Review: Acadoodle

Acadoodle.comonline

Price: $99/ £66 per annum (approx)

Authors: Dr John Ryan, Dr John Seery

Acadoodle is a subscription-based online resource for ECG training that boasts a large selection of video tutorials which can be viewed individually, or as part of a tested course. The ECG Teacher sections are the primary focus of this review, but other courses such as blood gas analysis are available, however.

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Produced by Drs John Seery and John Ryan, I found these courses to compliment my study, and even when I wasn’t watching them directly, I found myself letting them play in the background as I read a textbook, or went over my lecture notes.

The videos themselves are well produced and make understanding the ECG and its subsequent analysis much easier. The animations are slick and the narration is clear, concise and full of all the pertinent diagnostic information you will require.

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Each area of study is tailored to a specific area of electrocardiogram diagnostics, so each playlist/module flows from one video to the next. In addition, the flow of the modules themselves makes sense, and the learning curve increases in a logical order and as such, each section follows on from the one that precedes it in a manner that doesn’t overload you with information before you’re ready.

A small selection of the videos are available on YouTube, so if you wished to try before you buy, then searching for “Acadoodle” would throw up some of the more basic tutorials for you to have a look at. I noticed that these YouTube videos are also embedded in the Acadoodle site proper, giving rise to a sometimes noticeable drop in picture quality, on occasion.

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It’s nearly impossible to fault the content and structure, as these videos have helped me immeasurably throughout the last six or seven months, but it is an expensive purchase for anyone, let alone students, especially when you consider that almost all of the content is in some way available via lectures or found in other, similar video courses on YouTube. In that respect, despite the quality of the content, I find it hard to recommend Acadoodle to physiology students who are considering purchasing a personal subscription, but for lecturers or professional bodies and universities, it should prove to be a valuable asset when clarifying concepts to a class full of students.

That isn’t to say that a student purchasing a subscription wouldn’t get a lot out of Acadoodle; it’s certainly worth it, it’s just expensive at a time when disposeable income is generally spent on textbooks or… food and shelter. If splitting £66 is something that you and a few peers feel is possible, then I highly recommend it, as the website can be used from multiple PCs with little to no issue.

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Synap: Beta Test Update

Synap is an upcoming revision tool that is driven by students. The platform enables students to create their own multiple choice questions and upload them, then download those created by others. It’s possible to “follow” other users, as you would someone on Twitter or, incidentally, this site (you can do that in the sidebar of this page…), and take any quiz that they have created. Image upload and basic editing is supported, so quizzes for physiology, such as ECG arrhythmia or echocardiography quizzes are more than possible, and are one of the reasons I decided to get involved with the whole thing. In addition, the app tracks your progress and structures your revision for you, based on your course and modules.

I’ve spent the last week or so beta testing the Synap web platform or, more specifically, I’ve been taking tests and creating basic ECG quizzes to help bug test and check functionality.

The platform, as I’ve mentioned, is currently in closed beta and only present on the web, so without having an app and a larger number of users I cannot comment on it fully, but as it stands, the processes involved in creating a profile and quiz are incredibly simple; adding and annotating images is a cinch, and a complete question only requires the user to add a correct answer and a few wrong ones. Whilst I encountered a few bugs initially, the feedback I provided was swiftly taken on board and the problems were remedied overnight. Taking quizzes is incredibly simple, and all you need to do is click “take quiz” (shockingly), then select your answers and have them marked. You can take these as many times as you like, too, and if the creator has provided any, feedback will be available for each individual question.

My only concern is the reliance on the quiz-maker supplying the correct information. I’ve taken a quiz wherein the correct answer was the only one that was possible to be correct (think “What has tusks and a trunk? 1) Elephant 2)Belephant 3)Your hamster”) yet I was still told my answer was wrong. This is a closed beta, though and that’s what these processes are for. I know it hasn’t escaped the attention of the developers, so we shall see how it is dealt with.

To break all of this down and show you what I know for sure so far, have a look at this (incomplete) features list:

  • MCQs:
    • Image/annotation upload
    • Correct answer & up to 5 incorrect
    • Optional feedback for test-taker
    • Optional link to external learning resource
    • Test result calculation
    • Obtainable achievements
    • Personalised revision quizzes sent to you
  • Community links based on:
    • Course/Discipline
    • Cohort
    • Institution

I’ll add to this list the more familiar I become with the platform.

Omair and James, its creators, and the rest of the Synap team hope that this app will enable students nationwide to help each other and revise together, and it’s a pleasure for me to be involved, even if it’s only in a small way, currently. I’ll continue to post updates as things progress.

