tag:blogger.com,1999:blog-24259173535892170442024-02-08T03:56:26.607+00:00Under DeconstructionMostly random writings about healthcare and music stuff. This blog will be updated on a very strict "As and When it pleases me" schedule. IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.comBlogger82125tag:blogger.com,1999:blog-2425917353589217044.post-58717795251838263442018-11-06T10:54:00.002+00:002018-11-06T10:54:20.328+00:00New HomeHi guys,<br />
<br />
Forgot to let you know but I've moved. So if you still want to read my blurp then head over to my <a href="http://ingvararni.wordpress.com/" target="_blank">WordPress page</a>.IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-45897063076173995272018-06-15T13:06:00.002+01:002018-06-15T13:49:39.225+01:00Metal Nurse: Acquired Brain Injury<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJXvmjrTrobhDGPHrVKghI5ZDDJdptmgAKZxm82MG9Iq4LiStMQb06jXlXWawqJ0gu8Uqduro0Xnh3VXkaqJwx5QST_weY3rT09X1rvOyHwInFwo8wyf2L2vh9SumMOfxMbqSKlhltxZw/s1600/nursestation.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: inherit;"><img border="0" data-original-height="350" data-original-width="960" height="72" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJXvmjrTrobhDGPHrVKghI5ZDDJdptmgAKZxm82MG9Iq4LiStMQb06jXlXWawqJ0gu8Uqduro0Xnh3VXkaqJwx5QST_weY3rT09X1rvOyHwInFwo8wyf2L2vh9SumMOfxMbqSKlhltxZw/s200/nursestation.png" width="200" /></span></a></div>
<span style="font-family: inherit;">I had already previously written about mental health, <a href="http://ingvararni.blogspot.com/2017/02/metal-nurse-physical-health-within.html" target="_blank">here</a> and <a href="http://ingvararni.blogspot.com/2016/09/metal-nurse-self-harm-and-suicide.html" target="_blank">here</a>. Recently due to unforeseen circumstances, I saw myself return to that field on a full-time basis. I still keep one hand in the acute sector because the experience you get there is second to none. Now the job I've moved into involves taking care of patients with Acquired Brain Injury(ABI), sometimes known as Traumatic Brain Injury. An area I didn't really think I'd have any interest in. But here I am. Since starting what has become a little evident is that ABI is often the condition that no ones know how to manage properly or wants to deal with. Sometimes it is pushed into the learning disabilities section, other times it put under the mental health umbrella or even put under the general health. What really has come to light is it is a syndrome that is so multi-faceted it needs input from all specialities, because it affects so many aspects of people's health. But whilst the patient who has the condition should be the focus, there has to be some work done with the family and friends of the patient. Because the person who they used to love and care for has changed, sometimes temporarily but more often than not permanently. It is a major global concern, but somehow often gets missed during a discussion regarding healthcare organisations and re-organisations. This is mostly because treating patients with ABI is expensive, it costs the NHS around <a href="https://www.headway.org.uk/news/national-news/traumatic-brain-injury-costs-15-billion-a-year-in-the-uk-says-new-research/" target="_blank">£15 billion per year</a>. In the US this is number is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652528/" target="_blank">$60.43 billion</a>. </span><br />
<span style="font-family: inherit;"><br /></span> <span style="font-family: inherit;"> So what exactly is ABI?</span><br />
<span style="font-family: inherit;"><br /></span>
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://upload.wikimedia.org/wikipedia/commons/d/de/JacksonJBS_A_descriptive_catalogue_of_the_Warren_Anatomical_Museum_1870_frontispiece_623x1024.jpg" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: inherit;"><img border="0" data-original-height="800" data-original-width="462" height="200" src="https://upload.wikimedia.org/wikipedia/commons/d/de/JacksonJBS_A_descriptive_catalogue_of_the_Warren_Anatomical_Museum_1870_frontispiece_623x1024.jpg" width="115" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: inherit; font-size: x-small;">Gage's skull</span><br />
<span style="font-family: inherit; font-size: x-small;">and the iron rod</span></td></tr>
</tbody></table>
<span style="font-family: inherit;">Well... Broadly speaking it is damage to the brain that happens after you are born. Whether it's due to a traumatic event such as an accident, assault or any other cause such as head injury and/or neurosurgery. Or could be damaged due to diseases, such as <a href="https://en.wikipedia.org/wiki/Meningitis">meningitis</a> or <a href="https://en.wikipedia.org/wiki/Encephalitis">encephalitis</a>, poisoning, <a href="http://ingvararni.blogspot.com/2015/01/student-nurse-perspective-stroke-and.html">stroke</a>, tumours, substance abuse and so on and so forth. It does not cover brain injury that occurs due to degenerative diseases such as <a href="https://en.wikipedia.org/wiki/Wilson%27s_disease" target="_blank">Wilsons Disease</a> or <a href="https://en.wikipedia.org/wiki/Neuroferritinopathy" target="_blank">Neuroferritonopathy</a>, or dementia. Some professionals do prefer to use the term Acquired Brain Injury as an umbrella term opposed to Traumatic Brain Injury. The reason being that Traumatic Brain Injury would cover head injuries caused by external forces such as those mentioned above as opposed to internal ones like meningitis etc. Possibly the most famous ABI patient has to be a gentleman named <a href="https://en.wikipedia.org/wiki/Phineas_Gage" target="_blank">Phineas Gage</a>. There is an excellent Wikipedia page about him, but for those who do not feel like they have enough time to read it, I'll try to summarise what happened. Mr Gage was a railroad worker who was survived an accident where a metal rod went through his skull, it went up through the left side of his skull just above his mandible as he was about to speak, behind his left eye and out at the top of his skull. Destroying large parts of his left frontal lobe in the process. Somehow he survived this and managed to live a relatively full life after the fact. But according to his friends and family, his personality completely changed. It took a few years but he did manage to regain a lot of his social skills and personal skills, but we are still not quite sure as to how. His case has been used to both prove and disprove a lot of hypothesis and theories regarding neurology, the physiology of the brain, and recovery models for patients with ABI</span><br />
<span style="font-family: inherit;"><br /></span> <span style="font-family: inherit;"><br /></span>
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://media.defense.gov/2015/Jun/04/2001052551/-1/-1/0/150528-F-JD261-103.JPG" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="571" data-original-width="800" height="142" src="https://media.defense.gov/2015/Jun/04/2001052551/-1/-1/0/150528-F-JD261-103.JPG" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Helmets prevent ABI</td></tr>
</tbody></table>
<span style="font-family: inherit;"><span style="font-family: inherit;">It is a very common injury, in the US, for example, it is estimated that </span><a href="http://www.internationalbrain.org/brain-injury-facts/" style="font-family: inherit;">over 5 million people</a><span style="font-family: inherit;"> are living with disability due to their brain injury. In the UK it appears to be a bit harder to find numbers on how many people are living with ABI, the numbers wary anywhere between </span><a href="https://www.ukabif.org.uk/data/" style="font-family: inherit;" target="_blank">60.000 and 900.000</a><span style="font-family: inherit;">, though </span><a href="https://www.centreformentalhealth.org.uk/" style="font-family: inherit;" target="_blank">Centre for Mental Health</a><span style="font-family: inherit;"> puts the number somewhere around </span><a href="https://www.centreformentalhealth.org.uk/traumatic-brain-injury" style="font-family: inherit;" target="_blank">1.3 million people</a><span style="font-family: inherit;">, with the highest number of affected being aged 15-24 years of age. But the latest statistics according to the head injury charity </span><a href="https://www.headway.org.uk/" style="font-family: inherit;" target="_blank">Headway</a><span style="font-family: inherit;"> makes a sobering reading nonetheless. In 2013-2014 there were a total of </span><a href="https://www.headway.org.uk/about-brain-injury/further-information/statistics/statistics-resources/" style="font-family: inherit;" target="_blank">348.934 admissions</a><span style="font-family: inherit;"> into hospitals due to ABI. If you break down those numbers a little further, head injury admission account for 162.544, of those 100.831 is men. Interestingly researchers in the Department of Neurosurgery, </span><a href="http://en.tnsi.org/" style="font-family: inherit;" target="_blank">Tianjin Neurological Institute</a><span style="font-family: inherit;"> in China did a systematic review regarding </span><a href="https://www.safetylit.org/citations/index.php?fuseaction=citations.viewdetails&citationIds[]=citjournalarticle_549622_13" style="font-family: inherit;">worldwide statistics</a><span style="font-family: inherit;"> of causes of ABI/TBI. What they found was that in Europe the largest cause of ABI was work-related or caused by falls, in Asia it was largely due to Motor Vehicle Collisions and the in the US mostly sports related. Basically what happens is that men take bigger risks, this could all be part of a larger part of the discussion regarding </span><a href="https://www.theguardian.com/commentisfree/2017/jun/26/men-die-before-women-toxic-masculinity-blame" style="font-family: inherit;" target="_blank">toxic masculinity</a><span style="font-family: inherit;">. Due to this disproportionate occurrence is why there are not as many services for female patients with ABI. The report by Centre for Mental Health states that a person who suffers from ABI is at double the risk of developing a mental health problem, regardless of whether they had no past history of mental illness. What it also showed was that around 60% of criminal offenders had some sort of brain injury, most of the time this turns out to be an accumulative injury. This is also a </span><a href="https://www.nature.com/articles/nrneurol.2013.33" style="font-family: inherit;" target="_blank">common occurrence</a><span style="font-family: inherit;"> with those who play contact sports on a regular basis, such as rugby, American Football, and football (Soccer to you barbarians). This also highlights the importance of safety equipment such as <a href="http://ingvararni.blogspot.com/2013/11/put-your-bloody-helmet-on.html" target="_blank">helmets</a> and padding.</span></span><br />
<span style="font-family: inherit;"><br />What are the effects of ABI?</span> <span style="font-family: inherit;"><br /></span>
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjugkCVjrR4uQvRobBKO_aA1Rcet_WhZtjG-2uc3faQgcJq_Qx8C9RIz9aiXGixNHKDUuaILyNzUfTt8wRLAczM7Pt2kyIG-Evq_HadHzDfAYOC60XYJJO5rpx_442gzZyzDYsQvuXPO6Q/s1600/Brain_injury_with_herniation_MRI.jpg" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: inherit;"><img border="0" data-original-height="666" data-original-width="640" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjugkCVjrR4uQvRobBKO_aA1Rcet_WhZtjG-2uc3faQgcJq_Qx8C9RIz9aiXGixNHKDUuaILyNzUfTt8wRLAczM7Pt2kyIG-Evq_HadHzDfAYOC60XYJJO5rpx_442gzZyzDYsQvuXPO6Q/s200/Brain_injury_with_herniation_MRI.jpg" width="191" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: inherit; font-size: x-small;">Brain MRI.</span></td></tr>
</tbody></table>
<span style="font-family: inherit;">The effect of ABI is varied. It affects every aspect of the persons being, whether emotional, psychological or physical. The most obvious and possibly most common one is the loss of inhibition, loss of emotional control and issues with the memory. The aspect that possibly puts the biggest strain on patients with ABI and their closest, is the loss of insight, loss of <a href="https://theconversation.com/children-learn-empathy-growing-up-but-can-we-train-adults-to-have-more-of-it-68153" target="_blank">empathy</a> and loss of sympathy. Patients with ABI can come across like they have dementia, though what has been found out is that patients who have ABI are more likely to develop <a href="http://synapse.org.au/information-services/dementia-brain-injury.aspx" target="_blank">dementia later in life</a>. </span><span style="font-family: inherit;">The symptoms of ABI largely depends on what part of the brain has been injured. The most common area to be injured are the </span><a href="https://en.wikipedia.org/wiki/Frontal_lobe" style="font-family: inherit;" target="_blank">frontal lobes</a><span style="font-family: inherit;">, this area is vital for forming memories, empathy, expressive language and more. With damage to the frontal lobe, changes </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/11122995" style="font-family: inherit;" target="_blank">to the personalities</a><span style="font-family: inherit;"> are more evident than when other areas of the brain are damaged. Hence the bigger social cost of ABI and managed, alongside the patient's rehabilitation. It can be distressing for both the patient and their loved ones when they lose the ability to put themselves in someone else's situation or say/do things that could be considered outside of the social norms. And they then cannot understand why other people are either upset with them or cannot relate to them. They cannot reflect on their behaviour, or do not see a problem with their behaviour and its impact on others. <a href="https://en.wikipedia.org/wiki/Disinhibition">Disinhibition</a> is a prevalent change that happens to ABI patients, alongside impulsiveness. They become more irritable, they get angrier quicker, with less patience for others and any interruptions to their concentrations. This often results in those patients becoming violent towards their carers and relatives. </span><a href="https://www.aphasia.org/aphasia-definitions/" style="font-family: inherit;" target="_blank">Aphasia</a><span style="font-family: inherit;"> is, according to the </span><a href="https://www.aphasia.org/" style="font-family: inherit;" target="_blank">National Aphasia Association</a><span style="font-family: inherit;">, </span><span style="font-family: inherit;"></span><br />
<blockquote class="tr_bq">
<span style="font-family: inherit;">"<span style="background-color: white;"><i>Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write.</i>" </span></span></blockquote>
