online LibraryBackground The standard duration of treatment for children with acute group A beta hemolytic streptococcus (GABHS) pharyngitis with oral ... Different antibiotic treatments for group A streptococcal pharyngitis - The Cochrane Library - van Driel - Wiley Online LibraryBackground Antibiotics provide only modest benefit in treating sore throat, although effectiveness increases in participants with positiv...

Below is a short summary of some of the tweets that I managed to capture. I've also added a bit of further reading for the Australian readers. One final lesson that can be learnt from this discussion, is that management is often guided by the population you are treating and the resources available to you.

Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis.

Some Further Reading

Australian Therapeutic Guidelines

The therapeutic goals used to justify antibiotic treatment for pharyngitis/tonsillitis are:

to prevent nonsuppurative complications (eg acute rheumatic fever, acute glomerulonephritis)

to prevent suppurative complications (eg acute otitis media, quinsy, acute sinusitis)

to shorten the illness.

Strep.Pyogenes
phenoxymethylpenicillin 500 mg (child: 15 mg/kg up to 500 mg) orally, 12-hourly for 10 days.

The InternCrisis: A New Year

2013-02-25T09:00:00.000+10:00

It's 2013, and roughly a month since most of the recent medical graduates started their internship. Yet it was not always a sure thing, and there were many Australian medical graduates who were left facing uncertainty at the end of their degree.

This year the campaign to find workable solutions has kicked off much earlier with the first ever National Medical Intern Summit being held last Friday. This was a summit that gathered health ministers, medical deans, economists, doctors, and various associations and societies, to address the shortage of internships for our Australian medical graduates.

Fortunately, while I couldn't take part in the summit, various attendees were busy tweeting, and Australian Doctor managed to brilliantly capture the day in this Storify Summary.

Also don't forget to checkout;

AMSA - http://www.amsa.org.au/
Medical Student Action on Training - http://interncrisis.org

SMACC2013
Finally a small pitch. Myself and Dave Townsend aka @FutureGP will be presenting at talk at SMACC concerning last years Social Media Interncrisis Campaign. If you are in Sydney, it would be great if you could come along to an awesome event. Otherwise, we will be putting the presentation online after the event, for all to see.

The FOAM Visualised

2013-02-19T12:44:00.003+10:00

After my previous post on Capturing the Great FOAM, I've been on the lookout for something that might make FOAM a little easier to process and visualise.

This is where a relatively new service called RebelMouse fits in.

FOAM on RebelMouse
RebelMouse allows you to visualise your social media feeds, into what I like to think of as an online media board.

So after playing round with it over the weekend I setup a page to capture and visualise the FOAM.

RebelMouse: FOAMed

https://www.rebelmouse.com/FOAMed/

It currently captures posts from the #FOAMed hashtag and FOAMEM RSS Feed. It is still early days, but thought others might also enjoy their FOAM visualised.

Know of a service you prefer or have feedback on the RebelMouse setup, comment below or send me a tweet at @IVLINE.

Capturing the Great FOAM

2013-01-24T18:57:00.000+10:00

There has been an ongoing discussion among a number of FOAM participants recently about creating a Journal of FOAM (this discussion is summarised best by BoringEM). This discussion has largely arisen as a result of critics saying FOAM lacks peer review.

However, while I think formal peer review is great in some circumstances, for one I thing I think it’s not what FOAM is necessarily about, two I think it largely happens anyway (e.g. retweets, feedback on twitter, word of mouth, etc), three there is a larger question about how we capture and collate high quality FOAM.

Why do we want to capture the good FOAM?
This may seem like a simple question, but I get the impression that people would have slightly different answers and it’s a crucial starting point.

In my opinion, the obvious reasons we want to capture and highlight the good FOAM, are that; it is going to improve our professional development, challenge our thinking or alter our clinical practice in a positive manner. Ultimately, we want access to the most correct information, in a timely fashion that suit our learning approach.

Strategies to evaluate, highlight and find good FOAM
There are a number of strategies that others have suggested or put in place to capture the good FOAM. I’ve outlined some of the strategies below, and potential pros and cons I see with each of them.

Twitter Feedback

Used by many.
How: Give feedback directly to the author and share online with others (e.g. through the #FOAMed hashtag).
Pros: Quick, easy, open too many participants, promotes ongoing discussion.
Cons: Comments are ultimately lost after a period of time. Feedback is also limited to 140 characters.