For more info, visit @Synap on twitter.

Thanks

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Holiday-Only Arrhythmias

During the festive season, its easy to indulge in excess; too many sprouts, an increase in afternoon napping, festive drinks… You know the score. It isn’t all smiles and sunshine, though, as we shall see.

One particular result of all the festive excess relevant to cardiac professionals, has been reported across the globe, but particularly in Entirely Fictitious Primary Care Centres (EFPCCs); Bacardi Branch Blocks, or BacBBs

BacBBs are thought to affect the heart as a whole, but it can be seen that they have a particularly odd effect on the ventricles, and cause an odd, never-seen-in-real-life depolarisation wave on the ECG, that actually defies physics and medical science by going back in time!

Symptom sheets compared with the compiled ambulatory data have shown unanimously that BacBBs are present sporadically within sinus rhythms, but coincide with that one-drink-too-many during a family game of Monopoly (Mr Moneybags isn’t thought to be an underlying cause, so the activity isn’t seen as a risk factor).

Atrial activity stops altogether, presumably because the SA node just forgets what it’s doing, as it’s seen enough crepe paper hats and screwdriver sets fly from crackers to last it a lifetime.

After an episode of BacBB, sinus rhythm resumes, and the patient will return to whatever their festive-norm may be until the next instance.

This phenomenon seems to disappear entirely during the first couple of weeks of January, when normal working hours begin again, hence, I feel that it is triggered by the holidays themselves.

None of this is being researched, or is even disputed, because it is both totally false, and invented entirely by me.

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Bacardi Branch Block

  • Common holiday rhythm abnormality only found during the festive season, and even then, only in fictitious settings
  • HR between 80-120bpm
    • Depends entirely on board game leader-board position
  • No P waves
  • Abnormal ventricular action
    • Resembles upturned cocktail glass
  • Is thought to only contribute to familial tolerance levels during prolonged exposure to each other

 

HAPPY HOLIDAYS FROM EVERYONE AT THE STUDENT PHYSIOLOGIST!!

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Virtual Reality In The Cath Lab

If you’ve kept abreast of tech news in the last few years, specifically with regard to Google Glass, you’ll probably be aware of two things: 1. it has been met with scepticism and apprehension, and 2. at present it’s largely pointless.

I’ll admit that the second point is subjective, but now, this (my) subjective view is likely to change. A team of cardiologists from Warsaw have used Glass’ virtual reality capabilities to tackle what is referred to as the “final frontier in interventional cardiology” by repairing a total occlusion of the right coronary artery.

An effective visualisation of the coronary arteries is often lacking using normal angiography radiology techniques, but by employing coronary computed tomography angiography (CTA), a smartphone app and a headset based on Google Glass, the team at the Institute of Cardiology have successfully restored blood flow in the right coronary artery of a 49y/o male, with two drug- eluting stents.

“This case demonstrates the novel application of wearable devices for display of CTA data sets in the catheterization laboratory that can be used for better planning and guidance of interventional procedures, and provides proof of concept that wearable devices can improve operator comfort and procedure efficiency in interventional cardiology,” says lead investigator Maksymilian P. Opolski, of the Department of Interventional Cardiology and Angiology at the Institute of Cardiology, Warsaw.

The set up itself projects the three- dimensional CTA images onto the Glass-based head mounted display via a mobile app featuring voice command and a zoom function. The combination allows for digital viewing of the coronary artery, the occlusion and the placement of the guide wire for stent implantation. Thanks to its basis in Google Glass, the device can record video, view images and also allow the practitioner to see the surrounding environment, simultaneously. The possibility for the lenses to be fitted with filters that protect the user from x-rays only cement this technology as one that cardiologists will look to use increasingly, after this first success.

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A. Surgeon using the Glass-based monitor to view CTA images on the lens. B & C. 3D images on lens show trajectory of distal right coronary and occlusion.

 

Virtual Reality might not be having the impact on video games that the industry had hoped, but it would appear to be having a profound impact on healthcare.

 

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Ref: Canadian Journal of Cardiology, Elsevier Health Sciences

SCST National Update

Yesterday, on the 20th of November, Oli and I attended the SCST annual update meeting. It’s the first physiology conference I’ve attended that wasn’t tied to one specific trust (the last one I attended was the Royal United Hospital’s respiratory medicine conference), rather, it was applicable to and attended by cardiac scientists from across the four home nations. The day was packed with talks, networking opportunities and insight into the future of the science. Speakers hailed from a variety of professions and organisations, but all were entrenched in the science of cardiology and education.

