5/7/11

Journals


Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care.



Hypoxia and Inflammation.



regards, taniafdi ^_^

Zinc Within 24 Hours of Symptom Onset May Be Helpful for Common Cold

News Author: Laurie Barclay, MD
CME Author: Hien T. Nghiem, MD

CME/CE Released: 02/23/2011; Valid for credit through 02/23/2012

February 23, 2011 — When given within 24 hours of onset of symptoms, zinc reduces the duration and severity of the common cold in healthy people, according to the results of a Cochrane systematic review reported online February 16 in the Cochrane Database of Systematic Reviews.

"This review strengthens the evidence for zinc as a treatment for the common cold," said lead author Dr. Meenu Singh, from the Post Graduate Institute of Medical Education and Research in Chandigarh, India, in a news release. "However, at the moment, it is still difficult to make a general recommendation, because we do not know very much about the optimum dose, formulation or length of treatment."
To evaluate the effect of zinc on common cold symptoms, the reviewers searched CENTRAL (2010, Issue 2), which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to May week 3, 2010), and EMBASE (1974 to June 2010). Inclusion criteria were randomized, double-blind, placebo-controlled trials in which zinc was used for 5 or more consecutive days to treat the common cold, or for 5 or months or longer for prevention. Data were independently extracted and trial quality examined by 2 reviewers.
The search identified 13 therapeutic trials enrolling a total of 966 participants, and 2 preventive trials enrolling a total of 394 participants, that met selection criteria. Zinc intake was associated with a significant decrease in duration of common cold symptoms (standardized mean difference [SMD], −0.97; 95% confidence interval [CI], −1.56 to −0.38; P = .001), as well as in severity (SMD, −0.39; 95% CI, −0.77 to −0.02; P = .04).
The proportion of participants symptomatic after 7 days of treatment was lower in the zinc group vs the control group (odds ratio [OR], 0.45; 95% CI, 0.2 - 1.00; P = .05). The zinc group also fared better than the control group in incidence rate ratio (IRR) for development of a cold (IRR, 0.64; 95% CI, 0.47 - 0.88; P = .006), school absence (P = .0003), and prescription of antibiotics (P < .00001).
However, overall adverse events were higher in the zinc group (OR, 1.59; 95% CI, 0.97 - 2.58; P = .06), as were bad taste (OR, 2.64; 95% CI, 1.91 - 3.64; P < .00001) and nausea (OR, 2.15; 95% CI, 1.44 - 3.23; P = .002).
"Our review only looked at zinc supplementation in healthy people," Dr. Singh said. "But it would be interesting to find out whether zinc supplementation could help asthmatics, whose asthma symptoms tend to get worse when they catch a cold."
Limitations of this review also include those inherent in the individual studies, such as placebo-blinding adequately described in only 6 trials, and allocation concealment unclear in 5 studies.
"[U]nlike trials relying on experimentally-induced rhinoviral colds, findings from large community-based trials will address issues relating to the diversity of and generalisability to the common cold," the review authors conclude. "In addition, given its toxicological profile, the potential for zinc to induce adverse effects at the doses participants are required to take also needs to be determined."
The study authors have disclosed no relevant financial relationships.
Cochrane Database Syst Rev. Published online February 16, 2011. Abstract
regards, taniafdi ^_^

