Elderly get more drugs in care homes

Northern Ireland elderly get more antipsychotic drugs in care homes

Antipsychotic drug dispensing in older people greater than doubled once they entered care

Elderly people in NI are given drugs including tranquilisers and anti-dementia drugs at a miles higher rate in care homes than after they live locally, a study has found.

The study was implemented by scientists from Queen’s University Belfast.

It analysed prescribing data for over 250,000 people, aged 65 years and over, living in NI from 2008 to 2010,

It found that antipsychotic drug dispensing in older people greater than doubled once they entered care.

The study found that 8.2% were prescribed the drug before entry to care homes and that rose to 18.6% after entering care.

Lead researcher at the Queen’s study, Aideen Maguire, said: “Although drug dispensing is high in older people in the neighborhood , we’ve found that it increases dramatically on entry to care.

“This study showed that the high uptake of psychotropic drugs observed in care homes in Northern Ireland can’t be explained by a continuation of drug use initiated locally previous to entering care.

“With an ageing population globally it will be significant that we glance on the reasons behind this kind of increase following admission to care.

“Antipsychotic uptake in Northern Ireland is analogous to that during the remainder of the united kingdom and Ireland, and this study highlights the desire for routine medicines reviews especially in the course of the transition into care.”

Students recruited for NHS 111

NHS 111 recruitment: ‘Students targeted’ in Kent

Recruitment of scholars to work at the new NHS non-emergency telephone service in Kent have been criticised.

South East Coast Ambulance Service (Secamb), which runs Kent’s service, has recruited 200 more call handlers.

However, it’s been accused by Medway Council of targeting students, with not enough training offered to new recruits.

Secamb said some “targeted recruitment” had taken place, but no “particular demographic” have been recruited.

Labour’s spokeswoman for health and community services at Medway Council, Teresa Murray, who also works at MidKent College, said the service wanted a versatile labour force.

“In my profession on the college we saw adverts coming in inviting kids to be recruited… when things began to get it wrong at 111 it was obvious the eight weeks training that each one of these workers had wasn’t adequate,” she said.

“Calls were getting dropped, people were being given information they weren’t ok with.

“Consequently, although the ambulance service deny this, we have seen A&E admissions rise.”

MidKent College, which has campuses in Medway and Maidstone, offers A-level and vocational courses for college kids aged 16 upwards.

‘Patients at risk’

Strood GP Dr Julian Spinks, who’s the vice chair of Kent Local Medical Committee, said call handlers has to be medically trained.

“There’s a danger that advice can be wrong and put patients in peril,” he said.

“On the other end of the spectrum because they’re having to err massively at the side of safety then patients turn out being sent to A&E.”

A spokeswoman for Secamb said it had worked hard to deal with any issues and concerns within the early stages of the hot service’s implementation.

She said: “This work has included the recruitment of extra staff to control a far higher demand than was anticipated.

“Now we have recruited to nearly all of these additional posts. Some of the roles are part time and weekend roles which suit some groups of folk.

“While some targeted recruitment can have taken place, we don’t have any policy to recruit from any particular demographic. All roles were freely available for anyone to use for via NHS jobs.”

Mosquitoes ‘ignore insect repellent’

Mosquitoes ignore repellent Deet after first exposure

Deet works the 1st time, but for some hours afterwards it loses its power

The frequent insect repellent Deet seems to be losing its effectiveness against mosquitoes, scientists say.

Researchers from the London School of Hygiene and Tropical Medicine say mosquitoes are first deterred by the substance, but then later ignore it.

They say more research is required to search out alternatives to Deet, which was first developed by the united states military.

The research was accomplished on Aedes aegypti, a species of mosquito that spreads dengue and yellow fever.

The findings are published within the journal Plos One.

Dr James Logan from the London School of Hygiene and Tropical Medicine, said: “The more we will understand about how repellents work and the way mosquitoes detect them, the easier we will be able to workout the way to get across the problem once they do become proof against repellents.”

Human bait

Deet – or N,N-diethyl-meta-toluamide – is among the most generally used active ingredients in insect repellents. It was developed by america military, following its experience of jungle warfare during World War II.

For a few years, it was not clear exactly how the chemical worked, but recent research means that insects simply don’t like the smell.

However, there are concerns that some mosquitoes are growing proof against it.

To discover more, researchers from the London School of Hygiene and Tropical Medicine took some A. aegypti mosquitoes within the laboratory, and tempted them with a human arm covered in Deet.

