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The ability to improve the health of another person or to save their life requires great skill, knowledge, and dedication. The impact that this work has goes above and beyond your average career, extending to the families and friends of patients. We were interested to discover what motivates the people who play a vital role in the health and quality of life of hundreds of people every year.

The post What inspires the people who save lives? appeared first on OUPblog.

It’s that time of year again: chestnuts are roasting on an open fire, halls are decked with boughs of holly, and everyone’s rockin’ around the Christmas tree…. As idyllic as this sounds, sometimes the holiday season just doesn’t live up to its expectations of joy, peace, and goodwill.

The post Christmas calamities appeared first on OUPblog.

This summer intrepid travelers everywhere are strapping on backpacks, dousing themselves in mosquito spray, and getting their inoculations -- ready to embark on journeys that will take them into contact with some of the most virulent viruses and nastiest bacteria on the planet. Even those of us who aren’t going off the beaten track may end up in close quarters with microbes we’d rather not befriend. Explore some of the most common infectious diseases around the globe and how to identify them in this infographic.

The post Common infectious diseases contracted by travellers worldwide [infographic] appeared first on OUPblog.

War. Of all human endeavours, perhaps none demonstrates the extremes of ingenuity and barbarity of which humanity is capable. The 21st century may be the century in which the threat of perpetual war is realised. Although many innovations have been brought about as a bi-product of the challenges war presents, the psychological and physical trauma wrought on the human body may prove too high a cost.

The post War: a legacy of innovation and trauma appeared first on OUPblog.

With a failing NHS and an ageing population in Britain, palliative care is a topic currently at the forefront of healthcare debate. Whether to abandon treatment in favour of palliation, is a challenging decision with profound implications for end-of-life care.

The post Palliative care around the world appeared first on OUPblog.

Today, 25 April is a joint celebration for geneticists, commemorating the discovery of the helix nature of DNA by James Watson and Francis Crick in 1953 and the completion of the human genome project fifty years later in 2003. It may have taken half a century to map the human genome, but in the years since its completion the field of genetics has seen breakthroughs increase at an ever-accelerating rate.

The post DNA Day 2015: celebrating advances in genetics and gene therapy [infographic] appeared first on OUPblog.

Today is the 60th anniversary of the polio vaccine being declared safe to use. The poliovirus was a major health concern for much of the twentieth century, but in the last sixty years huge gains have been made that have almost resulted in its complete eradication. The condition polio is caused by a human enterovirus called the poliovirus.

The post An interactive timeline of the history of polio appeared first on OUPblog.

Investigations into the nature of epilepsy, and its effects on those diagnosed with the disorder, can be traced back for almost 2,000 years. From associations with lunar cycles, to legislation preventing those with epilepsy to marry, the cultural and scientific record on epilepsy treatment is one of stigma and misunderstanding.

The post The history of epilepsy: an interactive timeline appeared first on OUPblog.

The field of anaesthesia is a subtle discipline, when properly applied the patient falls gently asleep, miraculously waking-up with one less kidney or even a whole new nose. Today, anaesthesiologists have perfected measuring the depth and risk of anaesthesia, but these breakthroughs were hard-won. The history of anaesthesia is resplendent with pus and cadavers, each new development moved one step closer to the art of the modern anaesthesiologist, who can send you to oblivion and float you safely back. This timeline marks some of the most macabre and downright bizarre events in its long history.

Heading image: Junker-type inhaler for anaesthesia, London, England, 1867-1 Wellcome L0058160. Wellcome Library, London. CC BY 4.0 via Wikimedia Commons.

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Many students, when asked by a teacher or professor to volunteer in front of the class, shy away, avoid eye contact, and try to seem as plain and unremarkable as possible. The same is true in dental school – unless it comes to laughing gas.

