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Monday 28 December 2009
Wednesday 23 December 2009
Quote of the Day!
“Medicine is learned by the bedside and not in the classroom…
To study the phenomena of disease without books is to sail into an uncharted sea, while to study books without patients is no to go to sea at all”
Sir William Osler (1849-1919)
Monday 7 December 2009
Dementia Test!
It's that time of year for us to take our annual senior citizen test.
Exercise of the brain is as important as exercise of the muscles. As we grow older, it's important to keep mentally alert. If you don't use it, you lose it! Below is a very private way to gauge how your memory compares to the last test. Some may think it is too easy but the ones with memory problems may have difficulty. Take the test presented here to determine if you're losing it or not. The spaces below are so you don't see the answers until you've made your answer. OK, relax, clear your mind and begin.
1. What do you put in a toaster?
Answer: 'bread.' If you said 'toast' give up now and do something else..
Try not to hurt yourself. If you said, bread, go to Question 2.
2. Say 'silk' five times. Now spell 'silk.' What do cows drink?
Answer: Cows drink water. If you said 'milk,' don't attempt the next question. Your brain is over-stressed and may even overheat.. Content yourself with reading a more appropriate literature such as Auto World. However, if you said 'water', proceed to question 3.
3. If a red house is made from red bricks and a blue house is made from blue bricks and a pink house is made from pink bricks and a black house is made from black bricks, what is a green house made from?
Answer: Greenhouses are made from glass. If you said 'green bricks,' why are you still reading these???
If you said 'glass,' go on to Question 4.
4. It's twenty years ago, and a plane is flying at 20,000 feet over Germany (If you will recall, Germany at the time was politically divided into West Germany and East Germany ). Anyway, during the flight, two engines fail. The pilot, realizing that the last remaining engine is also failing, decides on a crash landing procedure. Unfortunately the engine fails before he can do so and the plane fatally crashes smack in the middle of 'no man's land' between East Germany and West Germany ... Where would you bury the survivors? East Germany , West Germany ,
Or no man's land'?
Answer: You don't bury survivors.
If you said ANYTHING else, you're a dunce and you must stop. If you said, 'You don't bury survivors', proceed to the next question.
5. Without using a calculator - You are driving a bus from London to
Milford Haven in Wales . In London , 17 people get on the bus.
In Reading , 6 people get off the bus and 9 people get on.
In Swindon , 2 people get off and 4 get on.
In Cardiff , 11 people get off and 16 people get on.
In Swansea , 3 people get off and 5 people get on.
In Carmathen, 6 people get off and 3 get on.
You then arrive at Milford Haven ..
Without scrolling back to review, how old is the bus driver?
Answer: Oh, for crying out loud!
Don't you remember your own age? It was YOU driving the bus!!
Exercise of the brain is as important as exercise of the muscles. As we grow older, it's important to keep mentally alert. If you don't use it, you lose it! Below is a very private way to gauge how your memory compares to the last test. Some may think it is too easy but the ones with memory problems may have difficulty. Take the test presented here to determine if you're losing it or not. The spaces below are so you don't see the answers until you've made your answer. OK, relax, clear your mind and begin.
1. What do you put in a toaster?
Answer: 'bread.' If you said 'toast' give up now and do something else..
Try not to hurt yourself. If you said, bread, go to Question 2.
2. Say 'silk' five times. Now spell 'silk.' What do cows drink?
Answer: Cows drink water. If you said 'milk,' don't attempt the next question. Your brain is over-stressed and may even overheat.. Content yourself with reading a more appropriate literature such as Auto World. However, if you said 'water', proceed to question 3.
3. If a red house is made from red bricks and a blue house is made from blue bricks and a pink house is made from pink bricks and a black house is made from black bricks, what is a green house made from?
Answer: Greenhouses are made from glass. If you said 'green bricks,' why are you still reading these???
If you said 'glass,' go on to Question 4.
4. It's twenty years ago, and a plane is flying at 20,000 feet over Germany (If you will recall, Germany at the time was politically divided into West Germany and East Germany ). Anyway, during the flight, two engines fail. The pilot, realizing that the last remaining engine is also failing, decides on a crash landing procedure. Unfortunately the engine fails before he can do so and the plane fatally crashes smack in the middle of 'no man's land' between East Germany and West Germany ... Where would you bury the survivors? East Germany , West Germany ,
Or no man's land'?
Answer: You don't bury survivors.
If you said ANYTHING else, you're a dunce and you must stop. If you said, 'You don't bury survivors', proceed to the next question.
5. Without using a calculator - You are driving a bus from London to
Milford Haven in Wales . In London , 17 people get on the bus.
In Reading , 6 people get off the bus and 9 people get on.
In Swindon , 2 people get off and 4 get on.
