Showing 91 - 100 of 276 annotations tagged with the keyword "Infectious Disease"
In How Doctors Think, Jerome Groopman explores clinical decision making with a particular emphasis on the poor communication skills and cognitive errors that often lead to misdiagnosis and inappropriate treatment. He uses a narrative approach, filling the book with compelling stories that illustrate the world of patient-physician interactions. Why did a second doctor quickly conclude that Blanche Begaye suffered from aspirin toxicity, while her first doctor mistakenly diagnosed viral pneumonia? Why did several physicians fail to diagnose Maxine Carlson's ectopic pregnancy until the day it ruptured? Groopman's storytelling skill permits him to convey complex concepts (e.g. availability bias, anchoring, and Ockham's razor) through conversation and narrative.
Three major themes run throughout the book, and each is presented with several variations. The first theme is that doctors who don't listen to their patients are likely to make serious mistakes in diagnosis and treatment. The second is that doctors frequently don't have the self-awareness to understand their own errors, especially those that involve dealing with ambiguity and understanding the importance of emotions. The final theme is that that patients ought to be active participants in their own care. This is not a new message, but Groopman frames it in a new way. Given the complexity of clinical decision making, and the many cognitive errors physicians may fall prey to, patients can improve their own care by helping their doctors minimize or avoid such errors. Among other things this means asking thought-provoking questions like "What else could it be?", "What is the worst thing it could be?," or "Is it possible I have more than one problem?"
This collection of essays by surgeon-writer Atul Gawande (author of Complications: A Surgeon's Notes on an Imperfect Science --see annotation) is organized into three parts (Diligence, Doing Right, and Ingenuity) and includes an introduction, an afterword entitled "Suggestions for becoming a positive deviant," and reference notes. Each part is comprised of three to five essays, which illustrate, as Gawande explains in the introduction, facets of improving medical care - hence the title of the collection: Better: A Surgeon's Notes on Performance. In typical Gawande style, even the introduction contains tales of patients - a woman with pneumonia who would have fared far worse had the senior resident not paid close and particular attention to her well-being, and a surgical case delayed by an overcrowded operating room schedule. Such tales are interwoven with the exposition of themes and the detailing of the medical and historical contexts of the topic at hand.
The essays, though loosely grouped around the improvement theme, can easily be read as individual, isolated works. The concerns range widely both geographically (we travel to India and Iraq as well as roam across the United States) and topically. For instance, we learn about efforts to eradicate polio in rural south India and the dedicated people who devise and implement the program. Another essay, far flung from the plight of paralyzed children, is "The doctors of the death chamber," which explores the ethical, moral and practical aspects of potential physician involvement in the American system of capital punishment (from formulating an intravenous cocktail ‘guaranteed' to induce death to the actual administration of such drugs and pronouncement of death).
In sum, the topics of the eleven essays are: hand washing, eradicating polio, war casualty treatments, chaperones during physical examinations, medical malpractice, physician income, physicians and capital punishment, aggressive versus overly-aggressive medical treatment, the medicalization of birth, centers of excellence for cystic fibrosis treatment, and medical care in India. The afterword comprises five suggestions Gawande offers to medical students to transform themselves into physicians who make a difference, and by including this lecture in the book, what the reader can do to lead a worthy life.
Summary:This Japanese horror story is set in a hospital in financial crisis, short of supplies and staff. We see various nurses and doctors struggling with their working conditions. A patient is injured falling out of bed, a nurse practices her IV technique on an unconscious burn patient, a demented woman wanders the hallways talking to apparitions she sees in mirrors. Two events set the central plot in motion: the burn patient dies because of a medication error and those present—Dr Akiba (Koichi Sato) who was responsible and Dr Uozumi (Masanobu Takashima) who was supervising, as well as the nurse who gave the lethal dose and her supervisor—decide to cover up the mistake, and a patient is brought to the ER suffering from a mysterious infection that is liquefying his internal organs.
Tracy Kidder met Paul Farmer in 1994 when the former was writing an article about Haiti. They next met again in 1999 but it was only when Kidder expressed an interest in Farmer and his oeuvre that Farmer emailed him back, writing "To see my oeuvre you have to come to Haiti" (17). Kidder did just that, following the peripatetic workaholic Farmer to Peru, Russia, Boston, and wherever Farmer flew, which is anywhere there is poverty and disease, especially infectious disease.
In Mountains Beyond Mountains (MBM), Kidder chronicles Farmer’s childhood, medical school years (almost a correspondence course with Farmer’s frequent trips to Haiti), his founding of Partners in Health (PIH) and the construction of the medical center in Cange, Haiti, where "Partners in Health" becomes Zanmi Lasante in Creole.