As a fourth year dental student, I’ve had times where I’ve tried to avoid professors’ questions about anatomical variants of nerves, or the correct way to drill a cavity, or what type of tooth infection has symptoms of hot and cold sensitivity. There are other times where you cannot escape having to volunteer. These include being the first “patient” to receive an injection from one of your classmate’s unsteady and tentative hands. Or having an impression taken with too much alginate so that all of your teeth (along with your uvula and tonsils) are poured up in a stone model.

But volunteering in the nitrous oxide lab … that’s a different story. The lab day is about putting ourselves in our patients’ shoes, to be able to empathize with them when they need to be sedated. For me, the nitrous oxide lab might have been the most enjoyable 5 minutes of my entire dental education.

In today’s dental practice, nitrous oxide is a readily available, well-researched, incredibly safe method of reducing patient anxiety with little to no undesired side effects. But this was not always the case.

The Oxford Textbook of Anaesthesia for Oral and Maxillofacial Surgery argues that “with increasingly refined diets [in the mid-nineteenth century] and the use of copious amounts of sugar, tooth decay, and so dentistry, were on the increase.” Prior to the modern day local anesthesia armamentarium, extractions and dental procedures were completed with no anesthesia. Patients self-medicated with alcohol or other drugs, but there was no predictable or controllable way to prevent patients from experiencing excruciating pain.

That is until Horace Wells, a dentist from Hartford, Connecticut started taking an interest in nitrous oxide as a method of numbing patients to pain.

Wells became convinced of the analgesic properties of nitrous oxide on December 11, 1844 after observing a public display in Hartford of a man inhaling the gas and subsequently hitting his shin on a bench. After the gas wore off, the man miraculously felt no pain. With inspiration from this demonstration and a strong belief in the analgesic (and possibly the amnestic) qualities of nitrous oxide, on December 12, Wells proceeded to inhale a bag of the nitrous oxide and have his associate John Riggs extract one of his own teeth. It was risky—and a huge success. With this realization that dental work could be pain free, Wells proceeded to test his new anesthesia method on over a dozen patients in the following weeks. He was proud of his achievement, but he chose not to patent his method because he felt pain relief should be “as free as the air.”

This discovery brought Wells to the Ether Dome at the Massachusetts General Hospital in Boston. Before an audience of Harvard Medical School faculty and students, Wells convinced a volunteer from the audience to have their tooth extracted after inhaling nitrous oxide. Wells’ success came to an abrupt halt when this volunteer screamed out in pain during the extraction. Looking back on this event, it is very likely that the volunteer did not inhale enough of the gas to achieve the appropriate anesthetic effect. But the reason didn’t matter—Wells was horrified by his volunteer’s reaction, his own apparent failure, and was laughed out of the Ether Dome as a fraud.

The following year, William Morton successfully demonstrated the use of ether as an anesthetic for dental and medical surgery. He patented the discovery of ether as a dental anesthetic and sold the rights to it. To this day, most credit the success of dental anesthesia to Morton, not Wells.

After giving up dentistry, Horace Wells worked unsuccessfully as a salesman and traveled to Paris to see a presentation on updated anesthesia techniques. But his ego had been broken. After returning the U.S, he developed a dangerous addiction to chloroform (perhaps another risky experiment for patient sedation, gone awry) that left him mentally unstable. In 1848, he assaulted a streetwalker under the influence. He was sent to prison and in the end, took his own life.

This is the sad story of a man whose discovery revolutionized dentists’ ability to effectively care for patients while keeping them calm and out of pain. As a student at the University of Connecticut School of Dental Medicine, it is a point of pride knowing that Dr. Wells made this discovery just a few miles from where I have learned about the incredible effects of nitrous oxide. My education has taught me to use it effectively for patients who are nervous about a procedure and to improve the safety of care for patients with high blood pressure. This is a day we can remember a brave man who risked his own livelihood in the name of patient care.

Featured image credit: Laughing gas, by Rumford Davy. Public domain via Wikimedia Commons.

