New measures to protect doctors after Bawa-Garba case

Jeremy Hunt says patient safety will improve if staff can learn from their mistakes. via BBC News - Health Read More Here..

The deaf patients 'left behind' by the NHS

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The children who hear 'terrifying' voices

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Premature birth test being trialled

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How to do a breast examination

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Funding cuts means access to sexual health clinics 'tougher'

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Acupuncture and Pain

Acupuncture is one of the oldest systems of traditional medicine. With roots in China, this medical system is more than 2000 years old. It differs from various other medical systems as it does not involve taking any herbs or substances. Instead, it involves inserting small needles at specific predefined points. From the 20^th century onwards, it has continued to gain prominence in the Western world, although many remain skeptical about efficacy.

These days, researchers want to know the exact mechanism of action of any medical system. They only trust the therapy if it has been proven as effective in randomized placebo-controlled clinical trials. Acupuncture has been the subject of many such trials, and its usefulness has been established in certain pain-associated conditions, mood disorders, and even in some diseases of internal organs. This led to the recognition of this medical system by many healthcare providers and medical organizations. In the US, acupuncture is recognized as complementary medicine. The WHO also recommends it for a number of specific medical conditions.

Clinical evidence of efficiency

Hundreds of clinical trials provide evidence of the effectiveness of acupuncture in various medical conditions. Among the most relevant trials are the so-called German mega-trials named ARC, ART, COMP, and GERAC. The primary focus of these trials has been pain relief in various musculoskeletal conditions. GERAC and ART were high quality random clinical trials investigating low back pain. These trials compared real acupuncture with sham acupuncture and standard care. Sham acupuncture involved needling without the use of conventional acupuncture points. Whereas standard care included the use of physiotherapy, exercise therapy, and NSAIDs (non-steroidal anti-inflammatory drugs). Results were measured after three months, and the response was defined as adequate if there was an improvement of more than 33% on the pain scale (the Von Korff Chronic Pain Grade Scale). After 6-months, the response rate with real acupuncture was 47.6%, while it was 44.2% with sham acupuncture, and 27.4% with standard care. Though these trials clearly demonstrated the efficacy of acupuncture, they also showed the effectiveness of sham acupuncture. Researchers think that this phenomenon is linked to psychogenic factors involved with back pain.

Interestingly, similar results were also demonstrated in various trials in the US. Though these trials show the usefulness of acupuncture in painful conditions, they also illustrate the value of psychogenic factors. Therefore, it is not surprising that acupuncture had also proven its utility in treating mood disorders and sleep disorders.

In Chinese medicine, the use of acupuncture is not limited to pain-related conditions. Thus, there is need for more extensive trials across a diverse range of diseases. The existing data do indicate that acupuncture may be an alternative approach for many difficult to treat chronic ailments.

Possible mechanisms

One of the areas of debate regarding acupuncture has been the difficulty in explaining its mechanism of action. As per traditional explanation, acupuncture is used to correct the flow of energy (Qi) in the body. This life energy flows through the fixed paths or highways in our body called meridians. Practitioners of acupuncture believe that in disease conditions there is a blockade of energy highways or meridians. Acupuncture is about creating the balance between the internal forces called Yin and Yang. However, the trouble is that modern science is not able to demonstrate or even understand the concepts of Qi, Yin, Yang, and Meridians.

In the last few decades, practitioners of modern science have made various attempts to explain the mechanism of action of acupuncture, and they came up with multiple theories.

