Sunday 31 October 2010

The CQC: death, gender, disability, mental health, religion and sexual identity.

The CQC is a giant spider that has been directed to spin its web over the former Health Care Commission and the Commission for Social Care Inspection (CSCI).  It is not mature enough to deal with the massive task that it is expected to undertake, nor does in have the spider power to fulfil its required tasks.  It makes mistakes!  Its intricate web is full of holes.  It has become a predator that eats itself!

It does however, have the ability to write great paper work!  Although I realise that its territory is now wider than 'starring' nursing  homes (which it doesn't do anymore and there is nothing yet in place to replace it!) - it does write a pretty mean 'Statutary notification' of death, that covers both hospital environments and care home settings.

This is (or was) was going to be it (the viewing of the document) - but now it aint!  Although I can recover the document on my personal site as I have saved it - it now shows 'error on the page' if I write the URL here!  So much for the CQC!  I have re-entered the CQC site and can no longer find this document!

Breaking it down on my print out (lucky I did this!), Sections 1-3 relate to location,  person and circumstances of death and are mandatory.   Section 4 asks for details of  the last person involved in providing care - but it is not mandatory.  Why not?  Sections 5-9 relate to medicines and medical devices and possible errors that could have caused death - yet are still not mandatory.  Why?  If we are going to have all this paperwork - it has to mean something.  It must have a purpose.  If not, why the need for it?

Section 10 deals with gender, ethnicity, disability, mental health, religion and sexual identity - again not mandatory but...why O why does it matter?    It is requested that non-mandatory information be provided.

If Mrs. Miggins was a white, Irish, disabled Zoroastrian with mental health issues relating to her doubts over her sexual identity - why does it matter?  She is dead!  Who will collate this unnecessary information?  What purpose does it serve? 

Please tell me - for I do not know!

Anna :o[  ???

Thursday 28 October 2010

29/10/10 is 'Wear it Pink Today!'

October is Breast Awareness Month.

One of the tiny little problems of being a nurse is that some folk think you have the knowledge base of a doctor - which of course you don't!

They will show you lumps and bumps and ask your opinion - or ask you this and that and expect an answer.  I can't give them one and suggest they see their doctor.  I have often been asked about mammograms and until earlier this year - would always suggest it made good sense to go ahead.

I have had one myself which proves I am ancient!  Of late, I have been swayed by medical opinion that it is perhaps not a good idea.  Or is it?

October is Breast Cancer Awareness Month.  Astra Zenaca, who manufacture Arimidex and Tamoxifen, founded the Awareness Month in 1995, its aim being to promote mammograms as the most effective weapon in detecting breast cancer.

Is this Big Pharma serving their best interests, directing medical care or just a nice thing to do; maybe the latter?

Although hearing similar stories last year, the seeds of doubt were sown in my mind in January, when I read reports such as this in The Telegraph.  It suggested that, despite a reported 1,400 lives saved per year - there is no evidence that the breast screening programme has saved lives and in fact, women have wrongly been told that they have breast cancer and undergo unnecessary surgery on tumours that would not progress to being harmful.

This article was based on this at the Nordic Cochrane Centre and was swiftly refuted by NHS choices who claimed that the research was a narrative review critiquing the 2008 Annual Review of the NHS Breast Screening Programme (NHS BSP), which reported on twenty years of mammogram screening in the UK.  See here for further details.

In March this year this article appeared in The Telegraph stating that two lives are saved 'for every woman unnecessarily treated'.  It is interesting reading.  It is admitted here that leaflets supplied did not inform of potential risks of screening.

Adverse effects of mammographic breast screening include:

Psychological and physical morbidity - mainly associated with false-positives.

False negatives - approximately 5% of cancers in women over the age of fifty are mammographically invisible.

A diagnosis of cancer that would not have become symptomatic during a woman's lifetime.

Radiation risk - an estimate that one extra breast cancer develops every year in women over fifty, after a latent period of up to ten years, for each million women screened.

There is undoubtedly harm related to breast screening - but there must be some good!?  A detection rate of 6.2 cancers - although some would be of the 'no harm' kind (?) - per 1000 women screened; of these, invasive cancers accounted for 1.4 per 1000.  This reported 1.4 - to me - suggests the risk is worthwhile?  However, if you visit NNT it seems that breast screening is a harmful waste of time.

Furthermore, regular self-examination is a waste of time too!  See here!

There is so much conflicting information, I am left a little confused!  I think I shall probably attend my next, unless something more robust convinces me otherwise.  I will still recommend that other women do too.  But should I?  Should I say - "Look at the evidence and make your own decision"?

What are your thoughts?

Anna :o]

PS We must (as girlies) take some responsibility for our health!  Poor diet, obesity and binge drinking may lead to breast cancer!

Thursday 21 October 2010

Good Old Copperfield!

"Life Is Not A Bed Of Roses"  or
"Living With Dementia".

Good Old Copperfield!  I love this blog in Pulse!  These two GPs always offer a wonderful insight into the joys and woes of their world.

Take a look at this weeks article "What, if not antipsychotics?"  It is pure truth and I love them for it!

