healthcare – Page 4 – The Student Physiologist

Light At The End Of The Tunnel

Having being around for a few years now, I’ve read an ECG or two in my time. If you’re still early on the road to becoming a fully-fledged Physiologist though, let me assure you of one thing: IT DOES GET EASIER!

I won’t lie, even with the experience I now have, there are still the occasional strips that leave me scratching my head like a confused monkey but on the whole, a 12-lead doesn’t scare me anymore. One thing that I think many students will find at some point during their learning, is that their more experienced counterparts have somehow forgotten how difficult it is to read an ECG. You might take an ECG for someone to check and receive a reply along the lines of ‘Well, obviously this is…’ Not all that helpful!

Learning to read an ECG is a lot like learning to read a new language. Sure, if you’ve been practicing for a long time, you’re pretty fluent, but it’s important to remember how hard you found it back when it was still just a foreign language to you. Only then can you start to empathise with those who are in that position now. And if you are in that position now, don’t give up!

If I could offer one word of advice to you, the person reading this who is desperately trying to get to grips with ECG, it would be this: get to know what a normal ECG looks like really, really, REALLY well. Then, get to know how that relates to the electrical and mechanical activity of the heart. (I suppose that’s sort of 2 pieces of advice but stick with me here). If you can get all of that into your head, you’re putting yourself the best possible position for progression. If you instantly know what a normal ECG looks like, any abnormality should stand out like a sore thumb. You might not know what the abnormality is, but if you know how the ECG waveforms relate to the mechanical activity of the heart, you can at very least a take good, educated guess on what that abnormality suggests the heart is actually doing. You won’t be an expert, not at first, but you will have the foundations on which you can build and make yourself one.

Therefore, the most important first step is to learn what is ‘normal’ but I’ll discuss that in detail in a later post.

Pacemaker Re-Use For The Developing World

To some of my experienced readers, the fact that pacemaker charities that recycle pacemakers exist may not be news at all, however if, like me, you had no idea, then hopefully this post will make for some heart-warming (sorry) reading.

I was interested in what happened to pacemakers when the user passed away, and after a quick internet search, I found that they were almost invariably stockpiled when cremation was requested, or buried with the deceased. Considering that there are over 34,000 pacing procedures performed in the UK alone, this seemed somewhat wasteful. Knowing that the average life of a standard pacemaker is currently anywhere between 6-10 years, I found it hard to believe that there would not be remaining battery life in the devices when they were no longer required.

Pacemaker research is advancing all the time; Medtronic released their “Micra” (pictured right), which is lead-less and no bigger than a large multivitamin tablet, so with more advances, the price of a standard pacemaker is dropping. The current prices are still out of reach for the people who need them in many developing countries and that’s before the cost of the procedure and hospitals accommodation/ follow up care are considered.

A study at the Hospital of the University of Pennsylvania, led by Dr Payman Zamani discovered that of 27 pacemakers taken from a mortuary stockpile, 8 had a remaining battery life of at least 4 years. This is obviously 8×4 years of alleviated symptoms that are going to waste in this one mortuary alone, and it was estimated in 2011 that more than 1 million people from the developing world died as a result of not having access to pacemakers, so health organisations began looking at ways to reduce this waste.

Companies such as Heartbeat International and Heart to Heart have been recycling pacemakers since as far back as 1994, but in 2013, Pace4Life, a UK company run by Chemistry graduate Balasundaram Lavan began a partnership with the NHS and other healthcare organisations, and morgues to recycle as many viable pacing devices as possible. It’s against EU legislation for recycled pacemakers to be used domestically, but it is well within the confines of European guidelines for them to be taken from consenting individuals and used outside of its boundaries

Pace4Life only accept devices with >70% battery life remaining and during the refurbishing process, all former patient data is erased, so confidentiality is in no way compromised. Their website at http://www.pace4life.org contains a list of studies and guidelines with which they work as well as patient, next of kin and mortuary donation documents to enable people to help the less fortunate gain access to potentially life-saving medical equipment.

I’ll let Lavan himself explain a bit more:

Thanks!

Q. What Natural Phenomenon Can Speak In Any Language?

A. An echo.

EDIT 17/9/15:

It has been brought to my attention that I didn’t word some of my last post particularly well. Upon looking this over, this is indeed the case.

It was not my intention to convey that healthcare scientists need not perform ECGs I intended to imply that whilst on my last placement, physiologists did not perform them, it was the responsibility of the A.T.O. hence, this is what led my mentor to say what they did regarding newly qualified and echo. This may not be the case across all trusts.

I neglected to include that due to the advanced nature of the practise of echocardiography, it is not featured in the PTP program. (This is good news for me and anyone else currently studying this degree, as I shudder to think of the extra workload that would be associated with it).

