Over the last year, the general public has been inundated with a steady stream of reports about the dangers of opiates — pain medicines like codeine, Percocet, and OxyContin. The harm in terms of ruined lives and death from illicit drugs such as heroin is not news. But what is new, and concerning, are the risks of prescription pain medicines — those doctors prescribe for pain due to a range of causes, including musculoskeletal problems like low back pain.
The history of using opiates for chronic pain
Back pain isn’t a new problem either, but the history of how doctors have treated it is probably new to many. A “cliff notes” version of what changed goes something like this. Studies showed that doctors weren’t adequately treating the pain of people with advanced cancer. Research also showed that pain medicines such as opiates improved quality of life for these terminally ill patients. This realization led to recommendations that doctors monitor pain as they would any other vital sign (like temperature or blood pressure) for all their patients — and that all types of pain receive aggressive treatment, including long-term (chronic) pain, such as low back pain. At the same time, drug companies promoted new formulations of opioid medications with longer duration of activity that made it easier for patients to take on a regular basis.
The problem was that this fundamental change in practice was really devoid of any proof that it would help people better manage pain and minimize its effect on their lives. Prior reviews of the medical literature have documented that there is little evidence supporting the use of opiates for chronic low back pain. The modest benefits seen were with short-term use. The practice of using these medicines for long periods of time has not been carefully evaluated. Few risks were seen in these short-term studies, but tolerance to the effects of the medicine, side effects and dependence/addiction have become clearer with longer use.
A recent study published in JAMA Internal Medicine adds to this knowledge. Dr. Abdel Shaheed and colleagues performed an updated literature review, and their conclusions reinforce that only short-term benefits have been proven and the amount of that benefit is modest. Moreover, they examined the doses of pain medicines used in these studies and found that the pain relief people actually experienced was not that great.
Opiates for chronic low back pain carry big risks with uncertain benefits
This and prior studies clearly show that the leap to widespread use of opiates for non-cancer pain was premature. We didn’t know the long-term benefits and risks. We still don’t know the benefits, but this dramatic increase in use of pain medicines hasn’t helped people return to their previous level of activity, and rates of disability haven’t gone down. What is becoming clear are the risks, specifically rates of addiction, overdoses, and the rise of deaths attributed to prescription opiates. And people who have become addicted to their prescribed pain medicines often switch to heroin, which is cheaper and more readily available.
Now this doesn’t mean that we should stop treating pain. For many, the pain is real, chronic, disabling, and they need help managing it. And it doesn’t mean that everyone prescribed opiates becomes addicted. Nor does it suggest that opiate medicines have no benefits at all. But what it should do is give all of us pause. The bottom line is that simply taking a pill (or a handful of pills) doesn’t fix low back pain — and can lead to a whole lot of trouble.
What you can do for back pain
Fortunately, there is growing evidence for treatments that can help with chronic low-back pain, but they aren’t simple fixes in the form of pills, shots or surgery. Instead, treatments should focus on getting back pain sufferers active again and learning to manage, not cure, the pain. A range of therapies including exercise, education about how to care for your back, yoga, and mind-body techniques have been shown to help control back pain. Over the last year, the general public has been inundated with a steady stream of reports about the dangers of opiates — pain medicines like codeine, Percocet, and OxyContin. The harm in terms of ruined lives and death from illicit drugs such as heroin is not news. But what is new, and concerning, are the risks of prescription pain medicines — those doctors prescribe for pain due to a range of causes, including musculoskeletal problems like low back pain.
The history of using opiates for chronic pain
Back pain isn’t a new problem either, but the history of how doctors have treated it is probably new to many. A “cliff notes” version of what changed goes something like this. Studies showed that doctors weren’t adequately treating the pain of people with advanced cancer. Research also showed that pain medicines such as opiates improved quality of life for these terminally ill patients. This realization led to recommendations that doctors monitor pain as they would any other vital sign (like temperature or blood pressure) for all their patients — and that all types of pain receive aggressive treatment, including long-term (chronic) pain, such as low back pain. At the same time, drug companies promoted new formulations of opioid medications with longer duration of activity that made it easier for patients to take on a regular basis.
The problem was that this fundamental change in practice was really devoid of any proof that it would help people better manage pain and minimize its effect on their lives. Prior reviews of the medical literature have documented that there is little evidence supporting the use of opiates for chronic low back pain. The modest benefits seen were with short-term use. The practice of using these medicines for long periods of time has not been carefully evaluated. Few risks were seen in these short-term studies, but tolerance to the effects of the medicine, side effects and dependence/addiction have become clearer with longer use.
A recent study published in JAMA Internal Medicine adds to this knowledge. Dr. Abdel Shaheed and colleagues performed an updated literature review, and their conclusions reinforce that only short-term benefits have been proven and the amount of that benefit is modest. Moreover, they examined the doses of pain medicines used in these studies and found that the pain relief people actually experienced was not that great.
Opiates for chronic low back pain carry big risks with uncertain benefits
This and prior studies clearly show that the leap to widespread use of opiates for non-cancer pain was premature. We didn’t know the long-term benefits and risks. We still don’t know the benefits, but this dramatic increase in use of pain medicines hasn’t helped people return to their previous level of activity, and rates of disability haven’t gone down. What is becoming clear are the risks, specifically rates of addiction, overdoses, and the rise of deaths attributed to prescription opiates. And people who have become addicted to their prescribed pain medicines often switch to heroin, which is cheaper and more readily available.
Now this doesn’t mean that we should stop treating pain. For many, the pain is real, chronic, disabling, and they need help managing it. And it doesn’t mean that everyone prescribed opiates becomes addicted. Nor does it suggest that opiate medicines have no benefits at all. But what it should do is give all of us pause. The bottom line is that simply taking a pill (or a handful of pills) doesn’t fix low back pain — and can lead to a whole lot of trouble.
What you can do for back pain
Fortunately, there is growing evidence for treatments that can help with chronic low-back pain, but they aren’t simple fixes in the form of pills, shots or surgery. Instead, treatments should focus on getting back pain sufferers active again and learning to manage, not cure, the pain. A range of therapies including exercise, education about how to care for your back, yoga, and mind-body techniques have been shown to help control back pain.
