Wednesday, January 6, 2010

Common drug may prevent skin cancer

A commonly used anti-inflammatory prescription drug can help decrease the risk of a common skin cancer in humans, says a researcher at Stanford’s School of medicine.

According to Jean Tang, MD, PhD, assistant professor of dermatology, although oral administration of the drug, celecoxib, is associated with an increased risk of heart attack and stroke in some people, it’s possible that topical application could have a safer, protective effect for people prone to developing the cancers, called basal cell carcinomas.

"Basal cell carcinomas are the most common human cancer in the United States," said Tang, "and their incidence is increasing steadily. This work identifies a possible way to prevent them."

She and her colleagues dovetailed studies in mice with a randomized, double-blinded clinical trial in humans to reach their conclusions.

The medical secret behind Mona Lisa's smile?

For centuries, art historians have been troubled by Mona Lisa's enigmatic smile - but, according to one doctor, her cholesterol levels were more worrying.


For Dr Vito Franco, from Palermo University, she shows clear signs of a build-up of fatty acids under the skin, caused by too much cholesterol.

He also suggests there seems to be a lipoma, or benign fatty-tissue tumour, in her right eye.

Dr Franco says his medical examinations reveal more than artistic viewings.

"Illness exists within the body, it does not have a metaphysical or supernatural dimension," Dr Franco told La Stampa newspaper.

"The people depicted in art reveal their physicality, tell us of their vulnerable humanity, regardless of the artist's awareness of it," he added.

Artistic diagnosis

The professor of pathological anatomy at Palermo University presented his finding at a medical conference in Florence.

Leonardo Da Vinci's 16th Century portrait was not the only work of art to receive the professor's medical diagnosis.

He also suggests the delicate elongated fingers in Botticelli's Portrait of a Youth reveal the boy was perhaps suffering from Marfan syndrome, a genetic disorder that affects connective tissues.

Dr Franco has even diagnosed the artist Michelangelo himself - depicted in Raphael's The School of Athens.

He says his swollen knees in the painting appear to indicate excessive uric acid and he could have been suffering from renal calculosis.

Laker graduate enjoying medical school in Poland


Choosing a college to attend is a major life decision for any high school student. To make this decision, students often look to the future to figure out where they want to be.

Stefani Terry, like other students, eyed the future, but she also considered the past when deciding where to attend college. She reflected on her family roots.

Terry, a 2006 Elkton-Pigeon-Bay Port Laker High School graduate, is attending Poznan University of Medical Sciences in Poznan, Poland. Her great-grandparents were Poland natives.

“My grandmother knew about the university and told me about it when I was thinking about studying medicine,” she said. “I decided to look into it more.”

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Terry contacted the university’s office in New York and received information.

“What really struck my interest was the six-year M.D. program,” she said. “There are no undergraduate requirements. Not only would going to Poznan University cut off two years (from my schooling), I also was looking forward to seeing more of Europe.”

According to the school’s website, the university began in 1919 and is the top-rated school in Poland. It offers medical, dentistry and pharmacy programs. About 4,000 to 5,000 students attend the university each year, and they take part in theoretical, practical and clinical activities in five modern university clinical hospitals.

In recent years, Poznan University of Medical Sciences has conducted research and developed collaborative projects with many leading universities in Europe and the U.S.

An education in medicine,history and culture Terry is in her fourth year of the medical program. The list of classes she’s currently taking would make many people’s heads swim. The list includes rheumatology, cardiology, pharmacology, toxicology, pediatrics, general, traumatic and cardiac surgery, psychiatry, radiology and more.

She said unlike other universities, Poznan University does not have students sign up for classes. The university sets the schedule for all students annually.

All of Terry’s classes are in English.

“The program I am in is specifically designed for foreign students,” she said.

While many people in Poland speak English, there still are some language barrier difficulties, she noted.

“Sometimes it’s hard to understand the professors because of the accent, but you get used to it,” she said.

Terry said Poznan University of Medical Sciences doesn’t really have a campus, as classes are conducted in buildings throughout the city.

While she’s learning plenty about medical sciences, one thing about Poznan University that she’s enjoying the most is history.

“Poznan was once the capitol of Prussia. Also, most of the city was destroyed during World War II, but everything was rebuilt as it was before the war,” she said.

Terry said Poznan has several malls and a great nightlife.

