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| HEALTH TRIBUNE |
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The relentless quest for safer medicare
The best disease fighter
Night fever: what happens when we don’t sleep
Morning workout better for women
Ayurveda & you
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The relentless quest for safer medicare Nearly half of the adverse events occurring among in-patients in the US and Australian study resulted from surgery. However, no speciality is immune to error. Procedural mishaps are common in surgical specialities perhaps because they are hard to disguise. The emergency department is the point of entry for acutely ill patients and many adverse events may occur in the patients being cared for there. Certain interventions signal that there is a high risk such as cardiothoracic surgery, vascular surgery, and neuro-surgery. However, no setting is free from hazards. Why do things go wrong? An analysis of serious errors reveals multiple system failures and the involvement of many individuals. The medical profession has not adapted to a consumer-driven environment. Rigorous standards used in the management of disease have not been applied to an examination of the causes and hence the prevention of patient dissatisfaction. The likely precipitant is a communication error. When something goes wrong, the instinctive response is to ask what happened, and how did it happen? If answers to these questions are not provided quickly, anger explodes and the question becomes “Whose fault was it?” Medical injuries differ from other injuries in two important respects. One, patients have placed considerable trust in their doctor, so their reaction may be especially powerful and complex. Two, they are cared for by members of the same profession and in some cases the same clinicians, and thus have a range of conflicting feelings even when the doctors are sympathetic and supportive. Caring for patients with adverse event A complete and sympathetic explanation is an essential therapy. Give an honest answer and tell the family what really happened. The patient and the family will forgive honest mistakes when they are disclosed promptly, fully and compassionately. The lack of an explanation is extremely distressing and a powerful stimulus to complaint. Clinicians should ensure the continuity of care and maintain the therapeutic relationship. Patients and families need more support. Patients need to be asked about any anxieties they may have about future treatment. A doctor’s behaviour after an adverse event is often the major factor determining whether the patient proceeds to lodge a complaint or does nothing. Effect of an adverse incident on doctors A doctor may experience shame, guilt and depression. Litigation and complaints impose an additional burden. Some physicians are deeply wounded over what is perceived as failed duty. The event weighs heavily on the mind. Doctors deliver care, but who cares for doctors? What needs to be done? A key factor in our quest for safer patient care is broader immunity for error reports and a non-punitive culture that places a higher value on resolving system-based problems than on punishing doctors for adverse events. Reporting programmes should be managed by an independent, multidisciplinary expert body that can objectively determine the system-based causes of adverse events and promote effective change. Emphasis on individual and the adverse event itself will not help. There is a need for standardised methods of investigating, documenting and disseminating errors and their lessons and accompanied by effective, timely system changes. The years ahead are crucial. Health services have to respond to public scrutiny. Healthcare organisations will become more accountable for the quality of what they do. The institution should offer training in the difficult task of communicating with patients and families in the aftermath of an adverse event. Medical profession cannot expect to avoid criticism, even though they work hard and competently in a difficult stressful environment. Be honest and open yet discreet with communication, not only with colleagues but with patients and staff as well. Happier patients are less likely to complain and air their grievances. Physicians need to stay up-to-date on the latest evidence and clinical recommendations. Take help when the patient is not getting better as quickly as expected, or when the patient’s presentation is a typical. Be honest with record keeping, be objective and be legible. Medical record can be the doctor’s best and only friend. Developing excellent relationship with patients, promoting good communication with patients, colleagues and other members of the care team, maintaining clinical competence, and producing accurate and legible notes can go a long way towards reducing medical malpractice suits. One should know when it is time to consult with a colleague or make a referral. The writer is Professor and Head, Department of General Surgery, |
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The best disease fighter FITNESS does not begin and end in the gym, the aerobic class or the jogger’s park. You take it with you wherever you are. It is a state of mind, a lifestyle. Weight-training is good for your heart. If you thought running or other aerobic activities were the only way to a healthy heart, take note. Research is proving that resistance exercise such as weight-training is effective in reducing blood pressure, controlling coronary risk factors, and a great help in preventing and managing diseases such as diabetes and osteoporosis. And that is on top of improving one’s strength, endurance and psychological well-being, much in tune with the WHO definition of health. In other words, weight-training brings many of the benefits associated directly with cardio-workouts! A regimen that includes both is definitely a powerful “combo” to maintain your body and health, but many people focus much of their limited energies on cardio-workouts, which is a mistake. For years, weight-training has suffered from lack of information and misinformation, and has been the forte of only some diehard exercisers. Specifically, people training more to protect their health than to build their body think cardio-workout is the best option for that goal, so they lace up their running shoes, jump on the bike or crank out 40 minutes on the alliptical machine and may never even touch a weight during their workouts. After all, cardiovascular training is all about the heart, while weight-training is all about building big muscles, right. Actually, it is wrong. Indeed, resistance training offers it all in terms of benefits. And while cardio-workout is a sound component of a total health and fitness programme, it is certainly not the most efficient road to benefits if it is your main mode of exercise and weight-training is only an afterthought. A recent study by the University of Wiscinsin reported in the European journal of Applied Physiology, offers more compelling evidence. Researchers found that after a 30-minute full-body workout, where subjects trained with their 10-rep maximum weight, the resting metabolic rate was elevated by 20 per cent for two days following the exercise session. In a 180-pound man, that averages to an extra 400 calories burnt per