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Category : All ; Cycle : June 2010
Medical Articles
Jun29
STRESS : A lifestyle Disease
STRESS : A LIFE STYLE DISEASE
Stress is the condition that results when person-environment transactions lead the individual to perceive a discrepancy, whether real or not, between the demands of a situation and the resources of the person's biological, psychological or social systems. In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. Stressful stimuli can be mental, physiological, anatomical or physical reactions.
Millions of people are looking for a magic supplement and herb combination that will increase their health and vitality. People are ingesting Coenzyme Q, pycnogenol, magnesium, Vitamin C, Gingko, Echinacea and thousands of other products and combinations. In many cases, these supplements give a slight energy and health boost. In some cases, the body needs both healthy foods and supplements to help recover from an illness. However, for most people, much of the increased need for nutrients is due in a significant part to a high level of daily physical and/or psychological stress.

Taking steps to relax and body and mind (in addition to getting adequate sleep) can be enormously healing and is highly recommended for those interested in healing acute or serious chronic illnesses or preventing future illnesses. Relaxation techniques can add enormous power to other holistic healing techniques. I hope that you take the time to make gradual changes which will allow deep relaxation and the healing and vitality that comes with it to become an increasing part of your life
Some Common Signs and Symptoms of Excess Stress
• Regularly walking, eating or working in a rushed way.
• Regularly thinking and worrying about the past or future.
• Frequent tension in the body (esp. neck, face, shoulders, back and chest, and stomach) which often goes unnoticed until one slows down, breaths deep and carefully surveys the body.
• Feeling of the "weight of the world" on your shoulders.
• Emotionally "on edge."
• Regular tiredness during the day.
• Significant need for outside stimulation to feel good (coffee, sweeteners, food, sex, TV, alcohol, money, accomplishments, etc.)
The Goal
Occasional challenges, both physical and psychological, are not unhealthy for most people. Occasional challenging projects, arguments, difficulties with children, difficulties at work/school, etc. are a normal part of life. These types of stresses are normal and can actually be strengthening. The goal is not necessarily to avoid all stressful events, but to develop the ability to relax during day-to-day activities and during challenging occurences (such as those mentioned above). Persons who are recovering from an illness should attempt to keep challenging situations to a minimum but not necessarily avoid them totally unless they are extremely weak.
Strategies For Stress Relief
As part of the process of curing an illness, promoting health & vitality and preventing illness and premature aging, it is important to gradually move towards a daily life that less stressful.
Some Strategies to Avoid
• Attempting to make everything in life stress-free.
• Focusing on every event and constantly reminding yourself to relax.
• Regularly avoiding the feeling of emotions (e.g., sadness, anger, joy, fear, etc.).
• There are a number of other things which will not work in the long run when used by themselves only -- long vacations, execise, etc.
The type of strategy which tends to work is the combination of gradually and gently trying to change one's habits plus regular practices or situations which help put the body in a relaxed state. Both types of strategies are important in promoting stress reduction.

Regular Practices and Situations to Promote Stress Relief

Note: The positive effects of these techniques vary from person to person.
Examples of Powerful and Healing Regular Practices
Taking a class and going to regular group practices can be crucial in promoting a regular practice. Some people have moved into teaching centers in order to be certain they will have a regular practice and promote healing and transformation.
• Yoga -- This is a wonderful practice for stress reduction and profound healing.
• Meditation
• Tai Chi
• Conscious Breathing Routine
• Pranayam
• Dancing
• Bioenergetics Classes
• Holistic Healing Retreat
• Vacation
• Massage (Some people practice regularly by exchanging with a partner.)

Daily Stress Reduction Tips

Note: As mentioned earlier, there will naturally be times when these tips are not used, but try to gradually incorporate them into your life where possible.
1. Add something beautiful to your life on a daily basis (e.g., flowers).
2. Do some enjoyable activities whenever possible.
3. Walk, work, and eat at a relaxed pace.
4. Take a short break after meals to relax.
5. If possible, go outside at least once per day and notice the simple things such as the weather, scenery, etc.
6. During the day, whenever you remember, notice and tension in your body (jaw, neck, diaphram, shoulders, etc.). Breath deeply and gently stretch and relax any tense areas.
7. If you notice your mind racing or worrying about the past or future, take a minute to breath deeply and gently focus on something in the moment such as your breath, scenery, birds.
8. Take breaks during the workday to relax.
9. Wear comfortable and loose clothing when possible. Take off your shoes when you can.
10. Avoid holding in feelings day after day, but instead, find a safe place to feel, express and embrace them.
Please be gentle with yourself. Some people find themselves falling back into excessively stressful habits from time to time. That is perfectly normal. Simply notice that change in a non-judgemental way and move back to the stress reduction practices and tips that promote a healthy way of life.
Stress Relief Ideas in Specific Situations
On many ocassions there are situations that come up which can cause significant amounts of stress. Listed below are a few such situations along with some ideas that I have found useful in addressing the situation. As in all of the idea listings on the Holistic Healing Web Page, please do not try to do everything at once.
• Financial Difficulties