Maternal Fructose Intake Impacts Female and Male Fetuses Differently

Study finds maternal fructose consumption may also effect placental development
Newswise — Chevy Chase, MD—A recent study accepted for publication in Endocrinology, a publication of The Endocrine Society, reports for the first time that maternal fructose intake during pregnancy results in sex-specific changes in fetal and neonatal endocrinology.
Fructose is a simple sugar found naturally in honey, fruit and some vegetables. Diets high in dietary fructose, particularly due to calorically sweetened beverages, are now increasingly common and have been shown to be detrimental to the regulation of energy intake and body adiposity. With the increasing prevalence of maternal obesity and its association with gestational diabetes, there has been growing interest in maternal nutrition on the risk of childhood and adult disease in the offspring.
“There has been a marked increase in the consumption of fructose-sweetened beverages and foods, particularly among women of reproductive age,” said Mark Vickers PhD, of the University of Auckland in New Zealand and lead author of the study.“ This is the first time that it has been suggested that female and male fetuses react differently to maternal fructose consumption, and that these sex-specific changes may be associated in changes in placental development.”
In this study, researchers examined female Wistar rats that were time-mated and allocated to receive either water or a fructose solution designed to provide 20 percent of caloric intake from fructose. Only female fetuses in the fructose-fed rats had higher leptin, fructose and blood glucose levels than their control counterparts. Male and female offspring of fructose-fed rats both showed higher plasma fructose levels and were hypoinsulinemic. Researchers also found that the placenta of female fetuses in the fructose-fed rats were lighter than the female fetuses in the control group.
“Further studies are now critical to establish the long-term effects of maternal fructose intake on the health and well-being of offspring and whether this study’s observed sex differences elicit different risk profiles for metabolic disease into the post-weaning period,” said Deborah Sloboda, PhD, also of the University of Auckland and co-author of the study. Dr Vickers is currently conducting a follow-up study in rats.
Other researchers working on the study include: Z.E. Clayton and C. Yap of the Liggins Institute and the National Research Centre for Growth and Development, University of Auckland in New Zealand.
The article, “Maternal fructose intake during pregnancy and lactation alters placental growth and leads to sex-specific changes in fetal and neonatal endocrine function,” appears in the April 2011 issue of Endocrinology
Founded in 1916, The Endocrine Society is the world’s oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, The Endocrine Society’s membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 100 countries. Society members represent all basic, applied and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Maryland. To learn more about the Society and the field of endocrinology, visit our site at www.endo-society.org.


regards, taniafdi ^_^

Sleep, Depression, and Stress Influence Weight Loss

News Author: Jim Kling
CME Author: Désirée Lie, MD, MSEd
CME Released: 04/05/2011; Valid for credit through 04/05/2012


April 5, 2011 — A new study suggests that sleep, depression, and stress are key components of an interventional weight loss program. The study was published online March 29 in the International Journal of Obesity.
The current US obesity epidemic is believed to have a number of contributing elements, including genetic, environmental, and lifestyle factors, such as disordered sleep patterns. Multiple studies have demonstrated an inverse association between sleep duration and weight gain.
To better understand the effects of sleep, screen time, depression and stress on weight loss success, the researchers, led by Dr. Charles Elder of the Kaiser Permanente Center for Health Research, Portland, Oregon, conducted a 2-phase randomized clinical trial. Phase 1 included a nonrandomized, 6-month behavioral weight loss intervention that included 472 adults with obesity (body mass index, 30 - 50 kg/m2). Phase 2 incorporated weight loss maintenance. The current study focuses on phase I results.
The phase 1 intervention included 22 group sessions, led by a behavioral counselor, during the course of 26 weeks. Participants were given recommendations to reduce food consumption by 500 calories per day, adopt the Dietary Approaches to Stop Hypertension pattern, and participate in at least 180 minutes of exercise per week.
Mean weight loss during phase 1 was 6.3 ± 7.1 kg, and 285 participants (60%) who lost a minimum of 4.5 kg were randomly selected into phase 2. Participants attended an average of 73.1% ± 26.7% of sessions. They filled out 5.1 ± 1.9 daily food records per week and reported 195.1 ± 123.1 minutes of exercise per week.
Stress and sleep time were revealed to be important factors in qualifying for phase 2. A 1-point change in the Perceived Stress Scale had an associated odds ratio of 0.966 (increased success associated with less weight loss, 95% confidence interval, 0.937 - 0.995; P = .024). Participants with a quadratic trend in sleep time had an odds ratio of 0.797 (95% confidence interval, 0.649 - 0.978; P = .030). Participants who slept 6 to 7 hours or 7 to 8 hours were more likely to qualify for phase 2 than those with other sleep times.
At entry into the program, lower stress was associated with greater ensuing weight loss (slope, 0.132; SE, 0.054;t = 2.42; P = .021).
Changes in baseline predictors during the program had significant impacts on success. Reduction in stress between entry and a post weight-loss follow-up visit as measured by the Perceived Stress Scale were associated with improved weight loss (r = 0.159; P = .048). A similar trend was seen in depression as measured by the Personal Health Questionnaire—Depression Subscale (= 0.223; P = .035).
The researchers found no correlation between screen time (ie, computer or television screen time in the previous 7 days) and weight loss success. Session attendance correlated positively with weight loss success (= −0.621), as were exercise (r = −0.361) and food records (r = −0.501; all P < .001).
"[These] results suggest that clinicians and investigators might consider targeting sleep, depression and stress as part of a behavioral weight loss intervention," the study authors conclude.
This work was funded by the National Center for Complementary and Alternative Medicine, National Institutes of Health. The study authors have disclosed no relevant financial relationships.
Int J Obesity. Published online March 29, 2011. Abstract