day! Additionally, the percentage of fat that was burned by the subjects also increased. The researchers concluded that the energy required to recover from a resistance exercise was significant enough to be helpful in a weight-loss programme. Following an aerobic exercise, a person’s resting metabolic rate remains elevated for anywhere from 60 minutes to about 12 hours, depending on the intensity and duration of the exercise session. Although a typical weightlifting workout may burn only about 60 per cent of the calories burned during a moderate bout of cardio-workout of the same duration (for instance, a 180-pound man would burn 210 calories in 30 minutes of weight-training vs. 360 calories if he jogged at six mile per hour for the same period), that gap closes over the longer term. The payoff for weight-training, however, comes during the following rest days, when that 180-pound man would burn an additional 800 calories simply from an elevated metabolism. Another thing to consider is the fact that a cardio-activity may burn calories, and it does condition the heart, but one thing cardio-activity does not do is to promote significant skeletal muscle growth. And muscle is a metabolic machine — a pound of muscle burns about 35-50 calories per day on an average. Surely, it is not much by itself, but it adds up. Add five new pounds of muscle, and your body will burn about 250 more calories each and every day. Suddenly, the calories that were going to your mid-section will be used as muscle fuel, keeping you leaner over the long haul. In a successful fitness programme, you need both weight-training and cardio-activity. But just keep in mind which form of exercise gives you the most bang for your bucks! The writer is a fitness and nutrition consultant
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Night fever: what happens when we don’t sleep IF F Scott Fitzgerald was right when he declared, "The worst thing in the world is to try to sleep and not to", then forcing oneself to stay awake for days on end must surely come a close second. Unsurprisingly, considering that we spend a third of our lives indulging in it, sleep is a necessity — though it is more necessary for some than for others. Lady Thatcher famously claimed to need no more than four hours a night, while some struggle if they don't get their head down for 11. The average works out at around eight hours for a good night's rest. You can train as hard as you like to go without sleep - your body will still want the amount it is genetically programmed to need. Cut sleep out and things rapidly begin to go downhill. One of the first signs that someone is suffering from sleep loss is that they start to become moody and irritable. "If someone teases them, they're liable to swing at them rather than take it as a joke," says Neil Stanley, chairman of the British Sleep Society and the resident sleep scientist on Shattered. The brain, perhaps surprisingly, tends to be the only organ affected by sleep loss. "There's very little evidence that the body fails at all if you go without sleep," says Professor Jim Horne, director of the Sleep Research Centre at Loughborough University. "Provided you get adequate nutrition and physical rest, all of the organs from the neck down can cope fine." Not so the brain, however. It's the one organ that really can't cope without sleep. Specifically, it's a region of the brain called the cerebral cortex that suffers the most. The cerebral cortex is arguably what makes us human. It governs what we think, what we say, what we do. "Without that, you become an automaton, a robot," says Horne. And that is exactly what the acutely sleep-deprived turn into. The transition to human robot can kick in after just two days without sleep. "You end up just staring at things because you don't know what to look at next." Gradually, other symptoms begin to appear, like being easily distracted and unable to take part in conversations. "If you are in a conversation [with a sleep deprived person], they will most likely have stilted speech and speak in a monotone and not about anything at all interesting," adds Horne. So what is it that periods of sleep, "those little slices of death", as Edgar Allen Poe called them, do for us? Essentially, sleep gives the cerebral cortex a chance to get enough rest so that it can start functioning normally again. "Even if you try and rest by shutting your eyes, plugging up your ears and lying on a bed with a mind clear of any thoughts, your cortex is not resting. Without sleep it just stops working," says Horne. Other parts of the brain do not work at such an intensity for all of our waking hours. Surprisingly little sleep is enough to rest the cortex, though - as little as two hours a night. Sleep deprivation does more than turn you into a non-communicative vegetable, however. Sleep-deprived people have increased appetites, become shaky, get headaches and, mysteriously, get more horny. "If you consider that the average man thinks about sex once
every 15 seconds, and you're awake for 24 hours a day, it's not surprising," says Stanley. As if to quell the urge, their bodies cool down a third of a degree. After three days without sleep, hallucinations can kick in. The longest scientifically documented case of sleep deprivation was the provided by an American, Randy Gardner, in 1964, who, in an attempt to set a world record, stayed awake for 11 days. Four days in, he had a hallucination in which a street sign turned into a person, an episode quickly followed by a delusion where he though he was a famous black footballer. The hallucinations are due to what sleep scientists call dream intrusion. "If you deprive yourself of sleep, your body still needs to dream," says Stanley. "But because the dream is playing while you're still awake, you have two realities going on, so the hallucinations can seem very real." Little is known about any long-term damage that sleep deprivation can cause. Studies in rats that were fed and watered, but kept awake until they died, showed that the animals eventually keeled over as their body temperature went haywire. They survived only 14 days, but as Horne points out, that's a long time for an animal that normally lives just two years. Just how long a human can go without sleep is hard to judge, except to say that it is likely to be much longer than Gardner managed. After sleeping off his 11 day awake-athon, he showed no signs of long-term physical or mental damage. Horne says the idea that people kept awake for days will eventually go mad and start beating each other is nonsense. "What's far more likely is they'll just sit around and finally conk out." Pushed to the absolute limit, however, the human body will ultimately succumb to sleep loss, although it would likely take more than 30 days of constant wakefulness. Rather than the brain burning out, sleep deprivation would ultimately become fatal because of the stress it causes. "If something was keeping you awake that long, you would have such a stress reaction that your immune system would probably collapse," says Horne. The result would be catastrophic. The immune system is constantly fighting small battles with microbes all over the body. When it collapses, the battle and the war are lost. "You would die of wholesale, massive infections. It would be like an extreme form of blood poisoning."