• Measurable effects of acupuncture: One of the explanations is that needling does cause local changes and alterations in reflexes. It also has systemic effects, as it changes the working of the autonomous nervous system. Thus, acupuncture affects blood pressure, heart rate, levels of various hormones, and changes the levels of neurotransmitters. All of this results in pain relief and other beneficial effects.
• Local mechanotransduction: This is a theory promoted by a French physician in 1961, who wrote that acupuncture points have lower local resistance when compared to surrounding skin. He wrote that while normal dry skin has a resistance of 200,000 to 2 million Ohms, acupuncture points have a resistance of just 50,000 Ohms. The believers in this theory say that acupuncture causes minute traumas at the points of needle insertion and thus stimulates survival mechanisms of the body. Needling stimulates homeostasis, anti-inflammatory responses, tissue regeneration, and much more.
• Neurohumoral theory: it has been demonstrated that acupuncture is useful in pain relief, and naloxone blocks its analgesic effect. Thus, researchers propose that needling at specific points leads to the release of endogenous painkilling opiate-like substances such as enkephalins, endorphins, dynorphins and some other neurotransmitters like serotonin and noradrenaline.
• Gate-control theory: This theory states that needling stimulates large myelinated nerve fibers. These fibers carry tingling sensations and feelings of warmth, and can inhibit the painful sensation that is transmitted to the brain by much smaller C-fibers via spinal tracts.
• Postsynaptic inhibition: This is another explanation, which states that acupuncture results in the inhibition of pain through a central mechanism via disinhibition of RAF. This phenomenon typically works in cases of extreme trauma like loss of limb. This central mechanism has a role in protecting the body from extreme stress and pain.
• Autonomous nervous system: Proponents of this theory suggest that acupuncture works by changing the balance of sympathetic and parasympathetic nervous system.
• Morphogenetic singularity theory: This is one of the more complicated hypotheses that tries to explain the existence of meridians. Advocates of this theory explain the presence of non-neural communication pathways in the body. During embryonic development, when neurons are not yet formed, cells must communicate among themselves to direct development. Meridians are just the remains of these early communication paths, which are still present in the adult body.
• Visualization: In recent years, fMRI methods have advanced a lot, and in many clinical studies it has been demonstrated that stimulation of various acupuncture points by needling results in activation of different brain centers, thus explaining the mechanism of action of acupuncture. It is believed that both the elements of morphogenetic singularity theory (meridians) and components of the neurohumoral response are involved in the stimulation of the brain.

It is obvious that various theories have been used to describe the mechanism of action of acupuncture, and most probably there is more than one mechanism is involved. Clinical trials do seem to indicate that acupuncture is beneficial in specific health conditions. But the way it works still remains a mystery.

References

Dong, B., Chen, Z., Yin, X., Li, D., Ma, J., Yin, P., … Xu, S. (2017. The Efficacy of Acupuncture for Treating Depression-Related Insomnia Compared with a Control Group: A Systematic Review and Meta-Analysis. BioMed Research International, 2017, 9614810. doi: 10.1155/2017/9614810

Kawakita, K., & Okada, K. (2014) Acupuncture therapy: mechanism of action, efficacy, and safety: a potential intervention for psychogenic disorders? Biopsychosocial Medicine, 8, 4. doi: 10.1186/1751-0759-8-4

White, A., & Ernst, E. (2004) A brief history of acupuncture. Rheumatology, 43(5), 662–663. doi: 10.1093/rheumatology/keg005

Wong MC, Shen HJ (2010) Science-based Mechanisms to Explain the Action of Acupuncture. Journal of the Association of Traditional Chinese Medicine (UK), 17(2), 5-10.

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Syphilis and gonorrhoea up by one-fifth

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"All Americans are just one bad tweet away from being fired"

From MarketWatch:

"If you use Twitter, you too are a public figure. And one egregious tweet could blow up your life.

The political climate puts all employers on high alert when it comes to the words and behavior of their employees.

Many people are plugged into the news cycle all day long. One in five employers think staff is productive fewer than five hours a day, with most citing smartphone use as the culprit.

The First Amendment protects free speech, but it may not protect your job if you do or say anything that is contrary to the company’s values, even if it’s a joke.

Anyone with a public Twitter account is a de facto public figure.