Financial difficulties can be enormously stressful for some people because our goals and our security is wrapped up in the need to have sufficient finances. Such difficulties often don't magically disappear, but there are some steps that can be taken to reduce or eliminate the stress and worry while working one's way through these difficulties. A few suggestions include:
o Steps -- Carefully follow the plan outlined in the book, "Your Money or Your Life." This book will take you step by step towards financial independence. Following the program in the book can also be useful in helping to find your goals and make career decisions.
o Share -- Tell at least one close friend, family member or religious leader (e.g., minister, priest , guru) about your difficulties. Keeping the difficulties secret will often add stress and eventually cause inner turmoil.
o Faith -- Persons who have a regular Meditation Practice or Spiritual Practice often develop enormous faith that difficulties can be worked through successfully. The potential stress can be reduced many-fold through these types of practices. While it doesn't directly effect the financial situation, these practices can improve health, reduce stress, make it easier to see worthwhile opportunities and make it easier to change habits that may, in some cases, contribute to financial difficulties.
o Acceptance -- While it may seem strange, having a loving acceptance of oneself in the current situation is often an important key to making a permanent change in the situation. This goes hand-in-hand with having a strong faith. If you look at people who successfully turn their lives around, you will usually notice both a loving acceptance of who they are as well as a strong faith. The opposite end of the sprectrum are the unfortunate souls who have lost their faith and their self-esteem (or never had it).

o Inner transformational tool that addresses the situation. Some such tools are Meditation Practice, Spiritual Practice etc
o Persons suffering from psychological illnesses which are contributing in some way to the financial difficulties can, if possible, have these health problems treated by a Holistic Healthcare Professional
o Tasks and Time Constraints

There are situations where there is constant time and work pressure and which adds significant stress to one's life. Sometimes these situations are not easily avoidable. In order to start a medical training program with friends (who had planned to start at a specific date), I chose to continue to work full-time, take prerequisite classes nearly full-time and to continue to serve as the webmaster for the Holistic Healing Web Page. In order to come out of situations like these with one's health, it is helpful to consider a few ideas which I have related below.
o Small Tasks -- Spliting projects and assignments into small pieces and doing a small amount of work on a regular basis on these projects is perhaps one of the very best ways to prevent becoming overwhelmed with work.
o Priorities -- Choosing appropriate priorities for tasks is an important way to avoid stress. Is it better to performs A+ (4.0 grade) in school and study all of the time or to get a B average and spend the extra time having fun, exercising, etc.? Is it better to work overtime completing projects to earn extra money or job prestige and not see your family much or to somehow avoid overtime work and spend alot of time with your family? These are the types of decisions which are important and can have a significant effect on stress levels. The decisions should be made while keeping in mind what it important in life. In my case mentioned above, I chose to work extra hard for a year in order to start a medical program with my friends. But if such a decision would cause extreme stress that would lead to health problems, I would not have decided to work so hard.
o Stress Reduction Practices -- Continuing a regular practice of stress reduction techniques such as yoga, bioenergetics or meditation can help one get through busy times with one's sanity. It can be many times easier to develop a regular practice by going to a class. Most people can spare at least 15-30 minutes per day to perform a short routine.