— The Guardian
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Morning workout better for women
WASHINGTON: For post-menopausal women, a little workout in the morning means a good night’s sleep, concludes a US study published in the journal Sleep. According to researchers from the Fred Hutchinson Cancer Research Centre, Seattle, women who exercise in the evening, on the other hand, were more likely to be up at night. “It’s like doing a brisk walk,” HealthDayNews quoted Anne McTiernan, a researcher, as saying. “Nobody is saying people have to be athletes and do marathons.” The research involved post-menopausal women in the 50-75 year age-group, who were not exercising at the start of the project. The participants were divided into two groups — 87 were placed in an exercise programme, which involved 45 minutes of walking or exercise bike five days a week. Eightysix women were part of a stretching programme, which was done for an hour a week under supervision and a half-hour three times a week on their own. Both groups were followed for a year. It was found that the women who exercised, averaged 70 per cent better sleep and the women who stretched, averaged 30 per cent better sleep.
— ANI
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Ayurveda & you OLD age is a subject of eight clinical specialities of classical ayurveda. Though aging is a lifelong process, the finality of it may not mean a lot for us unless we reach the fourth or fifth decade of our life. It is true that everyone doesn’t undergo age-related changes with the same speed and intensity. But as we grow older, it becomes very important for all of us to know and recognise some of these transformations that occur in our body with the passage of time. These changes may be categorised as external (those which are visible) and internal, or those which occur in the organs or the systems of the body and the changes relating to the sense organ perceptions. According to ayurvedic physiology, it is more of the vata dosha, which, with advancing age, gradually displaces the other two — the kapha and the pitta. Here is a brief description of some of these major changes that, as we grow old, occur in our body. The external changes are most obvious in the hair, face, skin, bony joints, stature and the posture and in the mobility of a person. With progressive graying and thinning of hair, the advancing age is marked by the wrinkling and creasing of the skin of the face and the body, resulting due to the loss of fat and the elastic tissues. Throughout the middle and the later years, the bones undergo changes like becoming less dense as they slowly lose mass and minerals. With the gradual depletion of cartilage and narrowing of the discs leading to the shortening of stature, arthritic changes dominate the picture and the weakened nervous system adds to the process of making the gait stiff and short. Apart from these visible changes, a lot more happens in our body that we are not able to see. Most of these changes are noticed only when a particular organ or system comes under strain and is afflicted. Starting from the gastro-intestinal tract, where atrophy of the stomach mucosa and altered motility result in the reduction of acid secretion and constipation, aging affects almost all organs of the body and slows down or impairs their functions. In most of the elderly persons, arterial stiffening and narrowing of vessels cause blood pressure to increase and in an adaptive manner the left ventricle of the heart also thickens. Limitation of the chest expansion and falling respiratory muscle strength is associated with the decrease of elasticity and gas exchange in the lungs. All these changes lead to the early feeling of breathlessness on physical exertion. Though the size of kidneys decreases approximately by 20 per cent in old age, in a healthy person this change mostly doesn’t bring any abnormality. But with enlarged prostate, the amount of urine a bladder can hold decreases. The most important degenerative change in old age occurs in the brain and the nervous system which results in the diminished responses anywhere in the body. The immune system also loses some of its efficiency in elderly people. Old age also encounters the reduction in the capacity of all sense organs, whether it concerns vision, hearing, taste, smell and touch and pain. The loss of transparency and increased thickness of the lens leads to a limitation in the vision. Some degree of hearing loss is also not uncommon in the elderly. Sensitivity to touch and pain also appears to decrease and it is seen that an older person may injure himself without feeling much of a pain. Most older people feel that they are not as fast or alert as they were in younger years. Family members and other persons who deal with elderly people should be aware of these characteristics of old age. The writer is a Ludhiana-based ayurvedic consultant. Email sanjivani@satyam.net.in |
DOCTORS operate in complex environments. Society has entrusted doctors with the burden of understanding and dealing with illness. Newspaper and television stories of adverse events occurring at the hands of doctors highlight the problem. No study has ever shown that medical care can be provided without error. In the US, medical error results in 44000-98000 deaths each year. Extremes of age, complex care, urgent care, and the burden of comorbid illness are associated with more errors.