The post Relax, inhale, and think of Horace Wells appeared first on OUPblog.

        

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Few fields develop as rapidly as medicine, with new breakthroughs in research, tools, and techniques happening everyday. This presents an interesting challenge for many medical publishers — trying to get the latest information to students, practitioners, and researchers as quickly and accurately as possible. So we are delighted to present a Q&A with Associate Editorial Director of Medicine Books, Craig Panner. Craig began his career at Oxford University Press eight years ago, and currently works across Oxford University Press’s medicine titles. In the interview below, Craig talks not only about his role, but also the medical publishing landscape in general, both past and future.

Could you tell us about your position as Associate Editorial Director?

My role is something of an interdepartmental liaison between the Medicine UK office and the psychology and social work group here at Oxford University Press. Collectively, we all work very closely together and when you have departments on both sides of the Atlantic, I think it is imperative to maintain and promote open lines of communication which is what I strive to do on a daily basis. Additionally, as Associate Editorial Director, I am also the commissioning editor for neurology and neuroscience, a role which I not only love, but I think helps keep me connected to, and informed about, what the other commissioning editors encounter on a daily basis.

In your experience, what are some of the challenges of transitioning medical books to an online environment?

Work in the computer lab by MCPearson. CC-BY-SA-3.0 via Wikimedia Commons.

I think one of the biggest challenges is that everyone has ideas of what they want, what functionality they expect, and how to be able to use that material. But like many things, we can’t please everyone so it becomes a matter of identifying the greatest common need and how to meet those requirements. Another large challenge is that the online environment is a constantly moving target, if you will: new functionalities are introduced, the “it” product is rolled out, and other similar bells and whistles are discovered and customers often want that too. But when we’re talking about a platform product like Oxford Medicine Online and the huge amount of data that is available, it’s often too difficult to demonstrate why instant changes can’t be incorporated.

What was the state of medical publishing when you began your career vs. how it is done now?

When I started in the publishing world (as a proofreader) back in 1992, everything was print. I remember when the company received its first apple computer: it was kept in an open office and you had to sign up to book time to use it. And, oddly, it was never in use: everyone was more comfortable using the mimeograph machine and the typewriters by their desk. But, in about the next five or six years, the online explosion happened and journals suddenly became available electronically, first via consortia only, then as individual subscriptions, and then individual articles.

Could you discuss Oxford’s relationship with the Mayo Clinic, and how it has grown or changed over the years?

Mayo Clinic is the largest integrated, not-for-profit group practice in the world, with nearly 4000 physicians and scientists at their three primary sites in Minnesota, Florida, and Arizona. And given that Oxford University Press is the largest and oldest university press in the world, it seemed like a natural fit for the two organizations to work together. For almost five years now, Mayo Clinic and Oxford University Press have continued to work together to create, prepare, and disseminate medical reference works that any practicing clinician, anywhere in the world, would find useful for their continued professional development. When we first began working together, the Mayo Clinic Scientific Press series of books was predominantly print. But with the launch of Oxford Medicine Online, and the subsequent development of the Oxford eLearning Platform, the Mayo titles now have the added functionality of utilizing the questions and answers that accompany many of the Mayo Clinic Board Review books for a truly interactive experience that more fully prepares doctors preparing to take their board exam, as well as doctors maintaining their certification, in a real time environment.

What are some of the greatest challenges of medical publishing?

Everyone is busy and everyone works more than a 40-hour week. Finding the time to develop and undertake, much less publish, a medical text is a real juggling act. Thankfully, with the history of Oxford University Press and the quality publications that we produce, we are a trusted publishing house where authors and editors can go with confidence. Another challenge in medical publishing is the time that it takes to produce a work. Not only does it take a fair amount of time to develop, to write or collate chapters, and to deliver the work, but in the old days, it would take a year to publish a book. Medical research and techniques move far more quickly than that time-frame would permit which is why the Medicine group now publishes works between 3.5 months to 5.5 months from receipt. All to better meet the needs of our readers.

