Bukan Permen Biasaaa... :P

regards, taniafdi ^_^

Words of Advice for Final Year Students.

 by

Eric Tam, Medical Student, Surgery, General, 02:08PM Feb 20, 2010

5th Year Medical Student, The Chinese University of Hong Kong

As our graduation is getting closer, professors and doctors who have taught us frequently share lessons learnt from their past experiences and highlight certain things we should avoid as junior doctors. So today I am going to share some of the words of advice with you:

 

1. "Medicine is showbiz"

Terrible as it sounds, there is some truth in it. The point my professor was trying to make was: It is not enough to be nice. It is more important to act nice. It is easy to ignore or act briskly with a patient when ten tasks await you. You have to actually show that you care about the patient and make it obvious to the patient, the patient's family, nurses and your colleagues. This does not mean that we have to be hypocritical, but that it is important to both be nice and act nice. Our professor told us there was once a bystander who filed a complaint because he witnessed that a doctor did not attend to a patient and thought that the doctor was non-caring. However, the bystander does not know the patient at all.

2. There is a higher calling for doctors

Our tutor asked if anyone in my group took the swine flu vaccine. He reminded those of us who have not taken the vaccine that as a responsible medical professional we should minimize our chances of spreading infections to our patients. He said that as doctors "we have a higher calling" and should bear that extra responsibility and risk for the benefits of our patients. Other examples would be vigorous hand hygiene and also just simply keep doing your job in times of crises. For example, Hong Kong was hit hard by SARS in 2003 and many health professionals contracted the SARS virus while caring for their patients. A small number of them even sacrificed their lives.

3. Spotting Simons

During our plastic surgery rotation, our professor introduced us to a hypothetical patient, Simon. Simon stands for "Single, Immature, Male, Overly-Expectant and Narcissistic". These characteristics were intended to describe the difficult patients undergoing cosmetic surgery who are more likely to be dissatisfied with surgical outcomes. The good patient for plastic surgery on the other hand is Sylvia and it stands for "Secure, Young, Listens, Verbal, Intelligent, Attractive" These two concepts were introduced by Professor Mark Gorney who worked in Stanford some years ago and mostly represent personal experiences rather any scientific criteria. The more important lesson here, however, is that you will encounter difficult patients whichever specialty you choose. Trust your instincts and don't promise things you cannot deliver just to make your patient happy. There may be medical-legal consequences which you cannot handle.

4. Seek senior doctors when appropriate

The professor who made point no.1 also warned us to seek senior doctors (or refer) when necessary. She quoted a story which made its way to the front pages of newspapers in Hong Kong. There was an A&E junior doctor who suggested to the family of a patient who had uncontrollable bleeding that they have to pay for Novoseven (recombinant factor VII) because it was a new drug and not provided freely under the government hospitals. Although the drug was not really that expensive and the family could afford it, the family was furious that the doctor even dared to talk about money in such life-threatening situation. The doctor did nothing wrong, followed protocols, but he should have consulted his seniors and let them handle such a sensitive issue. 

I hope you find the above advices useful and please share some of your own!

source : click here

regards, taniafdi ^_^

Journal of The Day 2.

1. Lasofoxifene in Postmenopausal Women with Osteoporosis.

2. Permethrin and Ivermectin for Scabies.

regards, taniafdi ^_^

Journal of The Day.

1. Newborn-Care Training and Perinatal Mortality in Developing Countries.

2. Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease.

regards, taniafdi ^_^

How Should I Rank Residency Choices for the Match?

Location. This is not insignificant. There are many glamorous cities in the country, but not every city is made for every person. Do you know anyone in the city that you are considering? Will you have any kind of support system outside of the hospital? You will immediately establish lifelong friendships during residency, and there is something exciting about starting over in a new place. But everyone has a different personality, and some people find it easier if a network already exists during a very challenging time.

Housing and salary. Is housing provided? If not, will the program's salary allow you to rent an apartment and still have money left over for your usual expenses? (See our previous columns on the accrual of credit card debt and how this should be avoided at all costs!)