“We have to be mindful of every word we speak and everything we write.” Even posting photographs or retweeting someone else’s tweet can be enough to get fired.

In fairness to American workers, it’s a double-edged sword: They’re often times encouraged to tweet and maintain an active social media presence."

References:

Like Roseanne, all Americans are just one bad tweet away from being fired https://buff.ly/2xB5bAm

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Ariana Grande says she has PTSD after Manchester attack

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'Remarkable' therapy beats terminal breast cancer

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When advertising your physician practice: Google and Facebook dominate 73% of U.S. digital advertising market

The WSJ expressed concerns about monopoly: Tech’s Titans Tiptoe Toward Monopoly https://buff.ly/2H5SHAh

"Imagine a not-too-distant future in which trustbusters force Facebook FB to sell off Instagram and WhatsApp. Imagine a time when Amazon’s cloud and delivery services are so dominant the company is broken up like AT&T. Imagine Google’s search or YouTube becoming regulated monopolies, like electricity and water.

Facebook Inc., Google parent Alphabet Inc. and Amazon.com Inc. are enjoying profit margins, market dominance and clout that, according to economists and historians, suggest they’re developing into a new category of monopolists.

Together, Google and Facebook take in 73% of U.S. digital advertising.

They also benefit from something historically unprecedented: the ability to get users to subsidize them with enormous quantities of free labor. Their systems are fueled by personal information, but instead of them hunting for it, people willingly provide it."

The reality is that if you choose to advertise your physician practice, there are 2 dominant channels:

- Google Ad Words https://www.google.com/ads
- Facebook Ads https://www.facebook.com/business/products/ads

Related articles for physicians advertising on Google and Facebook:

Online Advertising Challenges for Medical Clinics | Physicians Practice https://buff.ly/2JjF7i2
Google Ads and Physicians: Get the Most for Your Money | Physicians Practice https://buff.ly/2Lb7tZ0

Marketing a Medical Practice Using Facebook | Physicians Practice https://buff.ly/2Ji5mW2
Using Facebook for Medical Practice Marketing | Physicians Practice https://buff.ly/2LcBh7x
Facebook Advertising Tips for Physicians | Physicians Practice https://buff.ly/2JnZuuv

References:

Tech’s Titans Tiptoe Toward Monopoly https://buff.ly/2H5SHAh
Healthcare and medicines - Advertising Policies Help https://buff.ly/2JmXVNa

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Breast cancer: Test means fewer women will need chemotherapy

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'Virtual brain operation' moves a step closer to reality

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Rikke Schmidt Kjaergaard on surviving locked-in syndrome

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Tramadol emboldens vigilantes to fight Boko Haram

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Bereaved parents 'let down at work by lack of support'

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Boy, 12, helps father fight anxiety and depression

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How Self-Compassion Can Fight Perfectionism

“Be kind to one another.”

You don’t need to be a die-hard Ellen DeGeneres fan to appreciate the value of that motto. And while we’re reminded how kindness goes a long way in our everyday interactions with others, we often forget to apply it to those who need it most: ourselves.

Whether it’s setting a personal weight-loss goal, or believing that we can ace a final exam—all of us are familiar with the experience of setting high standards. We’re even more familiar with the inevitable let-down that comes from not living up to those very standards.

Enter, the life of a perfectionist.

But, importantly, not all perfectionists operate the same. There are different types that are associated with different psychological outcomes.

On the one hand, if you strive to attain your ambitious goals and prevent yourself from being overly self-critical, you might be a personal strivings perfectionist. This isn’t so bad. In fact, this type of perfectionism is more likely to lead to relatively higher levels of self-esteem and decreased levels of negative affect.

On the other hand, if you constantly believe that you are not good enough, if you judge yourself by your shortcomings, and if you are constantly worried that other people won’t approve of you, then you might be more on the side of maladaptive perfectionism. This form of perfectionism has been linked to depressive symptoms in both adolescents and adults.