The story of Farmer’s crusade for a more rational anti-tuberculosis regimen for resistant TB; his political struggles to wrestle with drug manufacturers to lower the price of these and medicines for HIV; his charismatic establishment of a larger and larger cadre, then foundation of co-workers; the story of Jim Kim, a fellow Harvard infectious disease specialist; Farmer’s marathon house calls on foot in Haiti; endless global trips punctuated by massive email consultations from all over the world; and gift-buying in airports for family, friends and patients--these are fascinating reading. In the end one is as amazed and puzzled by the whirlwind that is Paul Farmer--surely a future Nobel Peace Prize laureate like Mother Teresa--as Tracy Kidder was and grateful to have the opportunity to read about it by such an intelligent writer.
Hicok begins the poem with a statement and jocular rhetorical question that set the tone and pace: "There are two kinds of people and five hundred / seventy-one thousand, three hundred / ninety-six species of beetle but who's / counting?" Immediately we wonder what are the two types of people and who would take the trouble to write out a species count while also joking about it.
The engagement with the poem continues as we learn about the narrator's platonic friend, an entomologist, freshly returned from the Amazon with a bottled beetle and a raging fever. The narrator, alarmed at her delusional state, rushes her to the hospital ("driving / in a way that proved you can be / in two places at the same time") and good medical care. After several days she has regained enough strength to say one word--jar--which refers to the jar containing her beetle specimen. The narrator restores the jar to her, she recovers and returns to the life she loves, a life in the treetops of the Amazon jungle.
Through the course of the poem, the poet plays with all manner of philosophy and religion. The beetle's body is likened to Michelangelo's image of the finger of God reaching towards Adam. The poet plays with numbers as well, rearranging the numbers of types of people and beetles (and throwing in the number of "delicatessens where you can get a fried- / tuna sandwich on waffles"). This lightness is a disarming way to shed light on the heart of the poem--the narrator's deep caring for the scientist and the scientist's deep caring for her work of discovery.
In this account of early practitioners and advocates of 'inoculation,' or the use of tiny amounts of smallpox contagion to induce a mild case of smallpox and immunity, author Carrell weaves prodigious historical research with fictionalized dialogue to create a tale of two prominent figures: Lady Mary Wortley Montagu of London and Dr. Zabdiel Boylston of Boston. Both Lady Mary and Boylston suffered scarring from smallpox, and, by living in the early 18th century, both witnessed the devastation of epidemics in terms of public health and private loss.
Both were also aware of the use of inoculation to prevent severe disease in Turkey (Lady Mary visited with her ambassador husband) and in Africa (on the advice of Cotton Mather, Boylston interviewed Africans, slave and freemen, living in Boston). Both faced formidable challenges and risked personal security to promote the use of this technique. Both proved their belief in the technique by the inoculation of their own children. And both, perhaps, met. At the behest of the Royal Society, Boylston traveled to London, witnessed numerous inoculations, and presented his Boston experience to the Society.
The book also chronicles the natural course of the disease, its various symptoms, forms and popular treatments, and the political impact of smallpox on the royal families of Europe and business interests in Boston. The medical research of various doctors is detailed. In particular, selected Newgate prisoners were offered pardon in return for participation in an experiment conducted by Mr. Maitland, who also inoculated Lady Mary's children. These experiments were used to test the safety and efficacy of inoculation prior to royal inoculation.
Ultimately, detractors of inoculation ceased their vitriolic attacks, as the risks of inoculation were proven to be far lower than exposure without such protection. The success of inoculation paved the way for Edward Jenner, often called 'the father of immunology,' to successfully use cowpox to induce smallpox immunity later in the 18th century.
In the not too distant future, the morose Egyptian, Antar, works in New York City, as a home-based computer employee, monitoring artifacts which he can study holographically through cyber space. He conjures up the I.D. card of one L. Murugan, who had supposedly disappeared in Calcutta back in 1995. Murugan is/was an expert on Nobel laureate Ronald Ross, discoverer of the role of the anopheles mosquito in the transmission of malaria.
Through flashbacks to the intense week of his disappearance and to episodes in the late nineteenth century, the virtual Murugan roams Calcutta trying desperately to understand and expose a subtext of counter science in Ross's laboratory. He is joined by Urmila, a journalist whose life is endangered by their collaboration.
Murugan theorizes that Ross was sloppy, intent on fame and fortune though a simplistic rendering of the parasite-host relationship; his discoveries were fed to him by others and he was blind to the spiritualistic ambitions of Mangala, his Indian laboratory technologist. Conceiving of the powerful significance of malaria prevention and control, Mangala held different views on the purpose and means of investigating the disease and, Murugan thinks, she anticipated the later discovery of another Nobel laureate, J. Wagner-Jauregg, in the use of malaria for the treatment of syphilis. The travels of Murugan and Urmila imply that these views are still there awaiting their own discovery.