Are the residents happy? You will hear rumors along the interview trail. Pay attention. Obviously, rumors are rumors, but hearing that residents in a particular program are very happy is an important piece of information.

Do you know any graduates from your medical school who are there? We all have a loyalty to our school. We want the best for students from our school. Often, these residents will be fantastic resources as you try to get real, honest information.

What is the academic vigor of the program? If you have a long-term goal related to academics, you want a program that will help foster that. If faculty members are not doing research and publishing, it may be more difficult for you to find a mentor. What are the daily or weekly conferences like? What are the academic requirements of the residents?

Teaching environment. With shorter work hours and increased patient volumes affecting all programs, many residents feel that the clinical teaching suffers. Ask about bedside teaching. The accrediting agency mandates a core content of lectures and conferences, but it is really the day-to-day operations that help you develop your clinical skills. You may best experience this with a second look. Show up on a noninterview day. See how the residents interact with each other and their attending staff.

regards, taniafdi ^_^

Management of Acute Poisoning From Medication Ingestion Reviewed.

 February 8, 2010 — Family physicians should be familiar with treatment of accidental and intentional medication ingestions, according to a review of the management of acute poisoning caused by medication ingestion published in the February 1 issue of American Family Physician.

"Poisoning from medications can happen for a variety of reasons, including intentional overdose, inadvertently taking an extra dose, dispensing or measuring errors, and exposure through breast milk," write Ivar L. Frithsen, MD, and William M. Simpson, Jr, MD, from Medical University of South Carolina in Charleston.

"The most common medication poisonings in adults (in order of prevalence) include analgesics; sedatives, hypnotics, and antipsychotics; antidepressants; cardiovascular drugs; anticonvulsants; antihistamines; hormones and hormone antagonists; antimicrobials; stimulants and illicit drugs; cough and cold preparations; muscle relaxants; topical preparations; gastrointestinal preparations; and miscellaneous drugs," Drs. Frithsen and Simpson write. "The most common medication poisonings in children (in order of prevalence) include analgesics; topical preparations; cough and cold preparations; vitamins; antihistamines; gastrointestinal preparations; antimicrobials; hormones and hormone antagonists; electrolytes and minerals; cardiovascular drugs; dietary supplements, herbal medications, and homeopathic medications; asthma therapies; antidepressants; and sedatives, hypnotics, and antipsychotics."

In the United States, several million episodes of poisoning are reported each year, causing significant morbidity and mortality rates. Nearly one half of all poisonings reported in the United States are attributed to acute medication poisonings, which should be considered in patients with an acute change in mental status.

Steps in Treatment of Poisoning

The first steps in treatment of a patient who has been poisoned are to evaluate the airway, breathing, and circulation, and to perform a complete history. Poisoning with drugs from certain classes, notably anticholinergics, cholinergics, opioids, and sympathomimetics, are associated with constellations of symptoms known as toxidromes. For example, anticholinergic poisoning is associated with delirium; hyperthermia; ileus; mydriasis; tachycardia; urinary retention; and warm and dry skin.

For identification of electrolyte imbalances and/or impairment of liver and renal function, basic laboratory studies, such as a complete metabolic profile, are an important part of the workup for possible medication poisonings. Clinical presentation and history should help determine what other laboratory studies are indicated.

Unless a specific antidote is available, management is supportive in most cases, because less than 1% of poisonings are fatal. Although single-dose activated charcoal is the preferred modality of gastrointestinal tract decontamination, it should not be used in all patients. The review includes specific therapies for acute medication poisoning based on the type of drug ingested.

For unstable patients who have ingested toxic medications, ongoing treatment should aim to correct hypoxia and acidosis and to maintain adequate circulation. Even when these patients appear to be compensating, their mental or hemodynamic status may deteriorate rapidly. Children are particularly susceptible to profound effects from even small amounts of medication.