So what do I tell my patients? For those with chronic back pain who aren’t on opiates, steer clear. For those who are already take them, you can’t go cold turkey. Your body has adjusted to these medicines and stopping them abruptly is a bad idea. With help, people on opiate pain relievers can try to wean themselves off these medicines gradually and replace them with other treatments. This isn’t easy, but for many people it starts a long process of regaining control over the pain that has taken over their lives and can help them avoid the terrible consequences of opiate addiction. At a recent meeting I offered a visitor lunch which she declined with obvious regret. She was hungry, and it was noon. But she was headed to her annual physical, and eating beforehand would mean returning another morning for a fasting cholesterol level. Most of us can relate to her annoyance, but thankfully this may soon be a thing of the past.
Doctors have traditionally ordered cholesterol tests to be drawn after an overnight fast. But this requirement causes a significant burden on both sides of the health care equation. Most people hate to fast. Skipping meals is particularly difficult for active people, people with diabetes, and children. Yet coming back for another visit is even more of a hassle, so many people just don’t bother. And it has been a drain for doctors, too, resulting in repeat test orders, phone calls, and patient visits.
International guidelines published last month in the European Heart Journal became the latest official recommendation against routine fasting for cholesterol tests. These guidelines defend what many health care systems and many doctors (including me) have been practicing for several years already. They should be met with universal acceptance, even if takes a while. There are several scientific reasons supporting this change.
The history behind fasting cholesterol tests
When doctors test for cholesterol, we almost always order a group of tests called a lipid panel (lipids are fat-containing molecules). This panel typically includes four separate measures:
Total cholesterol concentration.
Low-density lipoprotein* (LDL) – cholesterol, often called the “bad” cholesterol. The amount of LDL in your blood strongly predicts your risk of cardiovascular disease, as higher levels are associated with development of plaque in the arteries.
High-density lipoprotein (HDL) – cholesterol, often called “good cholesterol” because higher levels protect against heart disease.
Triglycerides (a different type of lipid molecule). High levels of triglycerides are also associated with vascular disease, although this relationship isn’t as well defined.
*Lipoproteins are the “packages” that transport cholesterol in the bloodstream.
Lipids have traditionally been drawn after a fast for two main reasons. The first was to minimize variation, since eating can affect some lipid levels. The second was to produce a better calculation of LDL-cholesterol, which is often derived from an equation thought to provide highly distorted results after eating. However, more recent studies have largely negated these concerns.
Scientists now agree that eating has only slight, clinically insignificant effects on three parts of the lipid profile: total cholesterol, and both HDL- and LDL-cholesterol. Food does raise triglyceride levels for several hours, usually to a modest degree. After a high fat meal these increases can be striking. Therefore, a doctor may still order a fasting test of triglycerides if non-fasting values are significantly elevated.
Perhaps more important, large-scale analyses have shown that non-fasting lipids don’t weaken the connection between cholesterol levels and harmful events like heart attack and stroke. In fact, post-meal measures are thought to strengthen the ability of lipid levels to predict cardiovascular risk. This observation may stem from the fact that most people eat several meals plus snacks during the day. That means we spend most of our time in a “fed” state, not a fasting state. So lipid levels after eating may best reflect our normal physiology.
An end to the dreaded overnight fast?
Guidelines for lipid panels have evolved over the past decade, supported by evidence from studies involving hundreds of thousands of people. Most recommendations now support non-fasting cholesterol tests for routine testing. (You can find a summary of these recommendations here.)
Some fasting lipids tests will remain necessary, especially in people with very high triglycerides. And some people will still need to fast for blood sugar levels, although an alternative test for diabetes (hemoglobin A1c) has replaced much of this testing. But for most, including those having routine cholesterol tests to weigh cardiovascular risk and for those taking drug therapy, this news is good news.
So ask your doctor if you really need to skip breakfast before your next blood draw. Traditions die hard, but both science and convenience may ultimately steer this one to its end. This is one change doctors and patients should celebrate together.
Hi clicks on this page, you’re probably a hard working student who wants to improve their study skills even further. Or maybe you’re someone who tries really hard or wants to try really hard, but you’re not really seeing that payoff in your numbers. But we’ve come to the right video because today we’re going to go over five ish study techniques to help you improve your study skills. I’m not going to go into the obvious ones, like do a bunch of practice problems. And always pay attention in class and don’t do homework in your bed. You know, make sure your desk is neat and your room is neat. I at least that helps me doing work in a clean environment. I feel a lot less messy.
When I feel less messy. I can be more productive. Write down all your work and make a plan or your notes or whatever works for you. When I say clearly do practice problems, pay attention in class, take notes, do your homework that will make the biggest difference. Honestly,
These are five things that you can do to sharpen your skills even further.
Number one, differentiate your study methods. Now, I’ve always found it really effective, especially in high school to study differently for different subjects. To me, this is a very similar idea to, you know, using different color binders for different subjects, or shooting the same flavor of gum while studying as when you’re taking the actual test.
I think it’s like the same effect. I think it just gets your brain used to different environmental conditions, different sensations when you’re doing a certain activity that allows you to switch between them more quickly and more efficiently. Now, there are an infinite number of study methods and everybody has their favorites. I’m going to quickly go over study methods that I use for different classes, especially when I was in high school. There were many for example, in math.
I always used whiteboards. I loved using whiteboards for math, because you can use different colors to visualize each step not only turns your map into a picture, but also allows you to
You clearly see each step. And you know, the colors make it a little more fun than just doing practice problems over and over again, on pencil on paper, what I would do is in the corner, I would write in small print the date of the test the name of the test, if there was one in beneath it, I would just quickly bullet the content that would be covered on the test. So it was like trig identities or you substitution or integrals or anything like that, I would just quickly bleed on here so I knew exactly what to cover and then I would keep that on there the whole time.
Related Post: Best Time Management Systems for Students
And then over here, I would do practice problems and practice problems over and over and over again history and social sciences in general government politics, all that I would mostly use quickly or Spanish or foreign language I was vocab I would like do piece of paper and fold it in half I’d have English on one side is finished on the other and I flipped through and check in quiz myself easily for economics I inserted picture right here I would do a bigger view on a whiteboard the day of the test just a few periods before my study hall because that’s just what worked well in my schedule in addition to making
My notes into a study guide or actually my notes already were a study guide. More on that in my how to take notes video and for science if it was like a physics or chemistry or something that and although the practice problems obviously I would do a lot of practice problems to study and look at all the questions and all tests and stuff like that but if it was more just like understanding concepts and memorizing material I would often use study song have a few of those on this channel and also listen to other people’s like ASAP science has some and yeah a lot of other people have some all you have to really do is go to the YouTube search bar and look up the topic and type the word song next to it. Something will come up this is YouTube.