This documentary film is narrated by Dustin Hoffman; all other characters play themselves. Five stories (pathographies) introduced as panels from the 14-acre AIDS quilt are interwoven with each other, together with personal photos, newsreels and radio reports to recount the history of the first decade of AIDS in the United States.
Tom was a highly educated and athletic, gay man whose story is told by his lesbian friend and co-parent of his adored little daughter. Rob was a married Afro-American, I.V.-drug-user whose loving wife recounts his battle with drugs as well as his disease and who views her own HIV seropositivity as "God’s will." Jeff’s story is told by his grieving male lover over images of his once golden health.
The parents of twelve-year-old hemophiliac, David, tell the story of his entire life as a rush to consume, from his babyhood forward until the sadness of his last Christmas. The shy, handsome architect, David, is mourned by his bisexual lover, a naval officer at the Pentagon, who now lies dying with the lesions of Kaposi’s sarcoma quite visible on his face.
The narrators describe solace they derived from quilting memorial panels for their loved ones. In the final scene, the AIDS quilt lies on the Mall in Washington as names of hundreds of loved ones are read by grieving families and friends.
As a medical student, Martin Arrowsmith (Ronald Colman) approaches the revered Professor Gottlieb (A. E. Anson) wishing to accelerate his studies into bacteriology research. Gottlieb insists that he complete his clinical training first. But Arrowsmith meets the cheeky nurse Leora (Helen Hayes) and throws over his plans for science in order to earn a marriage-sustaining living as a general practitioner in her native South Dakota.
Assuaging his undying passion for research (in the family kitchen), he takes on the problem of an epidemic of black leg disease of cattle and earns the animus of a veterinarian and the admiration of the Swedish farmers by single-handedly disproving the efficacy of a government serum, developing his own serum, and conducting a controlled trial to prove its worth. His frustrated and unemployed wife--now displaced from her own kitchen--continues to support him, answering always "Yes, Martin. No, Martin. Whatever you say, Martin."
The couple move to New York City where Arrowsmith intends to devote himself full time to science at the side of his old hero Gottlieb in the McGurk Institute (a thinly disguised Rockefeller Institute). In his new laboratory, Arrowsmith utters a prayer for clear vision and humility--a prayer that seems to go unanswered.
Late one snowy night after two years of fruitless work, he discovers that "something" (in the novel, it is bacteriophage) has killed the bacteria he has been incubating. "Is it important, Martin?" asks Leora. He is brutal in his zealous response, his eyes gleaming with the promise of promotion, fame, and fortune. But after days of exhausting labour, he learns that he has been scooped by Felix D’Herelle a (real) researcher at the Pasteur Institute.
Arrowsmith quickly finds a new passion and travels to the Caribbean to conduct research into the effect of a serum on bubonic plague. Gottlieb makes him promise to act like a scientist (not a G.P. or a quack) and to withhold the remedy from half his patients. He tries to convince the colonial authorities of the importance of controlled testing, but is rebuffed with accusations of turning humans into guinea pigs. A black medical graduate of Howard University invites him to a different island where the epidemic is so thick that the people willingly cooperate with the controlled trial.
Leora, who had refused to remain in New York, is now left behind. The film implies clumsily that the now solitary Arrowsmith--ecstatic to be back in the research trenches--has a romantic encounter with Joyce, a beautiful stranded tourist (Myrna Loy). Meanwhile, Leora contracts plague from a cigarette, which has absorbed plague germs from Martin’s sloppy lab technique, and which she smokes because of Martin’s inattention and abandonment. She dies miserably and alone.
Crazed with remorse, Arrowsmith abandons his scientific principles and allows the entire population to be treated with the serum after all. The epidemic is arrested. But Martin knows that his success does not justify his scientific sin. Still grieving for Leora, he returns to New York to much fanfare, but is unable to find absolution from Gottlieb who has just had a stroke. He runs out on his lover, his institute, and a press conference to join a friend who is establishing a Walden-like institute dedicated to pure research in Vermont.
This is a sequence of six poems that form the centerpiece of Doty's book of the same name. The scene is the coast (Provincetown) where the author's companion, Wally, is dying of AIDS: "sometimes / when I put my head to his chest / I can hear the virus humming . . . . " The poet dreams of a dog they don't have. He dreams of saving Wally. Wally tells him of a dream of light and beckoning.
Michael dreams of "helping Randy out of bed" and, suddenly, Randy steps out of his body. Among these coastal dreams of caring and dying, Atlantis emerges "from the waters again: our continent, where it always was / . . . unforgettable, / drenched, unchanged." In the end (and before Wally's end), they do get a new dog who "licks Wally's face" and "bathes every / irreplaceable inch / of his head."