Where do you think medical publishing is headed in the future?

I wish I knew! The electronic environment will obviously play a huge role for the rest of my career but given that it, literally, changes daily and the needs and expectations of our readers changes with it, it is impossible to guess where things are going. And that’s what makes publishing so much fun. I can say that I think that immediate access to point of care information, along with suggested secondary and tertiary information will become second nature. The online environment won’t do the thinking for the clinician, but it will certainly supplement their decision making and knowledge base far more completely than anything that we’ve had previously.

How has the process of actually doing medical research changed over the years? In other words, how are people accessing the content then vs. now?

Medical research has definitely changed over the years. When I first started out, clinicians and researchers had offices lined with books and journals, filing cabinets filled with journal reprints, and personal databases (for the electronically savvy) of key articles. Much of that is gone now and when you speak with a junior doc they will often say that everything they need is available to them electronically. Searching the web is obviously faster but the ability to utilize the web to link journals, books, databases, and the like has expanded the available knowledge base of today’s clinician, no matter where in the world they are located. And because of how we do research and how we follow up with patients, a doctor can now check up on, and advise upon, a patient from anywhere that they are traveling to. Geographic boundaries really no longer exist.

How have extra online features, like multimedia, changed the way medical research is done?

The various additional features that the online environment facilitates are amazingly useful in this busy world we live in. Not only do these extra features teach the reader on their own schedule, but these features can help facilitate the decision making process. If we are talking about videos that show two different, but somewhat similar, symptoms the multimedia material can help show, literally, how the two disorders are different. Likewise, being able to quickly reference additional material via a third party database–let’s say genotypes, for instance–you negate the need to stop what you’re doing, go to a book, a journal, or even the library but, instead, go directly to the source, find what you need, make the judgment and continue with your work. Medical research really is nothing like it was five years ago and will not be the same five years from now.

Craig Panner is the Associate Editorial Director of Medicine Books, and works in Oxford’s New York office.

Oxford Medicine Online is an interconnected collection of over 500 online medical resources which cover every stage in a medical career. Our aim is to ensure that the site delivers the highest quality Oxford content whilst meeting the requirements of the busy student, doctor, or health professional working in a digital world.

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The post A conversation with Craig Panner, Associate Editorial Director of Medicine Books appeared first on OUPblog.

        

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The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online. To highlight some of the great resources, we’ve pulled together some interesting facts about the esphophagus from Stephen Hauser’s Mayo Clinic Gastroenterology and Hepatology Board Review.

(1) The esophagus has two major functions: to propel food boluses downward to the stomach and to keep stomach contents from refluxing upward. The esophagus accomplishes these functions by its tubular anatomy and motility that involves the contraction and relaxation of sphincter muscles and precisely timed peristaltic waves.

(2) The initial process of swallowing is under voluntary control. A swallow is initiated by the lips closing, the teeth clenching, and the tongue being elevated against the palate, forcing the bolus to the pharynx. Entry of the bolus into the pharynx triggers the involuntary swallowing reflex.

(3) Oropharyngeal dysphagia is often characterized by the complaint of difficulty initiating a swallow, transitioning the food bolus or liquid into the esophagus, meal-induced coughing or “choking,” or of food “getting stuck” in the voluntary phase of swallowing.

(4) Patients with an esophageal body or LES disorder describe “esophageal dysphagia” characterized by the onset of symptoms moments after the initiation of a swallow. They usually can sense that the food or liquid bolus has traversed the oral cavity and has entered the esophagus. They complain of food feeling “stuck” or “hung up” in transition to the stomach.

(5) Gastroesophageal reflux is the reflux of gastric contents other than air into or through the esophagus. Gastroesophageal reflux disease (GERD) refers to reflux that produces frequent symptoms or results in damage to the esophageal mucosa or contiguous organs of the upper aerodigestive system and occasionally the lower respiratory tract.

