I haven't written any posts for a couple of days as I've been back on the night shifts again and so I've been feeling utterly exhausted. Luckily I am off until Saturday night so I have some time to catch up on sleep and get a 'normal' routine back.
Today over 2 million people are going on strike, including all of our local schools. It is expected that one fifth of the NHS workforce will be included in these statistics- the biggest strike in 20 years. NHS employers reassure the public that contingency plans will be put in place to ensure that A&E, cancer treatment and End-of-life care all have enough staff to function adequately. However non emergency treatments and routine appointments may suffer from the strike. This can only worsen the current issues regarding waiting lists- hopefully patients will get seen as soon as possible and it wont create too much of a backlog.
Wednesday, 30 November 2011
Saturday, 26 November 2011
Change in HPV vaccine
The Department of Health has announced that a new vaccine will replace the HPV vaccine.Girls (aged 12-13) will now receive a vaccine which will protect them against cervical cancer and genital warts.
The new vaccine 'Gardasil' will replace 'Cervarix', a cheaper vaccine used from 2008. Both jabs protect against Human Papilloma virus (HPV) types 16 & 18 which cause over 70% of cervical cancer cases. Gardasil also protects against types 6 & 11 which cause genital warts. It is thought that we may be able to significantly reduce the prevalence of this sexually transmitted infection as well as preventing 400 deaths from cervical cancer.
This article shows how healthcare is forever changing both in terms of technology and funding. It has now become economically viable to change to a more expensive vaccine in order to provide people with further protection.
The new vaccine 'Gardasil' will replace 'Cervarix', a cheaper vaccine used from 2008. Both jabs protect against Human Papilloma virus (HPV) types 16 & 18 which cause over 70% of cervical cancer cases. Gardasil also protects against types 6 & 11 which cause genital warts. It is thought that we may be able to significantly reduce the prevalence of this sexually transmitted infection as well as preventing 400 deaths from cervical cancer.
This article shows how healthcare is forever changing both in terms of technology and funding. It has now become economically viable to change to a more expensive vaccine in order to provide people with further protection.
Tuesday, 22 November 2011
Sunday, 20 November 2011
A Code of conduct for Care Assistants
The government are setting up new standards for carers who look after the elderly and ensuring that they all have minimum training. This is due to a questionable quality of care given by some individuals. It is believed if there was more safe guarding on the qualification of care assistants we could be more confident that more carers would do the job properly. The government had proposed to set up compulsory registration for healthcare assistants however, Mr Lansley reported that is couldn't be justified in our current economic climate.
This article is particularly interesting to me, as I am currently working as a carer in a nursing home. Despite being paid minimum wage to do a difficult and demanding job, I can say from the heart that I get a genuine 'buzz' from making a personal difference to the patients' lives. Also I can go home after my 12 hour shift knowing that as a team we have done our best to cater for their personal needs. These horrific stories of poor quality care really do shock me, it makes you wonder why they are working within healthcare!? Setting up a code of conduct will hopefully ensure that other homes across the country can provide decent care for those who need it most.
Due to all these nightmare stories in the media about abuse and neglect of the elderly, I often feel some of the relatives do not respect the carers. This is made more complicated when you have residents with dementia. For example, one lady told her daughter that she hadn't had anything to eat all day, literally minutes after I had finished feeding her a roast dinner. It makes us look disgraceful, especially when we have to try and justify ourselves.
There is another muddled lady who asks for the toilet every 10-15 minutes, even after we have just taken her. We take her regularly throughout the day, however it is certainly not every 10 minutes as this would mean neglecting the needs of the other clients if we focused all our time in her (plus you cannot physically pass waste every 10 minutes- unless you had a medical problem). When visitors come into the lounge and hear her ask for the toilet, it looks incredibly bad on our behalf when we don't take her. I feel that the bad publicity that carers are getting nationally is affecting the trust people have in care assistants. It sometimes feels like there is a huge generalisation and that we are being punished for the sins of those people who abuse the gift of being able to help someone who needs it.