Number two should be obvious, but if it’s not, I’m going to reiterate it. Always ask for help. Always ask for help. Always ask for help. Don’t be ashamed of asking for help. I did it all the time. The smartest people do they’re not ashamed to go to a teacher or go to a professor’s office hours or whatever to seek.
further explanation on a concept that’s totally normal is literally the teacher professors job, you’ll need more than just like a five minute conversation or five minute explanation see if your teacher will stay after school and work with you or if they have study sessions or if there is somewhere you can go to get further review or if they recommend reading certain chapters in your textbook doing practice problems or reviewing for a test and you really you’ve come across something you really don’t understand take some sticky notes and make a little note of it so that when you go and see your teacher professor to ask them about it leader you know exactly what to bring up you know exactly what your question will be.
Number three review easily review mindlessly review without straining your brain. This was one of my favorite tactics in high school because it was just so easy, no effort. Really what I’m talking about is just kind of always having information and knowledge and answers around you turn those mundane transitions of everyday life turn those mundane tasks into an opportunity.
To deeper you to further engage yourself intellectually listen to a podcast. When you’re in the car when that is relevant to what you’re learning or is related to something that you’re interested in, you can play sideshow Crash Course physics girl, very task to be sauce any educational content creators videos while you’re in the shower getting ready in the morning going to bed just having information constantly being read to you and explain to you in the background of your life I think is really helpful You don’t have to be focused in on what they’re saying but just having it there I think kind of shapes your mind to listen more as well as just learn more because you won’t pick up on all the information because you’re not in a situation where that’s your main focus but but you might learn something new or use it as an opportunity to review something that’s on coming test other methods you can employ that fall under this umbrella of number three is reading you can read I encourage you to read articles, books, even Twitter threads on topics that you’re interested about. I think that counts.
You can if you’re studying and you just want to always have the information around you again but physically you can take sticky notes and you can just put concepts and reminders of certain pieces of information all over your room all over your house so that you see them in your everyday life
Number four This one’s a big especially if you’re taking a college or AP class know the format of the exam that you’re taking know how many questions are going to be on it know how much time you have know if you need a pencil or pen know if you can bring a calculator know what kind of calculator you can use know how many sections there are no know if there’s going to be a break in between know it’s multiple choice short answer long essay, short essays and anything like that true false because that way you can practice problems like that you’ll feel so much more comfortable because you will have seen that material that style so much before and my fifth tip is to make it fun. This depending on the type of person you are fun means different things.
Like if you really like just bunker down and just silence desk, nothing but a desk light on just working for six straight hours that works for you go for it. You do you boo. I’m not judging you. But for me, especially when it comes to like math and science. I like to have fun while I do it.
I will listen to music if I’m doing those kinds if I’m doing a problem set, or I’ll watch Netflix really like this because I feel like if you have a good time when you’re doing your work, you all associate positive feelings and positive emotions with that work and it will make you enjoy learning more.
Obviously you can’t do that with all things like if you’re reading I definitely can’t watch Netflix. Well, I read but sometimes I listen to classical music and listen to an audio book. I can find that that helps say, Do whatever you need to do to trick yourself into thinking that homework is fun.
focus focus. espresso beans. help you do were like Adderall accepts just happy and not at all please don’t do trophies don’t do at all. Unless you’re subscribed to you. Please don’t. Please don’t don’t. I have never have never will. You won’t either. But we read on this thing. Yeah, that’s pretty much it. For me.
It all comes down really to preparing yourself ahead of time and making your work and you’re studying colorful and fun. Leave a comment down below about your favorite studies strategy or any one of these that you plan on trying out also let me know other content that you guys would maybe want to see.
Let me know if you guys would be down for like fitness and lifestyle videos because I totally be down to make those that hopefully really fun tips coming out in a few days. So stick around for that. Okay. Again, I’m Hannah and thank you so much for reading. I hope this helps. Hello everyone. We are now in 2019. And if you’re already feeling behind on your organization system for 2019, I’m here for you. I believe. And this is a mode of my year that if you want to achieve things in life, you need to start simple. And you need to go back to basics to achieve the perfect balance of what you need to be productive and organized.
This is why we are going to start with the free full organization system that will absolutely help you get your life together have everything seamlessly organized into one ecosystem.
So today we are going to talk of course, about the Google Apps for productivity and organization. Basically, this means that the Google ecosystem includes the calendar file, managing email, managing with productivity tools, text editors, and note taking app regarding the pros and cons of the Google ecosystem. I will start
By saying that it’s free. So as long as you have a compatible device, an internet connection and Google products aren’t blocked in your country, you’re able to access Google Apps. Also,
their synchronization between all the devices you use to access the same account and you have the ability to sign in into your organization system. In any computer or device. There’s also concept backing up of your information, so you’ll never be afraid of losing anything.
So there are simple tools that make your organization system that much easier to use and to manage for cons. We can also take simplicity because it can be a burden for some users who prefer complex tools to organize their lives. And also the digital environment may not be very convenient or the best start for some people.
I myself use a hybrid of an analog and digital system. There are some tests that I prefer to do on papers if that’s your case, and it prefer to all of your organization in paper that’s just fine. Also, you mostly need an internet connection.
If you live in an area where that’s hard to come by, you might have a lot of trouble making the most out of this ecosystem to build a foundation of our organization system.
We’re going to start with Google Keep and I believe that Google Keep is one of the most underrated organization apps out there yes we’ll keep is a very simple app but it’s really powerful because its simplicity ease transported to other types of Google apps like calendar in Gmail, but we will talk about that later.
So for now, what you need to know is that Google Keep acts as a dashboard where you can place post it notes with all kinds of to do’s of notes and reminders.