As expected, the repellent put the insects off their potential meal.

However, a couple of hours later when an identical mosquitoes were offered an opportunity to dine again, the researchers found that the Deet was less effective.

To investigate why this may be happening, the researchers attached electrodes to the insects’ antenna.

Dr Logan explained: “We were ready to record the response of the receptors at the antenna to Deet, and what we found was the mosquitoes were now not as sensitive to the chemical, so that they weren’t picking it up besides.

“There’s something about being exposed to the chemical that first time that changes their olfactory system – changes their sense of smell – and their ability to sniff Deet, which makes it less effective.”

Arms race

Earlier research by the similar team found that genetic changes to an identical species of mosquito could make them proof against Deet, even though it was not clear if there have been any mosquitoes like this inside the wild.

Dr Logan said it was vital to comprehend both these permanent genetic and temporary olfactory changes that were happening.

He said: “Mosquitoes are important at evolving very in no time.”

He stressed that the findings won’t stop people from using Deet in high risk areas, but that they might help scientists who’re looking for new versions which may be effective.

To follow up at the study, the researchers now plan to determine how long the effect lasts after the initial exposure to the chemical.

The team would also desire to study the effect in other mosquitoes, including the species that transmit malaria.

End of life care to be overhauled

End of life care to be overhauled

Social Care Minister Norman Lamb “There should be a more personal approach”

There should be an overhaul inside the way dying patients are cared for in England, ministers have conceded.

The government has ordered hospitals to hold out immediate reviews in their practices and announced the Liverpool Care Pathway might be phased out.

It comes after an independent report concluded the pathway, which is able to involve the withdrawal of food and treatment, was being “misused”.

It can be replaced by individual end of life care plans within a year.

These plans could be tailored take into consideration different conditions.

One of the key criticisms of the independent review – chaired by crossbench peer Baroness Julia Neuberger – was that the LCP had become a “tick box” exercise, which failed to take the person patients’ circumstances into consideration.

The Care Quality Commission, which regulates hospitals, has also been told to guarantee end of life care becomes a more important component to the inspection regime.

‘Deeply distressing’

Care and Support Minister Norman Lamb said: “We are hoping the actions we’ve taken today will reassure patients and their families that everybody coming to the tip in their life is getting the absolute best care and that concerns are being handled swiftly.

“I actually have personally heard families describe staff slavishly following a process without care or compassion and leaving people suffering on the end in their lives. Here is something we can’t allow to move on.

“People’s final days must be as comfortable and dignified as possible. For this reason there’s a place for thoughtful and careful end of life care that involves patients and their families, however it is obvious what we now have has to be replaced in order to create a smarter way of doing this.”

The review was installation on the turn of the year amid concerns with the manner the LCP was getting used and the truth that hospitals were being financially incentivised to apply it.

The LCP is suggested as best practice in Scotland and northerly Ireland in addition to England. Wales has its own system.

The review, which took evidence from patients and health staff in addition to reviewing literature, said a “deeply distressing” picture had emerged.

It described patients being left without adequate nutrition and hydration with reports of patients desperately attempting to suck sponges utilized by staff to dab their faces.

The experiences of several families were included inside the review’s report – lots of which concerned the wrong denial of fluids.

One said: “We were told that if we would have liked anything to drink then the only real way can be fore the family to soak a paper towel from the dispenser int he toilet and let her suck it.”

But the review also said they’d found evidence that after the LCP was used correctly and in consultation with the patient and their relatives it may help ease death.

Nonetheless, Baroness Neuberger said the LCP needed to be phased out as there have been now simply too many unacceptable cases to “turn the clock back” and get it used properly be everybody.

NHS waiting list information ‘poor’

Audit Scotland warns NHS waiting list information ‘poor’

From Democracy Live: Health Secretary Alex Neil responded to the report at parliament

Scotland’s public sector watchdog said it was unable to assert whether NHS waiting list manipulation had taken place, because of “poor” information.

In a small variety of cases, it said patients were inappropriately marked as unavailable for treatment, but couldn’t say whether these were deliberate.

Audit Scotland said the management and scrutiny of the system “had not been ok”.

Health Secretary Alex Neil insisted the issue was “historical”.

Speaking on BBC Radio Scotland’s Good Morning Scotland programme, the minister admitted that IT systems had not been robust enough but that was now changing.

He added that the facility to list patients as “socially unavailable”, thereby removing them from the waiting time system, not existed.