Multiple factors, including pharmacokinetics of the ingested substance and the ability to be monitored in the home environment, must be considered in the disposition of a person who has been poisoned. Longer monitoring is required for patients with signs or symptoms of toxicity. For patients who have attempted suicide, psychiatric evaluation and often psychiatric hospitalization are indicated. Counseling referral is recommended for patients with evidence of substance abuse.

Am Fam Physician. 2010;81:316-323.

  

regards, taniafdi ^_^

K A R M A P L U R K

•  Kenapa nieh karma ga naek2 secara progressive...., susah amat..., "ditendang" dikit keatas apa ya..?
• koq bisa ada mila???? apa cursornya yah...(sigh.....)

regards, taniafdi ^_^

Yudisium 01022010

Hwaaa...., senangnya...,  thanks ALLAH SWT.

Akhirnya Alhamdulillah..., semoga jd dr. yang berguna bagi nusa bangsa n agama.'N sukses dunia akhirat..., amien3x ya RABBal'alamien.

This picture : me n my beloved sister...

regards, taniafdi ^_^

Lactobacillus Improves Helicobacter Pylori Infected Gastritis

Helicobacter pylori (H. pylori) are considered to be the most important etiological agents of chronic gastritis. The eradication of H. pylori depends on the combination of antibiotics and acid suppression drugs. Unfortunately, the side effects of antibiotics reduce the curative effect and treatment compliance. Probiotics provides an alternative method which can inhibit H. pylori infection efficiently without antibiotics associated side effects.

A research team from China investigated the potential anti-H. pylori and anti-inflammation in vivo effects of two lactobacillus strains from human stomach. Their study was published in the World Journal of Gastroenterology.

Their results illustrated that both lactobacillus strain Lactobacillus fermenti (L. fermenti) and Lactobacillus acidophilus (L. acidophilus), showed significant anti-H. pylori activity, while strain L. fermenti displayed more efficient antagonistic activity in vivo whose efficacy is close to the standard triple therapy, thus significantly improving the H. pylori-associated Balb/c gastritis.

Their study provided a new clue for the therapy of H. pylori associated diseases, which could be prevented and treated by regulating the balance of flora in stomach. Thus lactobacillus can be a choice to replace antibiotics or as an adjuvant to antibiotics in treating H. pylori-infected diseases.

Reference:

Cui Y, Wang CL, Liu XW, Wang XH, Chen LL, Zhao X, Fu N, Lu FG. Two stomach-originated lactobacillus strains improve Helicobacter pylori infected murine gastritis. World J Gastroenterol 2010; 16(4): 445-452 http://www.wjgnet.com/1007-9327/16/445.asp

Source:

Ye-Ru Wang

World Journal of Gastroenterology

regards, taniafdi ^_^

What Should I Do If I Witness a Medical Error?

Medical errors are prevalent, often times preventable, and are the responsibility of each and every member of the healthcare team. Even as a medical student, you have a duty to protect your patients and keep them safe. Witnessing a physician make an error puts you in an awkward position, but the more you feel empowered to protect your patient, the easier it will be to speak up.

As reported in the landmark paper, "To Err is Human," between 44,000 and 98,000 deaths per year are due to medical errors.[1] Many of these errors are preventable. Do not underestimate your role as part of your patient's safety net. You can help prevent these errors and also help disclose them when they happen.

In a recent article by 3 medical students, 1 student explains how she helped intercept a potential error when a patient was improperly prepped for surgery.[2] She spoke up, not once but twice, so that the patient could be re-prepped. Even within the medical hierarchy, your communication is important. In that moment, she put the patient first and helped avoid a potentially harmful error.

When medical errors occur, it is our duty to disclose them. Truthful disclosure is good for patients. Recent evidence shows us that most patients actually prefer to know about medical errors that have happened to them. Furthermore, surveyed patients said they would be less likely to sue if they were informed of the error by the attending physician.[3]

So now that you feel empowered to prevent and help disclose medical errors, how do you do so? The easiest way is to be direct and honest in a respectful manner. You are never wrong if you put the patient first. Remember that you are a part of a team.