Gastroenterology and hepatology encompass a vast anatomical assortment of organs that have diverse structure and function and potentially are afflicted by a multiplicity of disease processes. Mayo Clinic Gastroenterology and Hepatology Board Review is designed to assist both physicians in-training who are preparing for the gastroenterology board examination and the increasing number of gastroenterologists awaiting recertification.

The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online. With full-text titles from Mayo Clinic clinicians and a bank of 3,000 multiple-choice questions, Mayo Clinic Toolkit provides a single location for residents, fellows, and practicing clinicians to undertake the self-testing necessary to prepare for, and pass, the Boards and remain up-to-date. Oxford Medicine Online is an interconnected collection of over 250 online medical resources which cover every stage in a medical career, for medical students and junior doctors, to resources for senior doctors and consultants. Oxford Medicine Online has relaunched with a brand new look and feel and enhanced functionality. Our aim is to ensure that the site continues to deliver the highest quality Oxford content whilst meeting the requirements of the busy student, doctor, or health professional working in a digital world.

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How can you resolve to change in 2013? With a community. The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online, and to highlight some of the great resources, we’ve excerpted Prathibha Varkey, MD, MPH, MHPE’s Mayo Clinic Preventive Medicine and Public Health Board Review below.

Community and population health can be enhanced by recognizing the different levels of influence, namely intrapersonal, interpersonal, and organizational influences. More recently, attention is being paid to the importance of interpersonal influences through the study of social networks. Smoking cessation rates of individuals increase as more contacts in their social network quit smoking, and individuals gain weight as more contacts in their social network gain weight. Another example of social influence is an after-school program for teenagers that may not change attitudes but may reduce the opportunity to engage in risky behaviors. Organizational support for behavior change can be in the form of higher taxes on tobacco or alcohol, building recreational centers to enhance physical activity, cleaning up the environment (in one study, neighborhood deterioration was a better predictor of sexually transmitted disease than low education attainment), and using or regulating message delivery by the media.

Bringing about change at the population level may follow the principles of diffusion of innovation, as described by Everett Rogers. In this model, the social system comprises five adopter categories: (1) innovators, (2) early adopters, (3) early majority, (4) late majority, and (5) laggards. Innovators are important for change because they get the process started, but they are not very influential because too much uncertainty about the changed behavior still exists when they adopt the change. The early adopters are key to diffusing an innovation; this group tends to include the opinion leaders, and others usually solicit their advice about new innovations. This model of diffusion of innovation predicts whether innovations and change will be successful on a large scale.

How rapidly an innovation will be diffused depends on the characteristics of the innovation, how it is communicated, and the social system. The characteristics of innovation that determine its speed of adoption include its perceived relative advantage over current practice, compatibility with current practices and needs of the adopters, ease of use (simple vs complex), “trialability” (testable on a small scale), and observability (visibility of results).

The principles of this model can be useful for predicting behavior change or diffusion of best practices at the community or population level. For example, screening mammography has been widely adopted by physicians because it is perceived to detect early stage breast cancer, the test is easy for physicians to order, patient compliance is not burdensome, and results are visible in a short time. In contrast, smoking cessation counseling has been slower to diffuse because the results are not as visible (most people will not quit when advised to do so), the intervention is more complex than just ordering a test, and physician practices are not geared toward counseling.

• Intrapersonal, interpersonal, and organizational influences affect community and population health.
• Health changes at the population level may propagate in a manner predicted by the principles of diffusion of innovation.

