The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online. To highlight some of the great resources, we’ve pulled together some interesting facts about the esphophagus from Stephen Hauser’s Mayo Clinic Gastroenterology and Hepatology Board Review.
(1) The esophagus has two major functions: to propel food boluses downward to the stomach and to keep stomach contents from refluxing upward. The esophagus accomplishes these functions by its tubular anatomy and motility that involves the contraction and relaxation of sphincter muscles and precisely timed peristaltic waves.
(2) The initial process of swallowing is under voluntary control. A swallow is initiated by the lips closing, the teeth clenching, and the tongue being elevated against the palate, forcing the bolus to the pharynx. Entry of the bolus into the pharynx triggers the involuntary swallowing reflex.
(3) Oropharyngeal dysphagia is often characterized by the complaint of difficulty initiating a swallow, transitioning the food bolus or liquid into the esophagus, meal-induced coughing or “choking,” or of food “getting stuck” in the voluntary phase of swallowing.
(4) Patients with an esophageal body or LES disorder describe “esophageal dysphagia” characterized by the onset of symptoms moments after the initiation of a swallow. They usually can sense that the food or liquid bolus has traversed the oral cavity and has entered the esophagus. They complain of food feeling “stuck” or “hung up” in transition to the stomach.
(5) Gastroesophageal reflux is the reflux of gastric contents other than air into or through the esophagus. Gastroesophageal reflux disease (GERD) refers to reflux that produces frequent symptoms or results in damage to the esophageal mucosa or contiguous organs of the upper aerodigestive system and occasionally the lower respiratory tract.
Gastroenterology and hepatology encompass a vast anatomical assortment of organs that have diverse structure and function and potentially are afflicted by a multiplicity of disease processes. Mayo Clinic Gastroenterology and Hepatology Board Review is designed to assist both physicians in-training who are preparing for the gastroenterology board examination and the increasing number of gastroenterologists awaiting recertification.
The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online. With full-text titles from Mayo Clinic clinicians and a bank of 3,000 multiple-choice questions, Mayo Clinic Toolkit provides a single location for residents, fellows, and practicing clinicians to undertake the self-testing necessary to prepare for, and pass, the Boards and remain up-to-date. Oxford Medicine Online is an interconnected collection of over 250 online medical resources which cover every stage in a medical career, for medical students and junior doctors, to resources for senior doctors and consultants. Oxford Medicine Online has relaunched with a brand new look and feel and enhanced functionality. Our aim is to ensure that the site continues to deliver the highest quality Oxford content whilst meeting the requirements of the busy student, doctor, or health professional working in a digital world.
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How can you resolve to change in 2013? With a community. The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online, and to highlight some of the great resources, we’ve excerpted Prathibha Varkey, MD, MPH, MHPE’s Mayo Clinic Preventive Medicine and Public Health Board Review below.
Community and population health can be enhanced by recognizing the different levels of influence, namely intrapersonal, interpersonal, and organizational influences. More recently, attention is being paid to the importance of interpersonal influences through the study of social networks. Smoking cessation rates of individuals increase as more contacts in their social network quit smoking, and individuals gain weight as more contacts in their social network gain weight. Another example of social influence is an after-school program for teenagers that may not change attitudes but may reduce the opportunity to engage in risky behaviors. Organizational support for behavior change can be in the form of higher taxes on tobacco or alcohol, building recreational centers to enhance physical activity, cleaning up the environment (in one study, neighborhood deterioration was a better predictor of sexually transmitted disease than low education attainment), and using or regulating message delivery by the media.
Bringing about change at the population level may follow the principles of diffusion of innovation, as described by Everett Rogers. In this model, the social system comprises five adopter categories: (1) innovators, (2) early adopters, (3) early majority, (4) late majority, and (5) laggards. Innovators are important for change because they get the process started, but they are not very influential because too much uncertainty about the changed behavior still exists when they adopt the change. The early adopters are key to diffusing an innovation; this group tends to include the opinion leaders, and others usually solicit their advice about new innovations. This model of diffusion of innovation predicts whether innovations and change will be successful on a large scale.
How rapidly an innovation will be diffused depends on the characteristics of the innovation, how it is communicated, and the social system. The characteristics of innovation that determine its speed of adoption include its perceived relative advantage over current practice, compatibility with current practices and needs of the adopters, ease of use (simple vs complex), “trialability” (testable on a small scale), and observability (visibility of results).
The principles of this model can be useful for predicting behavior change or diffusion of best practices at the community or population level. For example, screening mammography has been widely adopted by physicians because it is perceived to detect early stage breast cancer, the test is easy for physicians to order, patient compliance is not burdensome, and results are visible in a short time. In contrast, smoking cessation counseling has been slower to diffuse because the results are not as visible (most people will not quit when advised to do so), the intervention is more complex than just ordering a test, and physician practices are not geared toward counseling.