Peer Feedback directly on the blog

Michelle Lin from Academic Life in Emergency Medicine, recently started to setup/trial a peer-review feature on her blog.
How: Created a peer review section at the bottom of each post, containing metrics such as accuracy, valid for practice, true to literature, overall quality. Rater is anonymous. Metrics are collated and viewable on each post.
Pros: Receives a peer review.
Cons: Is viewable on the blog only. This is useful for those viewing the blog post and as feedback to author. However, this data (as far as I’m aware) is not available beyond that direct level.

Search Engines

Examples: Google, Bing, EMGoogle
Pros: Provide a quick means of usually finding relevant material based on keywords, page views and site rankings.
Cons: The above metrics don’t always correspond with quality. New or low ranking sites can have their posts further down search results, and subsequently a great post may be overlooked. Your search results are only as good as the data you put in. No written feedback generally available to author or viewer.

RSS Feeds and Feed Readers

How: Depends on which feed reader use, but a number have options to vote or comment on posts. Subscribe to the FOAMEM feed (http://www.foamem.com/feed/) for a full suite of Emergency Medicine FOAM feeds.
Pros: can capture large amounts of material/resources. Readers can discover material typically based on popularity (e.g. page views).
Cons: Takes time to setup, subject to your own selection bias. Comments are not shared with the larger community.

Blog Reviews/Grand Rounds

Example: LifeintheFastLane.com Reviews
Pros: Collation of a number of FOAM posts. Ideal for those with limited time, as less time is spent looking for quality resources.
Cons: At the end of the day a review is only as good as the author who selected the posts. It is susceptible to selection bias. Typically only highlights the author’s views of what constitutes good posts.

Journal of FOAM

Not in existence as of yet.
Pros: Brings peer review to some FOAM Content. More pros can be viewed at BoringEM’s post on Journal of FOAM.
Cons: Creates essentially a closed feedback network. Selection of quality FOAM resources is determined by a few. Likely to have significant time requirements on any editors/reviewers. Again see BoringEM’s post for some more cons.

Global Medical Education Project

www.gmep.org
How: GMEP already captures a large portion of FOAM such as images, videos, questions and even podcasts.
Pros: Free access. Allows users to tag, vote up/down, comment, share, add to folders.
Cons: Requires authors to host their material on GMEP (some may not like this as it takes away page views from their site). Requires viewers/reviewers to sign-up to GMEP. Only captures feedback posted on GMEP.

Out of all the strategies I’m least keen on having a Journal of FOAM. This is for several reasons including;

Twitter provides quick dissemination of material/feedback, is open to many and promotes discussion. So is ideal (provided there are people to drive it) in getting a relative idea of the quality of FOAM resources.
I believe reviews like the once-a-week LITFL Review already do a good job of collating quality material, but in an informal matter. So if anything I would like to see more reviews started up by different authors.
I believe that there are better options available, which fit within what I like to think of as the principles of FOAM.

Currently, I feel that GMEP with a few modifications could potentially offer the best method of capturing and reviewing FOAM resources.

My dream FOAM Capturing Machine.
My dream FOAM capturing machine would have the following components (there are obviously limitations with my model, but one can dream);

Chiefly it would be a web portal that functions as an online directory. This differs from GMEP which I view as an online repository.
Material is still posted on individual blogs, websites, podcasts, etc. So the author still has control over their material.
A peer review (widget/plugin) similar to Michelle Lin’s, that can be attached to each blog post on the author’s blog, with the data feeding back into the directory.
A tracker on each blog post, which captures metrics such as page views, length on page and so on (similar to Google Analytics), which feeds back into the directory and helps determine resource ranking.
A system to capture tweets relating to an author’s content.
Online Directory Features

Search
Best blogs, Podcasts,etc/new blogs, etc
Most popular/most recent/highest quality/and so on FOAM posts.
Tags and categories
Resource type (blog, podcast, etc)
Level of Education/What level is it pitched at (e.g. medical students, consultants)
Discussion/Comments section
Ability to curate reviews on the site (e.g. select a number of posts, that then get posted as a review). Again have ranking of the reviews.
Ability to favourite items for own personal viewing later.

So essentially it would be a system that collates a large percentage of the subjective and objective data around a particular FOAM resource.

The Wrap-up
There are currently a number of concepts, coming through the FOAMed movement on ways of evaluating and highlighting FOAM resources. The selection of strategies I’ve mentioned above, are merely just a few of them.

I’m keen to see FOAM remain largely open-access and crowd driven, rather than delegate the responsibility of curating quality resources to a few. I believe the community already does a reasonable job of this, and rather we need a way of capturing these resources & feedback for the long-term.

If you have any thoughts on anything I’ve mentioned, please leave your feedback here or flick me a message at @IVLine. It is always welcome, and hopefully will promote a solution that works best for the majority of the FOAMed community.