So in your main dashboard, you can see these little notes that you can color code and then click and drag according to your own priorities, your arrow key and even if you want, you can simply establish blocks of color so you can see how many tasks you have according to the topic you shows for each color. The best way to organize your notes with Google Keep is basically sabotaging a color for each kind of topic you are choosing for each node.
So for instance here I have yellow for every YouTube related task and I have blue for every school related.
Task wise tasks are personal tasks, including things like personal to do’s appointments, financial stuff, and so on. The second thing you can do to really organize your notes is using labels these act as tax so it can simply create a note, assign it a color, and then choose a label according to the topic of the notes.
So you can select the label on the left side of your screen to access all notes labeled with that name. Also, as I said before, you can click and drag every single note so you can have the order of notes that you prefer to get yourself organized. Also, since it’s a Google product. You can also download Google Keep to your phone, so it synchronizes with every
See: Best Study Tools for Medical Students – Top 5 Study Techniques
Everything you do on your computer when you migrate all of your to do’s all of your notes, all of your project notes into Google Keep, you can definitely go to Google Calendar and start managing your time, your appointments and your tasks. My basic tip for Google calendar to work is creating a calendar for each categorized sort of information you’re trying to place your calendar.
So for instance, in my particular case, I use for instance, rav4 family sharing tasks and appointments. I use purple for my history classes, I use orange for any YouTube related stuff. This is a really good way for you to understand which parts of your week are allotted to certain parts of your life, and so on.
The second tip I can give for Google Calendar users is using the upper part of your calendar to schedule daily tasks instead of hourly events. So even if you’re using a calendar blocking technique to manage your time and your digital calendar sometimes
Your events that are occur hourly, but instead they occur on a daily basis. This happens mostly with holidays, birthdays and things like that. So what I do in these cases is creating that event, then assign it to one of those specific color coded calendars and then drag the event up to the top of my calendar where it will be considered a daily event that do not need to assign an hour for the event to be completed are finished possible. calendar has a function of sinking with all of your devices and also inviting it also allows you to invite people to share your calendar This is really good for things like housework, your business, teamwork, or even scheduling meeting hours with the book clubs, work groups, and so on.
The power of your Google ecosystem really shows up here when you access it tools in the right tab in the right side you have these little app lets that you can access to open up different Google apps that can synchronize and can be used with your Google Calendar.
So for instance, we have already set up all of our tasks in Google Keep. And by clicking the respective button on your Google Calendar app, you can access all those tasks so you can better understand by looking at those tasks. Those color coded knows how you need to schedule your time better, what type of to do’s you need to integrate into your calendar, what kind of goals you need to project in your schedule, and so on. Also, if you set reminders, both in your Google Calendar and in your Google Keep apps, you can also get on track with your tasks and with your events by being smart with how establish those alarms go off in your phone.
After that, I think it’s time for you to manage all of your files with Google Drive. If you’ll basically be the only file manager you need in case you have a permanent internet connection. So Google Drive is free until 15 gigs which may definitely not be enough for you to keep all of your files but 100 gigs goes for less than $2.
A month. And if you’re a student, that’s what you’ll need in case you deal with PDF and text documents. Mostly just like any file manager on your computer. Google drive’s allows you to create folders and organize them according to name and color. So you can basically create a full fledged file managing system online.
That way, you never fear losing your files since Google Drive backs up your documents to the cloud. So they’re always there. Even if your computer crashes. There’s nothing really special about Google Drive in itself.
It’s a very simple and powerful tool for you to organize all of your files and being sure that that can be accessed anywhere. If you cannot rely on a specific device to do all of your work.
You also have sharing capabilities with other users. And the good thing is you do not need to share your whole files with your friends and family because you can select the specific folders or files you want to share. Also, the good thing is that when you are storing documents in Google Drive if they are text based
documents, you can quickly open them up in Google Docs and added them on the go. And Google Docs is actually pretty powerful text editor, although is not as powerful as Microsoft Word, but it definitely has all the tools you need, including an commenting interface, as well as sharing capabilities that make it a solid text editor. In case you need something a little bit more structured than Google Keep.
It also has constant cloud backup. So you’ll never worry about losing your files. And although the tools are nothing to elaborate, they will make the job just fine.
Finally, I want to talk about Gmail. And I’m not going to talk about Gmail in itself as a mailing service in comparison to other mailing services. But I want to talk about the organization tools inside Gmail that make it the perfect tool for you to organize your mail if you are into the Google ecosystem. So the first thing I love about Gmail is the ability to call her
code and label my emails effectively, just like I do with my calendars. I have very specific labels in my Gmail, things like answered, not answered sponsorship, inquiry blog post, any school related emails and so on. And every time I get an email, I will automatically label it according to one of those things.
And I will just label of those unanswered or an open emails with that label. So I know I need to get back to them as soon as I can.
The second thing I enjoy about Gmail is that integration with other Google apps like calendar, Google came and tasks. So basically, you can open that side on the right side of your screen.
And Gmail lets you peek into those apps and use them side by side to interconnect all the information from that same account. This really comes in handy for some instance you’re using a gmail to schedule a meeting and you need to access your calendar instead of having to access the calendar in another tab or even in another device.
If you prefer it that way, you can simply open the Calendar tab inside your Gmail account and see if you have a free slot of time to schedule that meeting and just type your mail right on the go. The third thing I really enjoy about Gmail is the ability to have different in boxes.
So for instance, I have a ton of social emails arriving every single day to my inbox, people who are messaging me on social media emails that are getting to my YouTube account, things related to my Instagram people replying to blog posts on my website and so on. And usually those emails are not a priority for me to answer.
So they’re all filtered into the social inbox so I can get them when I can get to them. Instead of having to constantly see my main inbox being floated with promotional emails with forum responses with social reminders and so on. I want to thank skill share for partnering with me today and being incredible at supporting more than 7 million people in your
learning journey skill share is an online learning community with more than 25,000 classes in dozens of different categories and they can help you build new skills develop new strategies and learn more about anything feel curious about skill shares portfolio includes productivity and business master classes, tutorials on how to work with different types of software language classes are some design courses and so on.
Here you are seeing a class on easy project management with Google which will be pretty useful in case you want to take what you’ve learned from this video further.
Also, premium membership gives you unlimited access to all these incredible classes. So no individual payments required and since skill share costs less than $10 a month for the yearly subscription.