http://www.medscape.org/viewarticle/740218?src=cmemp

regards, taniafdi ^_^

How Can I Get Enough Sleep During Med School?


Response from Graham Walker, MD 
Resident, Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY



Sleeping well -- or at least enough -- is a challenge for medical students and even for physicians long after they've finished a grueling residency. If it's not the long hours, it's a late call in the middle of the night or the tossing and turning while you worry about a patient you saw on the previous day. At the same time, not sleeping well sets you up for a rotten next day filled with brain fog and the mistitration of caffeine. One of the most frustrating things is knowing that you need to sleep but feeling wide awake. What are we to do?
Ask any sleep specialist and they'll tell you that it all begins with good "sleep hygiene." That term refers to the behavioral and environmental factors that precede sleep and that may interfere with sleep. To improve your sleep hygiene:
  • Avoid stimulants and depressants starting 6 hours before your bedtime (some would even say after noon). The goal is to prime your body to be appropriately tired at just the right time.
  • Don't take naps. As great as they feel, they're going to mess up your sleep cycle.
  • Don't study or do anything else in bed besides sleep. This helps train your body so that your bed is the place where you sleep, and getting in bed means "time to get sleepy."
  • Dark, quiet, and cool conditions are most conducive to falling and staying asleep.
You can find more recommendations at the University of Maryland's Sleep Disorders Center Website.
So that's how to fall asleep, but how can you fit it into the demanding lifestyle of a medical student?
Like everything, it's all about balance. When you hear people talking about having a balanced life (social life, academic life, work life, family life), they never mention their sleep lives. You get 24 hours in a day to do with as you please, but sleep affects your ability and motivation to do what you want in other parts of the day. Sure, you can be the all-star in rotations and studying and still have a social life, but if you're sleeping 1 hour a night you will fall asleep in lectures, overdose on coffee, and feel cranky all day long. Making sleep a priority is vital to performing well in life. (Think of it this way: If you're getting a good night's sleep, you'll be energized the next day and less sluggish. You could potentially get more done because you're efficient.)
When it's late and I'm studying, I try to recognize my own limitations and the law of diminishing returns: You can only cram so much into your head in one evening. The later it gets, the less able you are to concentrate, analyze, and store the information that you so desperately want. Do you ever find yourself staring at a page trying to read but finding your mind constantly wandering? Alert! Alert! It's tired! Sleep helps you consolidate and lock in facts that you've been learning all day. If you don't sleep, what's the point of all that studying?
That said, even the most dedicated people have times when they simply have to cram. Try this method next time: Study until you start to recognize those diminishing returns, and then throw down a bookmark and go to sleep. Set your alarm for a couple of hours earlier than when you'd normally get up. You'll be surprised how much easier it is to study at 4:00 AM with some sleep under your belt than it is to wade through information at the end of a long day.
Finding the right way to sleep -- and knowing what your own body needs -- is absolutely critical to your success as a physician. Experiment with different approaches, and once you find what works for you, commit to it. You will be happier, healthier, and better able to cram that last bit of knowledge into your head to do your best in medical school, residency, and your career.
Now if you'll excuse me, it's time for a nap.

regards, taniafdi ^_^

Is It Okay to Take a Break From Medical School?