This article is particularly interesting to me, as I am currently working as a carer in a nursing home. Despite being paid minimum wage to do a difficult and demanding job, I can say from the heart that I get a genuine 'buzz' from making a personal difference to the patients' lives. Also I can go home after my 12 hour shift knowing that as a team we have done our best to cater for their personal needs. These horrific stories of poor quality care really do shock me, it makes you wonder why they are working within healthcare!? Setting up a code of conduct will hopefully ensure that other homes across the country can provide decent care for those who need it most.
Due to all these nightmare stories in the media about abuse and neglect of the elderly, I often feel some of the relatives do not respect the carers. This is made more complicated when you have residents with dementia. For example, one lady told her daughter that she hadn't had anything to eat all day, literally minutes after I had finished feeding her a roast dinner. It makes us look disgraceful, especially when we have to try and justify ourselves.
There is another muddled lady who asks for the toilet every 10-15 minutes, even after we have just taken her. We take her regularly throughout the day, however it is certainly not every 10 minutes as this would mean neglecting the needs of the other clients if we focused all our time in her (plus you cannot physically pass waste every 10 minutes- unless you had a medical problem). When visitors come into the lounge and hear her ask for the toilet, it looks incredibly bad on our behalf when we don't take her. I feel that the bad publicity that carers are getting nationally is affecting the trust people have in care assistants. It sometimes feels like there is a huge generalisation and that we are being punished for the sins of those people who abuse the gift of being able to help someone who needs it.
Friday, 18 November 2011
NHS need to target their hidden waiting list
Patients are supposed to be seen by the NHS within 18 weeks however over 250 000 patients have waited for more than their fair share of time. Health Ministers say we must aim to reduce this backlog to 50 000 by April 2012. It is believed that there isn't a bit enough incentive to reduce these hidden waiting lists as it could be justified to leave patients for over 18 weeks for clinical reasons (such as weight loss) or personal/ work commitments.
Andrew Lansley states that next year we will 'clamp down on this practice' to ensure patients are treated. By extending the contractual conditions patients past the 18 week marker will not be forgotten, giving an increased incentive for hospitals to treat their patients. Lansley explains that if we can reduce the 'volume of growth' for the demand of NHS resources we will be more able to treat the patients who have become lost in the system.
Andrew Lansley states that next year we will 'clamp down on this practice' to ensure patients are treated. By extending the contractual conditions patients past the 18 week marker will not be forgotten, giving an increased incentive for hospitals to treat their patients. Lansley explains that if we can reduce the 'volume of growth' for the demand of NHS resources we will be more able to treat the patients who have become lost in the system.
Wednesday, 16 November 2011
Patients' own stem cells used to repair their hearts- The Lancet
Encouraging results have come from a study looking at the safety and health improvements when using cardiac cells to repair damaged tissues of the heart. In the trial patients with heart failure had tissue removed from the right atrial appendage during a heart bypass operation.
The stem cells isolated from this cardiac tissue were cultured (until there were 2 million cells per patient) given before being injected into the patient 100 days later. 7/14 of the patients were given stem cell treatment with the other patients remaining in the control group.
The doctors worked out the percentage efficiency by looking at the left ventricle ejection fraction (% of blood leaving LV per beat). There was 30.3% increase which then raised by 38.5% after 4 months. However some doctors are concerned that the placebo effect has not been controlled with no placebo treatment given to those 7 control patients. Also it can be noted by experts that ejection fraction is not the same as a measurement for the quality of life.
The use of stem cells from the bone marrow is also being investigated in London with randomised clinincal trials looking to help patients within 6 hours of a heart attack in NHS trusts. Although results are also 'promising' we are still at early stages.
Monday, 14 November 2011
Post Graduate Communication Conference 9/11/11
On Thursday I had the opportunity to be an active observers on a communication course alongside doctors and dentists. This postgraduate conference day was focused on communication skills associated with teaching and learning.