<span style="font-family: inherit;">This inability to be able to say what you mean to say, or form the right words, or sentences, can become very frustrating for the patient. And their closest. It can have a major impact on their rehabilitation and recovery.<br /><br />There is also Ataxia, which according to the <a href="https://www.ataxia.org.uk/" target="_blank">Ataxia UK</a>,</span><br />
<blockquote class="tr_bq">
<span style="font-family: inherit;"><span style="font-family: inherit;">"<span style="background-color: white; color: #424242; text-align: justify;">Ataxia’ is an umbrella term for a group of neurological disorders that affect balance, coordination and speech. There are many different types of ataxia that affect people in different ways. "</span></span></span></blockquote>
One of the more challenging aspects of these patients care in my view is something called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567054/" target="_blank">"Cognitive Fatigue"</a>. This is where a patient gets more tired and has greater difficulty in concentrating on things that they used to be able to do with ease prior to their injury. This can lead to fluctuation in their mood and difficulties with their emotions and behaviour. Thankfully with the right support, and right support network this can be overcome through intensive rehabilitation.<br />
<br />
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-zaDqqqrD9gnW-6c1i0z-7TZD9xEMrdlwmwgxkV8k918BFvl5-4f-UVBdJkYPk4GN7dP2C5HoJxgWXyT2feYdE9CXaHzHMhr0q8pEZUALMEUWPp1o5YTQwB8K5btJwn8Myc8jUe_ejJY/s1600/epilepsy-156105_960_720.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="547" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-zaDqqqrD9gnW-6c1i0z-7TZD9xEMrdlwmwgxkV8k918BFvl5-4f-UVBdJkYPk4GN7dP2C5HoJxgWXyT2feYdE9CXaHzHMhr0q8pEZUALMEUWPp1o5YTQwB8K5btJwn8Myc8jUe_ejJY/s200/epilepsy-156105_960_720.png" width="151" /></a></div>
The most common physical health complaint that occurs to patients <a href="https://www.sciencedirect.com/science/article/pii/S1059131115002332" target="_blank">post head injury</a> is <a href="https://en.wikipedia.org/wiki/Epilepsy">epilepsy</a>. Epilepsy is a category of neurological disorders that are defined by epileptic seizures. These seizures can come in many forms such as:<br />
<br />
<ul>
<li><a href="http://epilepsyontario.org/about-epilepsy/types-of-seizures/tonic-clonic-seizures/">tonic-clonic seizures</a>, also known as grand mal. </li>
<li><a href="http://epilepsyontario.org/about-epilepsy/types-of-seizures/focal-or-partial-seizures/">focal seizures</a></li>
<li><a href="http://epilepsyontario.org/about-epilepsy/types-of-seizures/absence-seizures/">Absences seizures</a></li>
<li><a href="http://epilepsyontario.org/about-epilepsy/types-of-seizures/atonic-drop-seizures/">Atonic seizures</a>, also known as drop attacks</li>
</ul>
<br />
These seizures can be short and only happen once, or they can be long and come upon in groups. Typically these are brought upon due to external triggers, such as flickering lights, environmental noises, poor diet (for example badly managed diabetes or excessive amount of stimulants like caffeine and sugar) etc. But with patients who have ABI, they more often occur due to internal triggers such as lack of sleep, stress, emotional excitement and boredom. Those who have ABI tend to be put on anti-epileptic medication prophylactically in order to prevent them from having seizures. Most seizures tend to be self-terminating but carers and family need to have rescue medicines such as <a class="gr-progress" href="https://patient.info/medicine/buccal-midazolam-for-seizures-in-children-buccolam">buccolam</a>, which is an oral solution, or <a href="https://medlineplus.gov/druginfo/meds/a605033.html">rectal diazepam</a> in order to cut those seizures short, especially if the patient has had more than the one seizure. Then there is <a href="https://en.wikipedia.org/wiki/Status_epilepticus">Status Epilepticus</a>, this is a seizure that lasts for longer than five minutes. It is an emergency situation often requiring intensive care input. The prognosis for patients who suffer from status epilepticus is not good, between 10%-30% of those who are diagnosed with it die within a month. Hence the need for speedy treatment, with optimisation of their medications and daily routines, such as strict sleeping regimes.<br />
<br />
As can be read this is a very big topic to write about, and there are issues that I have not touched upon. As I have mentioned frequently, this is a major global health concern. It has a multi-faceted impact. It does not just impact on the patient who suffers from the injury, it also affects their friends and family. But not just that due to the disability that comes with it and given the age it occurs most commonly, it can also affect the larger economy. The rehabilitation can take months if not years if they were in employment they will either have to take a long period off in order to return or never return at all. There is a definite need for more centres that provide rehabilitation and treatment for ABI, and this can only be beneficial to everyone. Not just those directly affected.<br />
<br />
For further information, I wholeheartedly recommend an organization called <a href="https://www.headway.org.uk/" target="_blank">Headway </a>who dedicate themselves solely to those who are affected by head injuries.<br />
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<br />IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-7683688310372773202018-04-24T19:51:00.002+01:002018-04-24T19:51:49.767+01:00Metal Nurse: Open visiting hours <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJXvmjrTrobhDGPHrVKghI5ZDDJdptmgAKZxm82MG9Iq4LiStMQb06jXlXWawqJ0gu8Uqduro0Xnh3VXkaqJwx5QST_weY3rT09X1rvOyHwInFwo8wyf2L2vh9SumMOfxMbqSKlhltxZw/s1600/nursestation.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="350" data-original-width="960" height="116" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJXvmjrTrobhDGPHrVKghI5ZDDJdptmgAKZxm82MG9Iq4LiStMQb06jXlXWawqJ0gu8Uqduro0Xnh3VXkaqJwx5QST_weY3rT09X1rvOyHwInFwo8wyf2L2vh9SumMOfxMbqSKlhltxZw/s320/nursestation.png" width="320" /></a></div>
This is possibly going to be the most controversial article I have written. At least amongst my nursing colleagues. It is regarding the dreaded creature called "Visitors". A lot of hospitals in the UK have rather strict visiting hours, often 1400-1600 and 1800-2000, sometimes less, sometimes more. Children wards would often have more lax hours because parents want to be with their kids and the kids want their parents. Not entirely sure where this practice came from or why. There are a lot of reasons bandied about, like that it is protected mealtime hours. Or it is to reduce the infection rate. But honestly, I suspect it is because most nurses just want to get on with their work without being questioned too much. But as a profession, we tend to forget that these relatives are people, people with worries for their loved ones.<br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQcG7m28xKNTp__kTzrcfZ4MpRlDBWSLgr0tTO_zCEDB85h7RPRa62XcPDuTUWOUUgSVe6T_tjoRTy1y2BzkziK_xNrnJk4eKfdNWA8AxRUjVtRtwqqew6KdR2XIZgKjA6jgFz5Vh7y6o/s1600/no-god-please-noooooo-16496000.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="347" data-original-width="500" height="138" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQcG7m28xKNTp__kTzrcfZ4MpRlDBWSLgr0tTO_zCEDB85h7RPRa62XcPDuTUWOUUgSVe6T_tjoRTy1y2BzkziK_xNrnJk4eKfdNWA8AxRUjVtRtwqqew6KdR2XIZgKjA6jgFz5Vh7y6o/s200/no-god-please-noooooo-16496000.png" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Usual reaction</td></tr>
</tbody></table>
Recently a relatively local hospital to me announced that they will change and extend the visiting hours. At first, my initial instinct was "<a href="https://www.youtube.com/watch?v=Tim5nU3DwIE" target="_blank">NOOOOOOOOOO</a>". But then when I started thinking about it I warmed up to the idea. Those strict visiting hours are a probably more of a nuisance because what happens is that visitors throng outside the unit, quite a few of them will try and be cheeky and ask if they can be let in earlier. A fair few of those get angry and start raising their voice, especially at the secretaries who like everyone else are just trying to do their job and do not deserve to be shouted at by people who most likely don't know how hospitals work. Then when the visitors do come in, they come in a drove. Then they form a line in asking a multitude of questions, usually when you are a little busy. They are concerned and worried and want to know what is happening to their loved ones and there is nothing really wrong with that. But when you are busy trying to help someone else it becomes frustrating, and because of confidentiality, you can't divulge why you are busy. So the visitors start to think you are rude and you as a nurse start to think that the visitors are self-centred, both of those assumptions are wrong. But it does get in the way of nurses and doctors work when they are halted in their duty, they do want to make sure that the patients are well cared for and do want to answer any queries and alleviate any worries that are voiced. One of the many problems we face as nurses as that as a profession we are very regimented and <a href="https://www.nursingtimes.net/focus-on-the-values-of-nursing-to-boost-care-not-checklists/5040127.article" target="_blank">task-oriented</a>, which can stifle good care and is not very conducive for the patients. I can hear my colleagues spit and spittle and go "Well, I'm not." I'm afraid that most of you are. This does include me, I know full well that I am and I do try my best to not be. We need to be better.<br />
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Now. This is not going to be a popular opinion. But... I think that the above-mentioned hospital is correct in <a href="https://www.magonlinelibrary.com/doi/full/10.12968/bjon.2015.24.22.1175" target="_blank">extending the visiting hours</a>. Visitors do have their own lives to lead, their own needs that need to be met. So why do they have to organize their lives around those visiting hours? With those new hours, the visitors can come in dribs and drabs as opposed to coming in like a slow mowing gnu herd which makes everyone miserable. A patient with a large family can have one or two people visiting them throughout the day as opposed to having a whole tribe sat around the bed space, potentially annoying the rest of the patients and their visitors in that bay. Not to mention the issues with parking, which does seem to peak at visiting hours.<br /><br />A lot of hospitals started giving relatives and friends of patients with relatives access to the ward outside normal visiting hours, after a campaign called '<a href="http://johnscampaign.org.uk/#/" target="_blank">John's Campaign</a>' which has been extremely helpful to both patients and the professionals that take care of them. The thing is that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2545771/pdf/bmj00284-0029.pdf" target="_blank">more liberal</a> <a href="https://journals.lww.com/ccmjournal/Citation/2008/01000/Visiting_hours_in_the_intensive_care_unit__More.49.aspx" target="_blank">visiting hours is better</a> for <span id="goog_1198145418"></span><a href="https://www.blogger.com/"></a><span id="goog_1198145419"></span>patient care. You get fewer complaints, the patients get better quicker and they tend to be more settled during their stay. <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/jhq.12035" target="_blank">Patients satisfaction</a> of their care improves. Which is always excellent. If visitors come in more infrequently this also gives nurses time to educate both the patient and their visitors, especially in terms of self-management and health promotion, which ideally should be part of all good care. Or it gives you enough time to figure out what happened, why it happened and how (hopefully) it can be prevented from happening again. Because collateral history can make such a big difference in patients care.<br /><br />It is by no means perfect, but to be honest it doesn't have to be. We are there to try and make sure that the patient gets better. And opening the visiting hours does exactly that.IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-62169575152192048982018-04-15T12:33:00.003+01:002018-04-15T12:33:39.001+01:00Metal Nurse: Cancer quackery and the vultures that peddle them<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJXvmjrTrobhDGPHrVKghI5ZDDJdptmgAKZxm82MG9Iq4LiStMQb06jXlXWawqJ0gu8Uqduro0Xnh3VXkaqJwx5QST_weY3rT09X1rvOyHwInFwo8wyf2L2vh9SumMOfxMbqSKlhltxZw/s1600/nursestation.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="350" data-original-width="960" height="72" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJXvmjrTrobhDGPHrVKghI5ZDDJdptmgAKZxm82MG9Iq4LiStMQb06jXlXWawqJ0gu8Uqduro0Xnh3VXkaqJwx5QST_weY3rT09X1rvOyHwInFwo8wyf2L2vh9SumMOfxMbqSKlhltxZw/s200/nursestation.png" width="200" /></a></div>
There are few things that gets my blood boiling like cancer quackery. I am not going to pretend that I am as knowledgeable as the revered oncology surgeon <a href="https://respectfulinsolence.com/who-is-orac/" target="_blank">Orac</a> over at <a href="https://respectfulinsolence.com/" target="_blank">Respectful Insolence</a>. But during both my professional time as a nurse and studying as a student nurse I have come across my fair share of despicable behaviour from people who proclaim themselves as some sort health care professionals, especially when it comes to cancer. Cancer is serious business, it is not something to take lightly. I abhor these vultures who flock around those who have been diagnosed with cancer, and worse still when they flock around the family and whisper such nonsense like "Gerson Therapy works better", "They are too acidotic, bicarb will cure them" and so on and so forth. They convince patients that evidence-based medicine cannot help but that faith-based healings, such as herbal medicine and homoeopathy, will. Then when the patient dies from their cancer they wash their hands of them and say that "Science does not know everything". Leaving a trail of destruction and sorrow in their path, whilst sowing seeds of doubt regarding real medical professionals who then have to pick up the pieces. <br />
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These vultures need to be stopped.<br />
