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Core goals for all hospitals

The following are the core goals for all hospitals:
  1. Improving patient care
  2. Reducing costs
  3. Creating a good image of the institution
  4. Maintaining a good morale among employees
Many of these goals have an inverse relationship, which means that quite often accomplishing one may come at the expense of another.  For example, order sets can improve patient care, yet the increase in workload results in burnout that reduces morale of workers, and creates negative word of mouth advertising.

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Core goals for all hospitals

The following are the core goals for all hospitals:
  1. Improving patient care
  2. Reducing costs
  3. Creating a good image of the institution
  4. Maintaining a good morale among employees
Many of these goals have an inverse relationship, which means that quite often accomplishing one may come at the expense of another.  For example, order sets can improve patient care, yet the increase in workload results in burnout that reduces morale of workers, and creates negative word of mouth advertising.

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Ready to quit smoking? MRI scan shown to predict success rate

This is another report about smoking that's quite interesting.  It reveals that brain scans can detect which smokers are most likely to quit smoking.  Not only that, the study reveals that the scans do a better job of predicting who will quit than the smokers themselves.

Twenty eight smokers were followed who wanted to quit, and they were showed a series of ads designed to help people quit smoking and their brains were scanned with functional magnetic resonance imaging (MRI).

The results showed an association between activity in a certain region of the brain called the medial prefrontal cortex and successfully quitting smoking , even when test subjects erroneously predict the likelihood of their success.

The study showed that activity in the medial prefrontal lobe was linked to a reduction in smoking after a month.  So even if people believed they couldn't quit smoking, they were not in tune with this brain activity.  If the brain activity was present, the likelihood that they'd succeed at quitting was increased.

So perhaps some day an MRI might be scheduled for those who are trying to quit smoking.  The images might be successful in determining the types of efforts needed to get people to quit smoking, and might explain why some people have a harder time quitting than others.

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Ready to quit smoking? MRI scan shown to predict success rate

This is another report about smoking that's quite interesting.  It reveals that brain scans can detect which smokers are most likely to quit smoking.  Not only that, the study reveals that the scans do a better job of predicting who will quit than the smokers themselves.

Twenty eight smokers were followed who wanted to quit, and they were showed a series of ads designed to help people quit smoking and their brains were scanned with functional magnetic resonance imaging (MRI).

The results showed an association between activity in a certain region of the brain called the medial prefrontal cortex and successfully quitting smoking , even when test subjects erroneously predict the likelihood of their success.

The study showed that activity in the medial prefrontal lobe was linked to a reduction in smoking after a month.  So even if people believed they couldn't quit smoking, they were not in tune with this brain activity.  If the brain activity was present, the likelihood that they'd succeed at quitting was increased.

So perhaps some day an MRI might be scheduled for those who are trying to quit smoking.  The images might be successful in determining the types of efforts needed to get people to quit smoking, and might explain why some people have a harder time quitting than others.

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The respiratory pump: How do we breathe?

When you are thinking about it, you can control your breathing on your own. Most of the time you are alive, however, you will have other things to think about, yet your breathing continues.
So how then do we breathe? (For further reading you can click here.)

The reason we continue to breathe whether we are thinking about it or not is because of the respiratory pump. It consists of the following:
  • Respiratory Center located in the brain
  • Peripheral and Chemo receptors
  • Nerves connecting the respiratory center with the respiratory muscles
  • Respiratory muscles
The respiratory pump basically works to perform the following functions. These functions are the reasons why we breathe:
  1. Homeostasis: Keeping balance inside your body, or maintaining a normal acid base balance (pH or hydrogen ions).
  2. Exchanging gas: Breathing in oxygen, and blowing out CO2.
According to Donald F. Egan's "Fundamentals of Respiratory Care", breathing is controlled by the Central Nervous System, and originates "in the brain stem, mainly from neurons located in the Medulla Oblongata (yet also in the pons). This gland controls breathing by messages it receives from Chemo receptors.

There are two sets of chemo receptors:
  1. Central: They sit right on the Medulla
  2. Peripheral: They are located in the "bifurcations" of both carotid arteries and the arch of the aorta, or somewhere between your shoulders and above your heart.
These chemo receptors send messages to the brain (the Medulla) based on changes in Carbon dioxide (CO2) the partial pressure of oxygen (PO2) in the blood.

Thus, there are two drives to breathe:
  1. The hypoxic drive: It accounts for 10-15 percent of your drive to breathe and no longer functions when your PO2 is greater than 170. When your PO2 drops below 70 a message is sent to the respiratory center to speed up breathing. A normal PO2 is about 104. This function is mainly performed by the peripheral chemoreceptors.