How to do an Online Pecha Kucha Talk

2013-01-09T09:30:00.000+10:00

Pecha Kucha is Japanese for 'chit chat, and the aim of this tutorial is to show you how to take this interesting presentation format online.

What is Pecha Kucha?
A presentation style where;

the talk has to be 6 minutes 40 seconds long
the talk has to have 20 slides
that means you average 20 seconds per slide

Tools
Below are some of the tools I mention in the video, that I either use or would recommend.

Creation Tools

Keynote (Mac)
http://www.apple.com/iwork/keynote/
Powerpoint (Windows/Mac)
http://office.microsoft.com/en-au/powerpoint/
Google Docs/Google Drive (Online)
https://drive.google.com
Zoho Online (Online)
http://www.zoho.com/
Prezi (Online/Windows)
http://prezi.com/

Recording Tools

Camtasia Studio (Windows/Mac)
http://www.camtasiasoftware.com
Screenflow (Mac)
http://www.telestream.net/screenflow/overview.htm
Jing (Windows/Mac)
http://www.techsmith.com/jing.html
Camstudio (Windows)
http://camstudio.org/
Screenr (Online)
http://www.screenr.com/

Audio Editing

Audacity (Windows/Mac/Linux)
http://audacity.sourceforge.net/
Adobe Audition (Windows/Mac)
http://www.adobe.com/products/audition.html
Avid Pro (Windows/Mac)
http://www.avid.com/US/products/pro-tools-software

Image Search Sites

Sharing Tools

Hashtag for the Australian Medical Community

2012-12-28T13:57:00.000+10:00

This has been a relatively big year for the Australian Medical Community in the Social Media World. We've seen a number of large campaigns kicked off by Australian Doctors and medical students such as, Jill Tomlinson with #DestroyTheJoint and the #InternCrisis campaign.

There has also been plenty of online education initiatives sprouting and growing as well from Australian soil. Most notably the Global Medical Education Project and the #FOAMed revolution, led by Mike Cadogan (@sandnsurf) of LifeintheFastLane.com fame.

Most notably however in my personal view, has been the rapid uptake of social media this year by the Australian Medical Community. I've been on twitter now for well over three years and the numbers of medical students and doctors I've seen join this year has been astounding.

Which leads to my next thought: Where is the hashtag, the community, the online forum for the Australian Medical Community?

Creating a Hashtag
The Online Australian Medical community has grown to a point, where it would be great to have a clear place to raise and share issues online.

Having been involved as a Facilitator of the #HCSMANZ hashtag, I have many ideas on what I think would work and what wouldn't.

But perhaps more importantly, I recognize that for a hashtag to truly work and grow, there has to be engagement and a sense of community.

Crowdsourcing a Hashtag
Here is the part where you come in. I would like to have a hashtag created for the Australian Medical Community, that represents as best as possible, people's interests and what they would like to see in the hashtag.

If you would like to be part of this process you can;

read and comment on the Basic Plan for Australian Medical Hashtag
If you wish to edit the document send me an email: aaron (at) ivline.info
Discuss on Twitter under the working hashtag #AUSMed
or you can leave comments here

Hope to see many people taking part in the creation of this hashtag so that we can come up with something that works best.

Rules of Neurological Examination

2012-11-27T11:07:00.000+10:00

When it comes to the neurological clinical exam, I've seen many a student shudder. How to Perform a Neurological exam went over the basics from a structured point of view. Now I'm going to introduce you to some rules of the Neurological Exam, pearls of wisdom, and perhaps most importantly what I like to call the Rule of 5s for Neurological Examination.

The Rule of 5s aims to encompass key considerations of a neurological exam. Though originally inspired by a quick quip from a Doctor on the wards, I've since trawled the internet and saw the pattern emerging everywhere. Thus, the Rule of 5s was born.The Rule of 5s is tailored towards Medical Students and Junior Doctors to layout the basics of neurological examination.

Rule of 5s
So the first part is obviously the entire Neurological Examination. This can be remembered by the Mnemonic below and is split into 5 parts;

CNS MD (Ves Dimov, M.D)

C erebellum and gait
N erves (CN I-XII)
S ensory exam
M otor
D TR (deep tendon reflexes)

Inspection is a key part of any clinical examination and with the Neurological exam there are 5 things you look for in particular.

Wasting
Deformities/Posture
Tremors/Tics
Fasciculations
Skin Changes

Limb Examinations
Next up on the list are the Limb Examinations. This can be split into upper (e.g. arms) and lower (e.g. legs) limbs depending on what information you are trying to get out of your examination. There are 5 main things you test for on limb examination; Tone, Power, Reflexes, Coordination and Sensation.