Response from Daniel J. Egan, MD 
Associate Residency Director, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY



This question is a bit of a challenge to answer. The most important consideration among those who will be reading your application to residency in a couple of years will likely be why? As you can imagine, there are reasons for taking a year off from medical school that some would consider good, and others that some would consider bad.
My global answer to your question is that a year off in most situations will not work against you or your future application. However, this advice comes with the disclaimer that an objective is in place, and that you'll have some sort of product to show for your time (eg, research publications, advanced degree).
I have to insert something here for those who might be reading this and thinking about time off for your mental health or overall well being. I want to make it clear that I think balance and well being are critical to your ability to take care of other people. I routinely tell residents who come to me with problems that in order for you to provide care to others, you have to make sure that you are taking care of yourself.
If you are taking time off, I would advocate that you do this in consultation with an administrator or dean at your school. Any interruptions in your training will become part of your application for residency later, and you will need to explain what happened. Most residency directors understand that some interruptions in school are unavoidable, but you want to avoid being the "red flag" applicant, especially in those specialties that are highly competitive, and those who are reading the applications are forced to try and find any reason to weed someone out of the huge numbers.
With that out of the way, I think there are many reasons to consider time off from school. Remember, this time off does not always come with funding and make sure that you have evaluated that situation as the accumulation of debt can become all too easy.
Having just completed an interview season, I can tell you that there are many students who have chosen to extend medical school for the pursuit of other interests. In many cases, this includes a second degree (eg, MPH, tropical medicine, MBA), which enhances the overall package of their applications. In other cases, students wanted to have a more prolonged international experience than the typical 1-month interval scheduled for an elective. Some students recognize that perhaps their grades are not at the top of their class, and they really desire a career in a very competitive specialty. A year of research in that field leading to abstracts, presentations, and hopefully publications may show commitment to the specialty and sacrifice to become more highly qualified (at least on paper). I would argue that most program directors reading an application filled with any of the above items would be impressed. The experience may help you stand out among a group of peers who are also very successful and accomplished.
In summary, time off from medical school should include a meaningful experience. However, I strongly advise you to carefully discuss your situation with your student affairs office to make sure that you continue to meet your graduation requirements and to have their support.

regards, taniafdi ^_^

5/7/11

Journals


Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care.



Hypoxia and Inflammation.



regards, taniafdi ^_^

Zinc Within 24 Hours of Symptom Onset May Be Helpful for Common Cold

News Author: Laurie Barclay, MD
CME Author: Hien T. Nghiem, MD

CME/CE Released: 02/23/2011; Valid for credit through 02/23/2012

February 23, 2011 — When given within 24 hours of onset of symptoms, zinc reduces the duration and severity of the common cold in healthy people, according to the results of a Cochrane systematic review reported online February 16 in the Cochrane Database of Systematic Reviews.

"This review strengthens the evidence for zinc as a treatment for the common cold," said lead author Dr. Meenu Singh, from the Post Graduate Institute of Medical Education and Research in Chandigarh, India, in a news release. "However, at the moment, it is still difficult to make a general recommendation, because we do not know very much about the optimum dose, formulation or length of treatment."
To evaluate the effect of zinc on common cold symptoms, the reviewers searched CENTRAL (2010, Issue 2), which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to May week 3, 2010), and EMBASE (1974 to June 2010). Inclusion criteria were randomized, double-blind, placebo-controlled trials in which zinc was used for 5 or more consecutive days to treat the common cold, or for 5 or months or longer for prevention. Data were independently extracted and trial quality examined by 2 reviewers.
The search identified 13 therapeutic trials enrolling a total of 966 participants, and 2 preventive trials enrolling a total of 394 participants, that met selection criteria. Zinc intake was associated with a significant decrease in duration of common cold symptoms (standardized mean difference [SMD], −0.97; 95% confidence interval [CI], −1.56 to −0.38; P = .001), as well as in severity (SMD, −0.39; 95% CI, −0.77 to −0.02; P = .04).
The proportion of participants symptomatic after 7 days of treatment was lower in the zinc group vs the control group (odds ratio [OR], 0.45; 95% CI, 0.2 - 1.00; P = .05). The zinc group also fared better than the control group in incidence rate ratio (IRR) for development of a cold (IRR, 0.64; 95% CI, 0.47 - 0.88; P = .006), school absence (P = .0003), and prescription of antibiotics (P < .00001).
However, overall adverse events were higher in the zinc group (OR, 1.59; 95% CI, 0.97 - 2.58; P = .06), as were bad taste (OR, 2.64; 95% CI, 1.91 - 3.64; P < .00001) and nausea (OR, 2.15; 95% CI, 1.44 - 3.23; P = .002).
"Our review only looked at zinc supplementation in healthy people," Dr. Singh said. "But it would be interesting to find out whether zinc supplementation could help asthmatics, whose asthma symptoms tend to get worse when they catch a cold."
Limitations of this review also include those inherent in the individual studies, such as placebo-blinding adequately described in only 6 trials, and allocation concealment unclear in 5 studies.
"[U]nlike trials relying on experimentally-induced rhinoviral colds, findings from large community-based trials will address issues relating to the diversity of and generalisability to the common cold," the review authors conclude. "In addition, given its toxicological profile, the potential for zinc to induce adverse effects at the doses participants are required to take also needs to be determined."
The study authors have disclosed no relevant financial relationships.
Cochrane Database Syst Rev. Published online February 16, 2011. Abstract
regards, taniafdi ^_^