During the day we learnt about body language, the importance of engaging with the learner and used actors and role play sessions to practice and learn.
The course started with a world cafe activity, in which we moved tables and discussed skills and attributes possessed by good leaders, teachers and how to give good criticism.
http://www.theworldcafe.com/
We went on to look at cultural differences and issues surrounding different common beliefs. Sometimes we do make assumptions that every reads from the same hymn sheet, however this is often not the case. By being patient and courteous we can reach a common ground. It is all the people involved's responsibility to adapt to the changes and to be curious rather than judgemental.
We later looked at assertion and how it is very different from aggression. Assertion is expressing yourself without putting yourself or others down.
During the day I had the chance to speak to and work with doctors and dentists. One of the junior doctors I spoke to noted how different post graduate learning as a newly qualified doctor to the teaching in medical school in terms of support and style. I spoke to an optometrist who got into his field of speciality after working on eyes in surgery. He explained that the hardest part of the job is not being able to help all his patients. It is difficult when you are presented with blind patients who you cannot give them their sight back. Sometimes he felt he wasn't making a difference to the patients he cares for.
I really understand this feeling of helplessness as when working with the elderly, it is inevitable that their conditions will get worse over time. I feel you have to look to make a difference to them in other ways such as through conversations and showing an interest in their lives.
I also spoke to a doctor who focuses on palliative care in a hospice setting, she had originally trained as a nurse. We shared a discussion in our tea break about how important it is to offer patients good communication and the time to talk towards the end of their lives. She had real faith that the personal attributes and experience I possess will really help me in my future medical career.
During the day we learnt about body language, the importance of engaging with the learner and used actors and role play sessions to practice and learn.
The course started with a world cafe activity, in which we moved tables and discussed skills and attributes possessed by good leaders, teachers and how to give good criticism.
http://www.theworldcafe.com/
We went on to look at cultural differences and issues surrounding different common beliefs. Sometimes we do make assumptions that every reads from the same hymn sheet, however this is often not the case. By being patient and courteous we can reach a common ground. It is all the people involved's responsibility to adapt to the changes and to be curious rather than judgemental.
We later looked at assertion and how it is very different from aggression. Assertion is expressing yourself without putting yourself or others down.
During the day I had the chance to speak to and work with doctors and dentists. One of the junior doctors I spoke to noted how different post graduate learning as a newly qualified doctor to the teaching in medical school in terms of support and style. I spoke to an optometrist who got into his field of speciality after working on eyes in surgery. He explained that the hardest part of the job is not being able to help all his patients. It is difficult when you are presented with blind patients who you cannot give them their sight back. Sometimes he felt he wasn't making a difference to the patients he cares for.
I really understand this feeling of helplessness as when working with the elderly, it is inevitable that their conditions will get worse over time. I feel you have to look to make a difference to them in other ways such as through conversations and showing an interest in their lives.
I also spoke to a doctor who focuses on palliative care in a hospice setting, she had originally trained as a nurse. We shared a discussion in our tea break about how important it is to offer patients good communication and the time to talk towards the end of their lives. She had real faith that the personal attributes and experience I possess will really help me in my future medical career.
Saturday, 12 November 2011
You Don't Know Jack 2010- Dr Jack Kevorkian
I watched this film today, and several times it made me really consider what I think about assisted suicide. Particular scenes were difficult to watch with strong emotional themes, I found the piece to be quite heavy going.
Dr Jack Kevorkian, played by Al Pacino, is compassionate about helping people to end their lives in order to escape suffering. He helped over 130 patients to end their lives using either potassium chloride or carbon dioxide gas. His strong feelings come from feeling lost and helpless after witnessing his mother suffer at the end of her life.
The first patient he assists is an ageing lady suffering from Alzheimer's disease. I found this scene quite unnerving to watch as the patient appears physically well and although she has mental deterioration, it is not at an advanced level (she can still currently function and live in her own home).However Dr Kevorkian still granted her wish and took her to the woods to use the 'Mercytron' in his camper van.
