In an era that that ‘evidence-based medicine’ is facing challenges from many fronts, the benefits of blood pressure control have been shown to decrease morbidity and mortality and increase lifespan. The evidence is strong and there is no disagreement among clinicians and researchers. However, there is considerable uncertainty and debate as to how much reduction is needed in systolic blood pressure among the leading guidelines that look at the same evidence. The JNC 2018, AHA/ACC and now NICE guidelines vary with the recommendations. The page below gives the summary of guidelines available from JNC 8 (2014), ACC/AHA (2107) and ESC/ESH
Sri Lankan Clinical Practice Guideline Portal - SLCPGP
All Sri Lankan clinical practice guidelines from one website
ප්රහාරයෙන් බිඳුණු මනස යළි හදාගන්නේ කොහොමද? පාස්කු ඉරිදා සිදු වූ අමානුෂික ත්රස්ත ප්රහාරය හේතුවෙන් තුන්සියයකට ආසන්න පිරිසක් මිය ගොස් පන්සියයකට ආසන්න පිරිසක් තුවාල ලැබූහ. මියගියවුන් අතර කුඩා දරුවෝ හතළිස් පහකට ආසන්න පිරිසක් වූහ. තුවාල ලද දරුවන් සංඛ්යාවද බොහෝය. නොසිතූ මොහොතක ඇති වූ මේ දැවැන්ත ව්යසනය හමුවේ සමාජයේ ලොකු කුඩා කාහටත් දැඩි මානසික කම්පනයක් ඇති වූ බව රහසක් නොවේ. මේ ව්යසනයට මුහුණ පෑ එමෙන්ම එය දුටු සමස්තයේ අවසාන බලපෑම ඇති වන්නේ මේ හැම දෙනාගේම මනසටය. මෙයට විසඳුමක් ලෙස සමස්ත සමාජයේ මෙන්ම දරුවන්ගේ මානසික ව්යාකූලතා අවම කිරීම උදෙසා කළ යුතු හා කළ හැකි දේ මොනවාදැයි, අපි මනෝ චිකිත්සාව පිළිබඳ මහාචාර්ය අතුල සුමතිපාල
Grief is the response to bereavement, which is the situation in which a loved one has died . Natural acute grief reactions are often painful and impairing with emotional and somatic distress, but should not be diagnosed as a mental disorder. However, bereavement is a stressor that can precipitate or worsen mental disorders (eg, unipolar major depression). In addition, complications (maladaptive thoughts, feelings, or behaviors) may occur, such that acute grief becomes intense, prolonged, and debilitating. This condition is called complicated grief, which is viewed as a unique and recognizable disorder that requires specific treatment. Ref -[UpToDate TERMINOLOGY The terms
Gene editing or genome editing is the technique used to replace or cutting pieces of DNA [Ref]. Using a component known as CRISPR to precisely pinpoint the sequence of DNA in the gene, an enzyme called Cas9 is used to cut through the part identified. It can also replace a removed part by another sequence of DNA. This technique can be used to replace a faculty gene or change a gene to make it behave differently. Gene editing can have very good effects like altering a disease gene or modifying a diseased gene to behave normally. However gene editing
People increasingly search the Internet regarding their health issues and a Google search may be the commonest in most instances. Even doctors ‘Google’ for a diagnosis [Ref]. Recently there has been a proliferation of more sophisticated programs called ‘symptom checkers‘ that attempt to more effectively provide a potential diagnosis for patients and direct them to the appropriate care setting. Many healthcare institutions provide symptom checkers such as WebMD, Mayo Clinic, HealthLine. Isabel and Balylon are two different applications that use different programming techniques to provide people with their symptom evaluation. Isabel uses the orthodox text-searching. Babylon uses a ‘Chatbot‘
Technology has enabled bionics and artificial intelligence, each of which can have important applications in health care. As we continue to substitute body parts with machinery, however, we might wonder, “What makes us human?” This drawing interrogates the relationship between humanity and embodiment, specifically in neck and facial musculature and brain structures. This image represents humankind’s union with technology. It shows the brain turning into a collection of integrated computer circuits and the neck muscles evolving into mechanization-ready cables, pumps, and wires. In artificial intelligence (AI), boundaries distinguishing life and technology are challenged. We wonder, “Is it possible for machines
A doctors Touch -Abrahim Verghsee
Overdiagnosis occurs when a diagnosis is “correct” according to current professional standards but the diagnosis or associated treatment is unlikely to benefit the person and will not cause symptoms or death. More broadly overdiagnosis refers to the related problems of overmedicalisation and subsequent overtreatment, diagnosis creep, shifting thresholds, and disease mongering, all processes helping to reclassify healthy people with mild problems or at low risk as sick.Read more
Seminar on Overdiagnosis / Too Much Medicine.
Sri Lanka Medical Association 26th March 2019. 12 - 2 PM
"Success is a lousy teacher. It seduces smart people into thinking they can’t lose.”
People think focus means saying yes to the thing you’ve got to focus on. But that’s not what it means at all. It means saying no to the hundred other good ideas that there are. You have to pick carefully. I’m actually as proud of the things we haven’t done as the things I have done. Innovation is saying no to 1,000 things.
Amara's law: We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run.
Essential Resources – FREE
The best, free and essential resources for evidence based practice
Essential Resources – PAID
The best, paid and essential resources for evidence based practice
Modern Medicine’s remarkable personalities
Archibald Leman Cochrane CBE was a Scottish doctor noted for his book Effectiveness and Efficiency: Random Reflections on Health Services. which advocated the use of RCTs to make medicine more effective and efficient. This eventually led to the development of the Cochrane Library database of systematic reviews, the establishment of the UK Cochrane Centre in Oxford and the international Cochrane Collaboration.
He is known as one of the fathers of Evidence-Based Medicine. He founded the first department of clinical epidemiology in Canada at McMaster University, and the Oxford Centre for Evidence-Based Medicine. One of his more famous quotes is: “Half of what you learn in medical school is dead wrong”
Abraham Verghese, MD, MACP, is Professor and Vice Chair for the Theory and Practice of Medicine at the School of Medicine at Stanford University. He is also a critically acclaimed, best-selling author and a physician with an international reputation for his focus on healing in an era where technology often overwhelms the human side of medicine. In 2016, Abraham Verghese received a National Humanities Medal, at the White House from President Barack Obama.