In Cardiff , 11 people get off and 16 people get on.
In Swansea , 3 people get off and 5 people get on.
In Carmathen, 6 people get off and 3 get on.
You then arrive at Milford Haven ..
Without scrolling back to review, how old is the bus driver?
Answer: Oh, for crying out loud!
Don't you remember your own age? It was YOU driving the bus!!
Saturday 5 December 2009
Joke of the week!
What are the three FASTEST means of Communication:
1. Tele-Phone
2. Tele-Vision
3. Tell a Woman
Need still FASTER - Tell her NOT to tell ANY ONE.
1. Tele-Phone
2. Tele-Vision
3. Tell a Woman
Need still FASTER - Tell her NOT to tell ANY ONE.
Friday 27 November 2009
Quotes of the day
- Avoid the crowd. Do your own thinking independently. Be the chess player, not the chess piece.
- A celebrity is a person who works hard all his life to become well known, then wears dark glasses to avoid being recognized
- If our house be on fire, without inquiring whether it was fired from within or without, we must try to extinguish it.
Tuesday 20 October 2009
Euro-english
The European Commission has just announced an agreement whereby English will be the official language of the European Union rather than German, which was the other possibility.
As part of the negotiations, the British Government conceded that English spelling had some room for improvement and has accepted a 5- year phase-in plan that would become known as "Euro-English".
In the first year, "s" will replace the soft "c". Sertainly, this will make the sivil servants jump with joy.
The hard "c" will be dropped in favour of "k". This should klear up konfusion, and keyboards kan have one less letter.
There will be growing publik enthusiasm in the sekond year when the troublesome "ph" will be replaced with "f". This will make words like fotograf 20% shorter.
In the 3rd year, publik akseptanse of the new spelling kan be expekted to reach the stage where more komplikated changes are possible.
Governments will enkourage the removal of double letters which have always ben a deterent to akurate speling.
Also, al wil agre that the horibl mes of the silent "e" in the languag is disgrasful and it should go away.
By the 4th yer people wil be reseptiv to steps such as replasing "th" with "z" and "w" with "v".
During ze fifz yer, ze unesesary "o" kan be dropd from vords kontaining "ou" and after ziz fifz yer, ve vil hav a reil sensi bl riten styl.
Zer vil be no mor trubl or difikultis and evrivun vil find it ezi tu understand ech oza. Ze drem of a united urop vil finali kum tru.
Und efter ze fifz yer, ve vil al be speking German like zey vunted in ze forst plas.
If zis mad you smil, pleas pas on to oza pepl.
Monday 19 October 2009
Thursday 8 October 2009
Boring!!!
3.1 Health and Disease: Public Health & Health Promotion
Practical 2: Population health assessment
Learning Objectives
Course objectives
Describe the main health problems experienced by populations and groups within them
Distinguish between different measures of health and disease
Describe health services organisation
Consider the options for investigation of a health problem in a population
Apply epidemiological principles and methods to medical practice
Explore the role of public policy in health
Practical objectives
By the end of this practical session students will be better able to:
- describe the issues involved in assessing the health of a population
- describe processes of assessing the healthcare needs of populations
- understand the concepts of need, demand and use
2.1 We need to assess population health and health care needs to develop policy, plan services, and allocate resources.
1. How can we measure health?
Prevalence is defined as the number of affected persons present in the population at a specific time divided by the number of persons in the population at that time.
Prevalence per 1,000 =
No. of cases of a disease present in the population at a specified time X 1,000
No. of persons in the population at that specified time
The incidence of a disease is defined as the number of new cases of a disease that occur during a specified period of time in a population at risk for developing the disease.
Incidence per 1,000 =
No. of new cases of a disease occurring in the population during a specified period of time X 1,000
No. of persons at risk of developing the disease during that period of time
Options for comparing frequency of health/disease states, risk factors:
- Comparing rates – we'll come back to SMRs later in practical
- Relative risk
- Attributable risk
- Odds ratio
2. How can we measure healthcare needs?
Revise need = capacity to benefit
Felt need (can be measured) vs unfelt need (cannot be except from through screening)
Met need vs unmet need
Role of clinical/professional judgement: need for healthcare
Normative need – depends on judgment of professionals
3. What factors influence demand for healthcare?
Demand = expressed need
Felt need
Illness behaviour
Supply/availability of services.
4. How can we measure prevalence of a condition?
Cross sectional surveys
Analysis of routine data
SMRs
Surveillance, Registers
5. How can we measure incidence of a condition?
Hospital data – new episodes: HIPE in Ireland (coding issues)
Primary care data
Surveillance, Registers
2.2 Mortality
6. Where do mortality data come from?
Death certificates: who completes them?