• "I Hate My Job" Syndrome

Job stress can be one of the biggest sources of stress for many people. In many cases, people feel hopeless when thinking about solving serious problems on the job, dissatisfaction with the job, or making career choices. In fact, a large percentage of the people I have met have had this situation at one time in their life. It can be difficult to heal a chronic illness if you are experiencing a large amount of stress on the job. In addition, chronic illnesses may become more likely if the excessive on-the-job stress is not addressed. Below are a few ideas which may prove helpful.
o Program -- The first four ideas suggested for Financial Difficulties above are highly recommended in this situation.
o Improving the Job -- A couple of excellent resources for making the very best of a difficult situation are 1) the book, "The Corporate Mystic: A Guidebook for Visionaries With Their Feet on the Ground" by Gay Hendricks & Kate Ludeman
o Personnel Office -- The Personnel Office in most companies is responsible for helping resolve conflicts with other employees and for resolving and problems you are having with job responsibilities. If discussing the situation with your boss does not resolve the situation or if you do not feel comfortable discussing the situation with your boss, please consider whether the Personnel Office in your company can help find solutions for the problem.
o Exploration -- Pursuing creative expression in various ways can be helpful in finding goals that may one day become a career. While it may not seem possible upon initial evaluation, many exciting hobbies can eventually become careers. Therefore, it can be helpful to take classes and explore various endeavors while paying attention to what excites you as a possible hobby or career.
o Bioenergetics -- One of the goals with Bioenergetic Analysis is to help the student "find their own movement." By learning to find my own movement physically and expressing myself vocally using Bioenergetic techniques, I gained confidence and skills in both identifying and pursuing my own career goals. Others have seen similar effects. The classes can be helpful in this regard, but one-on-one work can be even more effective.
Difficulty Making Changes !!
Many people say I am having difficulty keeping a regular practice of yoga/meditation as well as eliminating habits that cause stress. I keep falling back into the same old patterns of stressful living and not taking care of myself. Do you have any ideas?

Having difficulty making changes can have a number of possible causes. Below are a few suggestions to consider:
o Class -- Taking a class can make an enormous difference in one's ability to keep a yoga or meditation practice going. I know some practitioners who give classes because it is easier for them to keep up a practice by doing so. Try to find a class near your home if possible.
o Friends & Family -- It can be much easier to make changes and sustain those changes you get regular support and love from close friends and family.
o Positive Influences -- Spend time around positive, cheerful people whenever possible. There's little that can drag a person down more easily than a lack of positive attitudes in one's life or excessive exposure to negative attitudes. Some people move to yoga or meditation centers or take retreats regularly at such centers in order to learn and to be around people who are positive and taking care of themselves.
o Programs -- Two different and very simple programs that people have found helpful are described in the following books. I would suggest only doing one program at a time.
o Meditation -- Inner Transformation techniques such as meditation has proven extremely helpful for many people in making changes.


Prof. G S Patnaik is a consultant orthopedic and spinal surgeon with advance degrees in orthopedic and trauma surgery ,sociology , economics,public administration.presently he is pursuing courses in management and international law. His interests includes study of scriptures of all faith and is a well known columnist and a gifted public speaker He can be contacted at Web Page: www.drgspatnaik.com


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Jun29
PCNL - HARD TALK - 3-day Course at MPUH Nadiad
MULJIBHAI PATEL UROLOGICAL HOSPITAL, NADIAD


JAYARAMDAS PATEL ACADEMIC CENTRE


‘HARD TALK’ – INSTRUCTION COURSE ON PCNL

Jayaramdas Patel Academic Centre (JPAC) at the Muljibhai Patel Urological Hospital (MPUH), Nadiad is organizing yet another Instruction Course on PCNL (Percutaneous nephrolithotripsy) between 1 - 3 July, 2010. For the first time in India, we are introducing the German technology “All seeing needle” to do PCN.

Stone management occupies a major portion of our clinical practice. Basically most of the stone cases are either neglected or diagnosed late. Very often they complicate other health problems like diabetes, hypertension, obesity, pregnancy, neurological diseases, CRF, Bleeding Diathesis, etc. This increases complication or failure to clear all stones.

‘Hard Talk’ is a unique concept. 15 topics pertaining to PCNL will be covered in the 3-day programme. A renowned faculty will present his views, experience and recommendations on the topic. Then a critic panel along with audience will critically analyze his views and recommendations.

President of the World Endourology Society, Dr. Paul Van Cangh from Belgium will be the international faculty, and Drs. S.V. Kandasami, Percy Chibber, Mallikarjuna C, Aneesh Srivastava, SK Pal, PP Rao, Jaydeep Date, Hemendra Shah and Rajesh Kukreja will be among the national faculty, besides Drs Mahesh Desai and R B Sabnis.

For the beginners it is always a dilemma how to learn to puncture. There will be various models available for ‘hands on’ practice to increase the skill. Around 60 persons are expected to participate in the programme.

Muljibhai Patel Urological Hospital, who are the pioneers in the field of nephro-urology in India, has handled more than 23000 stone cases so far.