A comprehensive and concise review of relevant preventive medicine and public health topics, the Mayo Clinic Preventive Medicine and Public Health Board Review is an ideal study guide for residents preparing to take the examination of the American Board of Preventive Medicine for the first time, as well as for physicians preparing for recertification. Its emphasis on evidence-based information and recommendations makes Mayo Clinic Preventive Medicine and Public Health Board Review a credible, practical resource that can be used in clinical, public health, and academic settings

The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online. With full-text titles from Mayo Clinic clinicians and a bank of 3,000 multiple-choice questions, Mayo Clinic Toolkit provides a single location for residents, fellows, and practicing clinicians to undertake the self-testing necessary to prepare for, and pass, the Boards and remain up-to-date. Oxford Medicine Online is an interconnected collection of over 250 online medical resources which cover every stage in a medical career, for medical students and junior doctors, to resources for senior doctors and consultants. Oxford Medicine Online has relaunched with a brand new look and feel and enhanced functionality. Our aim is to ensure that the site continues to deliver the highest quality Oxford content whilst meeting the requirements of the busy student, doctor, or health professional working in a digital world.

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The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online. To highlight some of the great resources, we’ve pulled together some interesting facts about anesthesia from James Hebl and Robert Lennon’s Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade. Get free access to the Mayo Clinic suite for a limited time with this Facebook offer (watch out, it closes today!).

(1) Egyptian pictographs dating back to 3000 BC showing a physician compressing a nerve in the antecubital fossa while an operation is being performed on the hand.

(2) William Halsted, M.D. (1852–1922; Chair, Department of Surgery, Johns Hopkins Hospital), used cocaine as local infiltration as he dissected down toward major nerve trunks. He then injected cocaine around them, performing regional blockade under direct vision.

(3) In Paris in the early 1920s, a new technique for blocking the brachial plexus from an axillary approach was introduced. M. Reding, M.D., studying the anatomy of the axilla, discovered that the nerves of the plexus surround the artery in a fascial sheath. Thus, using the artery as a landmark, Reding found that the fascial compartment could be filled with local anesthetic to result in brachial plexus blockade. Reding blocked the musculocutaneous nerve, which lay outside the sheath, by infiltrating the coracobrachialis muscle.

(4) Paresthesia technique—the long-preferred method of regional anesthesiologists—was slowly replaced during the 1980s as peripheral nerve stimulation began to emerge. During its development, peripheral nerve stimulation was thought to provide superior localization of neural structures compared with blind paresthesia-seeking techniques. Peripheral nerve stimulators transmit a small electric current through a stimulating needle that, when in proximity to neural structures, causes depolarization and muscle contraction.

(5) In contemporary medical practice, regional anesthetic techniques have expanding socioeconomic and clinical implications. For example, studies evaluating patient satisfaction have found that perioperative analgesia and the avoidance of nausea and vomiting are consistently two of the highest concerns among patients.

(6) Ultrasound guidance may represent the 21st century’s version of Halsted’s anatomical dissection down to the brachial plexus.

Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade by James Hebl and Robert Lennon is a practical guide for residents-in-training and clinicians to gain greater familiarity with regional anesthesia and acute pain management to the upper and lower extremity. It emphasizes the importance of a detailed knowledge of applied anatomy to safely and successfully performing regional anesthesia. It also provides and overview of the emerging field of ultrasound-guided regional anesthesia, which allows reliable identification of both normal and variant anatomy. Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade contains more than 200 beautifully illustrated anatomic images important to understanding and performing regional anesthesia. Corresponding ultrasound images are provided when applicable.

The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online. With full-text titles from Mayo Clinic clinicians and a bank of 3,000 multiple-choice questions, Mayo Clinic Toolkit provides a single location for residents, fellows, and practicing clinicians to undertake the self-testing necessary to prepare for, and pass, the Boards and remain up-to-date. Oxford Medicine Online is an interconnected collection of over 250 online medical resources which cover every stage in a medical career, for medical students and junior doctors, to resources for senior doctors and consultants. Oxford Medicine Online has relaunched with a brand new look and feel and enhanced functionality. Our aim is to ensure that the site continues to deliver the highest quality Oxford content whilst meeting the requirements of the busy student, doctor, or health professional working in a digital world.

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