Maternal Fructose Intake Impacts Female and Male Fetuses Differently

Study finds maternal fructose consumption may also effect placental development
Newswise — Chevy Chase, MD—A recent study accepted for publication in Endocrinology, a publication of The Endocrine Society, reports for the first time that maternal fructose intake during pregnancy results in sex-specific changes in fetal and neonatal endocrinology.
Fructose is a simple sugar found naturally in honey, fruit and some vegetables. Diets high in dietary fructose, particularly due to calorically sweetened beverages, are now increasingly common and have been shown to be detrimental to the regulation of energy intake and body adiposity. With the increasing prevalence of maternal obesity and its association with gestational diabetes, there has been growing interest in maternal nutrition on the risk of childhood and adult disease in the offspring.
“There has been a marked increase in the consumption of fructose-sweetened beverages and foods, particularly among women of reproductive age,” said Mark Vickers PhD, of the University of Auckland in New Zealand and lead author of the study.“ This is the first time that it has been suggested that female and male fetuses react differently to maternal fructose consumption, and that these sex-specific changes may be associated in changes in placental development.”
In this study, researchers examined female Wistar rats that were time-mated and allocated to receive either water or a fructose solution designed to provide 20 percent of caloric intake from fructose. Only female fetuses in the fructose-fed rats had higher leptin, fructose and blood glucose levels than their control counterparts. Male and female offspring of fructose-fed rats both showed higher plasma fructose levels and were hypoinsulinemic. Researchers also found that the placenta of female fetuses in the fructose-fed rats were lighter than the female fetuses in the control group.
“Further studies are now critical to establish the long-term effects of maternal fructose intake on the health and well-being of offspring and whether this study’s observed sex differences elicit different risk profiles for metabolic disease into the post-weaning period,” said Deborah Sloboda, PhD, also of the University of Auckland and co-author of the study. Dr Vickers is currently conducting a follow-up study in rats.
Other researchers working on the study include: Z.E. Clayton and C. Yap of the Liggins Institute and the National Research Centre for Growth and Development, University of Auckland in New Zealand.
The article, “Maternal fructose intake during pregnancy and lactation alters placental growth and leads to sex-specific changes in fetal and neonatal endocrine function,” appears in the April 2011 issue of Endocrinology
Founded in 1916, The Endocrine Society is the world’s oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, The Endocrine Society’s membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 100 countries. Society members represent all basic, applied and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Maryland. To learn more about the Society and the field of endocrinology, visit our site at www.endo-society.org.


regards, taniafdi ^_^

Sleep, Depression, and Stress Influence Weight Loss

News Author: Jim Kling
CME Author: Désirée Lie, MD, MSEd
CME Released: 04/05/2011; Valid for credit through 04/05/2012