Kidney Stones Overview
The kidney acts as a filter for blood, removing waste products from the body and helping regulate the levels of chemicals important for body function. The urine drains from the kidney into the bladder through a narrow tube called the ureter. When the bladder fills and there is an urge to urinate, the bladder empties through the urethra, a much wider tube than the ureter.
In some people, the urine chemicals crystallize and form the beginning, or a nidus, of a kidney stone. These stones are very tiny when they form, smaller than a grain of sand, but gradually they can grow to a quarter inch or larger. The size of the stone doesn't matter as much as where it is located.
When the stone sits in the kidney, it rarely causes problems, but should it fall into the ureter, it acts like a dam. The kidney continues to function and make urine, which backs up behind the stone, stretching the kidney. This pressure build up causes the pain of a kidney stone, but it also helps push the stone along the course of the ureter. When the stone enters the bladder, the obstruction in the ureter is relieved and the symptoms of a kidney stone are resolved.


****

P A JOSEPH
OSD, MPUH NADIAD WWW.MPUH.ORG


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Jun29
Prolapse of Rectum
Rectal prolapse is an uncommon condition akin to prolpase of utreus seen in some women after multiple childbirths. It is an abnormal protrusion of rectum outside of anus and it is quite grotesque for the patient himself and others to look at. The protrusion can range from a few centimeters to a foot or more.
This condition is often seen in children who are malnourished and suffering from chronic diarrhoea. and this protrusion can be pushed back into the pelvic cavity most of the times. Rectal prolapse in children is usually self limiting and doesnt require any treatment.
This condition is also seen in individuals with microcephaly(small undeveloped brain) and mental retardation.
Prolapse of rectum is also seen in some healthy adults who generally come to the clinic with a long history. They are usually in the habit of pushing the prolapse back into the rectum on their own. Constipation is a very common symptom and at times perienal pain and discomfort forces them to see a specialist. Ulceration and bleeding is not uncommon.

Medical management doesnt help. Most patients will require surgical treatment in the form of laparoscopic or open rectopexy wherein a synthetic wire mesh is used to anchor the rectum in the pelvis to prevent the rectum to slide down. results are usually good and a transient constipation may persist for a while after the surgery. Prolapsed rectum is a condition which should not be ignored and should be shown to a specialist ASAP.

Dr.Patta Radhakrishna MS MCh
Sr. Consultant Surgical Gastroenterologist &
laparoscopic surgeon
Apollo Hospitals(main), Chennai.


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Jun28
dry mouth
Everyone has a dry mouth once a while when ther are upset,, nervos under pressure or scared.But if someone have it all the time or most of the time it is termed a dry mouth.
It is a condition of not having saliva or so called spit which keeps the mouth wet in enough amount.
Saliva is most imp as it helps in digestion,, buffers oral cavity so prevents infections by controlling growth of harmful microorganisms
If not in sufficient amount causes tooth decay &gum diseases &one might not get proper nutrient due to difficulty in chewing & swollowing foods &may lead to bad health
There are diff causes of dry mouth such as parkinsons disease ,,diabetes ..hiv after radio&chemotherapy for cancer or may be due to nerve damage of saliva producing glands or glands itself due to trauma in head &neck region


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Jun27
NUTRITIONAL SUPPORT IN PANCREATITIS
Acute pancreatitis results in a hypermetabolic, hyperdynamic, systemic inflammatory response syndrome that creates highly catabolic stress state.Gut rest, with or without parenteral nutrition, is considered to be the standard care in patients with acute pancreatitis aiming towards decrease enzyme production.Recent evidence however, suggests that enteral nutrition may be feasible and perhaps desirable in such patients.Studies have shown that the site in the gastrointestinal tract to which feedings are delivered determines whether the pancreas is stimulated and that jejunal feedings results in negligible increase in enzyme, bicarbonate, and volume output from the pancreas.Some experts suggest that enteral feedings stimulates lysosomal movement to cell surface, minimising intracellular release of pancreatic enzymes, and that it also reduces the production of proinflammatory mediators that may be therapeutic in patients with acute pancreatitis.
On the other hand, it is reported that Total parenteral nutrition, impairs humoral and cell mediated immunity, increases the vigour of the proinflammatory response, increases bacterial translocation, and increases infection rates in various critically ill patients. Lack of enteral feeding results in atrophy of the GI mucosa, bacterial overgrowth, increases intestinal permeability, and translocation of bacteria or bacterial products into the circulation.TPN , and thereby , enteral starvation results in rapid and severe atrophy of lymphoid tissue associated with gut , impairs B and T cell lymphocyte function and phagocytosis.
Most cases of acute pancreatitis are mild and self limiting, with serum enzyme levels returning to normal within 2-4 days.However early initiation of enteral feedings should be considered for moderate and severe pancreatitis.Placement of a jejunal feeding tube is best as it is seen that pancreatic stimulation from enteral nutrients decreases as the feeding site moves down the bowel. Well nourished patients with mild pancreatitis who can resume oral intake within few days may not need this but previously malnourished patients and patients unable to resume oral intake would benefit from enteral nutritional support.TPN should be only considered if enteral feeding is contraindicated for some reason.