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One of the main points to keep in mind regarding cancer is that there are at least <a href="https://www.cancer.gov/types" target="_blank">100 different types of cancers known</a>. Each with their own pathophysiology's, each with their own characteristics and each with different ways of treatment. So when you see someone that claims that they can cure cancer or know how. Ask them which type of cancer, then ask them how.<br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvDI93vRajdzKAbykPleiT9EiOdldkSOvo45walBN8iljHFqE86rPC_um0eu6QNW5va_JQtK59O1a7iqAHc2H12EJh6u749g6A_jyPIFG2BNcKAkvzvaLcWg3uxyOhMvUJJEGGEwWIvCQ/s1600/FB_IMG_1521825607870.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="960" data-original-width="664" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvDI93vRajdzKAbykPleiT9EiOdldkSOvo45walBN8iljHFqE86rPC_um0eu6QNW5va_JQtK59O1a7iqAHc2H12EJh6u749g6A_jyPIFG2BNcKAkvzvaLcWg3uxyOhMvUJJEGGEwWIvCQ/s320/FB_IMG_1521825607870.jpg" width="221" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="https://chronicleflask.com/" target="_blank">Chronicle Flask</a></td></tr>
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Thankfully, <a href="https://www.cancerresearchuk.org/" target="_blank">Cancer Research UK</a> has got several articles <a href="http://scienceblog.cancerresearchuk.org/2014/03/24/dont-believe-the-hype-10-persistent-cancer-myths-debunked/" target="_blank">debunking</a> common cancer myths. One of the ones I have come across rather repeatedly is that acid environment causes cancer. So people should eat alkaline food. Like... Uhm... <a href="http://www.realfoodforlife.com/16-health-benefits-of-lemons-the-alkaline-powerfood/" rel="nofollow" target="_blank">Lemons</a>? Really? Lemons?! Yeah, lemons. That famous alkaline fruit. With pH of 2.0, wait... you mean that is not how it works? Somehow the proponents of alkaline diet to cure cancer suggest that lemon becomes alkalotic when you digest it. That somehow gastric acid (pH of 1.0 - 2.0) cancels out the citric acid. I am not sure what biology, or <a href="https://www.youtube.com/watch?v=bB2Ea79M7qU" target="_blank">chemistry classes</a> these quacks have been going to but they need to get a refund for that.<br />
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The body self-regulates its acid-alkaline level. The body maintains a very strict pH of 7.35 - 7.45. Go below that and you go into <a href="https://en.wikipedia.org/wiki/Acidosis" target="_blank">acidosis</a> and go above that and you go into <a href="https://en.wikipedia.org/wiki/Alkalosis" target="_blank">alkalosis</a>. Both can and will kill you. A glass of lemon water is not going to do anything to shift it either way.<br />
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And honestly guys. The same goes for Bicarbonate of Soda. That excellent <a href="https://www.bbcgoodfood.com/glossary/bicarbonate-soda" target="_blank">baking ingredient</a> and <a href="https://www.goodhousekeeping.co.uk/institute/household-advice/cleaning-tips/21-cleaning-problems-you-can-solve-with-bicarbonate-of-soda" target="_blank">cleaning material</a>. The same doofuses who talk about cancer being acidic also advocate that people eat a whole <a href="http://scienceblog.cancerresearchuk.org/2014/03/24/dont-believe-the-hype-10-persistent-cancer-myths-debunked/#fungus" target="_blank">load of Bicarb</a>. You might neutralize you gastric acids for short period, and given the quantities, you would have to eat in order to do anything to cancer cells you would also neutralize your vital statistics.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgU7wlM9eEFngN18MZJb7orG3mmDhwv9ATKK765VU07p4nUvwig7j8wLE-UtCwyZr2nS5UXPzkspnynaZfQd1Vkql-SryChW3vz9yRhtMHeG__35jEw79VgLFT0DykMYYsepiFb2iILWU/s1600/xkcd-cells.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="678" data-original-width="437" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgU7wlM9eEFngN18MZJb7orG3mmDhwv9ATKK765VU07p4nUvwig7j8wLE-UtCwyZr2nS5UXPzkspnynaZfQd1Vkql-SryChW3vz9yRhtMHeG__35jEw79VgLFT0DykMYYsepiFb2iILWU/s320/xkcd-cells.png" width="206" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="https://xkcd.com/1217/" target="_blank">XKCD: Cells</a></td></tr>
</tbody></table>
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I do have a lot of people on my FB friend list and a lot of them are well-meaning. But sometimes they share memes that are more harmful than helpful. I have seen a lot of people share memes and quackery articles that usually have something to do with 'XYZ kills cancer cells, scientismints prove!'. The problem with that is that ANYTHING will kill cancer cells in a petri dish, including washing up liquid. You are not going to cure cancer with washing up liquid. In vitro studies can be interesting, but sadly do not translate into the real complex systems like the human body. For example, a popular meme walks about cannabis killing cancer. Again at Cancer Research provides an <a href="http://scienceblog.cancerresearchuk.org/2012/07/25/cannabis-cannabinoids-and-cancer-the-evidence-so-far/" target="_blank">excellent article</a> laying out the truth regarding Cannabis, it uses in cancer treatment and what current evidence says about it. Cannabis has been found to be <a href="https://www.cancer.gov/about-cancer/treatment/cam/patient/cannabis-pdq" target="_blank">very useful</a> in managing nausea, pain, anxiety and other side effects from the cancer treatment. But it is still not the cure for cancer.<br />
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Then there is this thing that cranks want to discuss called Vitamin B17. Can I just clear things up? <a href="http://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/complementary-alternative-therapies/individual-therapies/laetrile" target="_blank">There is no such thing as Vitamin B17</a>. What these con people are referring to is a substance better known as <a href="https://en.wikipedia.org/wiki/Amygdalin" target="_blank">amygdalin</a>. Amygdalin is a perfectly natural compound which is found in apricot kernels, lima beans, clover, peach stones and many many more. When consumed amygdalin converts to <a href="https://en.wikipedia.org/wiki/Cyanide" target="_blank">cyanide</a>. It is not a vitamin. It will kill you, I suppose in a way it does kill cancer.<br />
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What people sometimes have to bear in mind when they read miracle stories about cancer is the phrase <a href="https://en.wikipedia.org/wiki/Spontaneous_remission" target="_blank">Spontaneous Remission</a>. Basically this is where cancer starts to improve for no discernible reason, it does happen. But it happens really, really seldom. Currently the statistics surrounding this is 1 in 100,000. If you know someone who this has happened to then be happy for them, but be vary of any talk about alternative therapies.<br />
<u></u><span style="color: #000120;"><br /></span>IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-36889126387649642832018-04-14T11:28:00.002+01:002018-04-14T11:32:11.543+01:00Carpe, The Kings are dead, long live the kings.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBnM7bHOybn9P0ldTWVT6fCKh4QVgmJGOECwzPPBCdZ8BphkLHld3VOyLU3KcFjHjT-YRsPBP-o4Jy0R1urqKWQp4zfbw3tLuGvaog9xdGAJGcfcv7VFiJ_ME1Tr32rN0W66xNfIpR5Ys/s1600/564314_293711344038145_1420641175_n.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="359" data-original-width="960" height="74" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBnM7bHOybn9P0ldTWVT6fCKh4QVgmJGOECwzPPBCdZ8BphkLHld3VOyLU3KcFjHjT-YRsPBP-o4Jy0R1urqKWQp4zfbw3tLuGvaog9xdGAJGcfcv7VFiJ_ME1Tr32rN0W66xNfIpR5Ys/s200/564314_293711344038145_1420641175_n.jpg" width="200" /></a></div>
Last night my other half and I attended what was in some ways a very sad night at <a href="https://whatpub.com/pubs/LUN/217/yorkshire-taps-lancaster" target="_blank">Yorkshire Taps</a>. The night was called <a href="https://www.facebook.com/events/816618291857875/" target="_blank">Carpe Noctem</a>, the last gig by the local kings of the music scene <a href="https://www.facebook.com/CarpeMusic/" target="_blank">Carpe</a>. These guys had been playing together for almost a decade and decided that enough was enough and have now called it a day after entertaining crowds with their funk laden grooves and joyous attitudes. First time I ever became aware of them was during the <a href="http://www.lancastermusicfestival.com/" target="_blank">Lancaster Music Festival</a> in 2014, and I have to say I was rather smitten from the get go. I wasn't the only one. These guys released one monster of an album during their career, they were the very definition of a band that should have got bigger.<br />
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From a purely musical perspective these guys were one of the most original composite bands I have had the pleasure of listening to. The mix of funk, jazz, hip hop, blues and hard rock with big band sentimentalities was all played with such confidence and relish. It could be argued that Flash is the front and centre of the band but that would be doing injustice to the rest of them because they all play such significant roles. <br />
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For example I remember seeing Carpe playing with Frenchie, the guitarist and singer, and they had to replace him with three other people. Jon Moore on lead guitar, is, well... Wow, those guitar solos were really rather awesome and never out of place. Frenchie's subtle rhythm guitar playing can't be underestimated, underpinning a lot of the songs. Has to be added that Flash is an excellent rapper, but they also have three really rather excellent singers who all have different styles but complement each other almost perfectly. Dave, Grum and Rachel's rhythm underpinning everything.<br />
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The thing that will stand out most is that what these guys wanted first and foremost was to have a good time and to make sure that everyone else did as well. I am going to miss knowing that they will be playing a gig locally.<br />
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IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-34672012275179857432018-04-09T18:12:00.002+01:002018-04-10T11:55:01.254+01:00Metal Nurse Sojourn: Part 3, Sofia and getting lost in the woods<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><div style="text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiM3AE3AvhrXG-7ssO3pmW0x2-pT1Apw5ogOG9Eyz6aM-fmdv3krHW8zFnkPUsxiorxFskcaaQBEbAZLlfFNQb7-SaRKeaM-VMwDY3WnhyphenhyphenjkxHmsRFDfV40ituuZ-xpX_t-RJ8PXsY0mFQ/s1600/WP_20170925_14_19_18_Pro.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="720" data-original-width="1280" height="112" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiM3AE3AvhrXG-7ssO3pmW0x2-pT1Apw5ogOG9Eyz6aM-fmdv3krHW8zFnkPUsxiorxFskcaaQBEbAZLlfFNQb7-SaRKeaM-VMwDY3WnhyphenhyphenjkxHmsRFDfV40ituuZ-xpX_t-RJ8PXsY0mFQ/s200/WP_20170925_14_19_18_Pro.jpg" width="200" /></a></div>
</td></tr>
<tr><td class="tr-caption" style="text-align: center;">Lost In The Woods</td></tr>
</tbody></table>
If you so desire you can read <a href="http://ingvararni.blogspot.com/2017/09/metal-nurse-sojourn-devin-townsend.html" target="_blank">Part One</a> and <a href="http://ingvararni.blogspot.com/2017/10/metal-nurse-sojourn-part-2-hearts-and.html" target="_blank">Part Two</a>, respectively or separately or not at all. The choice is entirely yours, though I would recommend that you do so.<br />
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The next day I got up early, got packed up, paid the hostel and set off to find that mysterious bus station again. In order to head back to Sofia. My other half had said that getting a bus was both quicker and cheaper, and of course provided better sightseeing opportunities than a train. Seeing as she had done a helluva lot more travelling than me, I took her word for it. She was correct. Getting the ticket was a bit of a trick, seeing as the lingua franca is Russian, but I did manage to obtain one. Then there was a bit of a misunderstanding regarding the seats, as I hadn't clocked on that that the seat numbers were on the tickets. Somehow I had expected it to be similar to the British system where people just plonk their butts anywhere. I got a mournful look from a Bulgarian grandmother and an international sign language explanation from another. The bus was full, and it was hot. And it only got hotter by the minute because the bus driver didn't want to open any windows or turn on the AC. It became very hard to keep my eyes open.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizFoVTpWQ0Z-2JTqYSNMnna3gszyC9pcbDv0SDkyOgsELP7jy587mVlni-Ljzi8Jcm8z5HDXCr46G0yKQwlJbbV6JJWr0iCDf3dbjtidmaDM7wAwZ60xE7OmLedZL27Y-RCPdkkpip_xs/s1600/IMG_4907.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizFoVTpWQ0Z-2JTqYSNMnna3gszyC9pcbDv0SDkyOgsELP7jy587mVlni-Ljzi8Jcm8z5HDXCr46G0yKQwlJbbV6JJWr0iCDf3dbjtidmaDM7wAwZ60xE7OmLedZL27Y-RCPdkkpip_xs/s200/IMG_4907.JPG" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="http://www.hostelmostel.com/" target="_blank">Hostel Mostel</a> in Sofia</td></tr>
</tbody></table>
When I got into Sofia I did my usual Google Maps cock-up. Attempting to find my hostel. <a href="http://www.hostelmostel.com/" target="_blank">Hostel Mostel</a> for those who want to know. It wasn't easy to find. Google Maps did take me to the approximate location. I really should have spent a bit more time in learning the Cyrillic alphabet. So I hung around a little bit then noticed other backpackers going through a security door. When you get through those doors you are greeted by endless cats, some pigeons and a really rather nice looking building that turns out to be the hostel itself. Which I neglected to take a photo of myself (the photo to the right is from their website), but I just really really needed to get my backpack off, have a kip and fuel up on some coffee. Once inside you are instantly hit with the relaxed atmosphere of the place and FREE COFFEE!!! I had to insist on paying up front because I was on a budget and wanted to make sure I had plenty to last me the rest of the trip. After fuelling plenty on coffee I got shown my room, which was in a different building but on the same street, and I instantly fall asleep. For 45 minutes.<br />
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After my kip, I go back to the common room of the hostel, get shown a map of where to go, where to eat and what there is to see. Then also with some aid from Google, off I trot.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmbPCdhaN2m9caUBqOkqMfVvlddxqQmxF_b2_UrsHUOvnbQEi4Vi_Z2p6_3UrpfVYuBXdVB56hFisEKaevSICE2vyKo1lSm9bgYL5Wi4VN-YSAOLhQrZlP_-hGrzD_-EQAhbQTVq_Twr4/s1600/WP_20170924_16_24_55_Pro.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="903" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmbPCdhaN2m9caUBqOkqMfVvlddxqQmxF_b2_UrsHUOvnbQEi4Vi_Z2p6_3UrpfVYuBXdVB56hFisEKaevSICE2vyKo1lSm9bgYL5Wi4VN-YSAOLhQrZlP_-hGrzD_-EQAhbQTVq_Twr4/s200/WP_20170924_16_24_55_Pro.jpg" width="112" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Monument To<br />