It’s no wonder then that researchers are curious to know more about interventions that help buffer against this maladaptive perfectionism. In one recent study, researchers examined the possibility that self-compassion can protect us against the negative effects of maladaptive perfectionism. The questions is, can self-directed kindness increase our chances of living a full, healthy life? Can it combat the symptoms of depression that come from this less ideal version of perfectionism?

Understanding self-compassion

You may ask, “What exactly is self-compassion? And is it something that can be cultivated by anyone, or is a skill that is only available to some of us?” To shed some light on these questions, researchers have broken down self-compassion into three main components: self-kindness, common humanity, and mindfulness.

While the first component is self-explanatory, the other two require careful consideration. When something terrible happens to us, often the initial reaction is to sit and wallow in our grief and self-pity. We convince ourselves that no one else is going through similar problems in their lives. But that is simply not true. Statistically speaking, it’s an erroneous judgment.

In order to be more accepting of ourselves, we need to realize that we are never as alone and isolated as we think we are. This is at the heart of common humanity.

At the same time, many of us are prone to over-analyzing painful experiences, or trying to avoid negative feelings altogether. Mindfulness then, is about acknowledging our thoughts, feelings, and emotions without judgement, and accepting them as part of the common human experience.

Back to our study. Taking into account these three sub-components, the researchers in the present investigation set out to predict that self-compassion would weaken the relationship between perfectionism and depression in both adolescent and adult populations.

The study

541 adolescents from grades 7 to 10 were recruited for the first study. Participants were asked to complete three online questionnaires during school hours, as part of a larger well-being intervention study. The questionnaires tapped into perfectionism, mood/feelings, self-worth and self-esteem, as well as reported self-compassion.

As predicted, self-compassion was found to moderate, or weaken, the relationship between maladaptive perfectionism and depression in this sample of adolescents. Next, the researchers wanted to see if the results would hold for adults.

515 adults from the general population were recruited through online advertisements. Again, participants were asked to complete the same questionnaires. Once again in line with the researchers’ predictions, self-compassion was found to weaken the relationship between perfectionism and depression in the adult sample. What was true for teens was also true for adults later on in life.

Why it matters

It seems that more than anything, today’s culture values perfection. Parents and teachers may push us towards excellence at school, our friends may judge us by how we dress and act in their company, and perhaps worst of all, our social media accounts constantly fool us into thinking that there are people out there who actually have perfect lives.

Good news, bad news. The bad news is that we can’t completely eradicate perfectionistic thoughts. Good news is that we can try to change our relationship to those thoughts through self-compassion. If we learn to cultivate self-kindness, connection, and mindfulness as we strive toward achieving our goals, any setback we face along the way will be met with greater resilience and mental strength. As a result, we are less likely to fall victim to the debilitating effects of depression, and more likely to live a happy, balanced life.

So, as Ellen DeGeneres reminds us, always be kind to others. But before you do, be sure to look after yourself first. In this case, it’s okay to be a little selfish.

References

Ferrari, M., Yap, K., Scott, N., Einstein, D., & Ciarrochi, J. (2018). Self-compassion moderates the perfectionism and depression link in both adolescence and adulthood. PLOS ONE, 13(2), e0192022. doi: 10.1371/journal.pone.0192022

Hill, R., Huelsman, T., & Araujo, G. (2010). Perfectionistic concerns suppress associations between perfectionistic strivings and positive life outcomes. Personality And Individual Differences, 48(5), 584-589. doi: 10.1016/j.paid.2009.12.011

NEFF, K. (2003). The Development and Validation of a Scale to Measure Self-Compassion. Self And Identity, 2(3), 223-250. doi: 10.1080/15298860309027

Stoeber, J., & Otto, K. (2006). Positive Conceptions of Perfectionism: Approaches, Evidence, Challenges. Personality And Social Psychology Review, 10(4), 295-319. doi: 10.1207/s15327957pspr1004_2

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