Wednesday, 30 December 2015

Princess Health and 19 Simple Tips for a Happy and Healthy Life. Princessiccia

Happiness and Health don't have to be a 'task' to achieve. Here are few very simple, easy-to-follow tips to continuously create both in our everyday life. 

#1
Try to make at least three people smile each day.

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#2
Don't waste your precious energy on gossip.

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#3
Dream more while you are awake. 

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#4
Read more books than you did last month.

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#5
Sleep 7-9 hours every day.

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#6
Smile and laugh more.

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#7
Drink at least 2 liters of water per day.

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#8
Call your family often.

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#9
No matter how you feel, get up, dress up and show up. 

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#10
Exercise at least 3-4 times a week.

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#11
Make peace with your past, so it won't spoil your present.

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#12
Live with the 3 E's: Energy, Enthusiasm, Empathy.

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#13
Eat more foods that grow on trees and plants, and less food that is manufactured in plants.

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#14
Try new things regularly.

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#15
Love Yourself, because You are Unique and Wonderful in your own way.

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#16
Play more games.

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#17
Realize, that problems are necessary to grow. They will fade away, but the lessons you learn will last a lifetime.

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#18
Get rid of anything that isn't useful, beautiful or joyful.

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#19
The best is yet to come...

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Photo credit: Pixabay.com






































































































































































































Tuesday, 22 December 2015

Princess Health and How Managerialists Turned Housestaff Training into a Zero-Sum Game: the Continuing Saga of the FIRST and iCompare Studies. Princessiccia

Princess Health and How Managerialists Turned Housestaff Training into a Zero-Sum Game: the Continuing Saga of the FIRST and iCompare Studies. Princessiccia

A ongoing controversy about two controlled trials (FIRST and iCompare) meant to test the bizarre hypothesis that sleep depriving medical housestaff (that is, physicians in training) would improve health care provided new evidence that academic medicine has been captured by managerialists.  

Background: the Controversy about the FIRST and iCompare Housestaff Sleep Deprivation Trials

In early December, 2015 we posted about two clinical trials, FIRST and iCompare, designed to test the hypothesis that  increasing housestaff sleep deprivation would improve care continuity, and thus somehow improve housestaff their performance and their patients' outcomes.  Not only did the studies' hypothesis seem strange, but the studies seemed to violate fundamental rules of research ethics.  Study investigators proceeded without obtaining formal informed consent from their house staff or patient research subjects, and did not allow any research subjects to opt out without penalty (e.g., house staff would have to quit their programs and find new ones to opt out).  Finally, after Public Citizen and the American Medical Student Association (AMSA) complained about the studies, study defenders based their arguments on logical fallacies.

Why would distinguished medical educators behave so strangely?  I hypothesized that medical educators could not imagine a way to improve care continuity without worsening trainees' sleep deprivation because all logical methods to do so would cost money.  However, the managerialist executives to whom medical educators are now beholden shrink from increasing costs, other than their and their cronies' own compensation.

Two Psychiatric Residents Write about the Zero-Sum Game of Housestaff Training

Of course, the controversy, and particularly the complaints from AMSA and Public Citizen have been largely anechoic.  But recently, the Washington Post published a commentary by two psychiatric residents on these issues.  The authors, Jeffrey Clark and David Harari, confirmed many of my concerns about the sleep deprivation trials.  They personally verified that the studies were done without informed consent from the research subjects.

The two of us and our patients were not provided informed consent before being enrolled in the iCompare trial.

The also confirmed that the trial investigators assumed they were working in a zero-sum framework.

We already know that extended shifts are dangerous. While many people rightfully suspect that current duty-hour limits aren�t improving outcomes, these studies err in assuming that the dangers of sleep deprivation must be traded for the dangers of shared patient care. Such a zero-sum framework won�t help us improve patient care or ensure the well-being of resident physicians.

To elaborate, the big problem with the duty hour restrictions is that while limiting the consecutive hours interns were supposed to work, this was not accompanied by any diminution of the total workload of housestaff at any one institution.

The standards published in 2011 by the Accreditation Council for Graduate Medical Education still allow hospitals to put residents through blistering 80-hour work weeks, while setting maximum shift lengths of only 16 hours for interns and 24 hours for more senior residents. Interns simply work shorter but more-frequent shifts. Doctors hand off patients to each other more regularly but without the training needed to manage these transitions effectively. And, by and large, hospitals have not responded to the changes with larger workforces, leaving residents no choice but to compress their daily work into shorter time periods.

It appears that housestaff were formerly sleep deprived not by their own choice, but because they were required to accomplish enormous amounts of work.  The new duty-hour limits rearrangde their work into shorter shifts, without diminishing their total responsibilities.  This does not seem like much of an improvement.  The FIRST and iCompare trials were designed to test whether removing the new duty-hour limits, and thus increase sleep deprivation, would somehow help, which ignores the reason  the new duty-hour restrictions were enacted.  But simply shortening shifts accomplishes little as long as total workload remains the same.