The Soviet Army</td></tr>
</tbody></table>
Sofia... Feels like a big city. Take it however you want, but to me, that is not always a compliment. Not exactly an insult either, I just feel a bit more on edge, not quite as safe. But it does have its fair share of beautiful buildings. Outside the Cathedral Saint Alexander Nevski, I dine of because it is still really rather warm. You get to see most of the touristy stuff in about an hours walk. Which I did, so with the trusty <a href="https://www.atlasobscura.com/" target="_blank">Atlas Obscura</a> I try to find something more obscure. I decided that I wanted to see '<a href="https://www.atlasobscura.com/places/monument-to-the-soviet-army" target="_blank">Monument To The Soviet Army</a>', which apparently gets vandalised in the most inventive ways on a regular basis. When I get to the park where it is meant to be located, I just see lots of teenagers. Lots and lots of teenagers on bikes and skateboards. Accompanied by loud, no-sensical music. Strutting their stuff, doing dangerously stupid tricks with minimal safety equipment. And an audience. Apparently, I had just walked into Sofia's annual <a href="https://www.facebook.com/events/102161883747260/" target="_blank">Extremefest</a>. Beer, burgers... And... And... BUNGEE JUMPING! Oh, heavenly sweet Buddha of the Latter Day. I needed to do that. Now! But sadly I was hampered by my budget. So instead I sat there, like some old fart watching other people fall to their almost deaths. One person chickened out. *Sniff*.<br />
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Oh and the monument, sadly scrubbed clean. Still nice and well done and fascinating to walk around and look at. Just not pop-culture referencing nice. So time to walk some more. Oooo, a squirrel... A BLACK SQUIRREL. That looks like a red one! Maybe we should import those into the UK. Oh, but it is the same species as the red one. Never mind then. Damn it was cute though.<br />
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The weather is still very nice so I just take my time to walk around the parks of Sofia. It is a nice city, good to spend a couple of days at. But to be honest, Plovdiv was nicer. Sofia is also slightly more expensive but that isn't really saying an awful lot. The one detail I did notice about Bulgaria is that there is not a lot of microbreweries. Which saddened me a little, there are some nice cheap lagers to be had. There was a lot of choice in vodkas and wines, but I prefer my ales. The city is alive, smells clean, and is not crowded with too many tourists. I know there are tourists around because the hostel is teeming with them. But it's not overrun with them like Prague. After much walking, I return back to my hostel to do some more writing and eat.<br />
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<tr><td class="tr-caption" style="text-align: center;">Sofia Day One</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjx0yFl2pyk_7Z5247jdJsdvmo469hDAo6pEnawi-x6SdnA15tD3DnjjSQ-Sn51k6ITa2nElJ4hvclI2SmwcXqksfre_Uc8MJ0S40hxtDqcGsORZPCfcKNMUWdC2TK9NObCw9u92KfDZAA/s1600/WP_20170925_11_57_09_Pro.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="903" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjx0yFl2pyk_7Z5247jdJsdvmo469hDAo6pEnawi-x6SdnA15tD3DnjjSQ-Sn51k6ITa2nElJ4hvclI2SmwcXqksfre_Uc8MJ0S40hxtDqcGsORZPCfcKNMUWdC2TK9NObCw9u92KfDZAA/s320/WP_20170925_11_57_09_Pro.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">National Museum of History</td></tr>
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The next day started off with another free meal a la Hostel Mostel. If there is one thing I'd take away from travelling to Bulgaria it is to book your stays at Hostel Mostel. It is cheap, secure and friendly. The biggest plus though is that you get two free meals, breakfast and dinner. Which when you are travelling on a tight budget is excellent, plus the food is tasty, but more importantly in vast quantities. Over a nice cup of coffee, I go through Atlas Obscura recommendations and prowl through Google Maps. Finally, I decide to walk to <a href="https://en.wikipedia.org/wiki/Boyana_Church" target="_blank">Boyana Church</a>. An Orthodox church dating from the 10th Century. Because... Why not. It's a nice walk. Shouldn't take too long. On my way I stop at the <a href="https://historymuseum.org/en/" target="_blank">National Museum of History</a>, I start to suspect that Google Maps is trying to get me killed because the route it wants me to walk through goes through a secure facility, surrounded with cameras and notices about hungry dogs and armed guards. The museum building itself is captivating with its surrounding scenery.<br />
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I don't think I w<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZbDmjIfB1PmP0whkaKcigWPWnNd2XxduFUbmhP_VgjWcVuOCwD4gt3NNQNi2sjZ_VbXv-7uj0qKCZPZAJuXLsFsDq1H2fmHThjdeTtY05orQACN_jG8bc3q8GCdAnkkxLAU3PnpAy9VY/s1600/WP_20170925_12_36_29_Pro.jpg" imageanchor="1" style="-webkit-text-stroke-width: 0px; background-color: transparent; clear: right; color: #0066cc; float: right; font-family: Times New Roman; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; margin-bottom: 16px; margin-left: 16px; orphans: 2; text-align: center; text-decoration: underline; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZbDmjIfB1PmP0whkaKcigWPWnNd2XxduFUbmhP_VgjWcVuOCwD4gt3NNQNi2sjZ_VbXv-7uj0qKCZPZAJuXLsFsDq1H2fmHThjdeTtY05orQACN_jG8bc3q8GCdAnkkxLAU3PnpAy9VY/s1600/WP_20170925_12_36_29_Pro.jpg" imageanchor="1" style="-webkit-text-stroke-width: 0px; background-color: transparent; clear: right; color: #0066cc; float: right; font-family: Times New Roman; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; margin-bottom: 1em; margin-left: 1em; orphans: 2; text-align: center; text-decoration: underline; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><br /></a>ant to press my luck too much. But I did manage to get into the museum. Which was captivating, the history of Bulgaria is an intriguing hotchpotch of different cultures amalgamating together. The Greeks have been here, The Romans, The Thracians, Bulgarians, the Ottomans and many more. Invaded by Hungarians, Mongolians, Serbs, and many more still. Then of course as can be seen above they have had a lot of input from the Soviets. Then there is the history of the <a href="https://simple.wikipedia.org/wiki/Cyrillic_alphabet" target="_blank">Cyrillic alphabet</a> itself, which remains the only alphabet where we can trace it back to its original creator, <a href="https://en.wikipedia.org/wiki/Clement_of_Ohrid" target="_blank">Clement of Ohrid</a>. After taking another moment to stop and have some coffee, I take in the view. Specifically, the mountain that Sofia is based right next to. I want to take a photo up there. So again after consulting with Google Maps (Even though it probably did try and get me killed before), I vacate the museum after spending a good two hours walking around. On my way out the guard eyes me up suspiciously with a cigarette in his mouth, doughnut at hand and a big gut. Probably feeling like he should be doing his job, he asked me to hand my bag over so he could search it. Thankfully I only had bottles of water and some apples. Which I had purchased on the way. Which happens to be water from the <a href="https://en.wikipedia.org/wiki/Devin,_Bulgaria" target="_blank">Devin</a> province, which considering my ultimate purpose of the trip just seemed to make sense. He seemed very disappointed by that.<br />
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I still hadn't made my way to Boyana Church so I start walking and sweating slightly. On my way there I come across a guy walking his pet cow. Boyana Church as mentioned previously was originally built in the 10th century, with various add-ons attached since then. It is on the <a href="http://whc.unesco.org/" target="_blank">Unesco Heritage List</a>, it's a beautiful little church located again in a beautiful piece of the country. But again because of budget constraints I couldn't afford to enter but had a good mooch around the building itself. I do now wish I had paid to go in because the frescos in there are so unique and breath taking. After getting my breath back I then decide to walk up to "Жива вода Бояна" which according to Google Translate means "Living Water Boyana". Whilst there I promptly get a little lost in the woods. But I took my time in being lost, the surrounding nature and the woods were just too good to not to do so in. <br />
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<tr><td class="tr-caption" style="text-align: center;">The Snail House</td></tr>
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If I had taken some more time I would have been able to locate the waterfall that starts the living water but instead I wanted to walk to a monastery as I had never been to one, at least not one which had monks in. This walk was filled with wondrous nature, empty houses, animals and birds that I don't get the opportunity to see elsewhere. Then I walked and I walked. And walked some more. After a while, it becomes clear to me that Google Maps doesn't know where it is taking me or what it is doing. After I while I give up on that and decided that I wanted to find the ski lift that takes people up to the top of <a href="https://en.wikipedia.org/wiki/Vitosha" target="_blank">Vitosha</a> Mountain. Again Google Maps fails me a little and I give up on that. At this point I was getting a little tired of walking around. So up comes Atlas Obscura and points into the direction of <a href="https://www.atlasobscura.com/places/snail-house-sofia" target="_blank">The Snail House</a>. Which I did get to see, but couldn't as it is only outside which is a tourist attraction, the inside is residential. Thus my day was almost to an end. I started walking back to my hostel because I didn't want to miss dinner. I was hungry. Like really, really hungry. The walk was long but mostly straight. On the way back I decided to stop at one of many, many pizza takeaways that were there. Selling pizza slices for less than a pound, by the pound by the looks of things. If you ever get to go to Bulgaria I do recommend those pizzas, they are worth every morsel, especially when you are starving. Again along the way I pass through various parks and see many historical buildings. After I reach my hostel I had done 40,000+ steps. My knees were aching and I was ready to enjoy this cheap lager that I had bought and vast quantities of Hostel Mostel food.<br />
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<tr><td class="tr-caption" style="text-align: center;">Church of Saint John Rila/ Lada / Abandoned Bus Shelter</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">The Woods at the foot of Vitosha</td></tr>
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I sit down. Read a little bit and write a bit more. Get to bed and fall asleep. The next day I packed everything up and headed back home. Happy.<br />
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<br />IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-9165596949949919232018-04-06T19:30:00.000+01:002018-04-06T19:31:57.341+01:00Metal Nurse: Alcohol Free For The Year<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: inherit;"><span style="font-family: inherit;"><span style="background-color: white; color: #1d2129;">On the 1st of March, I decided to take a sabbatical from alcohol. Not because I am an alcoholic, but because I don't want to become one. </span></span><span style="background-color: white; color: #1d2129;">In the past year, I have found that my consumption of beer has gone up. I could see how easy it is to go from just having one, to JUS</span><span class="text_exposed_show" style="background-color: white; color: #1d2129; display: inline;">T having two, to JUST having three. This would just start the occasional evening, slowly creeping up to every evening. Working where I work I have taken care of plenty (too many) people who are there because of alcohol. And every time I think "I don't want to end up like that". To end up having to take medications to assist you through the withdrawals, end up having seizures because said alcohol withdrawal. Running the risk of developing <a href="https://emedicine.medscape.com/article/186101-overview" target="_blank">Hepatic Encephalopathy</a>. Hooked up to a <a href="https://www.medicines.org.uk/emc/product/1427/pil" target="_blank">vitamin drip</a>, plus other intravenous fluids because chances are that you will also be severely hydrated because the alcohol has depleted your vitamins and electrolytes from your body and brain. Taking copious amounts of laxatives in order to prevent the <a href="https://www.medicines.org.uk/emc/product/1427/pil" target="_blank">build-up of ammonia</a> in your body.</span></span><br />
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<span class="text_exposed_show" style="background-color: white; color: #1d2129; display: inline; font-family: inherit;">Yes, I am not an alcoholic and I didn't feel like I am becoming one. But quite frankly I didn't want to risk becoming one. It just doesn't feel worth it. There isn't just the physical health side of things to consider there is also the mental health aspect of it. For many it is a form of coping mechanism to drink excessively, to suppress their depression and hide their anxiety. Without actually being aware that it is making both of those worse. Long-term excessive drinking can and does lead to <a href="https://www.rcpsych.ac.uk/healthadvice/problemsdisorders/alcoholdepression.aspx" target="_blank">psychosis and dementia</a>. To go from wanting a drink to needing a drink, when you feel jittery and shaking, which doesn't stop until you've had your breakfast consisting of last nights unfinished booze. If you already suffer from <a href="https://www.nhs.uk/conditions/clinical-depression/" target="_blank">depression</a>/<a href="https://www.nhs.uk/conditions/generalised-anxiety-disorder/" target="_blank">anxiety</a> you run the risk of making it worse, and if you don't suffer from those debilitating illnesses you run the risk of developing them. Then there is the public health implication. In the UK excessive alcohol consumption costs society as a whole a whopping <a href="https://www.gov.uk/government/publications/health-matters-harmful-drinking-and-alcohol-dependence/health-matters-harmful-drinking-and-alcohol-dependence" target="_blank">£21 billion</a>. In the US the number is <a href="https://www.cdc.gov/alcohol/data-stats.htm#economicCosts" target="_blank">$249 billion</a>, and that was in 2010, I can't imagine that that number has gone down since. <a href="http://www.who.int/en/" target="_blank">WHO</a> estimates that alcohol accounts for <a href="http://5.1%25/">5.1%</a><span id="goog_453010151"></span><a href="https://www.blogger.com/"></a><span id="goog_453010152"></span> of the total global disease burden, in 2012 over 3 million died due to alcohol-related conditions. </span><br />