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Jun26
THE ACID PHOBIA
Gastric acid has a longstanding reputation of being a corrosive agent that can eat through an unprotected stomach wall and "burn a hole in your stomach." , but the percieved dangers of gastric acid are more fantasy than fact. An acid environment can be corrosive for certain inorganic compounds like metals and enamels, but gastric acid is not all that destructive for organic matter. If you have ever spilled orange juice(pH=3) or lime juice(pH=2) on your hands, you have experienced the non destructive nature of acidity in the organic world.Infact the pickling process uses an acid(vineger) to preserve organic matter(food).
The perception of gastric acid as a destructive force is a direct result of the traditional notion that gastric acid is the main cause of peptic ulcer disease.However, recent evidence indicates that local infection with Helicobactor pylori is responsible for most cases of peptic ulcer disease.


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Jun23
HAZARDS OF TONGUE PIERCING
LIKE BODY PIERCING ie NOSE EAR LOBE, EYEBROWS BELLY ETC TONGUE PIERCING BCOMING POPULAR .
IT INVOLVES PLACING STUD THROUGH TONGUE.THIS STUD CAUSES CHIPPING OF TEETH,, RECESSION OF GUMS AND MAY B NERVE DAMAGE.
PEOPLE GOING FOR SUCH THINGS DONT REALIZE RISK FOR DEVLOPING FATAL INFECTIONS.
UNCLEAN PIERCING EQUIPMENT CAN GIVE RISE INFECTIONS LIKE BLOOD BORNE HEPATITIS ,,TOOTH FRACTURES , AND INSTRUMENT USED MAY PIERCE BLOOD VESSEL '


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Jun23
PREOPERATIVE MEASURES TO REDUCE ANASTOMOTIC LEAK
Anastomosis is used when a hollow organ such as intestine needs to be severed and reconnected to allow fluids to flow through it, most commonly because part of the organ needs to be removed.An anastomotic leak is a breakdown along an anastomosis which causes fluid to leak.Leaks can occur for number of reasons and it is not always the mistake on the part of the surgeon.other reasons could be poor wound healing and unexpected stress and pressure on the anastomosed area.Patients who undergo bariatric surgery usually have multiple comorbidities, such as diabetes, hypertension, poor nutrition, less exercise tolerance, and sleep apnea which puts them on high risk for postoperative leaks.
All factors that improve intestinal blood flow and oxygen carrying capacity should be optimized preoperatively.These include anemia, iron, cardiac function, sleep apnea, preoperative hydration to prevent hypoperfusion and hypotension during surgery.Poor control of diabetes can adversely effect healing and HgbA1c should be stable and less than 6% prior to surgery.decreasing the size of the liver preoperatively affords better visualization of the operative field specially if its going to be a laparoscopic surgery.Steatohepatitis is frequently associated with morbid obesity and a two weeks preoperative low energy diet may help reduce the liver size thus resulting in a technically superior anastomosis.Specific preoperative antibiotic therapy may also help towards preventing postoperative anastomotic leak.


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Jun17
KNOWLEDGE DISSEMINATION: CONTINUED MEDICAL EDUCATION
Knowledge Dissemination: Continued Medical Education

Key words: Knowledge, Medical Knowledge , hoarding , dissemination


Introduction:

At the simplest level, dissemination is best described as the delivery and receipt of a message, the engagement of an individual in a process, or the transfer of a process or product. It is also helpful to think about dissemination in three broadly different ways, viz., dissemination for awareness, for understanding , and for action. Indeed, effective dissemination of a knowledge product will most likely require that it satisfy all three in turn: utilization is the goal. Knowledge is a "thing" that simply needs to find a good home… Nowhere is this more apparent than in the worthy effort to define dissemination as consisting of four activities: spread, exchange, choice, and implementation.

Definitions of dissemination also reflect differing assumptions and beliefs about the ways in which knowledge is used, indeed about the very nature of knowledge itself. The focus varies from perceiving dissemination and utilization as linear, mechanical processes of "transfer," in which knowledge is packaged and moved from one "place" to another, much as an appliance might be packaged and shipped, to characterizing the process as highly complex, nonlinear, interactive, and critically dependent on the beliefs, values, circumstances, and needs of intended users.

