The mere mention of Xbox 360 , PS3 and Nintendo Wii in front of some parents can raise their hackles because they see these video game systems as a source of distraction and bad influence on their children. Parents have complained that their children’s academic achievement has suffered with the availability of video games in the household. However some might say it depends. A study from New York examined the association between television, movie and video game exposure and school performance in 4508 middle school students (grades 5-8) in the Northeastern United States (Pediatrics 2006; 118: e1061-1070). Among other things, they looked at weekday and weekend television and video screen time, cable movie channel availability and television content. The study found that the odds of poorer school performance increased with increasing weekday exposure to the media. Interestingly, weekend screen time and video game use were not associated with school performance.

While video games may be the bane of some parents’ life, they have found a niche in the medical world. For example, video games have been used for distraction and behaviour modification therapy. A study from New Jersey Medical School recently evaluated the effectiveness of a hand-held video game in reducing pre-operative anxiety in children undergoing outpatient surgery (Paediatr Anaesth 2006; 16:1019 – 1027). One hundred and twelve children were randomly assigned to three groups: parent presence (PP), PP + a hand-held video game and PP + a sedative given > 20 minutes before entering the operating room (MPP). Children who had a video game did not experience an increase in anxiety before they were given anaesthesia. Children in the PP and MPP groups all experienced a significant increase in their anxiety level. Indeed the effectiveness of video games in distracting children around the time of being given anaesthesia has led to the development of a device called PediSedate® (Paediatr Anaesth 2007; 17: 162 -166). This device is essentially a video game with a head set which allows the child to listen to the audio portion of the game. However, there is a nasal piece from the headset which allows the administration of nitrous oxide in oxygen to the child while he is playing the game. The inhaled nitrous oxide sedates the child while he is being distracted by the video game.

‘I am not addicted. I am honing my surgical skills!’ That would be the ultimate excuse for every video game player being accused of spending too much time on the console. A recent study from Beth Israel Medical Center (Arch Surg 2007; 142: 181 – 186) examined the potential link, in trainee surgeons, between video game play and laparoscopic surgical skill and suturing (keyhole surgery). Thirty three surgeons participated in the Rosser Top Gun Laparoscopic Skills and Suturing Program and they completed three different video game exercises (Top Gun). The study showed that surgeons who had a past history of video game play of > 3 hrs / wk completed Top Gun with 37% fewer errors and completed it 27% faster than those who played < 3 hrs / wk. Those who are current video game players made 32% fewer errors, performed 24% faster and scored 26% better overall than their non-playing colleagues.

Like flight simulators, video games are being used in simulators to help train surgeons in performing certain operations. However, these games are no substitute for experience gained in performing the real thing. Simulators still cannot provide tactile feed back to the surgeon during an operation. A surgeon not only relies on what he sees but also what he feels during an operation in order to do his job. Simulators can help to reduce the learning time but can’t replace the real thing yet!

If you visit any Spanish town in the afternoon, you will find that most, if not all, shops are be closed for a few hours before opening again in the evening. During this period of closure the shopkeepers and workers have their afternoon nap! This practice is common throughout the Mediterranean region.

A recent epidemiological study from the University of Athens analysed participants in the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) general population cohort and in particular, examined the effect of midday siesta on dying from heart disease (Arch Intern Med 2007; 167: 296 – 301). They studied 23,681 individuals who had no history of coronary heart disease, stroke or cancer at the time of enrollment and who were followed up for a mean of 6.32 years. Among men and women, after controlling for potentially confounding variables such as co-morbidity, physical activity and diet, those taking a siesta of any frequency or duration had a 34% lower risk of dying from heart disease. Those individuals who occasionally took naps had a 12% lower risk of dying from heart disease than those who did not take naps at all. Those individuals who regularly took naps had a 37% lower risk of dying from heart disease. Among men, this beneficial effect of napping was stronger in those who were working at the time of enrollment, but this is not seen among women because of the small number of deaths in this group of individuals. The midday nap is not hours of sleeping but a mere 30 minutes!