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<span style="font-family: inherit;"><span class="text_exposed_show" style="background-color: white; color: #1d2129; display: inline; font-family: inherit;">I know that there is also that rumour that it helps to relax, but I am not so sure anymore. I didn't actually find that it does. If anything I feel more stressed, especially the day after, my sleep is more disrupted and I am even grumpier when I wake up. All good research also shows that. You don't get enough sleep. You don't get enough <a href="https://www.youtube.com/watch?v=5rOiW_xY-kc" target="_blank">REM</a> <a href="https://www.howsleepworks.com/types_rem.html" target="_blank">sleep</a>, it disrupts your <a href="https://www.nigms.nih.gov/education/pages/Factsheet_CircadianRhythms.aspx" target="_blank">circadian rhythm</a> because alcohol relaxes your muscles it makes you more prone to <a href="https://www.nhs.uk/conditions/obstructive-sleep-apnoea/" target="_blank">sleep apnea</a>, etc etc. Recent <a href="https://www.livescience.com/60329-online-insomnia-therapy-mental-health-symptoms.html" target="_blank">research</a> have been implicating lack of sleep as one of the causes of ill mental health, as opposed to a symptom. So it all seems a little circular. I felt it was time to smash that circle. I like my sleep, and I prefer my sleep to be undisturbed. I especially didn't want to have to wake up several times just to have to empty my bladder. I want to wait at least another 50 years until that has to be a feature in my life.</span></span><br />
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<span style="font-family: inherit;"><span class="text_exposed_show" style="background-color: white; color: #1d2129; display: inline;"><span style="font-family: inherit;">Even just looking at the health evidence of all the ill effects that alcohol does to your body and mind. Alcohol has been linked to an increased risk of <a href="http://www.cancerresearchuk.org/health-professional/cancer-statistics/risk/alcohol" target="_blank">cancer development</a>. At least <a href="https://www.drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/diseases/alcohol-and-cancer/" target="_blank">7 different ones</a>, including breast cancer, bowel cancer and liver cancer. Drinking also increases your risk of developing <a href="https://www.britishlivertrust.org.uk/liver-information/liver-conditions/cirrhosis/" target="_blank">cirrhosis of the liver</a>, which itself is a risk factor in developing cancer of the liver. There is also increased the risk of developing <a href="https://www.nhs.uk/conditions/acute-pancreatitis/symptoms/" target="_blank">acute pancreatitis</a>, which itself leads to <a href="https://www.nhs.uk/conditions/chronic-pancreatitis/" target="_blank">chronic pancreatitis</a>, which in turn increases your risk of developing <a href="https://www.ncbi.nlm.nih.gov/pubmed/28762376" target="_blank">pancreatic cancer</a>. Alcohol also adversely affects the cardiovascular system. It <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513687/" target="_blank">increases your risk</a> of developing <a href="https://www.medicalnewstoday.com/articles/150109.php" target="_blank">hypertension</a>, <a href="https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease" target="_blank">coronary heart disease</a> and <a href="https://www.bmj.com/content/360/bmj.j5842" target="_blank">peripheral vascular disease</a>. All of which also increase your risk of <a href="http://ingvararni.blogspot.co.uk/2015/01/student-nurse-perspective-stroke-and.html" target="_blank">stroke</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314445/" target="_blank">heart attacks</a>. You run the risk of developing <a href="https://en.wikipedia.org/wiki/Wernicke%27s_encephalopathy" target="_blank">Wernicke's Encephalopathy</a>, which is caused by depletion of thiamine, this condition often precedes a condition called <a href="https://www.alz.org/dementia/wernicke-korsakoff-syndrome-symptoms.asp" target="_blank">Korsakoff Syndrome</a>. The more I read and the more I think about it, it just doesn't feel worth it. </span></span></span><br />
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<span style="font-family: inherit;"><span style="background-color: white; color: #1d2129; display: inline; float: none; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">Plus it's expensive. I don't particularly like the day after feeling, not just the full-blown hangover. But that 'bleurgh' feeling without a headache. Even without thinking about all the physical health issues, it just doesn't feel worth it. </span><span style="font-family: inherit;"><span class="text_exposed_show" style="background-color: white; color: #1d2129; display: inline;">But giving up the alcohol. That does feel worth it.</span></span></span><span style="font-family: inherit;"><span class="text_exposed_show" style="background-color: white; color: #1d2129; display: inline;"><br /></span></span>IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-49312439682364676282018-04-04T18:30:00.000+01:002018-04-04T23:20:45.547+01:00Metal Nurse: From Non-Vaccinating to Peer Vaccinator<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJXvmjrTrobhDGPHrVKghI5ZDDJdptmgAKZxm82MG9Iq4LiStMQb06jXlXWawqJ0gu8Uqduro0Xnh3VXkaqJwx5QST_weY3rT09X1rvOyHwInFwo8wyf2L2vh9SumMOfxMbqSKlhltxZw/s1600/nursestation.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="350" data-original-width="960" height="116" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJXvmjrTrobhDGPHrVKghI5ZDDJdptmgAKZxm82MG9Iq4LiStMQb06jXlXWawqJ0gu8Uqduro0Xnh3VXkaqJwx5QST_weY3rT09X1rvOyHwInFwo8wyf2L2vh9SumMOfxMbqSKlhltxZw/s320/nursestation.png" width="320" /></a></div>
What follows might shock a few people, especially those who only really got to know me post 2012. I was not always the stone hard pro-vaccine<a href="http://ingvararni.blogspot.com/2017/10/metal-nurse-peer-vaccinator.html" target="_blank"> nurse</a> that I am now. In fact... Most people I know today would probably define me as anti-vaccine, I am not sure if I would. But then again I am looking at myself rather than judging someone else. This all also ties in with what I keep on saying regarding <a href="http://ingvararni.blogspot.com/2018/03/metal-nurse-education-matters.html" target="_blank">Education</a>, <a href="http://ingvararni.blogspot.com/2015/08/metal-nurse-spaketh-critical-thinking.html" target="_blank">Critical Thinking</a> and Evidence.<br />
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I guess it all started with my fascination with herbal medicine and other alternative healing practices. I had a very nice and sizeable herbal remedy bookshelf. The pride of which was my '<a href="https://www.amazon.co.uk/Green-Pharmacy-Rodale-Conditions-Authority/dp/1405006676/ref=pd_cp_14_1?_encoding=UTF8&psc=1&refRID=GXVSTDYTBG7JNXK5QJBX" target="_blank">The Green Pharmacy</a>' by <a href="https://en.wikipedia.org/wiki/James_A._Duke" target="_blank">Dr James D. Duke</a>. I'll come back to that in a bit. I also used '<a href="https://www.amazon.co.uk/Miriam-Polunin-Healing-Living-Paperback/dp/B00RWLPUM8/ref=sr_1_1?ie=UTF8&qid=1522833833&sr=8-1&keywords=healing+foods+miriam+polunin" target="_blank">Healing Foods</a>' by Miriam Polunin, still, do when the occasion takes me. I liked my herbal teas, I was especially a big fan of <a href="http://www.celestialseasonings.com/" target="_blank">Celestial Seasonings</a>, which has proved to be extremely hard to get hold of in the UK. I liked the whole alternative lifestyle, I was an active Buddhist practising <a href="https://en.wikipedia.org/wiki/Nichiren_Buddhism" target="_blank">Nichiren Buddhism</a>, I did most of my shopping in a local Health Food Shop. I was living in a town which had a big Buddhist centre just outside of it. Though in my defence I did not take to Astrology, or Reiki, or Faith Healers, and I had some serious doubts about Homeopathy. As well as Bach's Remedies. But I did use the phrase "Sometimes Science Doesn't Know Everything", and right now I want to slap my younger self. But I wouldn't because as odd as it all sounds this is what made me who I am today. I didn't trust medicine that much, and if I could help it I'd rather get a herbal remedy than go to my GP and then the pharmacy. I wanted things organic when possible. I wanted things local. I wanted things compostable. I wanted cloth nappies. I wanted wholewheat pasta.<br />
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In 2004 my first child was born. Along with the usual worries of being a new parent, in a foreign country, was the question of vaccinations. I have to admit I do not remember the whole national outcry regarding the <a href="https://www.historyofvaccines.org/content/articles/do-vaccines-cause-autism" target="_blank">MMR and Autism</a>, I think I was sort of cursorily aware of it. Especially the <a href="https://www.theguardian.com/science/2010/jan/28/mmr-vaccine-ben-goldacre" target="_blank">whole question</a> of whether Tony and Cherie Blair had vaccinated their youngest son. There were also plenty of Daily Mail, Daily Express and The Independent papers containing some articles regarding the <a href="https://tallguywrites.livejournal.com/148012.html" target="_blank">MMR vaccine</a> in the nursing home I worked in. So it was all there, I just didn't think I had taken any of it in. But then my ex-wife and I walked into the health food shop to ask the "experts". We were given a pamphlet written by an art lecturer in a local college. That clearly stated that vaccines weren't necessary. That vaccines were probably more dangerous than the illnesses they prevented. That there was this obscure hospital somewhere that managed to cure ALL of their <a href="https://medlineplus.gov/smallpox.html" target="_blank">smallpox</a> patients whereas another obscure hospital all of them died who had had the smallpox vaccine. Vaccines make babies asthma worse and induce eczema. And there and then the decision was made. My eldest was not vaccinated. She never got any of those illnesses. She did get ill. But never any of vaccine-preventable ones. Yeah, I did have to defend my decision. Using the "I am the parent, it is my right" defence. Again right now I want to punch my younger self. Have to say even then I wasn't particularly against vaccines. I did get the flu vaccine when I could because I was working with vulnerable people, but somehow that didn't stretch to me thinking about my home life. I just didn't see them as that important anymore... Even though, as mentioned previously, I got the flu jab when I could. And so it was left and pretty much forgotten.<br />
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Until my second child was born in 2010. Then the whole question of vaccinating the child rose again. My ex-partner was not against it. But was quite happy to follow along with what I and my ex-wife had done with my eldest child. Or at least delay the vaccines until she felt it was right for our youngest to be vaccinated. But we had a few health struggles with the youngest. She had a hard time feeding, and often little ill. Which also made us delay the vaccines. Then... three of us got this horrible cough. That would not relent. Would not stop. My eldest coughed so much one night she vomited all over her bed, and couldn't remember any of it the following day. I had to sleep with pillows propped up. My youngest coughed and coughed and struggled often to breathe. We listened, and we <a href="https://www.joe.ie/life-style/shouldnt-google-symptoms-online-598393" target="_blank">Googled</a>, we searched on YouTube. To this day I am still convinced that she had <a href="https://patient.info/health/cough-leaflet/whooping-cough" target="_blank">Whooping Cough</a>. But the GP's didn't agree and diagnosed her with <a href="https://www.blf.org.uk/support-for-you/bronchiolitis" target="_blank">Bronchiolitis</a>, on the basis that he had not seen a case of Whooping Cough in 10 years. Which in itself does say something? At the time I had been working on <a href="https://www.bankpartners.co.uk/news/2016/02/what-is-an-nhs-staff-bank/" target="_blank">the bank</a> at the local acute Hospital, so there is still the chance that I might have caught it there and passed it onto my kids. But still... Thinking about that barking noise that she made, how breathless she got, the fever, the gasp. I can't help but think that the GP was wrong. My youngest got her vaccines shortly after she had recovered from all of that, but almost a year behind schedule. But inexplicably I didn't get my eldest vaccinated. Because I didn't think she needed it.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgymsPOtVpCg-TEO-x3mreqQDZz_0NAhKs0HDFRaaavqzknczbdVIaHCYGXT5RLgSPcfGVC81RSKBqFO01LTBCsB5AU0T-wLDnxg0BwRPbHk9zBlGyOAdnzhWOhX3nd4jPM8PjQh4Wwe60/s1600/il_fullxfull.1045377744_lwfk_1024x1024.jpg" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="672" data-original-width="672" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgymsPOtVpCg-TEO-x3mreqQDZz_0NAhKs0HDFRaaavqzknczbdVIaHCYGXT5RLgSPcfGVC81RSKBqFO01LTBCsB5AU0T-wLDnxg0BwRPbHk9zBlGyOAdnzhWOhX3nd4jPM8PjQh4Wwe60/s200/il_fullxfull.1045377744_lwfk_1024x1024.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="https://pithitude.com/collections/magnets/products/ninja-nurse-magnet-or-button-k7?variant=30376861956" target="_blank">Ninja N urse Button</a>.</td></tr>