It’s the perfect companion for the learning with us.
Yes. Also if you are one of the first 500 people to click the link in the description box you’ll get your first two months of unlimited classes for free. Don’t forget subscribe to the channel and I’ll see you next week with
The history of using opiates for chronic pain
Back pain isn’t a new problem either, but the history of how doctors have treated it is probably new to many. A “cliff notes” version of what changed goes something like this. Studies showed that doctors weren’t adequately treating the pain of people with advanced cancer. Research also showed that pain medicines such as opiates improved quality of life for these terminally ill patients. This realization led to recommendations that doctors monitor pain as they would any other vital sign (like temperature or blood pressure) for all their patients — and that all types of pain receive aggressive treatment, including long-term (chronic) pain, such as low back pain. At the same time, drug companies promoted new formulations of opioid medications with longer duration of activity that made it easier for patients to take on a regular basis.
The problem was that this fundamental change in practice was really devoid of any proof that it would help people better manage pain and minimize its effect on their lives. Prior reviews of the medical literature have documented that there is little evidence supporting the use of opiates for chronic low back pain. The modest benefits seen were with short-term use. The practice of using these medicines for long periods of time has not been carefully evaluated. Few risks were seen in these short-term studies, but tolerance to the effects of the medicine, side effects and dependence/addiction have become clearer with longer use.
A recent study published in JAMA Internal Medicine adds to this knowledge. Dr. Abdel Shaheed and colleagues performed an updated literature review, and their conclusions reinforce that only short-term benefits have been proven and the amount of that benefit is modest. Moreover, they examined the doses of pain medicines used in these studies and found that the pain relief people actually experienced was not that great.
Opiates for chronic low back pain carry big risks with uncertain benefits
This and prior studies clearly show that the leap to widespread use of opiates for non-cancer pain was premature. We didn’t know the long-term benefits and risks. We still don’t know the benefits, but this dramatic increase in use of pain medicines hasn’t helped people return to their previous level of activity, and rates of disability haven’t gone down. What is becoming clear are the risks, specifically rates of addiction, overdoses, and the rise of deaths attributed to prescription opiates. And people who have become addicted to their prescribed pain medicines often switch to heroin, which is cheaper and more readily available.
Now this doesn’t mean that we should stop treating pain. For many, the pain is real, chronic, disabling, and they need help managing it. And it doesn’t mean that everyone prescribed opiates becomes addicted. Nor does it suggest that opiate medicines have no benefits at all. But what it should do is give all of us pause. The bottom line is that simply taking a pill (or a handful of pills) doesn’t fix low back pain — and can lead to a whole lot of trouble.
What you can do for back pain
Fortunately, there is growing evidence for treatments that can help with chronic low-back pain, but they aren’t simple fixes in the form of pills, shots or surgery. Instead, treatments should focus on getting back pain sufferers active again and learning to manage, not cure, the pain. A range of therapies including exercise, education about how to care for your back, yoga, and mind-body techniques have been shown to help control back pain. Over the last year, the general public has been inundated with a steady stream of reports about the dangers of opiates — pain medicines like codeine, Percocet, and OxyContin. The harm in terms of ruined lives and death from illicit drugs such as heroin is not news. But what is new, and concerning, are the risks of prescription pain medicines — those doctors prescribe for pain due to a range of causes, including musculoskeletal problems like low back pain.
The history of using opiates for chronic pain
Back pain isn’t a new problem either, but the history of how doctors have treated it is probably new to many. A “cliff notes” version of what changed goes something like this. Studies showed that doctors weren’t adequately treating the pain of people with advanced cancer. Research also showed that pain medicines such as opiates improved quality of life for these terminally ill patients. This realization led to recommendations that doctors monitor pain as they would any other vital sign (like temperature or blood pressure) for all their patients — and that all types of pain receive aggressive treatment, including long-term (chronic) pain, such as low back pain. At the same time, drug companies promoted new formulations of opioid medications with longer duration of activity that made it easier for patients to take on a regular basis.
The problem was that this fundamental change in practice was really devoid of any proof that it would help people better manage pain and minimize its effect on their lives. Prior reviews of the medical literature have documented that there is little evidence supporting the use of opiates for chronic low back pain. The modest benefits seen were with short-term use. The practice of using these medicines for long periods of time has not been carefully evaluated. Few risks were seen in these short-term studies, but tolerance to the effects of the medicine, side effects and dependence/addiction have become clearer with longer use.
A recent study published in JAMA Internal Medicine adds to this knowledge. Dr. Abdel Shaheed and colleagues performed an updated literature review, and their conclusions reinforce that only short-term benefits have been proven and the amount of that benefit is modest. Moreover, they examined the doses of pain medicines used in these studies and found that the pain relief people actually experienced was not that great.
Opiates for chronic low back pain carry big risks with uncertain benefits
This and prior studies clearly show that the leap to widespread use of opiates for non-cancer pain was premature. We didn’t know the long-term benefits and risks. We still don’t know the benefits, but this dramatic increase in use of pain medicines hasn’t helped people return to their previous level of activity, and rates of disability haven’t gone down. What is becoming clear are the risks, specifically rates of addiction, overdoses, and the rise of deaths attributed to prescription opiates. And people who have become addicted to their prescribed pain medicines often switch to heroin, which is cheaper and more readily available.
Now this doesn’t mean that we should stop treating pain. For many, the pain is real, chronic, disabling, and they need help managing it. And it doesn’t mean that everyone prescribed opiates becomes addicted. Nor does it suggest that opiate medicines have no benefits at all. But what it should do is give all of us pause. The bottom line is that simply taking a pill (or a handful of pills) doesn’t fix low back pain — and can lead to a whole lot of trouble.
What you can do for back pain
Fortunately, there is growing evidence for treatments that can help with chronic low-back pain, but they aren’t simple fixes in the form of pills, shots or surgery. Instead, treatments should focus on getting back pain sufferers active again and learning to manage, not cure, the pain. A range of therapies including exercise, education about how to care for your back, yoga, and mind-body techniques have been shown to help control back pain.