Due to the long distance travel and Birmingham’s seemingly city-wide roadworks, Oli and I missed the introduction, but we were present for the rest of the day and we recorded and annotated everything else, so whilst I’ll provide an overview here, detailed breakdowns of everything relevant to PTP study will be supplied separately, as and when time and my coursework volume allows.

Of particular note is the information on preceptorship qualification, delivered by Sophie Blackman of SCST and Boston Scientific. I collared her after the event proper, and she kindly agreed to provide the literature pertaining to this, so as soon as it’s available, I’ll add it for you all to have a mosey over. It seems like a great opportunity for newly- qualified practitioners to become super confident in all aspects of their job, so I highly recommend that you read the contents when they’re available.

Dr Patricia Oakley of King’s College outlined the plans for a new variety of health clinic: the centre that isn’t home and isn’t a hospital, but the “place in the middle”. These will be networked, multidisciplinary centres, featuring social workers, scientists, psychiatrists, GP’s, etc, so cardiac physiologists will most likely be a necessity in their implementation. The whole session really drove home the emerging importance of this profession, but also the requirement of all of us, student and qualified, to ensure that the cardiac physiologist is recognised as being at the forefront of innovation so as not to be overlooked. It was mentioned more than once, that if we don’t put ourselves forward for emerging structures, someone else will.

Dr Oakley told of the need to reduce treatment variability by region. Her example was the treatment of amputation as a result of diabetes; Devon has, by far, the highest number of below-hip amputations when compared with the rest of the UK, due to the fact that the majority of Devonian surgeons trained under a surgeon who has a penchant for this level of removal. The advent of these networked clinics will reduce this level of variability and promote consistency across the home nations.

The president of the AHCS, Dr Brendan Cooper delivered the final talk of the day, discussing the future role of the healthcare scientist in wider healthcare and medicine, and the need for physiologist prescribing. I’ll provide  a detailed breakdown of this talk next, and shall hopefully post it in this coming week.

 

 

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Mental Health

This post is something of a departure from the usual fayre, in that it is far more personal, and, for a number of reasons, much more difficult to write.

I know more than a couple of people who decided against a career in healthcare due to their mental health issues, with depression and bipolar being cited as the chief afflictions. They felt they would be judged by colleagues and potential employers, perhaps being overlooked for postgraduate positions or being seen as an inferior member of staff.

The very nature of mental health conditions such as these means that every day is a struggle in and of itself regardless, and this is only exacerbated when depression is at a particularly debilitating level. Often, once the sufferer has climbed the seemingly impossible mountain that is just getting out of bed, having to face an interview wherein the disclose or discussion of one’s pertinent medical history would be a requirement, is akin to reaching the top of Everest, only to find that it’s doubled in size. It’s overwhelming. The fear of being judged and viewed as damaged can stop a person for whom depression is an issue, from doing a multitude of things.

I know this, because I suffer with these things.

I was diagnosed as being bipolar when I was 16. Since then I’ve overheard colleagues in various places say (not about or directed at me, I’ll add)“it’s just the grumps- get over it”, “everyone has bad days and THEY manage to pull themselves together without attention-seeking” or that they “don’t believe in rubbish like [depression]”.

I’ll just add, that I’ve been slightly misleading: these three comments weren’t from a variety of places. They were from the staff in a hospital. One hospital ward, to be more specific.

These comments emanated from people who deal with and treat illness on a daily basis, and often these illnesses aren’t directly visible. Why, then, is a mental health illness less credible than a physiological one, even if it also, can’t be seen?

Hospitals have upped their game when it comes to mental health training, so I’d assume that due to the increased awareness, opinions such as these are slightly less commonplace, but there is still a lot more that can be done; subjects like this are still difficult to discuss and there still exists a fear upon doing so.

I have no doubts in my abilities as a healthcare scientist. I’m confident in everything I have learned thus far, and have proved as such through testing and assessment. I’m not frightened of learning everything else that I have to in order to qualify and more, either; I relish the challenge. My issues lie in the everyday tasks that my colleagues seem to be able to do, that I cannot. For example, I have of late, found it incredibly difficult to climb the aforementioned first mountain, and get out of bed, and I hate how weak I feel it makes me. I have a crippling fear of failure, despite enjoying challenge and I sometimes loathe that one is quite often more powerful than the other despite my best efforts.

The thing is, when I’m happy, I’m REALLY happy. I’m enthusiastic, talkative, and willing to do anything, but in the back of my mind, there’s always the knowledge that it isn’t going to last; I’m going to come crashing down and revert back to a miserable person to be around. It’s these days that I can’t face leaving the house unless I absolutely have to. It’s these days that I’d rather complete lectures from home, in solitude.