The majority of people I am proud to care for have some form of dementia.  We are strange in our home for we regard the residents as our employers - we work for them!

Living with dementia is not a bed of roses; it is not two sweet little old ladies enjoying tea and scones and a confused chat - although it can be for a lucky few.  Some residents are lucky in that they are totally apathetic and appear to suffer no emotional harm.  But perhaps they do in the quiet strange place in which they dwell - I don't know.

Living with dementia is about existing in a frightening, alien world where even you closest family will eventually become strangers.  For some - it must be akin to being in a permanent drunken stupor where you touch, feel and attempt to understand and make sense of  all that is around you - but you can't.

It is about Annie, who, when waking in the morning finds herself in a strange room and she is frightened!  Strangers enter her room and talk to her - but she doesn't understand what they are saying.  They continue talking as they help her from her bed and begin to undress her and prepare her for her day.   But she screams "Police!  Police!" and kicks and bites and punches, for she fears she is being raped.

It is about Jim - who despite family fears that it would be harmful - has been told that he has dementia by his psychogeriatrician, for he believes that Jim has a right to know and it is in Jim's best interests.  What about Jim's right not to know?  Jim is angry, agitated, anxious and so very afraid.  He is tormented and his family can no longer cope with the stress that caring for Jim brings.

He has entered nursing care much earlier than would perhaps have been required if he had not known.  He is resentful and insulted by required, personal interventions and reacts with extreme violence.  He sleeps little and wanders the home, entering others bedrooms as he searches for his wife.  He requires 1-1 observations through the night as he is a danger to himself and others.

After other meds have been tried and have not alleviated his distress - he is prescribed antipsychotics and after a while he is calmer, but still a little troubled.  He now eats and joins in activities and sleeps.  His life has regained a certain quality.

It is about Betty who is a long term resident.  She has in her time, worked as a barmaid and a carer.  When she first arrived she would attempt  (as if driven by routine) to tidy the home - clearing away plates and cups before residents had finished their meals.  These residents reacted in anger and sometimes physical conflict ensued - for social inhibitions often fly away when you have dementia.  She attempted to 'go home' with staff - thinking she had finished her shift - and when she couldn't, would erupt into violent behaviour.  She was prescribed antipsychotics and calmed and regained a certain quality to her life.

They were taken away from her earlier this year, following the DOHs insistence that side effects outweighed benefits with regards to the elderly.  She is now again that poor, mad, tormented and very distressed soul; she wanders the home, interfering with others and invading their space.  They slap her and she slaps back.
We fill in Safeguarding Vulnerable Adults forms for all involved and send them off to the powers that be and all is tickety-boo!  But who is the vulnerable adult here?  Betty who is now permanently tormented to meet DOH directives or the poor souls whose space she persistently invades?

Given the choice - I would rather live five years of a drug-induced calm - where my life had a level of quality than seven years existing in a permanent, living hell on earth.

I agree with Copperfield in that it is socially unacceptable to allow the elderly to suffer in torment.  Why do we allow it?


Saturday 16 October 2010

Isn't Technology Wonderful?

Microsoft's SenseCam
Please visit Time magazines photogallery re "A Simple Camera Helps an Amnesiac".

Also when there, click onto Claire's story.

As no doubt you realise - I love Time magazine!  I love the little snippets of information it gives as well as a wider view of all that is happening in the world around us and often above us.

I love the way it plops through my letterbox on a Saturday morning as if in an invitation to share its knowledge within.

Anna :o]

Saturday 9 October 2010

A 1,000 Registered Managers are Missing From Care Homes!

I have just read this in Nursing 
It states that registered managers are missing from 1,000 care homes.  I can understand this as you must be a masochist to take on this momentous task.

No longer are care managers able to operate hands on care - for they are bogged now with mandatory paperwork!  Duplication is the name of the game!  Local authorities now demand  the same paperwork (if not more) than the CQC and do their own inspections.

This must be in place and that must be in place for innumerable agencies!  Risk assessments are there for everything, including possible toxic vapours from photocopiers!

Local authorities now demand their own induction for new starters!  Managers must now sign off over a hundred and twenty questions relating to the care that new carers and nurses provide.  Nurses must now state on Mar Charts why they administer analgesia, anti-emetics, meds for constipation and creams!  I don't know - why do we?

There are so many mandatory training requirements - that you need to employ more staff than the home needs - purely to cover staff that are attending training.  Staff are so dazed with all these training requirements that they cease to listen - they are tired of it!  I am!  I truly believe that repetitive training videos are a sure fire cure for insomnia - as I certainly fight sleep!  Doctors - pick up on this!

Employment laws now mean that carers or nurses who don't care, can no longer have their employment terminated - unless gross misconduct is involved.  Their rights are paramount and stuff the residents!  I would think that a caring attitude is essential in these roles - but not so!

It is well recognised that some of those newly pregnant seek out roles in care.  They declare their pregnancy not long after starting and the law entitles them to 'soft options' and their fellow carers have to take the brunt of this.  There is also a knock-on effect to the level of caring offered to the residents.