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Then in March 2012. I started my academic journey as a Nurse. This is actually where me re-reading of the Green Pharmacy by Dr James Duke came into its own, throughout the book Dr Duke advocated the use of evidence, the use of critical thinking, the use of making sure you ask the experts. Because in his words he was not a doctor but a botanist. I had gone into nursing hoping to be able to start evidence-based herbal healthcare. But what I did find was the evidence was lacking in that field and I also found that medicine was at the heart herbal based. Because the majority of the medicine are based on original herbal compounds like Digoxin, or aspirin, or a lot of the <a href="https://en.wikipedia.org/wiki/Plant_sources_of_anti-cancer_agents" target="_blank">chemotherapies</a>. Then during my placements in my first year, I started encountering patients, invariably over 70 years of age, who had been inflicted by <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-communic-vpd.htm" target="_blank">vaccine-preventable diseases</a>, and survived but did not come out whole. There was a gentleman who was <a href="https://www.hear-it.org/measles-can-cause-hearing-loss" target="_blank">deaf</a> because of <a href="http://vk.ovg.ox.ac.uk/measles" target="_blank">measles</a>. There was a lady who had <a href="https://www.ottobock.co.uk/orthotics/conditions-and-rehabilitation/polio/" target="_blank">callipers</a> and used a wheelchair because of <a href="http://vk.ovg.ox.ac.uk/polio" target="_blank">polio</a>. There were people with <a href="https://www.blf.org.uk/support-for-you/bronchiectasis" target="_blank">bronchiectasis</a> because of Whooping Cough. And their friends and families who weren't so lucky and died because of those illnesses that we can now prevent from occurring. My mother told me about her experience of measles, and the siblings my grandfather lost due to Whooping Cough. I got involved in vaccine debates on Facebook, especially on a page called '<a href="https://www.facebook.com/RtAVM" target="_blank">Refutations to Anti-Vaccine Memes</a>'. I started reading a lot more scholarly articles. I reflected and<a href="http://ingvararni.blogspot.com/2014/01/student-nurse-perspective-flu-vaccine.html"> I wrote</a>. I applied my critical thinking to my past uncritical thinking.<br />
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August 2012 my eldest got all of her vaccines. Her vaccine injury was a sore arm, immunity and most likely the eventual coming of old age.<br />
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This is why I harp on about evidence and education. One cannot be without the other, and without either, I would never have learned more about vaccines. Or medicine. Or nursing. Or the consequences of not vaccinating. My eldest daughter was lucky because of <a href="https://www.vaccinestoday.eu/stories/what-is-herd-immunity/">herd immunity</a>, other people often aren't that lucky.IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.comtag:blogger.com,1999:blog-2425917353589217044.post-55701839675159166182018-03-17T20:18:00.003+00:002018-03-17T20:18:57.330+00:00Metal Nurse: Education matters<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJXvmjrTrobhDGPHrVKghI5ZDDJdptmgAKZxm82MG9Iq4LiStMQb06jXlXWawqJ0gu8Uqduro0Xnh3VXkaqJwx5QST_weY3rT09X1rvOyHwInFwo8wyf2L2vh9SumMOfxMbqSKlhltxZw/s1600/nursestation.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="350" data-original-width="960" height="116" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJXvmjrTrobhDGPHrVKghI5ZDDJdptmgAKZxm82MG9Iq4LiStMQb06jXlXWawqJ0gu8Uqduro0Xnh3VXkaqJwx5QST_weY3rT09X1rvOyHwInFwo8wyf2L2vh9SumMOfxMbqSKlhltxZw/s320/nursestation.png" width="320" /></a></div>
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There is a very dangerous undercurrent of thought going on, which is veering very closely to becoming an drowning wave. It's the thought that nurses do not need to be educated. Let alone university educated. The odd thing is that this thought is so utterly prevalent in England, whereas the rest of the world have all been giving nurses degrees that take 4 years to obtain. But here on Blighty, being educated is somehow oddly frowned upon. I'll just put it very simply:<br />
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<b><u>Education Matters. Education Save Lives. </u></b></div>
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Good education can be the difference between life and death. I have written about this <a href="http://ingvararni.blogspot.com/2014/04/student-perspective-more-education-is.html" target="_blank">previously</a>. I know a fair few people will not believe and often will scoff at the idea. But it is true. Patients are <a href="https://www.nhs.uk/news/medical-practice/patients-are-safer-with-better-educated-nurses/" target="_blank">safer</a>. Patients live longer. Patients are less likely to die. And that is what everyone who is involved in healthcare should want. That is what the government should want. But it would seem that this present government don't actually care, they've removed the bursaries. Thus making what was already a challenging course into debt laden amalgamation of Gladiator and Mastermind. This is not helped by NHS England cutting the <a href="http://www.nationalhealthexecutive.com/Health-Care-News/short-sighted-training-cuts-are-harming-nursing-workforce" target="_blank">CPD funding</a> right down to the bone. Meaning that existing nurse do not have the opportunity to further their own education. That there will be less training available to supplement already existing nurses skills. Thus providing fewer opportunities for nurses to further their own career. This doesn't just affect the <a href="https://www.nursingtimes.net/news/workforce/health-education-england-cuts-put-nurse-cpd-at-risk/7020666.article" target="_blank">nurses future opportunities</a>, it also affects the patients present care.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjtP8fEXxTed1zduDfYW3jntR3p0czzH9PJSBrYgQBumMLO3I2DdWZHU1G5JIC9hrrZWSx_1Su8znspUqfjWzWhV3T2wWVsaEhm-N6EDYU7pEwKbc13hesn-fUg2NT2xerpOuiilvvJWE/s1600/terry-pratchett-quote-and-therefore-education-at-the-university-mostly.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1600" data-original-width="1280" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjtP8fEXxTed1zduDfYW3jntR3p0czzH9PJSBrYgQBumMLO3I2DdWZHU1G5JIC9hrrZWSx_1Su8znspUqfjWzWhV3T2wWVsaEhm-N6EDYU7pEwKbc13hesn-fUg2NT2xerpOuiilvvJWE/s320/terry-pratchett-quote-and-therefore-education-at-the-university-mostly.jpg" width="256" /></a></div>
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Since making nursing an all degree course there have of course been scoff of derision from a lot of other nurses and carers who had been in the profession for a long time. The same scoff of derision when <a href="http://memoriesofnursing.uk/articles/a-brief-history-of-nursing-in-the-uk" target="_blank">Project 2000</a> was introduced, when nursing was systematically removed from largely hospital based to largely university based. But it was held up often by more experienced staff who somehow thought that nursing and medicine was more based on intuition, feelings and experience. These people did not want their authority challenged. They would also scoff and spit out phrases like "They are too posh to wash" or "These people come from uni and don't understand personal care", first of all the former is complete and utter bunk and as for the latter that is what placement mentors are for. To teach student nurse, which included personal care. That is why they are on placement, it is to learn how to care for their patients and how to put what they learn in university into practice.<br />
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"What does writing a 4000 word essay about XYZ got to do with real life nursing"... Well quite a lot actually, when you are writing about a particular subject it gives you chance to not just look at THAT particular subject but the subjects that connect to it. Also if the student nurse is on placement during that time they get to put what they learn into practice (Again). If it is do to with a certain ailment or medication or treatment, then more often that not these students then get to know patients better. In order to develop a better understanding of how all of those things come together. Plus also when you qualify there is an awful lot of writing you have to do. In many forms, whether that is as part of a nursing record. Reflection. Statement. Incident report.<br />
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Being a qualified nurse is a huge responsibility and when you learn how to write things, you also get to learn how to justify your actions, you get to learn how and why you need to challenge things as your patients advocate.<br />
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That is why you write essays. Because you NEED to know these things. You need to know WHY you are doing the stuff you are doing. You cannot just say "Because we have always done it this way". It is not an option. The patients care depends on this. The patients LIVES depend on this.<br />
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Whilst I do agree that experience is important. Experience tempered with knowledge is even better. And knowledge is better coming from a systematic education, which is based on the latest research and evidence, rather then as an ad-hoc on the job hoofing which is usually mentioned as an afterthought. This helps no one, least of all the patient who should be at the centre of this. Caring is important part of being a nurse, but... being caring is not the ONLY thing that makes a good nurse. A lot of people seem to get hung up on that fact. A good nurse does not just care, but they also know. Education matters. Good education saves lives.IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-68172042542598328702017-10-10T12:49:00.002+01:002017-10-10T13:01:19.464+01:00Metal Nurse Sojourn: Part 2, Hearts and all<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0NARFMQxQfcLi2osJt1h6xhbrbaM0Gn2F9qU4aL2cs2itRZTsNwArPN-0ISXyKXkktYAIQL0BCvgu8aufx3yXVTR1bwPRcVShroizkJVsEqpOERqa1D16MUY0OGStlqw7aTSGX-CFTQU/s1600/WP_20170923_12_54_42_Pro.jpg" imageanchor="1" style="clear: left; display: inline !important; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0NARFMQxQfcLi2osJt1h6xhbrbaM0Gn2F9qU4aL2cs2itRZTsNwArPN-0ISXyKXkktYAIQL0BCvgu8aufx3yXVTR1bwPRcVShroizkJVsEqpOERqa1D16MUY0OGStlqw7aTSGX-CFTQU/s320/WP_20170923_12_54_42_Pro.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Alyosha Monument</td></tr>
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You can read the first part <a href="http://ingvararni.blogspot.com/2017/09/metal-nurse-sojourn-devin-townsend.html" target="_blank">here</a>.<br />
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So now that the main reason for my journey has been and gone. Time to explore this beautiful country. It's still very warm, at least for my cold cold Icelandic blood. I started the next day with some light breakfast and a lot of coffee, and one plan only. To see the mahoosive statue that is overlooking Plovdiv, <a href="https://en.wikipedia.org/wiki/Alyosha_Monument,_Plovdiv" target="_blank">The Alyosha monument</a>. For no particular reason except it looks huge, and interesting and the walk looks like it will be worth it. The Alyosha monument is there to honour a single giant Soviet soldier who single-handedly saved Bulgaria from the Ottomanazi's. Until the day he was cursed by a Ottomanwitch that he would turn to stone on top of his minions as soon as he struck a menacing pose when looking towards Moscow for inspiration. So I just walked around, the statue was fascinating, massive and quite stunning to look at. The park it was situated in the middle of was quite the trek and jungle to get through, with its many dead ends, overgrown paths and defunct fountains. But it also had a summer theatre in the style of the Roman Amphitheatre.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHlv5J-wvckoUVNnI2LVhMvR5VlzDN4WH_9-pqjqqpk56Pu2pPPz3T6Gv10VwBxJc6w2OOhPKTIenIPOlmH5cTn9k65XDN8SwxscckzjZ8NQkSvktjGrOj_bjN0jlh0jo6MymXpHDr8tg/s1600/WP_20170923_14_04_47_Pro.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="903" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHlv5J-wvckoUVNnI2LVhMvR5VlzDN4WH_9-pqjqqpk56Pu2pPPz3T6Gv10VwBxJc6w2OOhPKTIenIPOlmH5cTn9k65XDN8SwxscckzjZ8NQkSvktjGrOj_bjN0jlh0jo6MymXpHDr8tg/s320/WP_20170923_14_04_47_Pro.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">River Maritsa</td></tr>
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In my wisdom I decided to walk from the statue to the <a href="https://www.inyourpocket.com/plovdiv/Lauta-Park_98929v" target="_blank">Leisure and Culture Park</a>, hoping obviously for plenty of culture and leisure. Found scant evidence of either, except for a graffitied monument and lots and lots of greenery. But it was a really nice day, so I just kept on walking. And walking. Then walked some more. Then I doubled back and started walking towards the river <a href="https://en.wikipedia.org/wiki/Maritsa" target="_blank">Maritsa</a>. But not before I came across a canal, that was right next to the river. Which only measure something like 1.5km long and 0.5 km wide, and covered with presumably husbands trying to stay away from their houses, fishing. Finally did get to the river itself, which had its own charm and make my way back into Plovdiv, during this time I witnessed a working <a href="https://en.wikipedia.org/wiki/Lada" target="_blank">Lada</a>. Oh, how I want one. Can't even explain why. They aren't good looking, they don't drive very well, they're uncomfortable to ride it. Takes ages to start when it gets a bit cold, which is amusing in its own right considering where they are manufactured. But they're functional, easy in terms of upkeep and takes a nuclear bomb to destroy them.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1tuJBlV8Rkd26nE_4YYIaK0d9szdJZQmvuqjx_C0vKfSCCET_dbPweQmmcNXJ514DO02GYIxXYPfyUAV3-7SIKf6UHQcmaLXx45szLbUh4CSwujlweNzI4C2Q9ejT_Ge6sLU1kbadIG0/s1600/21764802_10155744801039154_1323089898432759218_n.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="450" data-original-width="800" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1tuJBlV8Rkd26nE_4YYIaK0d9szdJZQmvuqjx_C0vKfSCCET_dbPweQmmcNXJ514DO02GYIxXYPfyUAV3-7SIKf6UHQcmaLXx45szLbUh4CSwujlweNzI4C2Q9ejT_Ge6sLU1kbadIG0/s320/21764802_10155744801039154_1323089898432759218_n.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The Indestructible Lada</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRON8F7KsCQtPj1gC-N9mcO5KzSHw08gItzGjQ_mp2ssIByNk51EangYSRxJM731pk4erMP85EK61KRE820uTPSIaPzgsFJqdeQ4YvqBElCxj3MEFOjdo5qecAj9TnryaCTbRaoFFph6k/s1600/WP_20170923_14_51_59_Pro.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="903" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRON8F7KsCQtPj1gC-N9mcO5KzSHw08gItzGjQ_mp2ssIByNk51EangYSRxJM731pk4erMP85EK61KRE820uTPSIaPzgsFJqdeQ4YvqBElCxj3MEFOjdo5qecAj9TnryaCTbRaoFFph6k/s320/WP_20170923_14_51_59_Pro.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Across the river</td></tr>