Many of which have 5 sub-components.

Tone (flaccid → normal → increased)
Power

0 = no contraction
1 = flicker of contraction (or felt on palpation)
2 = movement possible when gravity eliminated
3 = active movements against gravity, but not resistance
4 = active movements against gravity and resistance
5 = normal power

Reflexes

0 = absent
+ = present but reduced
++ = normal
+++ = increased, possibly normal
++++ = greatly increase (often associated with clonus)

Coordination

Finger–nose test
Rapid alternating movements
Rebound
Heel-shin test
Foot tapping

Sensation

Touch
Temperature
Pain
Vibration
Proprioception

Pathological Localisation
Finally it is important that we try to localise the area of pathology, whether it be frontal lobe, brain stem or spinal cord. Again there are 5 considerations for pathological localisation, which I've developed the following mnemonic for;

C erebellar
L ower Motor Neuron
U pper Motor Neuron
E xtra-pyramidal Tract
S ensory

Other Symptoms & Assessment
The Rule of 5s continues on to several other aspects of the neurological exam. Some may be familiar, but I hope there are some new ones as well.

Assessing Pupils

P upils
E qual and
R eactive to
L ight and
A ccomodation

Key Cerebellar Symptoms

Ataxia (Can be gait or limb specific. Uncoordinated voluntary movements)
Nystagmus
Tremor
Dysathria (slow slurred speech)
Hypotonia

Dysphasia

Global dysphasia
Expressive dysphasia
Receptive dysphasia
Conductive dysphasia
Nominal dysphasia

Assessing Elderly Patients
From Oxford Handbook of Clinical Examination & Practical Skills comes another glimpse of the Rule of 5s in action. There are 5 key things to take both on History and do on Examination of the Elderly patient.

History

Witness histories
Drug history
Intercurrent illness
Cognition and mood disorders
Functional history

Examination

Observe
Think
Assess cognition
Gait
Therapy colleagues

Other Rules of Neurological Exam
So above is my Rule of 5s. But there are many rules and mnemonics you can put into practice as well.

Brainstem Rules of 4
(Peter Gates’ The Rule of 4 of the Brainstem - Int Med J 2005;263-266 – PDF)
In the rule of 4 there are 4 rules

There are 4 structures in the ‘midline‘ beginning with M
There are 4 structures to the ‘side‘ (lateral) beginning with S
There are 4 cranial nerves in the medulla, 4 in the pons and 4 above the pons (2 in the midbrain)
The 4 motor nuclei that are in the midline are those that divide equally into 12 except for 1 and 2, that is 3, 4, 6 and 12 (5, 7, 9 and 11 are in the lateral brainstem)

See Lifeinthefastlane.com for the full illustrative guide to the Rule of 4 of the Brainstem.

Head trauma: rapid neuro exam 12 P's (Ernest Boiselier and Sung Kim):

P sychological (mental) status

P upils: size, symmetry, reaction

P aired ocular movememts

P apilloedema

P ressure (BP, increased ICP)

P ulse and rate

P aralysis, Paresis

P yramidal signs

P in prick sensory response

P ee (incontinent)

P atellar relex (and others)

P tosis

Peripheral nervous examination:
"Tall People Run-over Small Children"

T one

P ower

R eflexes

S ensation

C o-ordination/ Clonus

Got you own tips and tricks to tackling the Neuro Exam?

Share them below.

HCSMANZ Summary - Social Media for Healthcare Activism

2012-11-19T12:13:00.001+10:00

On Sunday 18th November we talked Social Media in Healthcare Activism & Advocacy. It was engaging chat with over 40 people participating and close to 500 tweets. People from many different backgrounds participated and it was great to share in the knowledge creation experience.

You can read the full transcript if you wish. However, I've taken the time below to summarise and organise chat, for those of you who want an eaiser to read account of last night's chat.

Also take a look at Carly Findlay's account (Healthcare activism - negotiation of care plans, holistic approaches and blogging as therapy) of the chat and what it means to be a health activist from a patient perspective.

Some key points we covered throughout the night were;

What is Healthcare Activism?
How does Social Media assist Healthcare Activism?
What are the benefits of it's use?
What are the challenges of using Social Media for Healthcare Activism?
How would you run a Healthcare Campaign?

Social Media for Healthcare Activism

2012-11-13T11:27:00.000+10:00

A healthy attitude is contagious but don't wait to
catch it from others. Be a carrier. Tom Stoppard

In light of a number of prominent activist campaigns that utilized social media recently (#ArabSpring, #Destroythejoint, #interncrisis), on Sunday 18th November we will be taking a look at Social Media for Healthcare Activism.