So what do I tell my patients? For those with chronic back pain who aren’t on opiates, steer clear. For those who are already take them, you can’t go cold turkey. Your body has adjusted to these medicines and stopping them abruptly is a bad idea. With help, people on opiate pain relievers can try to wean themselves off these medicines gradually and replace them with other treatments. This isn’t easy, but for many people it starts a long process of regaining control over the pain that has taken over their lives and can help them avoid the terrible consequences of opiate addiction. At a recent meeting I offered a visitor lunch which she declined with obvious regret. She was hungry, and it was noon. But she was headed to her annual physical, and eating beforehand would mean returning another morning for a fasting cholesterol level. Most of us can relate to her annoyance, but thankfully this may soon be a thing of the past.
Doctors have traditionally ordered cholesterol tests to be drawn after an overnight fast. But this requirement causes a significant burden on both sides of the health care equation. Most people hate to fast. Skipping meals is particularly difficult for active people, people with diabetes, and children. Yet coming back for another visit is even more of a hassle, so many people just don’t bother. And it has been a drain for doctors, too, resulting in repeat test orders, phone calls, and patient visits.
International guidelines published last month in the European Heart Journal became the latest official recommendation against routine fasting for cholesterol tests. These guidelines defend what many health care systems and many doctors (including me) have been practicing for several years already. They should be met with universal acceptance, even if takes a while. There are several scientific reasons supporting this change.
The history behind fasting cholesterol tests
When doctors test for cholesterol, we almost always order a group of tests called a lipid panel (lipids are fat-containing molecules). This panel typically includes four separate measures:
Total cholesterol concentration.
Low-density lipoprotein* (LDL) – cholesterol, often called the “bad” cholesterol. The amount of LDL in your blood strongly predicts your risk of cardiovascular disease, as higher levels are associated with development of plaque in the arteries.
High-density lipoprotein (HDL) – cholesterol, often called “good cholesterol” because higher levels protect against heart disease.
Triglycerides (a different type of lipid molecule). High levels of triglycerides are also associated with vascular disease, although this relationship isn’t as well defined.
*Lipoproteins are the “packages” that transport cholesterol in the bloodstream.
Lipids have traditionally been drawn after a fast for two main reasons. The first was to minimize variation, since eating can affect some lipid levels. The second was to produce a better calculation of LDL-cholesterol, which is often derived from an equation thought to provide highly distorted results after eating. However, more recent studies have largely negated these concerns.
Scientists now agree that eating has only slight, clinically insignificant effects on three parts of the lipid profile: total cholesterol, and both HDL- and LDL-cholesterol. Food does raise triglyceride levels for several hours, usually to a modest degree. After a high fat meal these increases can be striking. Therefore, a doctor may still order a fasting test of triglycerides if non-fasting values are significantly elevated.
Perhaps more important, large-scale analyses have shown that non-fasting lipids don’t weaken the connection between cholesterol levels and harmful events like heart attack and stroke. In fact, post-meal measures are thought to strengthen the ability of lipid levels to predict cardiovascular risk. This observation may stem from the fact that most people eat several meals plus snacks during the day. That means we spend most of our time in a “fed” state, not a fasting state. So lipid levels after eating may best reflect our normal physiology.
An end to the dreaded overnight fast?
Guidelines for lipid panels have evolved over the past decade, supported by evidence from studies involving hundreds of thousands of people. Most recommendations now support non-fasting cholesterol tests for routine testing. (You can find a summary of these recommendations here.)
Some fasting lipids tests will remain necessary, especially in people with very high triglycerides. And some people will still need to fast for blood sugar levels, although an alternative test for diabetes (hemoglobin A1c) has replaced much of this testing. But for most, including those having routine cholesterol tests to weigh cardiovascular risk and for those taking drug therapy, this news is good news.
So ask your doctor if you really need to skip breakfast before your next blood draw. Traditions die hard, but both science and convenience may ultimately steer this one to its end. This is one change doctors and patients should celebrate together.
Hi clicks on this page, you’re probably a hard working student who wants to improve their study skills even further. Or maybe you’re someone who tries really hard or wants to try really hard, but you’re not really seeing that payoff in your numbers. But we’ve come to the right video because today we’re going to go over five ish study techniques to help you improve your study skills. I’m not going to go into the obvious ones, like do a bunch of practice problems. And always pay attention in class and don’t do homework in your bed. You know, make sure your desk is neat and your room is neat. I at least that helps me doing work in a clean environment. I feel a lot less messy.
When I feel less messy. I can be more productive. Write down all your work and make a plan or your notes or whatever works for you. When I say clearly do practice problems, pay attention in class, take notes, do your homework that will make the biggest difference. Honestly,
These are five things that you can do to sharpen your skills even further.
Number one, differentiate your study methods. Now, I’ve always found it really effective, especially in high school to study differently for different subjects. To me, this is a very similar idea to, you know, using different color binders for different subjects, or shooting the same flavor of gum while studying as when you’re taking the actual test.
I think it’s like the same effect. I think it just gets your brain used to different environmental conditions, different sensations when you’re doing a certain activity that allows you to switch between them more quickly and more efficiently. Now, there are an infinite number of study methods and everybody has their favorites. I’m going to quickly go over study methods that I use for different classes, especially when I was in high school. There were many for example, in math.
I always used whiteboards. I loved using whiteboards for math, because you can use different colors to visualize each step not only turns your map into a picture, but also allows you to
You clearly see each step. And you know, the colors make it a little more fun than just doing practice problems over and over again, on pencil on paper, what I would do is in the corner, I would write in small print the date of the test the name of the test, if there was one in beneath it, I would just quickly bullet the content that would be covered on the test. So it was like trig identities or you substitution or integrals or anything like that, I would just quickly bleed on here so I knew exactly what to cover and then I would keep that on there the whole time.
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And then over here, I would do practice problems and practice problems over and over and over again history and social sciences in general government politics, all that I would mostly use quickly or Spanish or foreign language I was vocab I would like do piece of paper and fold it in half I’d have English on one side is finished on the other and I flipped through and check in quiz myself easily for economics I inserted picture right here I would do a bigger view on a whiteboard the day of the test just a few periods before my study hall because that’s just what worked well in my schedule in addition to making
My notes into a study guide or actually my notes already were a study guide. More on that in my how to take notes video and for science if it was like a physics or chemistry or something that and although the practice problems obviously I would do a lot of practice problems to study and look at all the questions and all tests and stuff like that but if it was more just like understanding concepts and memorizing material I would often use study song have a few of those on this channel and also listen to other people’s like ASAP science has some and yeah a lot of other people have some all you have to really do is go to the YouTube search bar and look up the topic and type the word song next to it. Something will come up this is YouTube.