Get the facts in a nonjudgmental way. Was this a medical error due to equipment or dispensing of medication? Medical students are still in the role of the learner. It never hurts to say something like, "this may be a ridiculous question but..." or "I may be mistaken, but..." This is a respectful way to ask what is right for the patient and oftentimes, once the error is identified, both you and the attending physician can then respond and inform the patient together.

Be a team member. You may feel compelled to "tell" on the attending physician or resident who committed the error, but this will not only undermine your relationship with the patient, it will also create distrust and lack of confidence within the whole medical team. As part of the team, your goal is to work with the attending physician to disclose to the patient or to make the error right. One way is to respect the authority of the attending physician by asking for their assistance. This can help deflect possible defensiveness that may arise. For example, you might say, "I spoke with Mrs. Jones and she is very concerned about X. I would like your help discussing it with her." If that does not work, then approach your resident. Again, put the patient first as in, "I was concerned about our patient when I saw Y. I'd like to talk to the attending physician, will you join me?"

Remember that the attending physician has the ultimate responsibility. If an error is made, it is his or her job to disclose the error to the patient. You may help protect your patient by asking the attending physician to disclose, but it is not your job to do it alone. If you are having difficulty, ask for a second opinion from a trusted faculty member or an ethics committee member.

I encourage you to read a series of medical student essays on this topic from JAMA.[4] In 1 excellent essay, Courtney J. Wusthoff beautifully summarizes the role of the medical student in an error situation[5]:

In determining a course of action, the medical student must consider duties to the patient, physician, and him- or herself. It is inappropriate for the student to unilaterally disclose the error, yet the student must not allow the patient to be deceived.

Medical errors will happen, and when they do, we must maintain our duty to the patient. Even though we all make mistakes, most of us want to do the right thing. In these situations, the right thing is to put your patient first and act in an ethical and respectful way.

References

1. Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system. Washington, DC: Institute of Medicine, National Academy Press, 2000.
2. Seiden SC, Galvan C, Lamm R. Role of medical students in preventing patient harm and enhancing patient safety. Qual Saf Health Care. 2006;15:272-276. Abstract
3. Witman AB, Park DM, Hardin SB. How do patients want physicians to handle mistakes? Arch Intern Med. 1996;156:2565-2569.
4. John Conley Ethics Essay Contest for Medical Students. Available at jama.ama-assn.org/cgi/reprint/286/9/1083.pdf. Accessed October 30, 2008.
5. Rajendran PR. Ethical issues involved in disclosing medical errors. JAMA. 2001;286:1080-1081. Abstract

source : http://www.medscape.com/viewarticle/582861

regards, taniafdi ^_^

Patients Happier When Doctors Discuss What Went Wrong

NEW YORK (Reuters Health) Nov 19 - Hospital patients who suffer a side effect from treatment are more likely to give high ratings to their quality of care when hospital staff are up front about what went wrong, a new study suggests.

In a survey of nearly 2,300 patients treated at 16 Massachusetts hospitals, researchers found that 603 had some sort of "adverse event" -- most often side effects from a newly prescribed drug or complications from surgery -- during their hospitalization.

When asked whether hospital staff had explained the problem to them, only 40% of patients said they had.

Yet, when staff did discuss the problem, patients were more likely to be happy with their care -- even when the adverse effect was a preventable one, the study found.

"Our findings show that disclosure is associated with patients' perception of higher-quality care, even when they were harmed by an adverse event," lead researcher Dr. Lenny Lopez, of Massachusetts General Hospital in Boston, said in a statement.

"We believe this is the first study to address how disclosure affects the quality-of-care impression in patients who actually were harmed during the course of their treatment and may reassure physicians and others who worry about the consequences of disclosure," he added.

Using hospital records and patient interviews, the researchers found that almost one-third of adverse events in the study were preventable -- being related to errors such as giving the wrong dose of medication.