If in future I make an error such as this, let me know and I shall endeavour to rectify it.

Many thanks,

TSP.

ORIGINAL POST:

Having seen what trust-employed cardiac physiologists are required to do, it seems rather strange to me that echocardiography isn’t really taught in either the PTP or STP programmes. By all accounts, it’s touched upon in the final stretch of the STP pathway, but not in a comprehensive manner. Assistant Technical Officers perform the vast majority of ECGs in my trust, so it isn’t necessary for qualified healthcare scientists to be placed in that area. My mentor told me that her cardiology department needs echocardiographers and that the discipline is underinstructed by the universities. Bear in mind this is only because it isn’t a part of the syllabus as it’s not currently required by the framework of Modernising Scientific Careers.
As a result, the trust I have been stationed in has taken to rounding up the students and providing its own echo tutorials after the working day is finished.
This is a great idea and is beyond the call of duty for the department physiologists, but it doesn’t strike me as something that should fall to the trust to have to subsidise. Echo is an increasingly utilised skill and the one that hospitals need their physiologists to be proficient in. If it isn’t being taught at undergraduate or masters level, then trusts will have to pay for the training and overtime required to bring their staff up to speed with each new generation of practitioners.

Over the summer, my university has purchased an echocardiography unit, so I assume we’ll have a bit of a head start, but surely if the practice of echocardiography is so important in the profession, it’s something that should be mandatory to teach in the academic training. Perhaps this is something that will be factored into the equation as the PTP and STP courses continue to change over time.

The Times They Are A-Changing.

Hello again!

It seems that as soon as I mentioned just how quickly this profession is evolving, something has been raised that enables me to give you an idea of how much.

This blog is called The Student Physiologist. The career’s professionals are known as physiologists or physiological scientists, ergo, myself and my peers are subsequently coined physiology students.

This, however, will soon be a thing of the past, as by the time I qualify, these terms will no longer exist. In their place will be Healthcare Scientist.

It’s difficult to find any sort of identity in such a changing professional environment and this difficulty is bolstered when a physiological scientist tries to explain their role within the NHS. We are among the most patient-facing scientists in the clinical setting, yet we are arguably the least “seen”, in that no matter the description of who you are and what your job is, patients and other staff alike will invariably refer to you as “nurse” or “doctor”. Whilst doctors and consultants are prevalent in this career, it is difficult to convey to patients and staff, the differences between medic and scientist in both the hospital and these roles specifically.

This has highlighted to me, the need for a global identity and perhaps a way for we, as the people with that identity, to forge it for ourselves.

As the evolution moves ever forward, this blog may be named The Healthcare Scientist and I may be signing off with the same name.
We shall see.

Thank you.

An Introduction.

Hello.

I have this last academic year, completed my first full year of Cardiac Physiology.
My course consisted of four modules, each focusing on broad, yet still specific areas of science and scientific practice.

The modules were as follows;

Biomedical Skills.
– Medical physics, algebra, calculus, etc.

Anatomy and Physiology.
– Exactly what it sounds like; anatomical systems, terminology, dissection, prosection, and a hell of a lot of pop quizzes.

Cellular biochemistry and Genetics.
– Microscopy, mrganic chemistry, pharmacology and, shockingly… Genetics.

Physiology and Patient Care.
– The physics, biology and methodology behind various medical tests and how to use and perform them, then interpret the results, patient psychology and care, and the pathology of cardiac and respiratory disease, etc.

I refrained from creating this blog until the start of my second year due to the irrelevant content of the first year as a whole. Whilst the first three modules listed were required by the curriculum, they were far from ‘physiology-centric’ and the final module was little more than a (very good) detailed introduction. This will change, however, from here on out.
I must stress that this is not a slight on the course structure or its content so far, as nearly everything that myself and my colleagues have been taught has been engaging and informative, I simply felt that to document such a broad range of topics on a Cardiac Physiology blog would quickly become something akin to an unwanted university lifestyle diary. I can assure you, that aside from study tips, this shall not be the case.

The next steps of my journey are the ones that will be of greatest interest to fellow students, physiologists and hopefully to the relevant governing bodies.

In the forthcoming posts, I shall document my feelings on the course structure, content, struggles I have encountered and where the career path seems to be going.
I intend to post once a week without fail, but will update with more frequency as points of interest present themselves.

To those just starting their journey, I will post some relevant information regarding the Physiology module from last year, but mainly to assist with what’s to come.

If you know anyone who is currently journeying down this pathway, or is thinking of doing so, point them in this direction. I aim to network, exchange ideas, discuss common issues and everything in between.

Thank you.