April 5, 2011 — A new study suggests that sleep, depression, and stress are key components of an interventional weight loss program. The study was published online March 29 in the International Journal of Obesity.
The current US obesity epidemic is believed to have a number of contributing elements, including genetic, environmental, and lifestyle factors, such as disordered sleep patterns. Multiple studies have demonstrated an inverse association between sleep duration and weight gain.
To better understand the effects of sleep, screen time, depression and stress on weight loss success, the researchers, led by Dr. Charles Elder of the Kaiser Permanente Center for Health Research, Portland, Oregon, conducted a 2-phase randomized clinical trial. Phase 1 included a nonrandomized, 6-month behavioral weight loss intervention that included 472 adults with obesity (body mass index, 30 - 50 kg/m2). Phase 2 incorporated weight loss maintenance. The current study focuses on phase I results.
The phase 1 intervention included 22 group sessions, led by a behavioral counselor, during the course of 26 weeks. Participants were given recommendations to reduce food consumption by 500 calories per day, adopt the Dietary Approaches to Stop Hypertension pattern, and participate in at least 180 minutes of exercise per week.
Mean weight loss during phase 1 was 6.3 ± 7.1 kg, and 285 participants (60%) who lost a minimum of 4.5 kg were randomly selected into phase 2. Participants attended an average of 73.1% ± 26.7% of sessions. They filled out 5.1 ± 1.9 daily food records per week and reported 195.1 ± 123.1 minutes of exercise per week.
Stress and sleep time were revealed to be important factors in qualifying for phase 2. A 1-point change in the Perceived Stress Scale had an associated odds ratio of 0.966 (increased success associated with less weight loss, 95% confidence interval, 0.937 - 0.995; P = .024). Participants with a quadratic trend in sleep time had an odds ratio of 0.797 (95% confidence interval, 0.649 - 0.978; P = .030). Participants who slept 6 to 7 hours or 7 to 8 hours were more likely to qualify for phase 2 than those with other sleep times.
At entry into the program, lower stress was associated with greater ensuing weight loss (slope, 0.132; SE, 0.054;t = 2.42; P = .021).
Changes in baseline predictors during the program had significant impacts on success. Reduction in stress between entry and a post weight-loss follow-up visit as measured by the Perceived Stress Scale were associated with improved weight loss (r = 0.159; P = .048). A similar trend was seen in depression as measured by the Personal Health Questionnaire—Depression Subscale (= 0.223; P = .035).
The researchers found no correlation between screen time (ie, computer or television screen time in the previous 7 days) and weight loss success. Session attendance correlated positively with weight loss success (= −0.621), as were exercise (r = −0.361) and food records (r = −0.501; all P < .001).
"[These] results suggest that clinicians and investigators might consider targeting sleep, depression and stress as part of a behavioral weight loss intervention," the study authors conclude.
This work was funded by the National Center for Complementary and Alternative Medicine, National Institutes of Health. The study authors have disclosed no relevant financial relationships.
Int J Obesity. Published online March 29, 2011. Abstract

http://www.medscape.org/viewarticle/740218?src=cmemp

regards, taniafdi ^_^

How Can I Get Enough Sleep During Med School?


Response from Graham Walker, MD 
Resident, Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY



