Minör Aciller: Akut Otitis Media

  Giriş Akut otitis mediada (AOM) en önemli tetikleyici faktör östaki tüpünün tıkanması, çoğunda neden nazofarenksteki bir üst solunum yolu enfeksiyonu Genellikle viral kaynaklı, östaki tüpünü etkileyen diğer alerjik veya…

Non-controlled and over-the-counter drugs of abuse


2.5 out of 5 stars

Abuse of Medications That Theoretically Are Without Abuse Potential. Reeves RR et al. South Med J 2015 Mar;108:151-157.


This review of noncontrolled prescription and over-the-counter drugs that can be and have been abused for non-medical or recreational purposes is rather sketchy and anecdotal (as the authors admit,) but nevertheless contains some useful information.

Classes of drugs discussed include:

  • Cold & Cough products: pseudoephedrine, ephedrine, oxymetazoline, dextromethorphan
  • Anticholinergics: diphenhydramine, benztropine, trihexyphenidyl (Artane)
  • Antipsychotics: quetiapine, olanzapine
  • Antidepressants: tricyclics, bupropion, fluoxetine, venlafaxine
  • Anitconvulsants: pregabalin, gabapentin
  • Muscle relaxants: carisoprodol, cyclobenaprine (Flexeril,) baclofen

Among the more interesting take-home lessons from tis paper :

  • bupropion is sometimes abused by nasal insufflation (snorting), thus bypassing first-pass metabolism and enhancing its cocaine-like effect at high doses [as the clip above shows, bupropion is also abused by injection]
  • dextromethorphan in large doses has dissociative and  hallucinogenic effects similar to theses of phencyclidine (PCP) or ketamine
  • gabapentin and quetiapine have been reported to enhance the effects of Suboxone (buprenorphine/naloxone)

Radiopaedia Emergency Radiology Course

Off the back of the very successful trauma radiology course last year, Andrew Dixon and Frank Gaillard from Radiopaedia and Andy Buck (from EDExam and the ETM Course) are presenting a new, one day, Emergency Radiology Course on Saturday May 16th at the Alfred Hospital in Melbourne.  This promises to be a great course that […]

Feedback: Giving it.

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There are few more valuable skills in helping your colleagues (and your own) professional development than the ability to give quality feedback.
And this is not just a skill for managers and educators. Everyone will be called to give some form of feedback at one time or another.

Good feedback should include journeys down two paths:

  1. Instruction & clarification. Helping to reveal specific traits and behaviours that may be ‘blind’ to the person. And to clarify deviations between preferred & actual behaviours (as well as encouraging exploration of ways to ‘get on course’).
  2. Motivation. By increasing the persons desire to perform well.


Giving Feedback. Specifics.

Be sensitive to the recipient’s self-esteem.

In general, we tend to interpret things about ourselves differently than others do. For example, we tend to judge ourselves by our intentions, while judging others on their actions. If we make a mistake we lean towards blaming the circumstances whilst others may blame us personally.

A person with higher self-esteem is more likely to respond well to positive feedback. Alternatively, someone with lower self-esteem is more likely to respond poorly to negative feedback.

If delivered well, feedback will make a significant impact on the recipient. It should therefore,  be given with due care and respect.

In fact one study found that the difference in times it takes us to sustain positive emotions versus recovering from negative emotions can be 3,000 percent!

Aim for feedback that is relevant and meaningful.

Make your feedback specific. Let them know exactly what they are doing wrong, then help them explore how to make course corrections.

Feedback should be specific, accurate, objective, timely, usable and checked for understanding by the receiver.

Emphasise elements of the behaviour or activity that they have the power to change.

Avoid praising effort. Being complimented on the fine effort you made after a failure has been shown to make people feel stupid and makes them frustrated towards achieving their goal.

Give honest feedback. Take care not to dilute the message.

Never try to make a team member feel that he wasn’t responsible for what went wrong (assuming he is, in fact, to blame), just because you don’t want to be “hard” on him. Letting him off the hook for his own mistake will rob him of a sense of personal control over his own work. Nothing is more de-motivating than feeling powerless. The short-term discomfort is nothing compared to the long-term damage that powerlessness can do. *[99U]*

Timing is everything.

Most of the time, the longer the delay in giving feedback, the less effective it will be. Although there are times when immediate feedback is not possible, or you need time to prepare a quality feedback session.

Negative feedback should ALWAYS be given in private.

Open to response and interaction.

Be prepared. Feedback may not run as smoothly as you want. And this is not a bad thing.
Responses may vary from defensive reactions to embarrassment.
Resist any temptation to mirror these reactions or get into argumentative conversations.
Make sure the person understands the intent of this feedback.

Focus on changeable behaviours rather than the personal characteristics.

Make strong links to the persons goals.

If the feedback is being given within the context of an existing set of goals or expectations, make sure it aligns with these components.

Language is important.

The language you use to give feedback is very important. Particularly when giving negative information.
Take time to think about what you mean to say, and how best to say it BEFORE the feedback occurs.

Bottom line:

  • Be specific versus general.
  • Describe versus evaluate.
  • Focus on the behaviour versus the person.
  • Maintain the relationship versus indulge in a self-serving conversation.

Featured image via: jphilipg


  1. The Key To Great Feedback? Praise the Process, Not the Person – 99U [Internet]. [cited 2015 Mar 24]. Available from: http://99u.com/articles/19442/the-key-to-great-feedback-praise-the-process-not-the-person
  2. Stone D, Heen S. Thanks for the Feedback: The Science and Art of Receiving Feedback Well [Internet]. Penguin Group USA; 2015. Available from: http://books.google.com.au/books?id=lIV9oAEACAAJ
  3. Rose M, Best D. Transforming Practice Through Clinical Education, Professional Supervision, and Mentoring [Internet]. Elsevier Churchill Livingstone; 2005. Available from: https://books.google.com.au/books?id=v-IJVRJXGtsC