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What good is a cold?

It is often quoted that 50% of people will succumb to an upper respiratory tract infection in the course of a year. The usual pathogens involved are viruses.

Rhinoviruses with more than 100 serotypes are the most common pathogens, causing at least 25% of colds in adults. Coronaviruses may be responsible for more than 10% of cases. Parainfluenza viruses, respiratory syncytial virus, adenoviruses and influenza viruses have all been linked to the common cold syndrome. All of these organisms show seasonal variations in incidence. The cause of 30% to 40% of cold syndromes has not been determined.

Purushothama V. Dasaraju and Chien Liu.

The natural history of a cold is typically complete resolution within seven to ten days. There is no cure and regardless of what treatment is offered most people are miserable during that time with a runny nose, cough, sneezing, fatigue and sore throat. This is one of the commonest reasons people seek medical advice if not the most common reason. Colds are typically seasonal, highly infectious and responsible for a huge cost to society . Not to mention the risk of being offered inappropriate treatment, especially antibiotics.

We might ponder a philosophical question- Who benefits from a cold? Certainly viruses do- they spread from host to host at an alarming rate. However viruses that cause a cold do not mutate like the flu virus does, so spreading through the community doesn’t support their evolution. The condition is not fatal therefore it does not appear to support the host’s natural selection. So what is the point of an infection that makes us miserable up to three or four times a year? We lose time off work, we take medicines that provide temporary relief and life simply becomes a little more difficult. Possibly the only part of society that benefits are those who sell medicines!

Research now suggests that not everyone suffers to the same extent.

The epidemiologic data suggest that endurance athletes are at increased risk for URTI during periods of heavy training and the 1-to 2-week period after marathon-type race events.

Nieman

Even after adjustment for other variables, men were significantly more likely to ‘over-rate’ their symptoms in comparison with the clinical observer than were women.

Macintyre

We found that high physical activity was associated with a lower risk of contracting URTI for both men and women.

Fondell et al

Data analysis showed that higher incidence of URTI was significantly associated with increased training ( tennis) duration and load, and competition level, on a weekly basis.

Novas et al

The risk of self-reported manifestations of the common cold was higher in workers who reported symptoms of depression.

Kim et al

Most of the relevant studies show a significant relationship between psychosocial factors and the onset or progression of acute respiratory tract illness. However, the psychosocial variables were not consistently evaluated across the included studies, and different methodological approaches were used to examine the association between psychosocial factors and acute respiratory tract illness.

Falagas et al

And finally most intriguing of all

Training in meditation or exercise may be effective in reducing ARI illness burden.

Barrett et al

This suggests that the URTI may serve as a barometer for stress in many people. This perspective may help those who advise or care for people who are experiencing symptoms of an URTI to consider what if anything can be done to address the other issues in their lives that may be problematic. By corollary people presenting for help with an URTI require the most skilled healthcare and not just a lecture on how paracetamol is the only treatment available.

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Ineffective handover can be fatal

Imagine what might lead to the worst outcomes in healthcare. It doesn’t actually have to happen but it might help to identify what could go wrong before it ever does. In most cases it will be a failure to communicate.

Ineffective hand-off communication is recognized as a critical patient safety problem in health care; in fact, an estimated 80% of serious medical errors involve miscommunication between caregivers during the transfer of patients. The hand-off process involves “senders,” those caregivers transmitting patient information and transitioning the care of a patient to the next clinician, and “receivers,” those caregivers who accept the patient information and care of that patient. In addition to causing patient harm, defective hand-offs can lead to delays in treatment, inappropriate treatment, and increased length of stay in the hospital. Joint Commission Perspectives

Much of what might make a difference needs those involved in whatever role to do basic things.

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Do you use your powers of observation?

Healthcare professionals and doctors in particular need to be observant. Many, if most are observant because it can make the difference between an early diagnosis and an early demise. I remember an ambulance crew saving a patient’s life not only by their rapid transport of a confused suicidal patient but because they noticed and reported the white mark around the lip of the glass she had been found drinking from. It turned out it was soluble aspirin and the patient was quickly diagnosed with salcylism.

The same powers of observation can be used to find new solutions or perhaps better solutions to common problems. Healthcare professionals are in contact with patients more than any policy maker or bureaucrat. If history has taught us anything it is that the most valuable solutions to healthcare problems are likely to be generated by those who don’t dismiss small details.

In a sense, curiosity is the mother of innovation. People often think that they will struggle to be innovative because they feel that they are not creative. Creativity is certainly useful, but curiosity is really all that you need to get the process started. Curiosity about what’s going on around you, and then curiosity about how an idea would work in another context. So, turn off autopilot mode in your brain, and be curious! Paul Matthews

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Do you perform any rituals when you consult?

Before a surgeon gets anywhere near a patient in the operating theatre he must wash his hands, put on a gown and gloves. He then drapes the patient and cleans the skin. As he makes his first incision there is no mobile phone on the table, he banishes all distractions and appreciates that the job isn’t over until he has sutured the wound. Whatever you do for a living how do you approach the job? If you adopted rituals would you perform better? Bacteria can destroy a surgeons work. What contaminates your work and how does that manifest in your results?

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What does your face say?

Are you aware what your facial muscles are doing when you are engaged in conversation? What about your neck and your shoulders? What do they leak about your mood? Your attitude? Your perspective? Is it possible they are sending entirely the wrong message?

Even though, there was no evidence found that displaying positive facial expression will increase the level of follower trust in their leader (both, affectively and cognitively) and their perceptions of leadership effectiveness, still the opposite was found to be true, which is a negative relationship between negative facial expressions and leadership effectiveness. This means, that the more the leader expresses negative facial cues such as lowered eyebrows and lip corners down, the less effective he or she is.

Pia Loeper, University of Twente

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