As usual in the lead up to my HCSMANZ chats, I like to provide some background reading material to get you thinking. Importantly, I want you to start thinking about what is health activism?

We will be kicking off the chat this week at 8:20pm AEST (i.e. Queensland Time)/ 9:20pm ADST (daylight saving time - if unsure check the time and date link below) to allow for some introductions, basic rules of the chat, and to go over how to get the most out of it.

For our global friends the time and date of the chat is available here; Time&Date.com

To find out more or to keep in touch follow @HCSMANZ on twitter and join our Facebook page.

Internet Activism

Internet activism (also known as digital campaigning, digital activism, online organizing, electronic advocacy, cyberactivism, e-campaigning and e-activism) is the use of electronic communication technologies such as social media, especially Twitter and Facebook, YouTube, e-mail, and podcasts for various forms of activism to enable faster communications by citizen movements and the delivery of local information to a large audience. Internet technologies are used for cause-related fundraising, community building, lobbying, and organizing. Wikipedia 2012

A Brief History of Some Online Activism provided by Mashable's Meghan Peters.

Mashable.com

How times have changed?
Little over a decade most communicators and activists were just talking about ways to engage the main stream media, often in isolation. Activism, required time, effort, street marches, writing letters to garner the attention of the main stream media and those leaders who can implement the change we desire.

With the rise of social media, and the democratisation of broadcasting thoughts to the masses, we’ve seen an increased ability for people to make their agendas clear to the world. This has been the first step and providing a voice to all. It still comes with the similar traditional challenge of being drowned out by larger and more influential groups and individuals. However, now chance is there that your concern or issue will be shared by others, and perhaps progress into a cause.

This is one of the greatest assets of Social Media; it empowers individuals, but more importantly fosters communities. It facilitates cooperation, collaboration, learning between geographically separate individuals to create in a sense a ‘virtual community’. The glue that holds these ‘virtual communities together are common goals/interests, participation, interdependence, reciprocation, and mutual trust and respect.

In my opinion, the health activism of today stills requires, the time, the effort, writing letters and traditional means of activism. Social media activism is not a substitute for this. Rather Social Media is an adjuvant. The most important role it plays is to allow the creation of communities, so that the next step can be taken as a collective group.

Social Media Communities
When thinking about communities, it important recognize what communities exist, what are they suitable for, and how they large are they. In the world of activism social media services are the tools or meeting grounds that allow you to bring these individual's together.

Further Resources
In two prior HCSMANZ chats we took a look at Digital Strategies for Healthcare Organisations and Integrating Social Media into Public Health. Both of these chats highlight a number of issues relevant to; starting and maintaining a health movement on Social Media.

Four Ways Social Media Is Redefining Activism
If sustainable activism requires passion and commitment, then it makes more sense that social media will facilitate rather than decrease advocacy by connecting more of those who do have passion. There are multiple paths to promoting social change: increasing awareness, providing support, and taking action. All are necessary.

Changing public awareness,
Word of mouth persuasion,
The increased sense of urgency
Enhanced individual agency

Read more for further explanation.

How Political Activists Are Making The Most Of Social Media

Lesson 1: Integration is key: Facebook, Twitter, YouTube. Consistent messages.
Lesson 2: Listen before engaging. Then engage in a sustained value-driven dialogue.
Lesson 3: Turn online interaction into offline action.

Social Media Handbook for Activists

http://www.activistrights.org.au/handbook/ch02s04.php

Healthcare activism: Should medical students care?

http://www.readperiodicals.com/201101/2302639771.html

Why Health Activists Should Care about FDA Regulations of Social Media

http://blog.wegohealth.com/2011/04/18/why-health-activists-should-care-about-fda-regulations-of-social-media/

Wego Health - A Community that aims to empower health activists

https://wegohealth.com/

A Trio of Twitter Tales by P. Mimi Poinsett MD

Change.org

OurSay.org

So I hope that stimulates some new thoughts and ideas, and reaffirms some old knowledge as well. I look forward to seeing you on Sunday to delve a little further into this topic.

“Find your voice, and inspire others to find theirs.” Stephen Covey

The InternCrisis Timeline

2012-11-01T09:18:00.000+10:00

To an outside person the internship crisis, might be a hard issue to understand. Which is why many of us have campaigned tirelessly on social media, started up websites, written to our politicians and worn our scrubs on the street.

For me though, the best way to explain a concept is imagery. I literally do believe a good picture tells a thousand words, if not more. Fortunately, there a many medical students with alternative skills, and thanks to Haris Noor, we now have a brilliant infographic explaining the how the InternCrisis arose.