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It cannot be overstated. But Plovdiv is a beautiful city. It feels open and homely. It just generally feels nice and on the whole a lovely place to live in. It feels historical. The buildings are gorgeous to look at, even the dilapidated ones... Actually, especially the dilapidated ones. The mixture of all the empires and civilisations that took hold of the city can be felt. Even if each successive ones tried to scrub the previous ones out of history. The predominant colour scheme tends to veer towards the matty, light coloured clay style. Most of the roads are cobbled. In Plovdiv, they also go for what is my favourite type of roofing with the reddish clay plated ones.<br />
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Just because, I decided to join one of those free guided tours. I'd walked mostly everywhere anyway,<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbbAXVUqUKPu-Befcm1h08ud5g7SqA88Zj9rJicLK8ptlkYBFkRQ3FOATYZSbkHUn7u9Q5jJ9ozgCtCcg8-07h_MoXtiFjUn1tfqqFAut9gZP42-RhoNB-Pl3SqVl4JyWz9DqL3tISYjQ/s1600/WP_20170923_18_32_44_Pro.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="903" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbbAXVUqUKPu-Befcm1h08ud5g7SqA88Zj9rJicLK8ptlkYBFkRQ3FOATYZSbkHUn7u9Q5jJ9ozgCtCcg8-07h_MoXtiFjUn1tfqqFAut9gZP42-RhoNB-Pl3SqVl4JyWz9DqL3tISYjQ/s320/WP_20170923_18_32_44_Pro.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Greek tragedy in Roman theatre.</td></tr>
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but since I couldn't understand the language or the alphabet, I thought it would be prudent to actually find out about the city from someone local. The guides name was Ilya, a budding law student. Who was also very enthusiastic about his city, and his enthusiasm was very infectious. For me it didn't really need to be. But here was a man who really loved his home city. During this time we find out that the aqueduct that the Romans built was demolished to build a church, and everything Roman was either destroyed or covered up with lots and lots of soil. And when the Ottomans came, they didn't destroy anything they just made the church into a mosque. Because it was cheaper to do that than build a bigger mosque. The city was first founded 7000 BC making it the longest-lived in settlement in Europe. In the meantime, it's been ruled by <a href="https://en.wikipedia.org/wiki/Thracians" target="_blank">Thracians</a>, Macedonians, the Greeks, The Romans, Bulgarians, Slavs and Ottomans. In fact, Plovdiv is a Bulgarian version of the name Philippopolis, named after <a href="https://en.wikipedia.org/wiki/Philip_II_of_Macedon" target="_blank">Philip II of Macedon</a>. If you go into H&M you can go into the basement where you can see the original seating of the gigantic Roman Colosseum.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijtx_3blV5F509_Bu8m_HAKrB8_D181ugxjirnDPhTRDkpaKPP0hHiroXsvO3WUhKoAN3sObG3a6huf-8juy49FwUI39K8Yfq1HP0MaNoo6Z_m1CWkOlnFmE-pM6uHgWRzhUguAmLqHhA/s1600/WP_20170923_20_55_46_Pro.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="903" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijtx_3blV5F509_Bu8m_HAKrB8_D181ugxjirnDPhTRDkpaKPP0hHiroXsvO3WUhKoAN3sObG3a6huf-8juy49FwUI39K8Yfq1HP0MaNoo6Z_m1CWkOlnFmE-pM6uHgWRzhUguAmLqHhA/s320/WP_20170923_20_55_46_Pro.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Chicken Hearts done Village Style</td></tr>
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After the tour me and two other travellers, an Israeli ex-soldier and Dutch marine biology (forever) student go to a local restaurant called <a href="http://www.rahat-tepe.com/" target="_blank">Rahat Tepe</a>, located at the foot of Nebet Tepe ruins. All I knew was that I wanted to try something Bulgarian, something local. So... I and the Dutch former Master student ordered Chicken Hearts done "<a href="https://www.youtube.com/watch?v=AO43p2Wqc08" target="_blank">Village Style</a>" and <a href="https://en.wikipedia.org/wiki/Patatnik" target="_blank">patatnik</a>, and Israeli former soldier ordered Chicken Livers done "<a href="https://www.youtube.com/watch?v=InBXu-iY7cw" target="_blank">Village Style</a>" and some sort of creamy salad with one single olive on top. The Chicken Hearts looked like an extremely simple meal. Loads of chicken hearts (at least 25 of them), slow cooked with some stock and lots of onions. It was delicious. The Patatnik was an interesting potato dish, never had anything like it. Never had a light potato dish for that matter. But that is what it was. Extremely light potato dish. Sort of felt and tasted like a cross between mash, souffle and omelette. Definitely a hint of mint and what also tasted like nutmeg, all baked in a clay dish. We all returned back to the hostel full and happy. Had a couple of beers with a Swede who lives in Norway, who kept on reminding me how old I am compared to him. Two exceptionally nice beers, 2 levs each.<br />
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The next day, I packed up. Wrote a little bit more and got ready to head off to Sofia. And hope that I will be back in Plovdiv with my beloved.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlLV9lYHPvc-q1WDq3c0F3Zr4ldvWIInB5F-r3O5xYoDxlLvNKv6Eo6mL4D5ZWloLKdum0NMX7X7QsWX61u4qwO9tahwk821BdtPbOqn9g1862j7i7-Vjv6eoZt72BZY_5ecUWROVbrAw/s1600/WP_20170923_12_28_33_Pro.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="903" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlLV9lYHPvc-q1WDq3c0F3Zr4ldvWIInB5F-r3O5xYoDxlLvNKv6Eo6mL4D5ZWloLKdum0NMX7X7QsWX61u4qwO9tahwk821BdtPbOqn9g1862j7i7-Vjv6eoZt72BZY_5ecUWROVbrAw/s320/WP_20170923_12_28_33_Pro.jpg" width="180" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Statue in the Aloyshoa Park</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiH6acBB9HyLCWEQtHE-gYVaJSpo-EuSjg4yYtDVRr7yfI3FyglMd3W2MYzrcsK_Ns087_ZHQ_m1kPnf2vdk_1EjD7y6UZ4rkzqMNbAptHZIQece0mI9i_tiFrIPiQjsLtA2wawFwrT0XY/s1600/WP_20170923_13_46_03_Pro.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="903" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiH6acBB9HyLCWEQtHE-gYVaJSpo-EuSjg4yYtDVRr7yfI3FyglMd3W2MYzrcsK_Ns087_ZHQ_m1kPnf2vdk_1EjD7y6UZ4rkzqMNbAptHZIQece0mI9i_tiFrIPiQjsLtA2wawFwrT0XY/s320/WP_20170923_13_46_03_Pro.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The Monument in Leisure and Culture Park</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYFTY1GCeFE3QwrhKSXvlXZaNm_SRtwRmMuI6j800qolYWepjrh7XqmDt3m-BCpR3GnkOeGBu6qUYuBoGy8fX_93shyphenhyphenCZdQLvHNxpbRknrWv4jBbK_DwGzf_ToDIL7dSPMpkut-DrrB14/s1600/WP_20170923_14_21_44_Pro.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="903" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYFTY1GCeFE3QwrhKSXvlXZaNm_SRtwRmMuI6j800qolYWepjrh7XqmDt3m-BCpR3GnkOeGBu6qUYuBoGy8fX_93shyphenhyphenCZdQLvHNxpbRknrWv4jBbK_DwGzf_ToDIL7dSPMpkut-DrrB14/s320/WP_20170923_14_21_44_Pro.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Graffitti, Abandoned building.</td></tr>
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IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-60665142568115939812017-10-02T19:02:00.002+01:002017-10-03T09:35:41.860+01:00Metal Nurse: The Peer Vaccinator<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPPGw34rA2oUzz0tb8_bkmKExV6zcn4cneY8FPyB8VPmlZWp9IF-887poA4KIwAht2jTqYotztQPMOLq5s4WzOKVbto3YrUXhA5o7pimt1tmQe4sly3FJnkPZy-xrp6pAe_oN8ozmaQwA/s1600/22137129_10155764568239154_3023050125824999522_o.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="902" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPPGw34rA2oUzz0tb8_bkmKExV6zcn4cneY8FPyB8VPmlZWp9IF-887poA4KIwAht2jTqYotztQPMOLq5s4WzOKVbto3YrUXhA5o7pimt1tmQe4sly3FJnkPZy-xrp6pAe_oN8ozmaQwA/s320/22137129_10155764568239154_3023050125824999522_o.jpg" width="180" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">One is filled with science juice.<br />
The other is filled with fiction.</td></tr>
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<span style="background-color: white; color: #1d2129; font-family: "helvetica" , "arial" , sans-serif; font-size: 14px;"> I have written two blogs about the importance of the flu vaccine, </span><a href="http://ingvararni.blogspot.com/2016/10/metal-nurse-importance-of-flu-vaccine.html" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" target="_blank">here</a><span style="background-color: white; color: #1d2129; font-family: "helvetica" , "arial" , sans-serif; font-size: 14px;"> and </span><a href="http://ingvararni.blogspot.com/2014/01/student-nurse-perspective-flu-vaccine.html" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" target="_blank">here</a><span style="background-color: white; color: #1d2129; font-family: "helvetica" , "arial" , sans-serif; font-size: 14px;">. Especially as someone who works within healthcare. <a href="http://www.skepticalraptor.com/skepticalraptorblog.php/" target="_blank">Skeptical Raptor</a> reblogs on a regular basis Mark Crislip's snarky article which riles against dumbasses who refuse the </span><a href="https://www.skepticalraptor.com/skepticalraptorblog.php/dumb-asses-flu-vaccine/" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" target="_blank">flu vaccine</a><span style="background-color: white; color: #1d2129; font-family: "helvetica" , "arial" , sans-serif; font-size: 14px;">. <a href="http://www.tarahaelle.net/" target="_blank">Tara Haelle</a> took her time to debunk almost all the myths that surround <a href="http://i%20have%20written%20two%20blogs%20about%20the%20importance%20of%20the%20flu%20vaccine%2C%20here%20and%20here.%20especially%20as%20someone%20who%20works%20within%20healthcare.%20skeptical%20raptor%20reblogs%20on%20a%20regular%20basis%20mark%20crislip%27s%20snarky%20article%20which%20riles%20against%20dumbasses%20who%20refuse%20the%20flu%20vaccine.%20tara%20haelle%20took%20her%20time%20to%20debunk%20almost%20all%20the%20myths%20that%20surround/" target="_blank">the flu vaccine</a>.</span><span style="background-color: white; color: #1d2129; font-family: "helvetica" , "arial" , sans-serif; font-size: 14px;"><br /><br />So I've started my second year as a peer vaccinator (or flu-buster, I prefer peer vaccinator because it makes me sound royal).</span><br />
<br style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 14px;" />
<span style="background-color: white; color: #1d2129; font-family: "helvetica" , "arial" , sans-serif; font-size: 14px;">In this role, I make my damndest sure that my co-workers and everyone who has a role that involves patient care are vaccinated against the flu. Because our job is to help to aid our patients, and that includes protecting ourselves from the flu and this provide herd immunit</span><span class="text_exposed_show" style="background-color: white; color: #1d2129; display: inline; font-family: "helvetica" , "arial" , sans-serif; font-size: 14px;">y for our patients who are too ill to receive it themselves. And they cannot afford to contract an illness as serious as influenza. Often healthcare workers will whine about their human rights, the problem there is of course that their human rights end where someone else's begins. Patients deserve the best treatment they can get. The problem also is that often doctors and nurses will and do end up being asymptomatic carriers, and thus can infect patients.<br /><br />Now. What's the point of the picture? Well, it's to demonstrate something that a lot of anti-vaxxers don't understand. Well, the stuff they don't understand can fill a whole series by George RR Martin. But this is to demonstrate dosage. Often in their lying liars bullshit memes, they will use a mahoosive syringe like the one on the right, with a massive needle, filled with massive amounts of oddly coloured liquid. You know, a total massive amount of massive bollocks. Because their stupidity knows no bounds. On a massive scale.<br /><br />Then, of course, you have those people who will blame any and/or all other illnesses they get on the flu jab. Sorry, but there are usually thousands of other respiratory illnesses flying around the same time when you get the flu jab. And for the love of gods if you smoke and you blame the jab for contracting something like pneumonia or bronchitis, then there is no helping your gullibility.<br /><br />The syringe on the left is a pre-filled flu vaccine. It holds a massive 0.5 mls of flu vaccine. Barely a 1/8 of a teaspoon. With a tiny needle.<br /><br />Protect yourself, care for your patients, love your family.<br /><br />Do your duty.<br /><br />Get vaccinated.</span>IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-84309589047511924362017-09-28T14:50:00.000+01:002017-09-28T15:21:47.022+01:00Metal Nurse Sojourn, Devin Townsend Project and first day in PlovdivSo my journey begins, as usual, in a slight panic with a sprinkle of anxiety in my hometown of Lancaster.<br />
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<tr><td class="tr-caption" style="text-align: center;">At Preston Station</td></tr>
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The surrounding area of Lancaster always makes me happy because it reminds me a little of my hometown, and thus also how happy I am that I don’t live there anymore. Not trying to take a giant shit on my hometown, I’m just glad that I don’t live there. But the first feeling is overshadowed and strong-armed when Preston comes into the horizon and I wish I was back in Iceland. It has to be said that England is beautiful. I’ve spent 14 years living here and that opinion hasn’t changed. Just like any other local inhabitant the British are so muted to their surroundings. Except when it comes to the Lake District and Yorkshire folk, those people make the average 17-year-old elder look like an agnostic.<br />
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Currently, I am making my way to Bulgaria. Might sound random, but I am going to see <a href="http://www.hevydevy.com/" target="_blank">Devin Townsend</a> play in a Roman Amphitheatre in <a href="https://en.wikipedia.org/wiki/Plovdiv" target="_blank">Plovdiv</a>. Not only that he is playing the entire <a href="spotify:album:7hjBb9Z7o4KO5AMYi5xm66" target="_blank">Ocean Machine</a>, as well as a “By Request” set list with an orchestra. Goddamn, the price was right. Fucking Devin Fucking Townsend. Playing the entire <a href="http://open.spotify.com/album/7hjBb9Z7o4KO5AMYi5xm66" target="_blank">Ocean Machine</a>. In Bulgaria. In a Roman Amphitheatre. Makes me wonder how much it would have cost if he had found a similar setting in the UK. Come to think of it, the <a href="https://en.wikipedia.org/wiki/Fountains_Abbey" target="_blank">Fountains Abbey</a> and <a href="https://en.wikipedia.org/wiki/Kirkstall_Abbey" target="_blank">Kirkstall Abbey</a> would have both provided excellent venues.<br />