As a care assistant in a nursing home, I have day-to-day experience of working with elderly patients who are affected by dementia and confusion. The thought of giving one of these ladies I care for, the means to give themselves a lethal substance does not sit nicely in my mind.
Throughout the film, the related controversies are illustrated with many religious groups protesting outside court buildings and his own home. Dr Death, as he is known, finds himself sneaking around like a criminal helping these people to end their suffering whilst assisted suicide was still legal in Michigan.
The emotional accounts given by those suffering from numerous conditions, which are affecting the quality of their lives, helps Kevorkian to win numerous court cases. He feels that a doctor is a healing profession and that living in agony is not living at all. As an audience it makes us empathise with these individuals whose day-to-day lives are so painful that all they wish for is to end it.
There is a huge emphasis on a 'dignified death' something which is portrayed when helping most of the patients. However in 1993, after Kevorkian was struck off as a physician, there was an incident whilst helping Mr Gale, a patient seeking assistance to die. To save resources the doctor made a cage to go over the patients' head in order to reuse the CO2 gas; since he had lost his access to supplies. The patient was over heating and struggling in distress when the gas could not escape and asked for the 'treatment' to be stopped before proceeding with the suicide.Was this a dignified death? also did this patient have the mental capacity to make this decision? If he changed his mind, did he have some doubt about going through with it? This particular incident highlights lots of relevant issues against euthanasia and physician assisted suicide.
Jack faced constant battles with the law to help his patients and there as still debates now about whether this is murder. The court said that aiding suicide is the same as the common law of murder. However Jack challenged that common laws are outdated e.g. it is a crime to not worship god or to change your religious views and that the work he does could never be compared to murder.
Some may argue that he then went too far, others call him a hero. Dr Death performed active euthanasia for Tom Youk by injecting him with a lethal substance. Kevorkian wanted to fight for the patients' rights to choose to end their lives so produced a video which he hoped would bring supporters to help him tackles the supreme court. However in court Kevorkian was found guilty and given a 10-25 year sentence for murder.
In 2009 Jack was released at the age of 79 after 8 and a half years in prison. The supreme court refused to here his case.
Although this is a screen play, the following links demonstrate how real this story is and help to bring things back to the controversial debate on-going worldwide.
Tom's euthanasia
Hearing from Tom's brother
Interview after 8 years in prison
Dr Jack Kevorkian, played by Al Pacino, is compassionate about helping people to end their lives in order to escape suffering. He helped over 130 patients to end their lives using either potassium chloride or carbon dioxide gas. His strong feelings come from feeling lost and helpless after witnessing his mother suffer at the end of her life.
The first patient he assists is an ageing lady suffering from Alzheimer's disease. I found this scene quite unnerving to watch as the patient appears physically well and although she has mental deterioration, it is not at an advanced level (she can still currently function and live in her own home).However Dr Kevorkian still granted her wish and took her to the woods to use the 'Mercytron' in his camper van.
As a care assistant in a nursing home, I have day-to-day experience of working with elderly patients who are affected by dementia and confusion. The thought of giving one of these ladies I care for, the means to give themselves a lethal substance does not sit nicely in my mind.
Throughout the film, the related controversies are illustrated with many religious groups protesting outside court buildings and his own home. Dr Death, as he is known, finds himself sneaking around like a criminal helping these people to end their suffering whilst assisted suicide was still legal in Michigan.
The emotional accounts given by those suffering from numerous conditions, which are affecting the quality of their lives, helps Kevorkian to win numerous court cases. He feels that a doctor is a healing profession and that living in agony is not living at all. As an audience it makes us empathise with these individuals whose day-to-day lives are so painful that all they wish for is to end it.