Sleeping well -- or at least enough -- is a challenge for medical students and even for physicians long after they've finished a grueling residency. If it's not the long hours, it's a late call in the middle of the night or the tossing and turning while you worry about a patient you saw on the previous day. At the same time, not sleeping well sets you up for a rotten next day filled with brain fog and the mistitration of caffeine. One of the most frustrating things is knowing that you need to sleep but feeling wide awake. What are we to do?
Ask any sleep specialist and they'll tell you that it all begins with good "sleep hygiene." That term refers to the behavioral and environmental factors that precede sleep and that may interfere with sleep. To improve your sleep hygiene:
  • Avoid stimulants and depressants starting 6 hours before your bedtime (some would even say after noon). The goal is to prime your body to be appropriately tired at just the right time.
  • Don't take naps. As great as they feel, they're going to mess up your sleep cycle.
  • Don't study or do anything else in bed besides sleep. This helps train your body so that your bed is the place where you sleep, and getting in bed means "time to get sleepy."
  • Dark, quiet, and cool conditions are most conducive to falling and staying asleep.
You can find more recommendations at the University of Maryland's Sleep Disorders Center Website.
So that's how to fall asleep, but how can you fit it into the demanding lifestyle of a medical student?
Like everything, it's all about balance. When you hear people talking about having a balanced life (social life, academic life, work life, family life), they never mention their sleep lives. You get 24 hours in a day to do with as you please, but sleep affects your ability and motivation to do what you want in other parts of the day. Sure, you can be the all-star in rotations and studying and still have a social life, but if you're sleeping 1 hour a night you will fall asleep in lectures, overdose on coffee, and feel cranky all day long. Making sleep a priority is vital to performing well in life. (Think of it this way: If you're getting a good night's sleep, you'll be energized the next day and less sluggish. You could potentially get more done because you're efficient.)
When it's late and I'm studying, I try to recognize my own limitations and the law of diminishing returns: You can only cram so much into your head in one evening. The later it gets, the less able you are to concentrate, analyze, and store the information that you so desperately want. Do you ever find yourself staring at a page trying to read but finding your mind constantly wandering? Alert! Alert! It's tired! Sleep helps you consolidate and lock in facts that you've been learning all day. If you don't sleep, what's the point of all that studying?
That said, even the most dedicated people have times when they simply have to cram. Try this method next time: Study until you start to recognize those diminishing returns, and then throw down a bookmark and go to sleep. Set your alarm for a couple of hours earlier than when you'd normally get up. You'll be surprised how much easier it is to study at 4:00 AM with some sleep under your belt than it is to wade through information at the end of a long day.
Finding the right way to sleep -- and knowing what your own body needs -- is absolutely critical to your success as a physician. Experiment with different approaches, and once you find what works for you, commit to it. You will be happier, healthier, and better able to cram that last bit of knowledge into your head to do your best in medical school, residency, and your career.
Now if you'll excuse me, it's time for a nap.

regards, taniafdi ^_^

Is It Okay to Take a Break From Medical School?


Response from Daniel J. Egan, MD 
Associate Residency Director, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY



This question is a bit of a challenge to answer. The most important consideration among those who will be reading your application to residency in a couple of years will likely be why? As you can imagine, there are reasons for taking a year off from medical school that some would consider good, and others that some would consider bad.
My global answer to your question is that a year off in most situations will not work against you or your future application. However, this advice comes with the disclaimer that an objective is in place, and that you'll have some sort of product to show for your time (eg, research publications, advanced degree).
I have to insert something here for those who might be reading this and thinking about time off for your mental health or overall well being. I want to make it clear that I think balance and well being are critical to your ability to take care of other people. I routinely tell residents who come to me with problems that in order for you to provide care to others, you have to make sure that you are taking care of yourself.
If you are taking time off, I would advocate that you do this in consultation with an administrator or dean at your school. Any interruptions in your training will become part of your application for residency later, and you will need to explain what happened. Most residency directors understand that some interruptions in school are unavoidable, but you want to avoid being the "red flag" applicant, especially in those specialties that are highly competitive, and those who are reading the applications are forced to try and find any reason to weed someone out of the huge numbers.
With that out of the way, I think there are many reasons to consider time off from school. Remember, this time off does not always come with funding and make sure that you have evaluated that situation as the accumulation of debt can become all too easy.
Having just completed an interview season, I can tell you that there are many students who have chosen to extend medical school for the pursuit of other interests. In many cases, this includes a second degree (eg, MPH, tropical medicine, MBA), which enhances the overall package of their applications. In other cases, students wanted to have a more prolonged international experience than the typical 1-month interval scheduled for an elective. Some students recognize that perhaps their grades are not at the top of their class, and they really desire a career in a very competitive specialty. A year of research in that field leading to abstracts, presentations, and hopefully publications may show commitment to the specialty and sacrifice to become more highly qualified (at least on paper). I would argue that most program directors reading an application filled with any of the above items would be impressed. The experience may help you stand out among a group of peers who are also very successful and accomplished.
In summary, time off from medical school should include a meaningful experience. However, I strongly advise you to carefully discuss your situation with your student affairs office to make sure that you continue to meet your graduation requirements and to have their support.

regards, taniafdi ^_^