In another study from Berlin (Atherosclerosis 2007 Feb 5, Epub), 2437 participants of the Study of health in Pomerania were studied to look at the association of sleep duration with carotid intima-media thickness (IMT) as a measure of generalized atherosclerosis (hardening of the blood vessels). The higher the IMT value, the greater is the amount of atherosclerosis. The  IMT values were lowest among subjects with an average sleep duration of 7-8 hours but increased with shorter sleep duration (5 hours of sleep) and increased even more in those who sleep 11 -12 hours.

Sleep is such a basic human function. With increasing demands from work or leisure activities, a lot of people cope by sacrificing part of their sleeping time. No doubt we can cope with some degree of sleep deprivation when we are still young. However, chronic sleep deprivation eventually catches up with us. Having a brief nap in the day is actually not a bad idea. In the financial / business parlance recently, you might have heard people talking about taking ‘power nap’. It is nothing new since the Greeks and Spaniards have been taking a siesta for centuries. A brief nap during the day certainly recharges your batteries for the rest of the day. So, at your next meeting with your boss, be bold and suggest that there should be a siesta time for the whole workforce. Either you will be laughed out of the office or you might just get your wish come true!

To all my Chinese readers, I wish you a very Happy Chinese New Year.

A patient with a large liver cancer recently had a liver operation by me. I removed the whole of his right liver in order to clear his cancer. On the morning of the 3rd day after surgery, he was already eating a normal breakfast, sitting up in bed and feeling reasonably well. However, over a period of about 4 hours in the afternoon, he became mentally obtunded and unable to move all 4 limbs. Blood investigations revealed no underlying biochemical abnormalities to account for his altered mental state. The liver function was slightly abnormal but certainly did not indicate liver failure to explain his metal disturbance. A search for any evidence of an underlying infection was negative and the search for a thyroid dysfunction was also unfruitful. A CT scan of the brain was also not helpful. The patient was supported and about 36 hours later the neurologist ordered a magnetic resonance (MR) scan of the brain to look for a brain stem (the part of the brain just before it ‘turns’ into the spinal cord) haemorrhage. Again the MR was normal. Feeling sad that we still did not know what is causing the loss of consciousness and physical function in my patient, I went back to examine the patient hoping to find any clues which might give me an idea of the cause of his problem. To my great surprise, when I called his name, the patient opened his eyes and spoke! He moved his limbs slowly when asked. Neither I nor the neurologist could explain this bizarre event. How I wished I had the help of a brilliant diagnostician like Dr House.

Who is Dr House? He is a doctor in a television series. Medical drama has been good material for making television series. In recent years, this has included series like St Elsewhere, Chicago Hope, ER, Strong Medicine and Gray’s Anatomy. The most recent one that has taken the TV screen by storm is the series House. The central character of this Fox Broadcasting Company medical drama is a Dr Gregory House. He is an infectious disease specialist who is also a brilliant diagnostician. He is able to solve all mysterious and difficult medical cases that seem to fox all his colleagues. However, he is also a very abrasive, tactless, self-assured doctor. As he is excellent at his job, his short-comings are tolerated.

In the real world, there are brilliant diagnosticians like Dr House. However, they are few and far between. In the real world, there will be cases which will elude the deductive power of even the best diagnosticians. Sometimes, television drama can lead the general public to have an unrealistic expectation of what a doctor and hospital can do. It could give a wrong impression of how successful a procedure is in real life. A study from Leuven, Belgium examined whether public perceptions of survival after in –hospital cardiopulmonary resuscitation (CPR) by physicians and nurses is related to the consumption of medical drama (Eur J Emerg Med 2002; 9: 325 – 329). They questioned 820 3rd and 5th year secondary school students about their estimates of the survival rate after in-hospital CPR. Students who watched more TV medical drama were associated with an increased estimate of survival rates.

I think House is an excellent TV medical drama. It certainly contains much interesting and accurate medical information to inform the public. The scenes are quite realistic and the cast act well. As for Dr House and his team who seem to be able to solve even the most obscure cases, you just have to take them with a pinch of salt!