There is a huge emphasis on a 'dignified death' something which is portrayed when helping most of the patients. However in 1993, after Kevorkian was struck off as a physician, there was an incident whilst helping Mr Gale, a patient seeking assistance to die. To save resources the doctor made a cage to go over the patients' head in order to reuse the CO2 gas; since he had lost his access to supplies. The patient was over heating and struggling in distress when the gas could not escape and asked for the 'treatment' to be stopped before proceeding with the suicide.Was this a dignified death? also did this patient have the mental capacity to make this decision? If he changed his mind, did he have some doubt about going through with it? This particular incident highlights lots of relevant issues against euthanasia and physician assisted suicide.
Jack faced constant battles with the law to help his patients and there as still debates now about whether this is murder. The court said that aiding suicide is the same as the common law of murder. However Jack challenged that common laws are outdated e.g. it is a crime to not worship god or to change your religious views and that the work he does could never be compared to murder.
Some may argue that he then went too far, others call him a hero. Dr Death performed active euthanasia for Tom Youk by injecting him with a lethal substance. Kevorkian wanted to fight for the patients' rights to choose to end their lives so produced a video which he hoped would bring supporters to help him tackles the supreme court. However in court Kevorkian was found guilty and given a 10-25 year sentence for murder.
In 2009 Jack was released at the age of 79 after 8 and a half years in prison. The supreme court refused to here his case.
Although this is a screen play, the following links demonstrate how real this story is and help to bring things back to the controversial debate on-going worldwide.
Tom's euthanasia
Hearing from Tom's brother
Interview after 8 years in prison
Wednesday, 9 November 2011
Light can treat cancer??
In the US they have found that a drug which attaches to tumours can be activated by waves of light. This study has suggested that particular areas can be targeted without damaging surrounding tissues.
The National Cancer Institute used an antibody which is complementary to the surface proteins of the tumour. IR700 is a light receptive substance which is activated by infra-red light. This chemical was attached to the antibody and used on mice with inserted tumours in an environment with IR light. Compared to the control group, the tumour volume was significantly reduced.
Cancer Research UK reported that photo-dynamic therapy or using antibodies has been successful in treating cancers so combining the treatments provides a promising answer.
It is important to consider that researchers are still at the animal testing stage and therefore we cannot be certain of how this treatment will affect humans.
The National Cancer Institute used an antibody which is complementary to the surface proteins of the tumour. IR700 is a light receptive substance which is activated by infra-red light. This chemical was attached to the antibody and used on mice with inserted tumours in an environment with IR light. Compared to the control group, the tumour volume was significantly reduced.
Cancer Research UK reported that photo-dynamic therapy or using antibodies has been successful in treating cancers so combining the treatments provides a promising answer.
It is important to consider that researchers are still at the animal testing stage and therefore we cannot be certain of how this treatment will affect humans.
Monday, 7 November 2011
GMC no longer registering medical students- November Student BMJ
The General Medical Council has decided that UK medical students are not to be registered when they start their training as it would bring no benefit to patients or added protection. The registration is required by all doctors to be able to practise medicine in the country. A 2010 review has suggested that rather than checking the fitness to practice at the point if registration by the GMC, local management of students would be quicker and more efficient. New students will be given 'welcome to medicine' packs when they start their degrees since the support alongside the GMC regulation is being removed. They have also made the decision to give provisional registration reference numbers to students at the beginning of their fifth year rather than at the end- giving them batter access to the NHS.
I am interested to know whether this will make a difference to those training to become doctors?
I am interested to know whether this will make a difference to those training to become doctors?
Saturday, 5 November 2011
Movember
I've just donated money toward my cousin's boyfriend who is growing a beard to raise money and awareness for prostate and testicular cancer. 'Movember' is a monthly campaign whereby men across the world are encouraged to grow a moustache. These men, the 'Mo Bros' are promoting the awareness which hopefully is encouraging people to talk about prostate cancer. It may also work by encouraging other men to go for a prostate examination.