Number two should be obvious, but if it’s not, I’m going to reiterate it. Always ask for help. Always ask for help. Always ask for help. Don’t be ashamed of asking for help. I did it all the time. The smartest people do they’re not ashamed to go to a teacher or go to a professor’s office hours or whatever to seek.
further explanation on a concept that’s totally normal is literally the teacher professors job, you’ll need more than just like a five minute conversation or five minute explanation see if your teacher will stay after school and work with you or if they have study sessions or if there is somewhere you can go to get further review or if they recommend reading certain chapters in your textbook doing practice problems or reviewing for a test and you really you’ve come across something you really don’t understand take some sticky notes and make a little note of it so that when you go and see your teacher professor to ask them about it leader you know exactly what to bring up you know exactly what your question will be.
Number three review easily review mindlessly review without straining your brain. This was one of my favorite tactics in high school because it was just so easy, no effort. Really what I’m talking about is just kind of always having information and knowledge and answers around you turn those mundane transitions of everyday life turn those mundane tasks into an opportunity.
To deeper you to further engage yourself intellectually listen to a podcast. When you’re in the car when that is relevant to what you’re learning or is related to something that you’re interested in, you can play sideshow Crash Course physics girl, very task to be sauce any educational content creators videos while you’re in the shower getting ready in the morning going to bed just having information constantly being read to you and explain to you in the background of your life I think is really helpful You don’t have to be focused in on what they’re saying but just having it there I think kind of shapes your mind to listen more as well as just learn more because you won’t pick up on all the information because you’re not in a situation where that’s your main focus but but you might learn something new or use it as an opportunity to review something that’s on coming test other methods you can employ that fall under this umbrella of number three is reading you can read I encourage you to read articles, books, even Twitter threads on topics that you’re interested about. I think that counts.
You can if you’re studying and you just want to always have the information around you again but physically you can take sticky notes and you can just put concepts and reminders of certain pieces of information all over your room all over your house so that you see them in your everyday life
Number four This one’s a big especially if you’re taking a college or AP class know the format of the exam that you’re taking know how many questions are going to be on it know how much time you have know if you need a pencil or pen know if you can bring a calculator know what kind of calculator you can use know how many sections there are no know if there’s going to be a break in between know it’s multiple choice short answer long essay, short essays and anything like that true false because that way you can practice problems like that you’ll feel so much more comfortable because you will have seen that material that style so much before and my fifth tip is to make it fun. This depending on the type of person you are fun means different things.
Like if you really like just bunker down and just silence desk, nothing but a desk light on just working for six straight hours that works for you go for it. You do you boo. I’m not judging you. But for me, especially when it comes to like math and science. I like to have fun while I do it.
I will listen to music if I’m doing those kinds if I’m doing a problem set, or I’ll watch Netflix really like this because I feel like if you have a good time when you’re doing your work, you all associate positive feelings and positive emotions with that work and it will make you enjoy learning more.
Obviously you can’t do that with all things like if you’re reading I definitely can’t watch Netflix. Well, I read but sometimes I listen to classical music and listen to an audio book. I can find that that helps say, Do whatever you need to do to trick yourself into thinking that homework is fun.
focus focus. espresso beans. help you do were like Adderall accepts just happy and not at all please don’t do trophies don’t do at all. Unless you’re subscribed to you. Please don’t. Please don’t don’t. I have never have never will. You won’t either. But we read on this thing. Yeah, that’s pretty much it. For me.
It all comes down really to preparing yourself ahead of time and making your work and you’re studying colorful and fun. Leave a comment down below about your favorite studies strategy or any one of these that you plan on trying out also let me know other content that you guys would maybe want to see.
Let me know if you guys would be down for like fitness and lifestyle videos because I totally be down to make those that hopefully really fun tips coming out in a few days. So stick around for that. Okay. Again, I’m Hannah and thank you so much for reading. I hope this helps. Hello everyone. We are now in 2019. And if you’re already feeling behind on your organization system for 2019, I’m here for you. I believe. And this is a mode of my year that if you want to achieve things in life, you need to start simple. And you need to go back to basics to achieve the perfect balance of what you need to be productive and organized.
This is why we are going to start with the free full organization system that will absolutely help you get your life together have everything seamlessly organized into one ecosystem.
So today we are going to talk of course, about the Google Apps for productivity and organization. Basically, this means that the Google ecosystem includes the calendar file, managing email, managing with productivity tools, text editors, and note taking app regarding the pros and cons of the Google ecosystem. I will start
By saying that it’s free. So as long as you have a compatible device, an internet connection and Google products aren’t blocked in your country, you’re able to access Google Apps. Also,
their synchronization between all the devices you use to access the same account and you have the ability to sign in into your organization system. In any computer or device. There’s also concept backing up of your information, so you’ll never be afraid of losing anything.
So there are simple tools that make your organization system that much easier to use and to manage for cons. We can also take simplicity because it can be a burden for some users who prefer complex tools to organize their lives. And also the digital environment may not be very convenient or the best start for some people.
I myself use a hybrid of an analog and digital system. There are some tests that I prefer to do on papers if that’s your case, and it prefer to all of your organization in paper that’s just fine. Also, you mostly need an internet connection.
If you live in an area where that’s hard to come by, you might have a lot of trouble making the most out of this ecosystem to build a foundation of our organization system.
We’re going to start with Google Keep and I believe that Google Keep is one of the most underrated organization apps out there yes we’ll keep is a very simple app but it’s really powerful because its simplicity ease transported to other types of Google apps like calendar in Gmail, but we will talk about that later.
So for now, what you need to know is that Google Keep acts as a dashboard where you can place post it notes with all kinds of to do’s of notes and reminders.
So in your main dashboard, you can see these little notes that you can color code and then click and drag according to your own priorities, your arrow key and even if you want, you can simply establish blocks of color so you can see how many tasks you have according to the topic you shows for each color. The best way to organize your notes with Google Keep is basically sabotaging a color for each kind of topic you are choosing for each node.