“It’s a beautiful sight walking through Stary Rynek, which means ‘old market,’” she said.

Terry also enjoys attending classes with students from various countries. She said most of the student body can be divided into three main groups, based on their native country: North America, Taiwan and Norway. The rest of the student body includes students from all over the world, she said.

“It’s really interesting,” she said. “It’s nice to experience other people’s way of life. It’s really opened my eyes.”

She said the students have many different religions, but there’s never been a problem.

“Everyone respects each other’s beliefs,” she said.

Terry said because she’s surrounded by various cultures, she’s tasted many types of food she may not have tried otherwise.

Learning through touring

For Terry, another bonus of attending college in Poland has been visiting many places in Europe. So far, she’s traveled to London, Paris, Rome, Milan, Florence, Pisa, Pompeii, Naples, Venice, Lucerne, Frankfurt, Berlin, Fussen, Munich, Prague, Vienna and Budapest, among other locations.

“I would love to go to Greece and Sweden sometime,” she noted.

Terry said she really enjoyed Lucerne because it’s near the Alps and the people were very friendly. She also liked Budapest because of the people and many things were inexpensive.

She also has been to various places in Poland, such as Warsaw, Krakow, Zakopane and Auschwitz.

“It was quite the experience when I toured Auschwitz,” she said. “Being there was very different then reading or watching videos of the history of the place.”

She said some of her travels were with friends from high school.

“My friend Bo Wisneski came to visit me during my first year,” she said. “Khristina Heck came during my second year. While she was here, we spent some time in Rome.”

Terry said she also was able to travel with Rex Huang of Taiwan, who was a foreign exchange student at Lakers while Terry was a student. They had kept in touch over the years, and he was studying in Germany when Terry traveled with him.

Hands-on summer schooling

In addition to classes, the university requires its students to do a month of training each summer to prepare them for the coming year. The training is for seven hours a day, five days a week.

After Terry’s first year at the university, she came back to Huron County and did clinical observation at Courtney Manor in Bad Axe.

“I was required to learn basic nursing skills,” she said. “I helped the nurses with basic care, such as feeding, helping people up to the bathroom, checking glucose levels and giving insulin. I also was able to observe the distribution of the medication by the nurses.”

For another clinical observation, Terry went to a cancer clinic in Houston, Texas.

“That was quite an interesting experience,” she said. “The clinic there uses unconventional treatment for cancer. They use normal cancer drugs, but for different purposes. The most impressive case they had was of a man who had prostate cancer. They tested his blood for any known overexpressed oncogenes, which are genes that cause cancer, and found that his HER2/NEU gene was overexpressed. That gene is common for breast cancer, and so they used a breast cancer drug that targets that gene. He is now in remission.”

She said while at the cancer clinic, she followed each doctor who worked there. She learned to read PET/CT scans, which shows if a cancer tumor is active.

Terry also spent some time at the Harbor Beach Community Hospital, where she followed emergency room doctors and spent time in the operating room.

She said at the beginning of last summer, she went on rounds at the John D. Dingell VA Medical Center in Detroit.

“I was going to do my month of training there, but my housing plans fell through,” she said.

Terry said in each of her clinical observations, she learned very valuable skills.

“From Courtney Manor, I learned how to take blood pressure, how insulin shots are administered, and I learned about different drug interactions,” she said. “When I was in Houston, I learned so much about oncology, it’s hard to list. It’s also a research center, so it was very interesting to me. They taught me how to take the patients’ history and about some abnormal findings on physical exams.”

She said at the Harbor Beach hospital, she learned how to look at ultrasounds, how to do different stitches, and about the operating room.

“The summer training is a real help,” she said. “(Within the first two weeks of class), we already covered many of the things I’ve learned (in clinical observations).”

Terry said during her clinical observations, she informed the medical professionals of where she was attending medical school.

“They were very impressed,” she said. “They were so positive and supportive. It also was nice to see how things work in the clinical setting, rather than just reading from a medical book.”

She said she’s not sure where her next clinical observation will be.

Life after Poznan University

When she graduates from Poznan University, Terry plans to return to the U.S. She said she’s not sure what area of medicine she wants to enter.

“I was thinking orthopedic surgery, but I know it’s extremely hard to get into,” she said.

Regardless of what she ends up doing, Terry feels she will be ready.