On top of this, there is the antagonistic approach of some GPs - but after reading an article in Pulse - I understand this a bit more and will write about it later.  GPs - talk to us as we do not realise that care homes put pressure on your practice!

If care homes are breaking the law by not having registered managers in the home, what are the CQC going to do about it?  Provide saints or people teetering on the edge of insanity to fill the posts?  At present - you have to be one or the other!

Care of residents will suffer.  It is inevitable.  Managers cannot manage a home if they are swamped in paperwork!

Anna :o[

Friday 8 October 2010

"For the Beauty of the Earth"

Time magazine photo gallery.

Please visit Time magazines photo gallery of newly discovered species in Papua, New Guinea.  Truly beautiful!

As an aside,  the title of the post "For the Beauty of the Earth" is a hymn written by Folliot S. Pierpoint (1835-1917).  Wiki reports that he wrote the hymn while "mesmerised by the beauty of the countryside that surrounded him".  I know the feeling!  And No, I am not trying to sell religion as I am an atheist!

One day, while still at junior school, a worrying rumour spread like wildfire round the school, in that, the following day (at noon) would be the end of the world!  The earth would be enveloped in catastrophic tidal waves and life would cease to exist!  Worried kids sought comfort and explanations from teachers and parents - but did not believe what we were told.

The Armageddon morning, in assembly, we sang "For the Beauty of the Earth" for the first time; the hymn being hauntingly beautiful and the tune a little melancholy - which was certain proof (to us) that indeed, the end of the world was nigh!

I lived by the South Coast then, and the school dining room had one very large wall which was made entirely of glass.  We kids on first sitting cringed in fear as we stared at the panoramic window, waiting for the tidal wave to envelop us all.  Never happened of course and I can't remember whether the dinner was good that day!

But I have always remembered the hymn and therefore the memory of that day.  Have you any interesting Armageddon stories?

Possibly interesting: "Dear God!  Man!" is an anagram of Armageddon.

Anna :o]

Thursday 7 October 2010

A Nice U-turn by NICE.

Will our elderly and vulnerable be respected and given the drug treatment they deserve?

Thousands of patients with early stage Alzheimer's could now benefit from drug treatment following a U-turn by The National Institute for Health and Clinical Excellence (NICE).  Presently, doctors are unable to prescribe donepezil, rivastigimine and galantamine to early stage patients to enable them to retain their mental faculties longer.

In 2005, NICE ruled that no Alzheimer sufferer should receive these drugs on the NHS (based on efficacy of treatment and value for money), and they then conceded in 2007 that only patients with moderate disease should receive them.

However, the decision was contested by drug companies and the Alzheimer's Society who queried the 'secret formula' used by NICE to calculate value for money.  The case went to the House of Lords and the secret formula was amended after NICE conceded technical inaccuracies.  This did not lead to a change in outcome.

Further campaigning by doctors, patients, families and the Alzheimer's Society has led to the new guidelines and recommendations.

NICE has also ruled that a fourth drug Ebixa should be made available for those with severe forms of Alzheimer's and for some with moderate disease.

It does appear to be good news!  In fact, brilliant news!

Anna G :o]

PS  For those of you who doubt the integrity of drug companies - you might find this interesting  which I stumbled across while researching. 

Monday 4 October 2010

Are your personal emails being scanned?

While at work yesterday I came across

Fridays edition of the Metro which I hadn't read, so proceeded to do so.  The headline was "Online snoops put Britain in the dock" which caught my interest.

It reports that Britain has been flouting European rules on internet privacy re online snooping for eighteen months and is been taken to court.

BT began testing Phorm software in 2006 to monitor internet activity to identify customers surfing habits and then place targeted advertisements on websites visited.  If you visit Phorm's website it does not mention scanning personal emails.

The majority of my incoming mail is from nursing/medical sites and sure enough all adverts relate to same.  Really I don't have a problem with this.

Oddly enough, on Saturday, when reading an incoming email from a friend, I noticed that the adverts related to the two main themes of my received, personal, private email.  I had never noticed this before as I pay little or no attention to the adverts.  I mentioned this find to my son who remarked that it was "Sinister".

After reading said article in the Metro I decided to browse through all my personal, saved emails.  In approximately 95% of cases - sure enough, the adverts related to themes in the letter.  Sheep were mentioned in one and all adverts related to sheep.  A friend mentioned that a close relative was near death in another and adverts in the sidebar related to palliative care, medical treatments, emergency surgery, etc - now I find this sick!

I do have a serious problem with my personal received and sent emails being scanned for the purpose of advertising.  It is not right and it is sinister!

Check your personal emails!

I am pleased that Britain is being hauled before the European Court of Justice!


Saturday 2 October 2010

Palaeopathology and Political Correctness?

Bonkers or brave?

recent article in the Journal of Medical Ethics discusses issues relating to biomedical research on the mummified remains of ancient human bodies.

It proposes that in an effort to gain further understanding of disease - we may be violating the rights and best interests of our ancient ancestors as they were unable to give informed consent.

Do you agree with this or do you think it is political correctness gone mad?