Hospital staff were less likely to discuss preventable adverse events with patients compared with ones that could not be avoided -- such as an unforeseeable reaction to a new drug. When patients suffered a preventable adverse event, staff explained the problem to them only 30% of the time, Lopez's team found.

Yet, patients tended to give their care higher quality ratings when a problem was explained to them, even when the complication was preventable.

On average, study patients rated their hospital care as "very good." But patients who'd discussed their adverse event with hospital staff were twice as likely to give high ratings as those who been given no explanation.

"It's quite notable that high-quality ratings continued to be associated with disclosure even when the event was determined to be preventable," Dr. Lopez said.

The findings, according to Lopez, suggest that hospitals should not be afraid to disclose the reasons for patients' adverse events, even if they did arise from error.

"Although rates of disclosure remain disappointingly low," he said, "our findings should encourage more disclosure and allay fears of malpractice lawsuits."

"Patients want to be told the truth," Dr. Lopez added, "and they perceive disclosure as integral to high-quality medical care."

Dr. Lopez and his colleagues report their findings in the Archives of Internal Medicine.

In a separate study published in the same journal, researchers focused on diagnostic errors by physicians. They found that among 300 doctors at 22 U.S. hospitals, the most commonly missed or delayed diagnoses were pulmonary embolism, drug reactions and overdoses, heart attacks and lung, colon and breast cancers.

On average, the doctors described committing or witnessing two such errors in their careers. "Actively soliciting such cases represents an opportunity for tapping into a hidden cache of medical errors that are not generally collected by existing error surveillance and reporting systems," the authors write.

Arch Intern Med 2009.

Source : http://www.medscape.com/viewarticle/712799

regards, taniafdi ^_^

Berapa kali sebaiknya pemeriksaan kadar gula darah dilakukan ?

The American Association of Diabetes Educators merekomendasikan kepada seluruh pasien untuk melakukan pemeriksaan kadar gula darahnya, terutama pada pasien yang menjalani terapi diabetes secara oral dan pemakaian insulin.(1). The American Diabetes Association merekomendasikan pemeriksaan kadar gula darah pada pasien Diabetes tipe 2, yang menjalani injeksi insulin, minimal 3 kali sehari, namun mereka juga berpesan bahwa frekuensi optimum dari pemeriksaan/pemonitoran kadar gula darah sendiri, tidak cukup baik pada pasien yang menjalani terapi obat-obatan oral atau injeksi insulin.(2). Yang lainnya berpendapat bahwa pasien yang menjalani terapi insulin sebaiknya melakukan pemeriksaan sendiri (self-monitor) kadar gula darah minimal 4 kali sehari, sebelum makan dan sebelum tidur, dan pasien dengan Diabetes tipe 2 sebaiknya memeriksa kadar gula darahnya minimal 4 kali seminggu (2 kali gula darah puasa dan 2 kali setelah makan.(3)

Referensi :

1. Austin MM, Haas L, Johnson T, et al; American Association of Diabetes Educators. AADE position statement. Self-monitoring of blood glucose: benefits and utilization. Diabetes Educ. 2006;32:835-836, 844-847.

2. American Diabetes Association. Standards of medical care in diabetes--2009. Diabetes Care. 2009;32(suppl 1):S13-S61.

3. Benjamin EM. Self-monitoring of blood glucose: the basics. Clin Diabetes. 2002;20:45-47.


regards, taniafdi ^_^

Apakah vitamin C efektif mengobati flu?

Fungsi Fisiologis vitamin C terkait dengan kekebalan (imunitas)

Pertama-tama, vitamin C terkonsentrasi terutama dalam sel darah putih tubuh kita. Diduga bahwa vitamin C memainkan peranan penting dalam kekbalan tubuh, tapi mekanisme masih dalam penelitian.

Berikut adalah fungsi fisiologis vitamin C terkait dengan imunitas:

1. Vitamin C membantu pembentukan protein yang disebut kolagen, yang dapat membawa sel-sel berkumpul bersama seperti lem. Hal ini terkait dengan memperkuat kulit dan membran mukosa, yang berperan dalam mencegah virus dan bakteri masuk ke dalam tubuh kita. Vitamin A juga memberikan fungsi yang sama, tapi mekanisme berbeda dengan vitamin C.