“I believe I am just as prepared here than I would be in any U.S. university,” she said.

Friday, January 1, 2010

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Saturday, November 15, 2008

Talking with patients about touchy subjects

Sexual dysfunction, depression, and abuse are only a few of the many "touchy" topics patients find hard to bring up to their healthcare providers. But these very problems could actually be at the root of what is happening to them medically. Discuss
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Machelle Seibel, MD, has had a lot of experience talking with patients about difficult topics. Seibel is director of the Complicated Menopause Program at the University of Massachusetts Medical School in Worcester, Massachusetts. People of both genders and all ages, he says, face life challenges that affect their well-being. "I've never met anyone going through a transition in life who didn't think it was complicated," he says.

Sometimes, what's troubling patients when they come into a health provider's office is not what they made the appointment for. For example, Seibel says a patient may come to see him because she says she wants to talk about medication or needs help knowing how to deal with hot flashes. But the conversation that needs to take place may actually be quite different. For instance, she may be worried that her recent forgetfulness and mood swings are symptoms of a more serious psychiatric disorder. Another patient may actually bring up the topic of a declining libido while, in her mind, she is really associating her sexual problems with an unraveling relationship.

When I recently talked with Seibel he shared some tips about what healthcare professionals need to do to help patients who have touchy subjects to explore.

Listen for clues about possible problems. Active listening is always an important communication skill. Seibel says one indication that there are unspoken concerns is a patient's response to a topic that is "out of range." A reaction that's out of proportion to what could normally be expected should alert the provider to pay close attention to what the patient is saying and not saying. Another clue, Seibel says, is when a patient "won't talk or won't stop talking, about a topic."

Establish rapport. Clinicians need at least tacit permission from patients before exploring difficult topics. Seibel starts with gentle questions about overall well-being. He then follows-up based on the patient's response. For instance, when a woman says that she fears memory loss means that she is losing her mind, Seibel might ask, "Can you tell me about family members with a history of mental disease?" He may follow-up with more specific questions such as, "What type of situations make you more tearful?" or, "What type of situations cause you to act in ways that are out of character?" Seibel asks these in open-ended ways so that responses provide more information other than just "yes" or "no."

Take a complete history. Seibel schedules extra time to discuss health histories with new patients. Some medical practices ask patients to complete and return health histories prior to first appointments. In Seibel's opinion, while this process may be efficient, it is not necessarily effective in uncovering "touchy" topics. He learns much more when talking with patients directly and noticing eye movements, hand gestures, and overall body posture.Raise topics yourself. Sometimes patients won't initiate discussions of topics they consider embarrassing or perhaps trivial. Clinicians may need to mention them first. For instance, when Seibel does a physical exam and notices that a woman's bladder has dropped, he might ask about problems with urine loss. This scenario is very common as about 30% of women have stress incontinence (or other type of urinary loss) but wait about three to five years to say anything. Seibel knows that incontinence is a highly treatable condition and therefore will mention it.Understand problems in context of family and social history. Although patients may come to appointments alone, their concerns may be as much about others as themselves. Many patients worry if they are destined for the same medical fate as their parents. For instance, a 59-year-old woman might be very concerned that she is getting osteoporosis since her mother fractured a hip at age 60. Likewise, people may be concerned about their loved ones' mental or physical health. This can be a "chicken and egg situation," says Seibel, as when a woman makes an appointment for problems with sexual functioning but spends most of the time discussing her husband's job stress or prostate cancer.

Know your boundaries. Patients are likely to pick up "vibes" when providers are uncomfortable discussing certain topics. This might happen when providers are in the midst of their own marital or financial problems or have strong views about sexual practices. In such instances, Seibel recommends that providers refer patients elsewhere. You can do so with statements such as, "We may have touched on something important, but I'm not the one to talk about it with you. I have a colleague who can help." And then make the referral. Another time for referral is when the patient's symptoms are outside your area of expertise. For example, you might refer patients to acute psychiatric care when they raise serious psychosocial concerns.

Manage issues of time. Even though Seibel invites patients to share concerns at the beginning of appointments, very often they wait until the very end to say what is really on their minds. If there truly is no time, you might say something like, "You just raised a very important point. Unfortunately, I don't have time to talk about it now. Let's make another appointment for you to come back and discuss it."