- Intrapersonal, interpersonal, and organizational influences affect community and population health.
- Health changes at the population level may propagate in a manner predicted by the principles of diffusion of innovation.
A comprehensive and concise review of relevant preventive medicine and public health topics, the Mayo Clinic Preventive Medicine and Public Health Board Review is an ideal study guide for residents preparing to take the examination of the American Board of Preventive Medicine for the first time, as well as for physicians preparing for recertification. Its emphasis on evidence-based information and recommendations makes Mayo Clinic Preventive Medicine and Public Health Board Review a credible, practical resource that can be used in clinical, public health, and academic settings
The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online. With full-text titles from Mayo Clinic clinicians and a bank of 3,000 multiple-choice questions, Mayo Clinic Toolkit provides a single location for residents, fellows, and practicing clinicians to undertake the self-testing necessary to prepare for, and pass, the Boards and remain up-to-date. Oxford Medicine Online is an interconnected collection of over 250 online medical resources which cover every stage in a medical career, for medical students and junior doctors, to resources for senior doctors and consultants. Oxford Medicine Online has relaunched with a brand new look and feel and enhanced functionality. Our aim is to ensure that the site continues to deliver the highest quality Oxford content whilst meeting the requirements of the busy student, doctor, or health professional working in a digital world.
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The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online. To highlight some of the great resources, we’ve pulled together some interesting facts about anesthesia from James Hebl and Robert Lennon’s Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade. Get free access to the Mayo Clinic suite for a limited time with this Facebook offer (watch out, it closes today!).
(1) Egyptian pictographs dating back to 3000 BC showing a physician compressing a nerve in the antecubital fossa while an operation is being performed on the hand.
(2) William Halsted, M.D. (1852–1922; Chair, Department of Surgery, Johns Hopkins Hospital), used cocaine as local infiltration as he dissected down toward major nerve trunks. He then injected cocaine around them, performing regional blockade under direct vision.
(3) In Paris in the early 1920s, a new technique for blocking the brachial plexus from an axillary approach was introduced. M. Reding, M.D., studying the anatomy of the axilla, discovered that the nerves of the plexus surround the artery in a fascial sheath. Thus, using the artery as a landmark, Reding found that the fascial compartment could be filled with local anesthetic to result in brachial plexus blockade. Reding blocked the musculocutaneous nerve, which lay outside the sheath, by infiltrating the coracobrachialis muscle.
(4) Paresthesia technique—the long-preferred method of regional anesthesiologists—was slowly replaced during the 1980s as peripheral nerve stimulation began to emerge. During its development, peripheral nerve stimulation was thought to provide superior localization of neural structures compared with blind paresthesia-seeking techniques. Peripheral nerve stimulators transmit a small electric current through a stimulating needle that, when in proximity to neural structures, causes depolarization and muscle contraction.
(5) In contemporary medical practice, regional anesthetic techniques have expanding socioeconomic and clinical implications. For example, studies evaluating patient satisfaction have found that perioperative analgesia and the avoidance of nausea and vomiting are consistently two of the highest concerns among patients.
(6) Ultrasound guidance may represent the 21st century’s version of Halsted’s anatomical dissection down to the brachial plexus.
Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade by James Hebl and Robert Lennon is a practical guide for residents-in-training and clinicians to gain greater familiarity with regional anesthesia and acute pain management to the upper and lower extremity. It emphasizes the importance of a detailed knowledge of applied anatomy to safely and successfully performing regional anesthesia. It also provides and overview of the emerging field of ultrasound-guided regional anesthesia, which allows reliable identification of both normal and variant anatomy. Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade contains more than 200 beautifully illustrated anatomic images important to understanding and performing regional anesthesia. Corresponding ultrasound images are provided when applicable.
The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online. With full-text titles from Mayo Clinic clinicians and a bank of 3,000 multiple-choice questions, Mayo Clinic Toolkit provides a single location for residents, fellows, and practicing clinicians to undertake the self-testing necessary to prepare for, and pass, the Boards and remain up-to-date. Oxford Medicine Online is an interconnected collection of over 250 online medical resources which cover every stage in a medical career, for medical students and junior doctors, to resources for senior doctors and consultants. Oxford Medicine Online has relaunched with a brand new look and feel and enhanced functionality. Our aim is to ensure that the site continues to deliver the highest quality Oxford content whilst meeting the requirements of the busy student, doctor, or health professional working in a digital world.
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Subscribe to only health and medicine articles on the OUPblog via email or RSS.
The post Six facts about regional anesthesia appeared first on OUPblog.