Coding issues: International Classification of Diseases version 10
Who does coding – trained coders who are clerical staff
A 49 year old woman was attending a wedding. She complained of a headache and within 3 hours became disoriented and collapsed. Emergency services were called. She was transferred to the local Accident & Emergency Department where she was pronounced dead on arrival. She had a diagnosis of breast cancer 5 years earlier. Her husband described how she had been intermittently disoriented in the previous 4 months and had been on anti-hypertensive treatment for the previous 10 years. An autopsy was conducted, describing cause of death as cerebral haemorrhage with evidence of brain metastases and malignant breast cancer.
7. You are the woman's GP. Complete the Death Registration Form. (See Appendix)
Refer to handout from CSO AFTER you have attempted to complete form.
Note that this could be a coroner's case as the woman died on arrival in hospital and may not have been seen by a doctor for some time (this will be considered in Forensic Medcine)
8. Discuss the issues associated with reliability and validity of death certificate data.
Errors in completing death certificates, validity of final clinical diagnosis with and without post-mortem examination, errors in coding death certs, changes in coding ICD-9 vs. ICD-10 etc.
Consider how this affects mortality data
9. How can the information from death certificates be used to plan services?
Death certificates go from the Registrar of Births, Marriages and Deaths to the Central Statistics Office.
Population based deaths rates from various conditions are calculated and used nationally / regionally to
- assess the extent of health/disease problems,
- develop policies and services to address these problems,
- evaluate the effectiveness of policies/services in addressing problems.
National data is shared with EU/WHO for international comparisons.
10. Discuss the importance of standardised mortality ratios and how they are calculated.
When examining mortality data in particular comparing two or more populations, or one population in different time periods, such populations may differ in regard to many characteristics that affect mortality, of which age distribution is the most important as it is the single most important predictor of mortality. Therefore standardizing mortality is a method applied in order to compare mortality while effectively holding age constant.
- Direct Standardisation: A standard population is used in order to eliminate the effects of any differences in age (EU standard population)
- Indirect standardisation: used in two circumstances in particular
- when age strata are not available
- when small population analysis is carried out e.g. occupational groups
SMR = observed x 100
expected
2.3 Population Health Assessment
Health status assessment: to identify, scope, characterise and quantify health issues or problems experienced by a specified population.
Health needs assessment: to determine and implement the optimal local solution to a specified population health issue or problem, on the basis of robust evidence, feasibility, stakeholder input and available resources.
Health care assessment: to evaluate existing services and to identify potential quality improvement though redesign, modification, or development.
Health Impact Assessment: a combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population and the distribution of those effects within the population
All require detailed information on health and health needs.
10. How do you think you would assess the need for, for example, breast cancer services in this region?
Note that needs assessment requires careful planning
Epidemiological approach to health needs assessment
Combines specific health status assessments with assessment of the effectiveness of potential interventions
- Incidence and prevalence
- Effectiveness and cost-effectiveness
- Existing services
What is the size and nature of the problem?
We want to know how many people are likely to be suffering from the condition, their characteristics (who/what/where/when etc), to what extent are they already receiving appropriate treatment/management (refer to guidelines if they exist)
- Incidence: National Cancer Registry
- Prevalence: consider sources of routine data such as SMRs from CSO, hospital activity from HIPE; if a prevalence study is needed possibly a questionnaire survey of population or of GPs
- Effectiveness and cost-effectiveness: Cochrane library, Effective Health Care Bulletins, UK's National Institute of Health and Clinical Effectiveness (NICE), specialised studies.
- Describe existing services: identify and describe services and interventions being delivered
Comparative needs assessment: contrast levels of services received by one population with other populations and with standards
The guidelines for the management of breast cancer from both the Royal College of Surgeons in Ireland and England are on Blackboard: these include for instance that multidisciplinary teams form the basis for best practice in the management of breast cancer; estimates of the surgical workload of a breast cancer unit; recommendations on treatment, staffing, appointment times, audit, quality standards, screening; training and education etc.
Corporate needs assessment: includes the views on demands and wishes of patients, carers, professionals, politicians, voluntary organisations and others.
Consider how to seek these views: consultation processes. Surveys, interviews, meetings, focus groups etc.
What are resource implications?
Costs, human resources, facilities etc
Competing priorities?
Appendix: Practical 2
Friday 5 June 2009
Wednesday 6 May 2009
Crime Story!!
This is crime story. Five friends lived in a room, Namely MAD, BRAIN, FOOL, NOBODY, SOMEBODY.
One day SOMEBODY killed NOBODY. At that time BRAIN was in bathroom, MAD called police.
MAD: Is it police station???
Police: Yes, what is the matter??
MAD: SOMEBODY killed NOBODY.
Police: Are you mad?