Occasionally, patients may be very tearful or upset and need time to regain their composure. There is no way around this. They need extra time. As needed and if appropriate, you might acknowledge that you have another patient to see but will come back in a few minutes to check on how he or she is doing.

Over the years, Seibel has found that it is "more embarrassing to bare your soul than your bottom." People obviously are willing to show off their bodies (as when wearing skimpy bathing suits or being examined) but far more reluctant to reveal any weakness or feeling of failure. To Seibel, being neutral, empathetic, and willing to listen transcends all differences when it comes to talking about touchy topics.

Idaho is One Step Closer to a Medical School

The state of Idaho is one step closer to having a medical school. Wednesday in Boise, the legislature's Medical Education Interim Committee met for the third time to discuss the possibility of opening a medical school in Pocatello.

During the meeting, a motion was passed to adopt the three prong approach which was approved in August by the Idaho Medical Association. The prongs include a four-year medical education program, expanding the residency program and adding more state funded medical school seats.

The committees made a motion to recommend the State Board of Education also adopt the approach.

The state board is meeting November18. The committee will also make its own recommendations to the legislature.

UCSF cited as "most improved" UC medical school for diversity

The UCSF School of Medicine continues to have one of the most diverse student bodies among California medical schools, according to a public policy institute study. Nearly one-third of students in last fall’s entering class -- 28 percent -- are from groups underrepresented in medicine.

The study, conducted by the Greenlining Institute, cited the UCSF School of Medicine as the most improved in a new status report on the diversity of the University of California medical student body.

The report notes that “UCSF has shown the greatest increases in African American and Latino representation among its matriculants, compared to its institutional peers.” Between 2001 and 2008, the proportion of African Americans at UCSF increased from 5 percent to about 10 percent and the proportion of Latinos increased from about 8 percent to about 13 percent. UCSF also has the largest number of African American and Latino students of all the UC medical schools.

The findings reflect an effort by UCSF leadership over the past several years to open medical school doors to all qualified students.

“This report is gratifying because we believe strongly that having a culture that embraces and promotes diversity is essential to fulfilling our health care education, research and patient care missions,” says J. Renee Navarro, PharmD, MD, director of academic diversity at UCSF.

School of Medicine Interim Dean Sam Hawgood, MB, BS, emphasizes that “diversity and excellence are inextricably linked.”

“There is overwhelming evidence that addressing the medical needs of our increasingly diverse communities requires us to have a similarly diverse community within the School of Medicine,” says Hawgood.

According to the Greenlining Institute report, diversity in the medical student body is important because studies show that patient satisfaction increases significantly if the patient and the doctor are of the same race. Additionally, the report says that minority physicians are much more likely to practice in areas experiencing physician shortages than are non-minority physicians.

The report notes that UCSF has not only improved its ethnic and racial diversity in number, but “has also emphasized the importance of race in medicine, paying particular attention to racial health disparities.”

Says Hawgood, “Diversity enhances the excellence of the school’s teaching, research, and clinical missions. It is not an unrelated or a stand-alone goal.”

Since 2004, the medical school has expanded its outreach efforts both to attract qualified students from underrepresented minorities and to increase the overall numbers of underrepresented minorities entering any medical school.

“The relative lack of diversity in medical school classes across the country reflects a broad problem throughout society. UCSF has always been among the leaders in the diversity of its student body,” says Hawgood. “We hope that some of the best practices at UCSF may help other schools make similar gains.”

Greenlining Institute researchers observed a pronounced difference in diversity between the first- and second-year classes at UCSF in 2007, which they attributed as “testament to UCSF’s efforts in just that one year to increase diversity” at its school of medicine. According to the report, the first-year class includes 10 more underrepresented minority students than the second-year class, a difference in representation of 28.6 percent and 22.6 percent.

In the fall 2008 UCSF medical school entering class, the number of underrepresented minority students includes African American, 10 percent; Mexican American, 10 percent; other Hispanic, 3 percent; Pacific Islander, 4 percent; and Native American, 1 percent -- for an overall total of 28 percent.

The full Greenling Institute report is available at http://greenlining.org/resources/pdfs/REPRESENTINGTHENEWMAJORITYPartIII.pdf..

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

Common drug may prevent skin cancer

A commonly used anti-inflammatory prescription drug can help decrease the risk of a common skin cancer in humans, says a researcher at Stanf...