2. Mengurangi stress juga terkait erat dengan vitamin C. Meski mekanismenya belum diketahui dengan jelas, namun vitamin C memang memiliki efek mengurangi stress. Hal ini meningkatkan daya tahan tubuh.

3. Vitamin C adalah vitamin antioksidan yang mudah larut dalam air. Hal ini berarti mengurangi kelebihan radikal bebas dan oksigen aktif dalam tubuh kita. Vitamin E, yang larut dalam lemak, juga memberikan fungsi yang sama. Sebagai tambahan, ketika vitamin E kehilangan sifat antioksidannya bila teroksidasi, maka vitamin C mengurangi vitamin E yang teroksidasi sehingga bisa kembali menjadi vitamin E. Hal ini dianggap baik untuk kesehatan kita untuk mengkonsumsi kedua vitamin C dan E.

Diduga bahwa radikal bebas dan oksigen aktif adalah faktor utama yang menyebabkan inflamasi seperti dermatitis atopik. Banyak peneliti yang tertarik mempelajari hubungan antara alergi dan antioksidan seperti vitamin C. Ketika virus, seperti virus influenza, masuk ke dalam tubuh kita, sejumlah besar oksigen aktif dihasilkan dalam sel darah putih, yang mengoksidasi virus, dan menghancurkannya. Dilaporkan bahwa konsumsi vitamin C secara masif adalah untuk menghilangkan kelebihan oksigen aktif ini. Karenanya, bisa kita katakan bahwa vitamin C turut melindungi jaringan ormal dari kelebihan radikal bebas dan oksigen aktif.

4. Telah diamati bahwa faktor-faktor yang terkait dengan imunitas meningkat ketika vitamin C dikonsumsi secara terus menerus dalam jumlah 10 kali lebih banyak dari kebutuhan gizi kita. Hal ini khususnya pada orang lansia.

Apakah vitamin C efektif untuk influenza?

Kita sering mendengar bahwa sangat baik untuk mengkonsumsi vitamin C untuk perlindungan tubuh kita di awal musim hujan. Diduga, vitamin C memiliki pengaruh tertentu terhadap influenza, dan lebih baik lagi bila vitamin C dikonsumsi dengan pertimbangan sebagai keseimbangan gizi. Efek vitamin C mungkin akan lebih baik bila dikonsumsi bersama dengan vitamin lainnya daripada dikonsumsi tunggal, seperti telah disebutkan di atas.

Saya mengenali vitamin C dibutuhkan untuk menjaga kesehatan daripada untuk menyembuhkan penyakit tertentu. Vitamin C juga terlibat dalam detoksifikasi senyawa organik, seperti obat-obatan, polusi lingkungan, dan bahan tambahan makanan. Dalam kehidupan modern, kita terpapar dengan stres dan polusi lingkungan yang mempengaruhi kesehatan kita. Inilah alasan mengapa kebutuhan gizi yang direkomendasikan untuk vitamin C yang diizinkan untuk orang dewasa dinaikkan dari 50 mg menjadi 100 mg. Saya kira sangat penting untuk membiasakan mengkonsumsi vitamin C.

source (click here)

regards, taniafdi ^_^

Lampu dengan tenaga darah manusia

Bagaimana, jika setiap kali anda ingin menyalakan lampu, maka kita harus berdarah terlebih dahulu? Maka dengan demikian, kita akan berpikir dua kali sebelum menerangi ruangan tersebut, dan menggunakan energi yang ada!

Ide dibalik ‘lampu darah’ tersebut, ditemukan oleh Mike Thomspon, seorang designer Inggris yang tinggal di Belanda. Lampu tersebut mengandung Luminol, senyawa kimia yangdigunakan ilmu forensik untuk mendeteksi keberadaan darah pada Tempat kejadian perkara (TPK). Luminol bereaksi dengan besi (ferum) pada sel darah merah dan membuat terang berwarna biru. Untuk menggunakan lampu tersebut, kita harus mencampurnya didalam bubuk aktivasi. Kemudian, kaca tersebut dipecahkan, lalu teteskan darah ke dalam bubuk.