Audit Scotland investigated after waiting list manipulation came to light in NHS Lothian.

They were criticised for removing patients from the 18-week waiting list once they refused to travel to England for treatment, marking them as “unavailable for social reasons”.

It also emerged that some staff at NHS Tayside said they felt stressed to mention patients were “unavailable” for appointments so that it will meet waiting-times targets.

Mr Neil, who made an announcement to the Scottish Parliament at the report, said an internal investigation on the health authority found no evidence of waiting time manipulation or coercion of staff.

The Audit Scotland report – which covered the period when Lothian waiting lists were being manipulated, between April and December 2011 – said there has been “widespread use across Scotland” of the social unavailability patient code during that point.

It said use of the code rose from 11% of patients in 2008 to greater than 30% in mid-2011, which came during a time when waiting time targets were being shortened.

Audit Scotland also said key areas of waiting time systems were inadequate.

It said limited information within the records of patients looking ahead to treatment meant it was not always possible to spot changes or check that status codes were applied appropriately.

The figure started dropping on the end of that year, but Audit Scotland said the cause of this was unclear as a result loss of available information.

“Audit Scotland found a small choice of instances where unavailability codes were used inappropriately,” the watchdog stated.

“Because of the poor information, it was impossible to establish whether these were attributable to human error, inconsistent interpretation of steerage, or deliberate manipulation.”

Scotland’s auditor general, Caroline Gardner, said: “The management and scrutiny of the waiting-list systems haven’t been ok.

“In the course of the period we reviewed, the Scottish government and boards were focussed on ensuring waiting times targets were being met but not giving enough attention to how this was being done.

“Better scrutiny of the increasing use of social unavailability codes can have highlighted concerns earlier. It also may have identified where waiting times pressures were building inside the system.”

Mr Neil said many of the recommendations within the Audit Scotland report were already being implemented.

He told the BBC: “Patients are ok with the waiting times, what we’re unhappy with is – now an historical situation – is the shortcoming of robustness in a few of the IT systems to record the detail of data that we’d like.”

Mr Neil said the social unavailability code was replaced in October by a brand new system giving patients more flexibility to agree once they need to be treated.

The explicit agreement of patients is additionally needed in the event that they want their treatment to be delayed.

Findings ‘unsettling’

The minister has announced that a pilot phone line for patients seeking advice on waiting times might be opened later this year.

The health secretary said work was also under approach to ensure patients knew their rights.

Labour health spokeswoman Jackie Baillie said: “This report makes clear that hidden waiting lists were widespread, not only in Lothian, and the SNP government was aware there has been an issue and did nothing.

“It preferred to believe it’s own spin and hype than concern itself with what was really occurring in our hospitals.”

Scottish Conservative deputy leader Jackson Carlaw added: “Should you have a look at the trends presented here, it’s difficult to arrive another conclusion than the deception utilized by NHS Lothian might was mirrored elsewhere.

“If that is not the case, the Scottish government must explain why there has been any such bizarre rise in patients who became unavailable over a reasonably short time period.”

Liberal Democrat MSP Jim Hume said: “This report takes the gloss off of the SNP government’s record on waiting times targets.

“People across Scotland will find the report’s findings disappointing and unsettling seeing that, earlier than the waiting-times scandal coming to light, as many as 30% of inpatients in Scotland were marked as socially unavailable.”

Iain Gray, convener of Holyrood’s cross-party audit committee, said it might be looking into the flaws raised within the report, adding: “Patient wait times are an incredible NHS performance target and intensely important to the patients themselves.”

Vasectomy Reversal

To anyone who is considering a vasectomy reversal, it is good to know that reversing a vasectomy is not unusual. Actually, advances in the technology means an experienced doctor can offer great chances for success. So rest assured that vasectomies can be reversed.

The decision of seeking the best vasectomy reversal is much tougher to make than undergoing a vasectomy, which is a quite simple and straightforward procedure, whereas a reversal is a much more complex microsurgery. This is a surgery which can last about 3 hours, and which requires technical skills that only doctors with extensive training can perform properly.

It is a common myth that urologists who have wide experience in vasectomies can just perform reversals. Nothing is further from the truth than this, and only specialised doctors should be considered for the best reversal to avoid any complication. Another common myth that is circulating is that reversals just do not work, due to anti sperm antibodies; but, these antibodies fade away in many cases and are not significant issues regarding reversals. Although it might seem to be viable and logical alternative, professionals in fertility don’t recommend In Vitro Fertilization or IVF, as an alternative to reversals. One of the main drawbacks to In Vitro Fertilization as an alternative to reversals is the great number of procedures which both the couple has to undergo. The single procedure of reversal is the better option.