  2. The CO2 drive: A normal CO2 is 35-45. When CO2 increases a signal is sent to the brain to increase your respiratory rate to blow off CO2 to maintain homeostasis. If your CO2 decreases a message is sent to slow down respirations so CO2 can build up to normal levels. CO2 is the main drive to breathe. This function is performed by the central chemoreceptors.
The peripheral chemoreceptors (hypoxic drive) is less of a drive to breathe because it sends signals to the brain far slower than central chemoreceptors. Thus, changes in CO2 effect your breathing about 90 percent of the time.

Let me confuse you a minute. The real drive of breathing is actually hydrogen ions . As hydrogen ions increase, your breathing speeds up. But, since hydrogen ions are not allowed to cross the blood brain barrier so that the pH of the brain can be different from the pH of the body, it cannot directly be used to stimulate breathing.

Thus, CO2 is used. CO2 is allowed to cross the blood brain barrier. Excess levels of CO2 arrive in the brain and are received by the Central Chemo receptors. Thus, "elevations in CO2... cause rapid diffusion of the gas into the CSF (Cerebral Spinal Fluid), where it dissociates into hydrogen ions and lowers the CSF, thereby stimulating the central chemo receptors. The central chemo receptors, in turn, signal the medulary centers to increase ventilation."

So you can see, CO2 "indirectly" causes changes in respirations.

Once the respiratory center receives a message from either the chemoreceptors, the message is interpreted and a signal is sent through through peripheral nerves. The signal travels along one of three peripheral nerves:
  1. Phrenic nerve: Starts at the top of the spinal cord (C3-C5) and insert in the diaphragm on either side of the heart
  2. Intercostal nerves: Start in the spinal cord (T1-T12) and each one travels under a rib and supply messages from the brain to the intercostal muscles
  3. Abdominal nerves: Start in both the thoracic and lumbar regions of the spinal cord and supply neural messages to the abdominal wall muscles
Before the message gets to the respiratory muscle it must pass through a synapse, or narrow gap between the neuron and the muscle. The synapse is called a neuromuscular nunction.

Neuromuscular junction: When an impulse is sent from the brain, it travels down a neuron to a synapse. The impulse signals the nerve ending to release acetylcholine, which is sensed by receptors on the muscle side of the synapse. This causes the muscle to contract, and a breath to take place.

To prevent the muscle from contracting too long, acetylcholinesterase destroys the acetycholine.

To learn about the muscles of respiration and how they help to create a breath click here.

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Why does smoking cause emphysema

Your humble Question:  Why does smoking cause emphysema

My humble answer:  The best answer I have found so far to this question comes from this press release from the University of Iowa regarding a recent study that suggests a CT monitoring blood flow in the lungs can detect emphysema in the early stages: 
Although the underlying causes of emphysema are not well understood, smoking increases the risk of developing the disease.  The study suggests that some smokers have an abnormal response to inflammation in their lungs; instead of sending more blood to the inflamed areas to help repair the damage, blood flow is turned off and the inflamed areas deteriorate.
The cellular pathway that turns off blood flow is helpful when an area of the lung has become permanently blocked and cannot be rescued. In that case, the lung "optimizes gas exchange" and stops supplying the area with blood. However, lung inflammation caused by smoking can be resolved and resultant damage repaired by increased blood flow, which brings oxygen and helpful cellular components to the site of injury.
This study suggests that the ability to distinguish when
I think that's a pretty good explaination of why smoking causes emphysema. 
to turn off or when to ramp up blood flow is defective in some people -- probably due to genetic differences. If this genetic difference is coupled with smoking, which increases lung inflammation, that could increase the risk of developing emphysema.
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Why does smoking cause emphysema

Your humble Question:  Why does smoking cause emphysema

My humble answer:  The best answer I have found so far to this question comes from this press release from the University of Iowa regarding a recent study that suggests a CT monitoring blood flow in the lungs can detect emphysema in the early stages: 
Although the underlying causes of emphysema are not well understood, smoking increases the risk of developing the disease.  The study suggests that some smokers have an abnormal response to inflammation in their lungs; instead of sending more blood to the inflamed areas to help repair the damage, blood flow is turned off and the inflamed areas deteriorate.
The cellular pathway that turns off blood flow is helpful when an area of the lung has become permanently blocked and cannot be rescued. In that case, the lung "optimizes gas exchange" and stops supplying the area with blood. However, lung inflammation caused by smoking can be resolved and resultant damage repaired by increased blood flow, which brings oxygen and helpful cellular components to the site of injury.
This study suggests that the ability to distinguish when
I think that's a pretty good explaination of why smoking causes emphysema. 
to turn off or when to ramp up blood flow is defective in some people -- probably due to genetic differences. If this genetic difference is coupled with smoking, which increases lung inflammation, that could increase the risk of developing emphysema.
 Facebook Twitter
read more...
 
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