Thompson mendapatkan ide ini beberapa tahun yang lalu, ketika sedang studi master pada Akademi Design Eindhoven di Belanda. Dia melakukan penelitian mengenai energi kimia untuk proyek tersebut, dan mempelajari kegunaan luminol.

‘ Bahwa energi menjadi sesuatu yang mahal, hal tersebut selalu membayangin pikiran saya. Penelitian ini adalah cara supaya kita berpikir secara alternatif mengenai cara menggunakannya’, Kata Thompson. Lampu tersebut dimaksudkan untuk ‘menantang persepsi manusia mengenai asal usul dari sumber energi kita’, demikian kata dia. Hal ini akan memaksa pengguna untuk ‘ berpikir ulang mengenai betapa berharganya energi, dan betapa selama ini telah terjadi pemborosan energi.’

Fakta bahwa lampu tersebut hanya bisa sekali digunakan, menjadikannya semakin pantas untuk jadi bahan renungan.

‘Kita harus dapat memutuskan, kapan menggunakan lampu tersebut, sebab ia hanya bekerja sekali,’ Kata Thompson. ‘ Hal itu menyebabkan kita merasa sayang untuk melakukan pemborosan.’

Thompson mendesain dan memproduksi lampu tersebut pada 2007, dan membuat video proyek tersebut pada tahun ini.

Diterjemahkan dari LiveScience.com

source : http://netsains.com/2009/10/lampu-dengan-tenaga-darah-manusia/

regards, taniafdi ^_^

A Wii Fracture

In 1990, Brasington described "Nintendinitis"1 in a patient with pain over the extensor tendon of her thumb after 5 hours of playing a Nintendo video game. Nintendo next released the highly popular Wii games console that includes a wireless remote capable of detecting movement in three dimensions. Clinicians began to see patients with "Wiiitis."2 There do not seem to be reports of associated bony injuries, although interactive gaming has been reported to aid in the rehabilitation of patients after fracture.3

In the United Kingdom, a healthy 14-year-old girl presented to the emergency department at Horton General Hospital in Banbury (near Oxford), having sustained an injury to her right foot with associated difficulty in mobilization. She had been playing on her Wii Fit balance board and had fallen off, sustaining an inversion injury. (The Wii Fit replaces handheld controls with a pressure-sensitive board about 2 in. off the ground that lets the user participate in tricky games that can improve balance.)

On examination, there was soft-tissue swelling around the base of the fifth metatarsal, which was maximally tender to palpation. A radiograph showed a small fracture of the base of the fifth metatarsal. The patient was treated conservatively with the use of crutches and was referred to the fracture clinic for outpatient follow-up. The fracture probably resulted from the pull of the peroneus brevis muscle during inversion of the ankle.

Other reported Wii-associated injuries have included traumatic hemothorax (from a fall while playing),4 dislocations, and head injuries (from being struck accidentally by a gaming partner).5

References

1. Brasington R. Nintendinitis. N Engl J Med 1990;322:1473-1474.
2. Bonis J. Acute Wiiitis. N Engl J Med 2007;356:2431-2432.
3. Wii games help fracture patients regain movement. Nursing Times. May 16, 2009.
4. Peek AC, Ibrahim T, Abunasra H, Waller D, Natarajan R. White-out from a Wii: traumatic haemothorax sustained playing Nintendo Wii. Ann R Coll Surg Engl 2008;90:9-10.
5. Wells JJ. An 8-year-old girl presented to the ER after accidentally being hit by a Wii remote control swung by her brother. J Trauma 2008;65:1203-1203.

source: NEJM, Volume 362:473-474, February 4, 2010. Number 5

regards, taniafdi ^_^