I haven’t missed a day’s work in my life, without good reason (case in point: nearly losing the end of an index finger in a professional kitchen blender, getting it stitched and, despite everyone but my boss telling me how moronic it was, returning to work on the same day), so it isn’t as though I choose to stay home and work because I’m lazy or work shy, or that I simply can’t be bothered, I think it’s because of the fact that because the work material is provided online, it means I can if I need to. I take some solace in the fact that my mental health issues have never stopped me from going to work, so I know that they won’t stop me from doing my job in the future, just that I might be less exuberant sometimes, as I do so.

The one thing I took on board from my ex-colleagues was that everyone does indeed, have bad days. The majority of people get through these bad days, too. I’m going to do the same. I won’t quit, no matter how difficult it may be, because I’ve worked very hard to get here. I’ve been in a battle with my own brain for a long time, and I’ve been winning, so there’s no way I’m going to stop now.

The more people that speak up about issues like this, the less taboo it will become, and the less room for stigmatism there will be. It isn’t something that falls squarely at the feet of sufferers, either, it’s something that everyone has to recognise and talk about. It isn’t easy, but it’s necessary. Mental health issues aren’t going to go away, but the ability to manage them has moved forward tenfold in recent years. Attitudes towards the subject now need to catch up.

If you, like some of my friends, are put off pursuing a career in healthcare because of mental health issues, don’t! You’ll be surprised at just how strong you can be. You’ll have bad days and good days, sure, but you’d have them anyway, wouldn’t you? Your good days will feel so much better if you’re doing something you want to do.

Thank you for reading. This is far from my whole story and I apologise if it seems slightly disjointed in places, but this is the hardest thing I’ve ever had to write.

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Are Athletes At Greater Risk Of Pacing In Later Life?

If so, what is the cause?

The Athletic Heart Syndrome isn’t indicative of any pathology in athletes, and although it is theorised that the changes the heart undergoes as a result of training, there exists no evidence of long-term effects. The athletic heart often has a resting rate much slower than that of an individual of a less active nature. This is not uncommon in physical athletes, as it has been reported that Sir Chris Hoy has a resting HR of 30bpm and fellow cyclist Miguel Indurain one of just 28..!

The cause of this is a very active vagal tone, resulting in bradycardia. As I’m certain many of you are aware, this is a condition that would almost certainly (correct me if I’m wrong) require pacemaker intervention in elderly patients, but in the case of athletes, this bradycardia is due to an increased stroke volume which means the required workload of the heart is decreased. All well and good whilst one is in training, but what if this lower HR did not ‘reset’ to within the normal parameters once training had ceased? I don’t think I’m incorrect in assuming that this would lead to the same treatment a non-athlete, former or otherwise, would receive anyway, regardless of any prior level of fitness.

There is in fact a 2007 study by Baldesberger et al, that suggests this is indeed the case.

Published in the European Heart Journal and found in full here: http://eurheartj.oxfordjournals.org/content/29/1/71 it is shown that there is a statistically significant increase of sinus node disease in the tested former cyclists when compared to the control group, in this case golfers.

Interestingly, I have stumbled across a British Heart Foundation- funded study run in part by the University of Manchester, that they feel suggests the increased presence of arrhythmias in athletes is due to molecular changes as oppose to increased activity in the autonomic nervous system.

The study in rodents showed a decrease in HCN4, a protein found in the mammalian SA node. In humans, a mutation in the HCN4 gene is sometimes found in patients exhibiting sick sinus syndrome and in those who display bradycardia, so the teams behind this study believe that if they can replicate the rodent’s results in humans, it will help us understand arrhythmias that endurance athletes often suffer in later life.

The published study can be found here: http://www.nature.com/ncomms/2014/140513/ncomms4775/full/ncomms4775.html

I’ll answer my second question, “if so, what is the cause?” with an obligatory “je ne sais pas”, but it’s clear that we are edging ever- closer to an answer. Of course, whether that answer is due to molecular changes, or nervous ones remains to be seen.

Either way, it is stated by the team at the University of Manchester that although endurance training can have harmful effects on the heart, these effects are more than outweighed by the benefits.

As an added bonus, here is a short video by Sarah Pratt showing some common differences in an athlete’s ECG (in this case the featured athlete is the NHL’s Tobi Rieder *!*) compared with that of the rest of us. Enjoy!

As ever, if I’ve missed anything, or am just plain wrong about any part of this piece, sound off in the comments below and I’ll do my best to rectify this.

Thanks!

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Q. What Natural Phenomenon Can Speak In Any Language?

Echo_TTEA. 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.

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