It has been estimated that almost half of vasectomy patients ultimately seek to undo the procedure with various reasons ranging from the feeling of inadequacy, to people who can develop a condition known as Post Vasectomy Pain Syndrome. Additionally, personal situations may have simply changed.

In the search for an appropriate vasectomy reversal professional, peer reviews and recommendations from the medical practitioners can be extremely helpful, with the primary medic a great source of information. A list of particular questions should be prepared in advance in order to alleviate very real concerns.

Total costs can also be an issue, as reversal procedures are normally not covered by medical insurance, and can be a substantial financial burden. Online advertisements about vasectomy reversal professionals abound. So, extreme caution is highly advised, and the word of mouth is probably still the best method of settling on the best qualified doctor.

It is also advisable to undergo the reversal within the shortest time period since the vasectomy was performed, and the higher will be the chance of success of the reversal, where restored sperm count may be the determining factor for theĀ  impregnation.

Luckily, newer procedures have been developed to help in achieving the best vasectomy reversal that is minimally invasive, like the no scalpel technique which is conducive to minimal trauma for the person. This is also referred to as the “key hole” method.

Once a person has decided to take the next step, he should search for the best microsurgical professionals and vasectomy reversal clinics in his area and talk further about his decision.

Dementia dogs start work

First dementia dogs start work with owners

Students at Glasgow School of Art had the speculation to coach guide dogs to assist those with dementia

The first ever “dementia dogs” were working with their new owners.

The dogs was trained to aid those with early-stage dementia and may remind them to take their medicine and help them get out and about.

They were the brainchild of a gaggle of scholars from Glasgow School of Art.

The students suggested that dogs can be trained to assist those with dementia within the same way that guide dogs help people who find themselves blind.

With the support of Alzheimer Scotland, Dogs for the Disabled and Guide Dogs Scotland, two dogs underwent 18 months of educating.

Golden retriever Oscar and Labrador Kaspa was working with their new owners for four months, after 18 months of teaching.

They has been taught to reply to alarms and convey medicine pouches, to nudge their owners to read a reminder and to encourage them to get off the bed within the morning.

Ken and Glenys Will cannot believe how much difference Kaspa has made to their lives. Ken had become scared of being alone after being diagnosed with dementia three years ago.

“Kaspa is the correct thing that’s ever happened to us,” said Glenys. “We will buy groceries and the dog will sit with Ken. i do not should worry about him. We’re both more relaxed.”

While she is operating as a lollipop lady, Glenys can now leave reminders beside an alarm for Ken.

“If i would like the oven on, I’ll leave a note beside the alarm inside the kitchen. When the alarm goes off Kaspa nudges and nudges Ken until he’s glad to wake up. It’s just amazing.”

Making progress

Frank Benham has also noticed a major difference in his wife Maureen since Oscar was placed with them. Maureen had lost confidence because she found it hard to carry conversations. Now they may be out day after day.

“You meet people at streetlevel and it is a conversation starter, especially if Maureen knows them.”

Frank Benham says Maureen is more confident since Oscar was placed with them

“Before we had the dog, I did get frustrated,” added Frank, “however the dog acts as a buffer between you. If it really works out and finally, down the road, it will likely be an ordinary thing for folk with Alzheimer’s or dementia to have a dog. i feel will probably be a superior achievement.”

The idea came from an unusual source, students at Glasgow’s School of Art. They were asked to return up with products to aid individuals with dementia.

One of them was Luke McKinney. “We thought, why can’t we train dogs to assist individuals with dementia within the same way as we train dogs to aid those who can’t see?”, he said.

“We presented the belief to Alzheimer Scotland and likewise some service users, and the feedback we got was instantly huge.”

The way ahead

Alzheimer Scotland worked with Banbury-based Dogs for the Disabled and Guide Dogs Scotland to spot suitable couples and dogs, with some extra funding from the Design Council and the Scottish government.

The first two dogs have proved so successful that two more are already undergoing training and the charities involved say dementia dogs is usually a significant new way of helping those with early-stage dementia.

“Supporting those with dementia and their families to live well with the illness requires innovative and imaginative approaches,” said Joyce Gray, deputy director of development at Alzheimer Scotland.

“Dementia Dog has had a really wonderful impact at the families involved.”