MAD: Yes, I"m MAD.
Police: Don`t you have BRAIN.
MAD: BRAIN is in bathroom....
Police: you FOOL...
MAD: No, FOOL is reading this joke...
One day SOMEBODY killed NOBODY. At that time BRAIN was in bathroom, MAD called police.
MAD: Is it police station???
Police: Yes, what is the matter??
MAD: SOMEBODY killed NOBODY.
Police: Are you mad?
MAD: Yes, I"m MAD.
Police: Don`t you have BRAIN.
MAD: BRAIN is in bathroom....
Police: you FOOL...
MAD: No, FOOL is reading this joke...
Monday 4 May 2009
Who is he?
There's a man is in the hospital, a friend walks in, then a priest walks in and the man leaves, the priest asks who that was, the man says" Brothers and Sisters I have none, but he's my Fathers Fathers son, who is he?
Tuesday 28 April 2009
Divorce Case!!
A Polish man married a Canadian girl after he had been in Canada a year or so, and although his English was far from perfect, the couple got on very well. One day, though, he rushed into a lawyer's office and asked if he could arrange a divorce for him, "Very quick"!
The lawyer explained that the speed of getting a divorce would depend on the circumstances, and asked these questions:
LAWYER: "Have you any grounds?"
POLE: An acre and half, and a nice 3 bedroom house.
LAWYER: "No, I mean what is the foundation of the case?"
POLE: "It is made of concrete, bricks & mortar."
LAWYER: Does either of you have a real grudge?"
POLE: No, We have a carport and don't need a grudge.
LAWYER: "I mean, what are your relations like?"
POLE: "All my relations live in Poland."
LAWYER: "Is there any infidelity in your marriage?"
POLE: "Yes, we have hi-fidelity stereo set & DVD player with 6.1 sound.
LAWYER: "No, I mean does your wife beat you up?"
POLE: "No, I'm always up before her."
LAWYER: "Why do you want this divorce?"
POLE: "She going to kill me!"
LAWYER: "What makes you think that?"
POLE: "I got proof."
LAWYER: "What kind of proof?"
POLE: "She going to poison me. She buy bottle at drug store and I read label. It say "Polish Remover"
The lawyer explained that the speed of getting a divorce would depend on the circumstances, and asked these questions:
LAWYER: "Have you any grounds?"
POLE: An acre and half, and a nice 3 bedroom house.
LAWYER: "No, I mean what is the foundation of the case?"
POLE: "It is made of concrete, bricks & mortar."
LAWYER: Does either of you have a real grudge?"
POLE: No, We have a carport and don't need a grudge.
LAWYER: "I mean, what are your relations like?"
POLE: "All my relations live in Poland."
LAWYER: "Is there any infidelity in your marriage?"
POLE: "Yes, we have hi-fidelity stereo set & DVD player with 6.1 sound.
LAWYER: "No, I mean does your wife beat you up?"
POLE: "No, I'm always up before her."
LAWYER: "Why do you want this divorce?"
POLE: "She going to kill me!"
LAWYER: "What makes you think that?"
POLE: "I got proof."
LAWYER: "What kind of proof?"
POLE: "She going to poison me. She buy bottle at drug store and I read label. It say "Polish Remover"
Thursday 12 February 2009
Wednesday 11 February 2009
God'S E-Mail
God looked at earth and wanted to know what kind of behavior that was going on. He decided to send an angel down to Earth to check it out. So he called one of His angels and sent the angel to Earth for a time.
When he returned, he told God, "Yes, it is bad on Earth; 95% are misbehaving and 5% are not."
God thought for a moment and said, "Maybe I had better send down a second angel to get another opinion." So God called another angel and sent him to Earth for a time too.
When the angel returned he went to God and said, "Yes, it's true-the Earth is in decline; 95% are misbehaving and 5% are being good."
God was not pleased. So He decided to E-mail the 5% that were good, because He wanted to encourage them. Give them a little something to help them keep going, do you know what that E-mail said?
;
;
;
No?
...
...
...
...
...
...
....
I didn't get one either :-)
When he returned, he told God, "Yes, it is bad on Earth; 95% are misbehaving and 5% are not."
God thought for a moment and said, "Maybe I had better send down a second angel to get another opinion." So God called another angel and sent him to Earth for a time too.
When the angel returned he went to God and said, "Yes, it's true-the Earth is in decline; 95% are misbehaving and 5% are being good."
God was not pleased. So He decided to E-mail the 5% that were good, because He wanted to encourage them. Give them a little something to help them keep going, do you know what that E-mail said?
;
;
;
No?
...
...
...
...
...
...
....
I didn't get one either :-)
Monday 2 February 2009
Friday 23 January 2009
Saturday 3 January 2009
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