So for instance here I have yellow for every YouTube related task and I have blue for every school related.
Task wise tasks are personal tasks, including things like personal to do’s appointments, financial stuff, and so on. The second thing you can do to really organize your notes is using labels these act as tax so it can simply create a note, assign it a color, and then choose a label according to the topic of the notes.
So you can select the label on the left side of your screen to access all notes labeled with that name. Also, as I said before, you can click and drag every single note so you can have the order of notes that you prefer to get yourself organized. Also, since it’s a Google product. You can also download Google Keep to your phone, so it synchronizes with every
See: Best Study Tools for Medical Students – Top 5 Study Techniques
Everything you do on your computer when you migrate all of your to do’s all of your notes, all of your project notes into Google Keep, you can definitely go to Google Calendar and start managing your time, your appointments and your tasks. My basic tip for Google calendar to work is creating a calendar for each categorized sort of information you’re trying to place your calendar.
So for instance, in my particular case, I use for instance, rav4 family sharing tasks and appointments. I use purple for my history classes, I use orange for any YouTube related stuff. This is a really good way for you to understand which parts of your week are allotted to certain parts of your life, and so on.
The second tip I can give for Google Calendar users is using the upper part of your calendar to schedule daily tasks instead of hourly events. So even if you’re using a calendar blocking technique to manage your time and your digital calendar sometimes
Your events that are occur hourly, but instead they occur on a daily basis. This happens mostly with holidays, birthdays and things like that. So what I do in these cases is creating that event, then assign it to one of those specific color coded calendars and then drag the event up to the top of my calendar where it will be considered a daily event that do not need to assign an hour for the event to be completed are finished possible. calendar has a function of sinking with all of your devices and also inviting it also allows you to invite people to share your calendar This is really good for things like housework, your business, teamwork, or even scheduling meeting hours with the book clubs, work groups, and so on.
The power of your Google ecosystem really shows up here when you access it tools in the right tab in the right side you have these little app lets that you can access to open up different Google apps that can synchronize and can be used with your Google Calendar.
So for instance, we have already set up all of our tasks in Google Keep. And by clicking the respective button on your Google Calendar app, you can access all those tasks so you can better understand by looking at those tasks. Those color coded knows how you need to schedule your time better, what type of to do’s you need to integrate into your calendar, what kind of goals you need to project in your schedule, and so on. Also, if you set reminders, both in your Google Calendar and in your Google Keep apps, you can also get on track with your tasks and with your events by being smart with how establish those alarms go off in your phone.
After that, I think it’s time for you to manage all of your files with Google Drive. If you’ll basically be the only file manager you need in case you have a permanent internet connection. So Google Drive is free until 15 gigs which may definitely not be enough for you to keep all of your files but 100 gigs goes for less than $2.
A month. And if you’re a student, that’s what you’ll need in case you deal with PDF and text documents. Mostly just like any file manager on your computer. Google drive’s allows you to create folders and organize them according to name and color. So you can basically create a full fledged file managing system online.
That way, you never fear losing your files since Google Drive backs up your documents to the cloud. So they’re always there. Even if your computer crashes. There’s nothing really special about Google Drive in itself.
It’s a very simple and powerful tool for you to organize all of your files and being sure that that can be accessed anywhere. If you cannot rely on a specific device to do all of your work.
You also have sharing capabilities with other users. And the good thing is you do not need to share your whole files with your friends and family because you can select the specific folders or files you want to share. Also, the good thing is that when you are storing documents in Google Drive if they are text based
documents, you can quickly open them up in Google Docs and added them on the go. And Google Docs is actually pretty powerful text editor, although is not as powerful as Microsoft Word, but it definitely has all the tools you need, including an commenting interface, as well as sharing capabilities that make it a solid text editor. In case you need something a little bit more structured than Google Keep.
It also has constant cloud backup. So you’ll never worry about losing your files. And although the tools are nothing to elaborate, they will make the job just fine.
Finally, I want to talk about Gmail. And I’m not going to talk about Gmail in itself as a mailing service in comparison to other mailing services. But I want to talk about the organization tools inside Gmail that make it the perfect tool for you to organize your mail if you are into the Google ecosystem. So the first thing I love about Gmail is the ability to call her
code and label my emails effectively, just like I do with my calendars. I have very specific labels in my Gmail, things like answered, not answered sponsorship, inquiry blog post, any school related emails and so on. And every time I get an email, I will automatically label it according to one of those things.
And I will just label of those unanswered or an open emails with that label. So I know I need to get back to them as soon as I can.
The second thing I enjoy about Gmail is that integration with other Google apps like calendar, Google came and tasks. So basically, you can open that side on the right side of your screen.
And Gmail lets you peek into those apps and use them side by side to interconnect all the information from that same account. This really comes in handy for some instance you’re using a gmail to schedule a meeting and you need to access your calendar instead of having to access the calendar in another tab or even in another device.
If you prefer it that way, you can simply open the Calendar tab inside your Gmail account and see if you have a free slot of time to schedule that meeting and just type your mail right on the go. The third thing I really enjoy about Gmail is the ability to have different in boxes.
So for instance, I have a ton of social emails arriving every single day to my inbox, people who are messaging me on social media emails that are getting to my YouTube account, things related to my Instagram people replying to blog posts on my website and so on. And usually those emails are not a priority for me to answer.
So they’re all filtered into the social inbox so I can get them when I can get to them. Instead of having to constantly see my main inbox being floated with promotional emails with forum responses with social reminders and so on. I want to thank skill share for partnering with me today and being incredible at supporting more than 7 million people in your
learning journey skill share is an online learning community with more than 25,000 classes in dozens of different categories and they can help you build new skills develop new strategies and learn more about anything feel curious about skill shares portfolio includes productivity and business master classes, tutorials on how to work with different types of software language classes are some design courses and so on.
Here you are seeing a class on easy project management with Google which will be pretty useful in case you want to take what you’ve learned from this video further.
Also, premium membership gives you unlimited access to all these incredible classes. So no individual payments required and since skill share costs less than $10 a month for the yearly subscription.
It’s the perfect companion for the learning with us.
Yes. Also if you are one of the first 500 people to click the link in the description box you’ll get your first two months of unlimited classes for free. Don’t forget subscribe to the channel and I’ll see you next week with
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