Stimulants, An Even Worse Solution

So Clark and Harari confirmed my concerns about the FIRST and iCompare trials.  But they added a new and in some ways even more dire concern.  They uncovered an even more troubling response by medical academics to the zero-sum game which the managerialists ensure they are playing.

Adequate sleep is a fundamental physiological need. No amount of caffeine, prescription stimulants (as some physician leaders have advocated for) or 'alertness management strategies' can adequately compensate for acute and chronic sleep deprivation.

In an aside, Clark and Harari suggested the medical educators were advocating that housestaff use prescription stimulants to counteract the effects of sleep deprivation.  This seems astonishing.

Yet a brief search revealed many informal accounts of medical students and housestaff using psychoactive prescription drugs to increase wakefulness.  For example, see an account of a medical student using Focalin (dexmethylphenidate) here.  Surveys, for example by Shy et al of emergency residents, suggest that use of stimulants by housetaff is rare,(1), but survey respondents may be unwilling to admit to such behavior, and emergency medicine residents may work shorter shifts than medicine and surgery residents.

Also, there is some other evidence that medical educators may encourage use of stimulants.  At least one 2014 guest poster on the KevinMD blog stated

at one medical university, it is common knowledge among the student body that struggling individuals are encouraged to see a physician about their 'possible ADD,' or attention deficit disorder.

Furthermore, in 2009, Rose and Curry writing in the Mayo Clinic Proceedings (2) noted that 

extending the use of drug therapy to include resident with no identified sleep disorder to improve concentration and learning, improve wakefulness, enhance performance, and promote high-quality patient care (especially at night) raises a variety of concerns

without explaining who came up with that idea in the first place.  However, in a response to a letter challenging their commentary, they denied (3) that they were advocating for such drug use, but never made clear who else was.

As we have noted, stimulants used for attention deficit and hyperactivity disorder (ADHD) are  amphetamines or relatives of amphetamines, and have dangerous adverse effects.  Encouraging, even subliminally, medical trainees to use such dangerous drugs to try to compensate for underfunding of training programs seems unethical, as the above letter writer pointed out.(3)  That medical educators would resort to such an extreme solution suggests how they are now boxed in. 

Conclusion: the Problem is Managerialism   

While the ongoing trials of housestaff sleep deprivation have been largely anechoic, the recent Washington Post commentary by Clark and Harari make questions about why in the world medical academics would have set up such trials and continue to defend them even more stark.

But it seems that medical academics are boxed in, playing a zero-sum game.  They may know that there housestaff are overworked and sleep deprived, a situation that endangers the housestaff and their patients.  Yet every reasonable way one could imagined improving the situation would require spending more money, most likely to hire more people to spread the workload.  Yet spending more money may be an anathema to the generic managers to whom medical academics report.  Spending more money would decrease revenue, and for many managerialist managers, increasing revenue, not patient outcomes or physician performance, is the prime directive.    


We have frequently posted about what we have called generic management, the manager's coup d'etat, and mission-hostile management. Managerialism wraps these concepts up into a single package.  The idea is that all organizations, including health care organizations, ought to be run people with generic management training and background, not necessarily by people with specific backgrounds or training in the organizations' areas of operation.  Thus, for example, hospitals ought to be run by MBAs, not doctors, nurses, or public health experts.  Furthermore, all organizations ought to be run according to the same basic principles of business management.  These principles in turn ought to be based on current neoliberal dogma, with the prime directive that short-term revenue is the primary goal.

To conclude, as I did on my first post on the sleep deprivation studies....  I hope that the two studies create the degree of controversy they deserve, and that the federal government promptly starts investigating honestly and thoroughly.  I further hope that this unseemly episode causes medical educators to rethink the cozy or at least conflict averse relationships they have with their managerialist leaders.

True health care reform would restore health care leadership that understands health care and medicine, upholds the health care mission, is accountable for its actions, and is transparent, ethical and honest.



References

1.  Shy BD, Portelli I, Nelson LS. Emergency medicine residents' use of psychostimulants and sedatives to aid in shift work. Am J Emerg Med 2011; 29: 1034-36. Link here.

2.  Rose SH, Curry TB.  Fatigue, countermeasures and performance enhancement in resident physicians.  Mayo Clin Proc 2009; 84:  955-57.  Link here.


3.  Paparodis R. Fatigue, countermeasures and performance enhancement in resident physicians.  Mayo Clin Proc 2010; 85: 300 - 303.  Link here.
Princess Health and Healing Back Pain. Princessiccia

Princess Health and Healing Back Pain. Princessiccia

I've put off writing this post for many years because I know it will be controversial. But we're a few days from Christmas, and I also know this post will be a wonderful gift for some people.

Chronic or intermittent pain, often located in the back, neck, and/or buttocks, is a major driver of personal suffering and reduced productivity in the US and other affluent nations. While pain can obviously have a variety of structural causes, such as sprained ankles or bruising, garden-variety back pain usually doesn't. I've come to believe that such pain is usually psychosomatic in nature-- in other words, caused by the brain but resulting in physical signs and symptoms in the body. It's widely accepted that a person's mental state can affect pain perception, but this idea goes further. Pain isn't just exacerbated by a person's mental state; it's often entirely caused by it.