Scholarly research makes a profound contribution to the social, cultural and economic wealth of a country. The results of research, referred to here as "scholarly knowledge", is created, organized, preserved and disseminated within the scholarly communication system. Many countries are undertaking national research strategies aimed at understanding and navigating these changes. In order to optimize the dissemination of scholarly knowledge, it is critical that we develop a comprehensive research strategy to examine the future of scholarly communication in this country.

Creation, manipulation, management and dissemination of knowledge cannot go on forever without determining what impact it is having on those who create it and those who use it. This paper explores methods of determining the impact of disseminated Knowledge. It does this by first defining what knowledge is. This is followed by a discussion on different mediums through which knowledge may be disseminated. It then discusses two questions – when do we know when to disseminate knowledge and how do we know when it has been disseminated.(1)


MEDIUMS OF KNOWLEDGE DISSEMINATION

Contrary to Plato and Foskett’s definition of knowledge, it is postulated that knowledge is information that is acceptable to a norm about a subject. In treating different mediums that may be used to disseminate knowledge, it is argued that mediums of disseminating knowledge can be grouped into two main categories, namely natural and man made mediums. Natural mediums of knowledge dissemination include audio and gestures, which are performed by all leaving beings whereas; man-made mediums include all mediums of communication that man has developed out of transforming matter.

Knowledge itself cannot be monitored, only presence in its carrier can. Ipso facto, analyzing different carriers of it or usethereof, not knowledge itself, can do evaluation of knowledge because an indisputable truth is that presence of knowledge is only manifest in its application. In monitoring and evaluating knowledge as transformed matter, the criteria of process and progress; relevance, efficiency, effectiveness, impact and sustainability may be used respectively. Techniques of analyzing applied knowledge data abound. For something to count as knowledge, it must actually be true. I see knowledge as information that is acceptable to a norm about a subject. As long as the information that you have conforms to an established and acceptable societal norm, it is knowledge it does not have to be true. If it conforms to an established norm, it will always be believed. As soon as the norm changes, what you know becomes information. When people do not believe you, it is simply because what you say to them is not acceptable to their norm. Good knowledge is useful knowledge. It permits man’s survival by allowing him to use it to solve his problems.

When we attend schools or listen to priests preach to us and accept what they tell us as reasonable and pass it on to other people or use it to solve our problems, what we are doing is simply accepting new norms about new or existing subjects. According to Polanyi, “…tacit knowledge is what is in our heads and explicit knowledge is what we have codified” Given that tacit knowledge is knowledge that is in our heads the easiest and the only way to disseminate this type of knowledge is through organs of the body. We can communicate it through voice. This method of communication is largely applied in schools from primary to tertiary. Besides explicit communication, a lot of information and knowledge is passed on from one person to another through gestures. Laughing is a simple sign of happiness. Shrugging your shoulders indicates that you do not know. Of unique interest to note though is that gestures are not universal, they are unique to societies. Nodding one’s head means that one is in agreement with what is being said after the European fashion. The converse is true in the Asian culture. In the Asian culture when you shake you head from side to side this means concurrence with what is being said. One of the notable efforts to try to address the problem of different norms and standards on gestures is what has come to be known as the sign language which came into being as an effort to address different human beings impairments such as speech and hearing. This confirms the definition made earlier on that knowledge is that which conforms to a norm about any subject.

The second type of knowledge is explicit knowledge. This is knowledge that has been codified. How can knowledge be codified? Codification of knowledge came as a result of man’s application of tacit knowledge to transform matter into various useful objects for his survival. Writing is the oldest form of codifying knowledge. Most of the world’s knowledge is in written form in the form of books. With further transformation of matter through application of tacit knowledge other ways of codifying knowledge have emerged over time. We now find knowledge in medium such as recorders, the INTERNET and others. Of particular interest to me is knowledge that is manifest in transformed matter.