With 1 in 9 men suffering from prostate cancer and one man dying each hour of everyday, this is a worthwhile cause. It is the most common cancer type within the male population. Testicular cancer is expected to kill 70 men in 2011. Unlike prostate cancer, which largely affects those over 50, testicular cancer is most common for those aged between 15-44. Men are encouraged to self examine regularly and to be aware of the size and shape of their testicles so they can report changes to their doctor.
The money raised in Movember is going to used to increase awareness and education as well as towards research. It is thought that global collaborative research projects are more effective than individual ones as multidisciplinary teams of key researchers can work together to increase the chance of a break through in less time.
uk.movember.com/?home
With 1 in 9 men suffering from prostate cancer and one man dying each hour of everyday, this is a worthwhile cause. It is the most common cancer type within the male population. Testicular cancer is expected to kill 70 men in 2011. Unlike prostate cancer, which largely affects those over 50, testicular cancer is most common for those aged between 15-44. Men are encouraged to self examine regularly and to be aware of the size and shape of their testicles so they can report changes to their doctor.
The money raised in Movember is going to used to increase awareness and education as well as towards research. It is thought that global collaborative research projects are more effective than individual ones as multidisciplinary teams of key researchers can work together to increase the chance of a break through in less time.
uk.movember.com/?home
Thursday, 3 November 2011
Organ donation
Yesterday I received my November issue of Student BMJ, which was nice to find on my doorstep when I got home from work! On one of the first couple of pages there was a short piece on organ donations and medical student had given their personal opinions on the matter. This made me think about how I felt about it; once I no longer need my organ why not give them to someone else who would gain from them. This morning I registered on the NHS website to become an organ donor.
To me, it is no different to passing down clothes I have outgrown to my siblings or giving old possessions to a charity shop. I can however understand that some are squeamish at the thought of being dissected and that other might not want to donate some organs such as their eyes as they feel they are unique to them. Also I can imagine that it is easier to donate your own organs than for your grieving relatives to make the decision for you. Some would be comforted that there is an upside to this traumatic event of losing someone, however others may find it hard to 'let go' and could not bear the physical thought of their loved ones being cut.
An article on the BBC news about a week ago looked at the success of organ donation in Scotland and are looking at setting up an 'opt out' scheme whereby all patients donate their organs unless they say otherwise. 37% of Scots have registered as donors however a further 600 donations are required. Changing to an opt out system hopes to increase the donations to save more lives however there are some issues to overcome before we can take patients assumed consent.
Wednesday, 2 November 2011
Teenage Gastric Balloon trial- BBC News
In Sheffield they have planned to trial the gastric balloon on 10 children (aged 13-18) who weigh between 14-20 stone. Although very few studies have been carried out on young people, it has been very effective with adults. The specialist children's hospital has intended to offer it as an option where other treatments have been unsuccessful.
Doctors have said that lifestyle advice is very important in helping young people to lose weight and that the gastric balloon is not a quick fix.
A gastric balloon works by inserting a silicon bag of saline or water into the patient's stomach and inflating it. The pressure created in the stomach gives the patient a sensation of fullness after eating a small portion. The balloon is usually removed after a maximum of 6 months and the patient must continue to eat smaller portions in order to maintain weight loss.
If the trial is approved, the young people will be followed over 2 years to see if the balloon has helped them to lose weight. They will also be working with the behavioural support team to try and support the adolescents to keep the weight off long term.
However before the doctors can go ahead with the trial, the ethics committee must agree.
Doctors have said that lifestyle advice is very important in helping young people to lose weight and that the gastric balloon is not a quick fix.
A gastric balloon works by inserting a silicon bag of saline or water into the patient's stomach and inflating it. The pressure created in the stomach gives the patient a sensation of fullness after eating a small portion. The balloon is usually removed after a maximum of 6 months and the patient must continue to eat smaller portions in order to maintain weight loss.
If the trial is approved, the young people will be followed over 2 years to see if the balloon has helped them to lose weight. They will also be working with the behavioural support team to try and support the adolescents to keep the weight off long term.
However before the doctors can go ahead with the trial, the ethics committee must agree.
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