Read more �

Monday, 21 December 2015

Princess Health and 7 Easy Tips To Enjoy Christmas Without The Weight Gain. Princessiccia

Christmas is about sharing love, spending time with family and friends, but let's be honest, for many of us, it is also about eating and drinking a lot... If you don't want to change your wardrobe in January and go one size up, then here are 7 easy-to-follow tips for you to enjoy Christmas without the remorse in January.

1. Healthy snacks on hand

It is so much easier to eat healthy when you find healthy food in your kitchen. So when doing your Christmas shopping, don't forget to add some healthy snacks to your shopping basket. What can you include here? All your favorite fresh fruits, some dried fruits (check the label to make sure they are without added sugar or syrups), your favorite nuts and seeds. Sometimes we just feel like eating something. At this moment, if you only have a box of chocolate at hand, then you will of course open it. BUT! If you have other choices too, then that "something" can be some nuts or fruit. At least you have a choice!

2. Drink lots of water

Our body shows thirst in many different ways. Sometime, when you feel slightly hungry, it can be because of dehydration, and a big glass of water will vanish your hunger. Drinking a big glass of water before going out makes sure you don't confuse hunger with thirst. Drinking a big glass of water at the party, during a meal, makes sure you feel nicely full without overeating. And drinking a big glass of water after the party keeps you hydrated and might protect you from a hangover the next day.

3. Never go to a party hungry

Remember the healthy snacks you bought? Snack on them throughout the day, and especially before going out, or before welcoming your friends for a dinner. You will eat a lot less! When hungry, it is very easy to overeat. Small portions will make you feel nice and full, and you won't eat a 3 course meal of huge portions. You will be surprised by the difference!

4. Careful with the alcohol

One of the facts you have to bare in mind is that alcohol contains huge amount of calories, so basically they contribute considerably to the weight gain. The other "trick" what alcohol does is that it makes you feel hungry and makes you lose control over deciding what is good and what is not, how much is enough and so forth. 

5. Mix healthy food with food you love

If you try to be restrictive when going out, then you might feel that you didn't enjoy the party at all. If you like to indulge, but you are afraid of the consequences, here is what to do. Wander first before putting anything on your plate. Check first what options you have. There are always some veggies and healthy food at a party. After having a clear picture of "what's on offer", take a plate, and fill it with healthy stuff, and add three of the 'indulgent food' you love. Mission accomplished!

6. Exercise

You don't necessarily have to go to the gym (only if you really want to). Some dancing in your living room or kitchen will do, mixed with few push ups, squats and plank . You will feel great and you will boost your metabolism (your body's ability to convert food into energy, rather than fat). It will boost your mood too, and you will be proud of yourself! Better 10 minutes exercise, than no exercise at all.

7. Have fun!

Laughter has been proven to burn calories too, and benefit our health in so many different ways. Don't spend too much time with calorie-counting, better spend that time with those you love, and make you laugh.

Merry Christmas!

Bonus Tip:

Think ahead! Regardless of your weight, you will want to exercise a lot in 2016. Simply because it keeps you healthy and fit. And our ZUMBA classes are great fun too! Our Magical Christmas Offer is on until Christmas. Click here to get it now, before prices go up!



































































































































































































Saturday, 19 December 2015

Princess Health and 5 Reasons Why You Should Avail of our Magical Christmas ZUMBA Offer. Princessiccia



1. Prices will go up!
This is one very obvious reason. Whether you are an existing customer, or new, we are sure that you would regret if you didn't secure your classes for 2016 at these very low prices. For the last time before our new price-plans come into place.



2. No need to invest in new fitness apparel!
Who doesn't need workout cloths? We all do! When you buy any of the offers now, you are in with the chance to WIN Zumba-outfit, value of �100! You can of course wear them to other fitness activities too - so who would say 'No' to such a prize? 




3. New Year's Resolutions - ?
Feel good ALREADY about your health-related New Year's Resolutions - Why wait? You already know what you want in 2016, why not secure their success NOW, and feel good about yourself? Staying fit while having fun - this is a goal that sounds pretty good, don't you agree? ;)



4. Extra money to spend!
With your purchase, you save a huge amount of money now, and you can feel free to spend the money saved on anything else. Buy presents, or even better: treat yourself - You deserve it! 



5. Wanna be happy and successful?
Countless studies done, hundreds of happy and successful people asked, and the result? One of the main habits of happy and successful people is that they plan ahead. Join the 'club'! Plan ahead! Buy your class-passes now! Be happy, successful - and last but not least: healthy and fit while having fun at our ZUMBA classes.

BONUS REASON: New classes starting in January (in addition to our existing ones): Terenure, Dundrum, Dun Laoghaire, Bray - and all the passes will be valid at these new locations too! 

Need more reasons? I don't think so, check them out again, and buy any of them (you can even have seconds or thirds of them ;) ) - just make sure that you are sorted for the whole 2016.

Excited?