HOARDING KNOWLEDGE

There is no stipulated rule on where and when knowledge should be disseminated. The simple answer to this question is knowledge is ready to be disseminated when the holder of it feels it is ready to be. Besides, it does not make sense to acquire knowledge to hoard it. In fact, it is impossible to hoard knowledge because we need to constantly exchange it for survival. Hoarding of knowledge makes sense only when one does it in order to gain comparative advantage over other human beings. Even this is not eternal. Overtime, the hoarded knowledge gets known and is further exchanged. Dissemination of knowledge is often done with a certain intention in mind. When this is the key reason for knowledge dissemination, it is important to determine whether knowledge dissemination has really taken place. This is important for a number of reasons. One, it allows for learning on whether knowledge was successfully disseminated so that if not other means of disseminating it successfully could be devised. For example, at institutions of learning gauging of knowledge dissemination is done through tests and examinations as we all know and two, for accountability purposes. (4) However, the key gauge of whether knowledge has been disseminated is its application. As indicated earlier, as tacit knowledge, knowledge application is seen in the development of different solutions in the form of products and services. In a codified form, knowledge dissemination is seen in the use of the products and services to solve societal problems. Note before, knowledge use does not only lead to useful solutions to societal problems, at times it creates more problems and leads to societal ills. A clear epitome of this is the atomic bomb that was dropped by the Americans on Hiroshima and the current nuclear age in which nuclear bombs, which are an epitome of man’s application of his knowledge, are a threat to humanity.


MEDICAL KNOWKEDGE

Medical doctors claim that their discipline is founded on scientific knowledge. Yet, although the ideas of evidence-based medicine are widely accepted, clinical decisions and methods of patient care are based on much more than just the results of controlled experiments. Clinical knowledge consists of interpretive action and interaction—factors that involve communication, opinions, and experiences. The traditional quantitative research methods represent a confined access to clinical knowing, since they incorporate only questions and phenomena that can be controlled, measured, and counted. (2)
Biomedical knowledge is expanding at an unprecedented rate-one that is unlikely to slow anytime in the future. While the volume and scope of this new knowledge poses significant organizational challenges, it creates tremendous opportunities to release and direct its power to the service of significant goals. One can achieve those by integrating numerous resource-intensive, technology-based initiatives-including personnel, services and infrastructure, digital repositories, data sets, mobile computing devices, high-tech patient simulators, computerized testing, and interactive multimedia-in a way that enables the center to provide information tailored to the needs of students, faculty and staff on the medical center campus and its surrounding health sciences colleges.
Emphasis must be made on discovering, applying, and sharing new knowledge, information assets, and technologies in this way is a collaborative process. This process creates open-ended opportunities for innovation and a roadmap for working toward seamless integration, synergy, and substantial enhancement of the academic medical center's research; educational, and clinical mission areas (5)
Continuing Medical Education
Continuing medical education (CME) plays a key role in test ordering, while pharmaceutical manufacturers’ representatives are important sources of information concerning new therapeutic agents. The dissemination of information is a complex process. Physicians frequently use multiple sources of information in the decision making process. Physicians and planners of CME must be aware of what types of educational activities are best suited for their needs (6)
The tacit knowing of an experienced practitioner should also be investigated, shared, and contested. Qualitative research methods are strategies for the systematic collection, organization, and interpretation of textual material obtained from talk or observation, which allow the exploration of social events as experienced by individuals in their natural context. Qualitative inquiry could contribute to a broader understanding of medical science. The Internet is a convenient but complex source for health information used by an increasing number of health consumers. Especially for people suffering from a chronic illness (e.g., diabetes), information seeking forms a part of the daily management of the disease, a “project of life.” The study of Web texts examines the citation patterns for a specific and controversial health issue: the beneficial or hazardous use of dietary chromium supplementation in diabetes self-management. Texts from different categories of Web sources (scientific, professional, educational, and commercial sources, as well as diabetes discussion groups) were analyzed in order to study how knowledge is transferred between sources, and how diabetics participating in discussion groups refer to and make sense of the information from different sources on the Internet. The citation patterns suggest that deviations from the traditional models of scientific knowledge dissemination can occur in the Internet environment (1).
It is beyond argument that Continued Medical education (CME) should play a very significant role in the changing health care environment. There are various types of literature (e.g., concerning learning and adult development principles, problem-based/practice-based learning, and other topics) that contribute to ways of thinking about and understanding CME. It is gratifying that the Association of American Medical Colleges (AAMC) has made a commitment to helping CME be more effective in the professional development of physicians.
The professional development of physicians is a lifelong commitment that builds on formal and informal opportunities to learn emerging science, apply innovations in clinical settings, and expand understandings of caring for patients. One essential element in that commitment has been continuing medical education (CME), the final part of the education continuum. Although CME has a long history in supporting physicians as lifelong learners, it has become increasingly important and focused during the past ten to 15 years as a result of the impact of changing educational, social, and political forces on medical practice. People in academic medicine can support continuing medical education to respond to the changed and changing health care environment, and suggest new directions for individuals and institutions involved with continued learning.
CONCLUSION
As far as medical knowledge dissemination it is imperative that collaboration among the appropriate academic groups, professional associations, and health care institutions, with leadership from the state bodies, is essential to create the best learning systems for the professional development of physicians.
Building new knowledge-based systems today usually entails constructing new knowledge bases from scratch. It could instead be done by assembling reusable components. System developers would then only need to worry about creating the specialized knowledge. New systems should interoperate with existing systems, using them to perform some of its reasoning. In this way, declarative knowledge, problem- solving techniques, and reasoning services could all be shared among systems. This approach would facilitate building bigger and better systems cheaply. The infrastructure to support such sharing and reuse would lead to greater ubiquity of these systems, potentially transforming the knowledge industry. One sees a vision of the future in which knowledge-based system development and operation is facilitated by infrastructure and technology for knowledge sharing. It is believed that newer initiatives currently under way to develop these ideas would pave a long way in the complex yet simpler process of knowledge sharing and dissemination. The future is looking expectantly to realize this vision.





