Issue 9 - Back to the beginning, grading & staging of cancer, and more...





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Issue 9 - Back to the beginning, grading & staging of cancer, and more...
By Pulsenotes • Issue #9 • View online
Happy Sunday!
Welcome to the ninth instalment of our weekly dose. First off, we’d like to say a huge thank you to everyone for supporting Pulsenotes! We love providing medical education and hope we continue to be a big part of your studies!
After nine weeks since the newsletter launch, we thought we’d take you back to the beginning to why we started pulsenotes! As always, Norton’s in the corner with some great medical bites and Sam will let you know what’s new this week. We’ve also got a shout out for the CRISIS project, a non-profit social enterprise helping key workers during this tough time!
Enjoy our content? - Remember to tell your friends about us!

Back to the beginning
It’s taken us a long time to get here, but finally Pulsenotes is making waves! Hard work and perseverance do pay off!
The idea for Pulsenotes came towards the end of med school. Norton and I, having recently finished our fourth year exams were amazed by the lack of good quality revision materials available on the internet (I mean it was 2012 - the internet had only been in common use for well over a decade!). 
We had also become fascinated by case-based learning. It was a technique heavily utilised by our med school, and to us, it made a lot of sense for teaching complex topics.
Norton doing what he does best...
Norton doing what he does best...
Despite our enthusiasm, we realised we couldn’t just start posting untried and untested content online. So we began by teaching in person. We started out by teaching small groups (typically first and second years) on common topics in anatomy and physiology. Although our lectures weren’t the most professional, people really seemed to like the way in which we delivered content. Always CONSISTENT and never OVERLOADED (no more death by PowerPoint!). We soon developed a small following, and over the course of a year, our lectures of ten had become lectures to over one hundred!
By the start of the next academic year, we decided it was time to take the show online. This however was not straight forward! We needed help, and so we turned to our newest house-mate. Sam, as now, was a broad-minded techie with a great business brain. Within weeks Sam had enrolled us at the innovation centre at our University and applied for a number of small innovation grants to help get us started. 
We needed to decide what we wanted pulsenotes to be. What became clear from our early discussions was that pulsenotes needed to be a one stop shop - not just videos, but a compliment of notes and questions as well. A complete study package.
The original wire-frame design (2014)
The original wire-frame design (2014)
Next, if we were going online we needed a platform - this was our Steve Jobs moment! We barricaded ourselves in a small room in the University library with a few pens and a flip board and started designing. Surprisingly after only a few hours of nonsensical chat and a couple of arguments here and there (catalysed by numerous energy drinks…) we produced a wire-frame for the pulsenotes website. To this day, remarkably, the function is near-identical. Our ethos then, as is now, was accessibility. We never wanted information more than three clicks (or taps) away. We also wanted to replicate the familiar ‘chapters’ of books with our online lectures - again, accessibility of information was KEY.
It’s been a couple of years since we took those first steps but now pulsenotes is finally starting to emerge as the resource we initially envisioned. A beautiful platform with notes, questions and videos all in one place. We’ve got BIG plans for the upcoming academic term so keep your eyes peeled!
Got a question? Message me on twitter! @plasticsreg
Benjamin Smeeton @plasticsreg
What's new this week?
Upcoming events - Join our Facebook Community for all the details!
Upcoming events - Join our Facebook Community for all the details!
LIVE events - what we’ve got coming up…
We’re providing FREE LIVE WEBINARS over the summer. This is what we’ve got lined up for the week ahead:
  1. Thursday 2nd July 10:00 BST - Pulsenotes LIVE: Inguinal hernias. Want to know your direct from indirect hernias? Be sure to catch this LIVE lecture with Sam and Ben.
  2. Friday 3rd July 14:00 BST - Pulsenotes LIVE: Multiple Sclerosis. Norton’s neurological series continues with Multiple Sclerosis - it promises to be an absolute cracker!
  3. Sunday 5th July 10:00 BST - Pulsenotes LIVE: Wrist fractures. Everyone’s favourite orthopod Abhi is back to take you though wrist fractures.
Remember - recordings of all these LIVE events will be available for members that aren’t able to make it!
New topics…
Norton continues with his series of medical topics with two new LIVE lectures:
  • Sarcoidosis
  • Parkinson’s disease
Our notes library keeps growing (we’ve just hit 162 topics!) and this week we’ve added all of these:
And there are many new question sets too!
  • Psychiatry
  • Endometrial cancer
  • Deep vein thrombosis
  • Pulmonary embolism
  • ECGs
  • Biliary atresia
  • Croup
  • Acute epiglottitis
Norton's Corner
Cancer grading and staging
The grade and stage of a tumour tells us important information about the behaviour and extent of cancer.
Oncology is a huge area of medicine. Almost every speciality will involve some aspect of oncological care. There are loads of niche terms in oncology, which can be hard to keep track of. Two concepts you should really try to understand are ‘grading’ and ‘staging’.
The grade of a cancer describes how much resemblance the cancer cell has to the original cell type. A cell that does not resemble the original cell type is said to be ‘poorly differentiated’ and is typically associated with more aggressive behaviour and worse outcome. A cell that does resemble the original cell type is said to be ‘well differentiated’ and generally associated with a better outcome. 
The stage of a cancer is critical to determine treatments, but can be very complex and important mainly for clinicians involved in treating patients with cancer. Stage also provides prognostic information. 
The stage of a cancer describes the extent of cancer spread, which is based on tumour size, presence of lymph node involvement and distant spread.
We call these factors ‘TNM’ (tumour, nodes, metastasis).
  • Tumour (T): size of tumour (usually in cm)
  • Nodes (N): number and location of lymph nodes involved
  • Metastasis (M): presence/absence of spread to a distant site
Within the TNM system, there are a few additional notations to be aware of. Tumour size is usually grouped into categories (for example, T1 = 0-2 cm, T2 = 2-5 cm). The number following ‘N’ usually refers to the number of lymph nodes involved. If tumour size, lymph nodes or distant spread cannot be assessed, the term ‘X’ is typically used (e.g. T2N1MX).
Finally, the complex TNM system may be simplified into stages. For example, the Duke’s classification in colorectal cancer categories it into four stages A-D. Each stage corresponds to specific TNM staging.
Grading and staging is hugely important for decisions about cancer treatment and prognosis.
It can get pretty complex for some cancers, but if you remember the above, it’s actually quite simple at its core.
Benjamin Norton (@medicalreg)
Shout out - The CRISIS Project!
The CRISIS project - write a letter to a key worker!
The CRISIS project - write a letter to a key worker!
The Crisis Project is a non-profit social enterprise aiming to create a community of changemakers. Their flagship project, Letters For The NHS, aims to connect volunteers with the key workers holding our country together right now.
They have over 800 volunteers writing letters with them and have been featured on the BBC, ITV and Sky Radio. Head over to where you can nominate any key workers you know to receive a letter, or you can sign up to volunteer. Also feel free to check out @thecrisisproject on Instagram where they post regular content and updates about the project.
Final words
Remember to get in contact with any questions, suggestions, or topics that you wish to be covered!
Thanks for reading, remember to tell your friends, and see you next week!
Instant access to over 160 topics, 1.1K questions & 40 hrs of video lectures!
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