References:

1. Enabling Technology for Knowledge Sharing
Robert Neches, Richard E. Fikes, Tim Finin, Thomas Gruber, Ramesh Patil, Ted Senator, William R. Swartout AI Magazine, Vol 12, No 3


2. Health discussions on the Internet: A study of knowledge communication through citations: Marianne Wikgrenv Department of Information Studies, Åbo Akademi University, Tavastgatan 13, FIN-20500 Åbo, Finland




3.Continuing Medical Education: A New Vision of the Professional Development of Physicians
Bennett, Nancy L. PhD; Davis, Dave A. MD; Easterling, William E. Jr. MD; Friedmann, Paul MD; Green, Joseph S. PhD; Koeppen, Bruce M. MD, PhD; Mazmanian, Paul E. PhD; Waxman, Herbert S. MD Academic Medicine: December 2000 - Volume 75 - Issue 12 - p 1167-1172

4. Www.researchutilization.org/matrix/resources/review/ -

5. Managing Knowledge and Technology to Foster Innovation at The Ohio State University Medical Center
Cain, Timothy J. PhD; Rodman, Ruey L. MLS; Sanfilippo, Fred MD, PhD; Kroll, Susan M. MLSAcademic Medicine:
November 2005 - Volume 80 - Issue 11 - pp 1026-1031

6. Information sources and clinical decisions: journal of General Internal Medicine Jeoffrey K. Stross Vol 2., No.3 May, 1987, 155-159


NB: This was a lecture delivered at the KNOWLEDGE GLOBALIZATION conference at Dhaka May 2010.Dr Patnaik was invited to chair the session on session of Education. The key note was delivered by Noble Laurate Dr Mohd Yunus. The conference was aimed at sharing knowledge with scholars and researchers across geographic and academic boundaries. It was a
global multidisciplinary conference with delegates from across the world.


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Jun13
BARRETT'S ESOPHAGUS
Barrett's esophagus is a condition in which the tissue lining the esophagus is replaced by tissue that is similar to the lining of the intestine. This process is called intestinal metaplasia. It is commonly seen in people with gastroesophageal reflux disease(GERD) which occurs when the lower esophageal sphincter opens spontaneously for varying periods of time or does not close properly and the stomach contents rise into the esophagus. It is also called acid reflux. Persistent reflux that occurs more than twice a week is considered GERD.
People with Barrett's esophagus have a risk of developing esophageal adenocarcinoma. It may be several years before cancer develops. Barrett's esophagus can only be diagnosed using an upper GI endoscopy to obtain biopsies of the esophagus.Several endoscopic therapies are available to treat severe dysplasia and cancer.During these therapies, the Barrett's lining is destroyed(Photodynamic therapy) or the portion of the lining that has the dysplasia or cancer is cut out(Endoscopic mucosal resection).
Your surgeon will present the options and help determine the best course of treatment for u.Periodic endoscopic examinations with biopsies to look for early warning signs of cancer is recommended for people who have barrett's esophagus.This is called surveillance.Typically, before esophageal cancer develops, precancerous cells appear in the Barrett's tissue.This condition is called dysplasia and can be seen only through biopsies.Multiple biopsies may be needed because dysplasia can be missed in a single biopsy.Detecting and treating dysplasia may prevent cancer from developing.Surgical treatment is recommended if a person has severe dysplasia and can tolerate the procedure.many patients with this condition are older and may have other medical problems that make surgery unwise. The type of surgery varies, but it usually involves removing most of the esophagus, pulling a portion of the stomach and attaching it to what remains of the foodpipe.


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