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And I am going on my own. The last time I travelled to foreign lands on my own was in 2001, to the monolith… I mean the UK. Which incidentally was also the first time I had left the Icelandic shores since I was 5 years old. I did try and find someone to travel with. But the only people I considered couldn’t due to one reason or another. But nevermind. I am going to see Devin Townsend. With an Orchestra!<br />
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Maybe it’s because it is not the usual flying time. But Birmingham International Airport is nice. The security wasn’t stressful, there weren’t a lot of people milling around. It almost feels peaceful. Or maybe it’s because I am not accompanied by three teenagers and a 7-year-old.<br />
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The flight itself was relatively painless. I manage to sleep through pretty much all of it. There’s not a lot to see when everything is black outside anyway. The terminal I landed in Sofia is tiny. And I mean tiny, it feels almost like the airport in my hometown with its one flight strip. Whilst I am trying to get my bearings, a man approached me saying that he’s a taxi driver. Something about him just screamed predator, he looked like a man who’d be willing to sell children into servitude and his grandma to a <a href="http://futurama.wikia.com/wiki/Soylent_Green" target="_blank">Soylent Green</a> factory. Took a long time to get rid of him, but when I did he just transferred his creepiness to other unsuspecting, tired travellers. So, yeah. I got my bearings, thanks to Google Maps. Thank god the <a href="https://www.youtube.com/watch?v=q5D0t6ejcGE" target="_blank">EU</a> has banned roaming charges. Find out that Terminal 2 is about 30-minute walk away and there’s a Metro Station there. So I start following G-Maps instructions…. And they want to take me through a restricted area, with armed patrol… Shit. Never mind, I do like a tourist and walk around it looking a little lost yet interested. Finally got to Terminal 2 which is huge! Massive! And very glossy. And there’s the Metro Station! Now I’m here, and now I need to not panic again. I need to find a way to get from the Metro station to the Central Station, I know I need to change somewhere. And I don’t understand the language or <a href="https://en.wikipedia.org/wiki/Cyrillic_alphabets" target="_blank">the alphabet</a>, which by the way is very pretty. But makes no sense to my foreign, Latin alphabet leaning, eyes. So instead what I do is look out for other travellers, with luggage and I just decide to follow. Like a knock-off badly written police procedural. I finally get to the station and at 0655 I managed to get a ticket for the 0700 bus to Plovdiv. Get on, fully intending on looking around. But promptly fall asleep.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjFHQ6oFYIWM6OUMtJn__hOEq5Wz8oiyFr7DXLUUVorJcajUorjIlPzXs6BnKL9kc4ufw9pYNM2wFnEcnd2UFp7EQNtGPnpYIXOlex5ZtK7OHywja9K5jaAS3ytvjZp48zxR-jVHhS-ss/s1600/WP_20170922_10_04_09_Pro.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjFHQ6oFYIWM6OUMtJn__hOEq5Wz8oiyFr7DXLUUVorJcajUorjIlPzXs6BnKL9kc4ufw9pYNM2wFnEcnd2UFp7EQNtGPnpYIXOlex5ZtK7OHywja9K5jaAS3ytvjZp48zxR-jVHhS-ss/s320/WP_20170922_10_04_09_Pro.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Hikers Hostel</td></tr>
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Then I woke up as we arrived into Plovdiv, what looks like a particularly rough area of Plovdiv. Not unlike some British estates, except with nicer roofs. But it gets lovelier and lovelier. We get to the Bus Station, gods I am so tired. So very very tired. And it felt cold. So cold. Maybe it was just me shivering more due to tiredness. So I buy myself an espresso and some kind of long pastry with what I hope is cheese in the middle, whatever it was. It was nice, filling and most of all warm, and it wakes me up enough to get my bearings. Thank goodness for Google Maps. I pop in where I need to go, and after a few wrong directions, I am finally on my way. The way to the hostel is nice, I walk through Tsar Simeon Park, past the Odeon of Philippopolis and up the market street. Past what I assumed at first was a statue of a monkey man, but I come to find out later was a tribute to a local legend. Towards one end of the Roman Stadium and Dzhumaya Mosque. I finally find my hostel, <a href="http://www.hikers-hostel.org/pd/" target="_blank">The Hikers Hostel</a>, which is smack right in the middle of Old Town, 5 minutes away from the Roman Theatre! It’s a friendly hostel, definitely marketed towards younger backpackers. The staff are extremely friendly, there is cheap and nice beer for sale, coffee on the go. I check in, go to my room which includes 3 bunk beds and two single beds. 8 lockers but only 4 of which have lockers. As previously mentioned, the staff are friendly, to the point where I get the feeling that some are chemically assisted to be so. In the background, there’s <a href="spotify:artist:4iRZAbYvBqnxrbs6K25aJ7" target="_blank">Dave Brubeck</a> playing. I kick off my shoes. Put down my backpack. I crawl into my bed after making it and promptly fall asleep. After a short, while I get woken up by another guest snoring, sounding like a motorbike with a broken muffler, and the nurse brain in my kicks in wondering worrying that they suffer from sleep apnea and whether they had brought their CPAP with them. Only for another part of my brain kicks back in and reminds me that I am not at work.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGBszw_lXbDH86Ox0nW1LpV77V9_2trYh-nqwoMytz1dTVct-Mm9Z4mJfTlRib1qYt7vmNFNhq7A1CzMINN9z-3J68zn-S2EYSrmHGRfgoGw3VynH74sOJ6EVfn0NMHYwJTNOq9LeqxTw/s1600/WP_20170922_13_27_25_Pro.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="903" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGBszw_lXbDH86Ox0nW1LpV77V9_2trYh-nqwoMytz1dTVct-Mm9Z4mJfTlRib1qYt7vmNFNhq7A1CzMINN9z-3J68zn-S2EYSrmHGRfgoGw3VynH74sOJ6EVfn0NMHYwJTNOq9LeqxTw/s320/WP_20170922_13_27_25_Pro.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Nebet Tepe ruins</td></tr>
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When I finally wake up I grab some coffee, okay lots of coffee, look at the map and make my way out. I do the touristy bits and walk around the ruins that are 2 minutes away. Mostly looking out for other metalheads. There’s a lot of them. Long hairs, scraggly beards, black t-shirts with metal logos. Everywhere. And there’s me in my short sleeved shirt, purplish-maroon hooded cardigan and a shoulder bag.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIN9sgePoEDmMWzU8Y4lB2DF7f6dayAnZoAUV4a01mBk9rF43R0eSaXRRpw26njFvk1mbYNYYZaVEDaggkTueLClTkw1VDRtA0HLuaKhe5PfVwGsKljijpqTDVuWMxypt9M1DTCaUeAJI/s1600/WP_20170922_10_02_01_Pro.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="903" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIN9sgePoEDmMWzU8Y4lB2DF7f6dayAnZoAUV4a01mBk9rF43R0eSaXRRpw26njFvk1mbYNYYZaVEDaggkTueLClTkw1VDRtA0HLuaKhe5PfVwGsKljijpqTDVuWMxypt9M1DTCaUeAJI/s320/WP_20170922_10_02_01_Pro.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Wall art in Plovdiv</td></tr>
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It cannot be overstated. But Plovdiv is a beautiful city. There are ruins everywhere, that also just happen to be littered with rubbish, but the amount of litter cute stray kittens compensates for that. I keep on walking around, wander into Regional Historical Museum. As a museum, it is fascinating, as a building it is awe-inspiring. I’d happily buy it. The one guy working there seems more interested in sitting in the garden and read his book, get the overwhelming feeling that I am getting in the way. But I want to see, so I pay and I walk around, let him get back to his book. After that I wander towards the Street of Art & Crafts, don’t see a lot of Art & Crafts. But I get into a nice cafe, that also specializes pottery and home baking. Sit down for a nice slice of Orange & Lemon cake and boiled coffee. Enjoy it in the garden, have a piece of serenity.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyDcwz8jyqwSeOlk8nplzbjQkclkWlADECp7m3lFOSbVYFCcWGrRWUJ-gXdrXVfN-Bf-7PWHqCZhA4HV8i47nUkSYwxRAZEGRly9wyu5GmZokuXpywZ9Vkk9vhAWocfusoQrSkvipfZ94/s1600/WP_20170922_14_24_32_Pro.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="903" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyDcwz8jyqwSeOlk8nplzbjQkclkWlADECp7m3lFOSbVYFCcWGrRWUJ-gXdrXVfN-Bf-7PWHqCZhA4HV8i47nUkSYwxRAZEGRly9wyu5GmZokuXpywZ9Vkk9vhAWocfusoQrSkvipfZ94/s320/WP_20170922_14_24_32_Pro.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Coffee, cake and relaxation.</td></tr>
</tbody></table>
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After a couple of hours wandering, I return to my hostel, now with <a href="spotify:artist:0kbYTNQb4Pb1rPbbaF0pT4" target="_blank">Miles Davis</a> in the background, and got to know some of my roommates. All of whom are here to see <a href="spotify:artist:54Xuca1P5nDqfKYZGDfHxl" target="_blank">Devin Townsend</a>. 3 guys flew from the UK. One medical student flew from Helsinki via Istanbul! And then there’s Dave who came from Chicago. Devin does seem to have extraordinarily dedicated fans. But it’s not only the people in the room, its everyone in the hostel whose going to see Devin! Three of us, me, not-Finnish medical student and Chicago Dave decide to walk together to the Roman Amphitheatre.<br />
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I bought a bottle of beer while waiting to get in, but before I get to finish it I have to leave it with security :'(.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCrZCdo1TeAzkpSSjEOwuL0Mwwv_fiTSJewG231vg2PWY14_V9hv6vxgjIIw_axBUNoWGU6TVsRw1ap2Nm8ecmZeMUL798YWn1EM-a4yvT3Fc5m3nOnrGLeQSevuib5aUllPx7HtNiAJU/s1600/WP_20170922_20_05_23_Pro.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="903" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCrZCdo1TeAzkpSSjEOwuL0Mwwv_fiTSJewG231vg2PWY14_V9hv6vxgjIIw_axBUNoWGU6TVsRw1ap2Nm8ecmZeMUL798YWn1EM-a4yvT3Fc5m3nOnrGLeQSevuib5aUllPx7HtNiAJU/s320/WP_20170922_20_05_23_Pro.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Devin Townsend Project</td></tr>
</tbody></table>
But anywho. I entered the arena. 5 and half hours later I leave utterly dumbfounded. Devin, his band, the orchestra and the choir blew my, and everybody else, mind away. I knew it was going to be good, but this good? Wow. There was no need for an encore. Devin did plenty. They started off with playing ‘By Request’ set list that included the orchestra. The <a href="https://www.setlist.fm/setlist/devin-townsend-project/2017/roman-amphitheatre-plovdiv-bulgaria-3be27460.html" target="_blank">setlist</a> couldn’t have been more perfect. Yeah, there were a few songs I’d have like to have listened to live like “<a href="spotify:track:2Z7dx5L9kYkWoXQUWrL8Ua" target="_blank">Solar Winds</a>” and “<a href="spotify:track:4VW4tznoAhLnwgjStIiILn" target="_blank">Suicide</a>”, but honestly all of the songs were perfect. And perfectly performed. I wasn’t sure if Devin would be able to perform all of his vocal styles in a live setting. But I was wrong. So very wrong, it was better. Much much better. Not only that Devin and the band seem so happy to be there. Devin being the humble guy that he is, thanking everyone. He does do a little talking in between songs, but nothing that distracts from the whole spectacle. To the gathering of nerds. Almost 5000 socially awkward people watching another socially awkward musician who loves to write serious songs and crack fart jokes between songs. From the explosive and hopefully "<a href="spotify:track:2qZnwY88TSeHGyXqgHGTHl" target="_blank">Truth</a>" to the closing notes of the majestic and serene "<a href="spotify:track:3u7TghtZRpducFZJyITANF" target="_blank">Deep Peace</a>", the band don't let up for a single minute. After the break, the orchestra disappears, and all that is left is Devin Townsend and his project. Onto the stage, he gets the original bassist from Ocean Machine, and it was heartwarming to witness. The live rendition of Ocean Machine also turned out to be better than the studio album, it was played to perfection. Including Devin’s finishing <a href="https://youtu.be/pm8zsLT29tQ?t=4m33s" target="_blank">shriek</a>. A couple of people start shouting for an encore, but after three hours of music, the majority feel that Devin Townsend and his band have given plenty. In terms of vocal abilities, he is up there with Freddie Mercury.<br />
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Best. Concert. Ever.<br />
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Got back to the hostel, and fell very happily to sleep.IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-33195525605561812562017-09-14T15:04:00.000+01:002017-09-14T15:04:22.665+01:00Metal Nurse: The Wonder of the NHS<div class="separator" style="clear: both; text-align: center;">
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Hopefully, it might not have escaped you, eagle-eyed readers that I am a nurse, I live in the UK and I work in the <a href="http://www.nhs.uk/pages/home.aspx" target="_blank">NHS</a>. So far I have worked in in the NHS for <a href="http://ingvararni.blogspot.com/2015/09/metal-nurse-spaketh-15-years-in.html" target="_blank">11 years</a>, I started off working as a healthcare support worker in 2006, in a mental health hospital. In 2010 I got a job within the acute trust and did some extra shifts within various medical and surgical wards. 2012 I went into training as a student nurse and qualified in 2015, and since then I've worked as a registered nurse working in acute settings.<br />
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I am very proud of my job. And I am very proud of working for the NHS. Just a little background, NHS stands for National Health Service. It was founded 1949, it was launched at the behest of a man called Aneurin Bevan, with three founding principles:<br />
<ul>
<li>Meets the needs of everyone</li>
<li>Free at the point of delivery</li>
<li>Based on clinical need, not ability to pay</li>
</ul>
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It is the fifth largest employer in the world, with over 1.5 million people working in various roles, to break it down that includes over 300,000 nurses, health visitors and midwives, over 100,000 doctors, almost 20,000 ambulance staff and more. Operating on a budget of <a href="https://www.gov.uk/government/news/department-of-healths-settlement-at-the-spending-review-2015" target="_blank">£116.4 billion</a>. NHS treats over 1 million people every 36 hours, including those people who come to the UK <a href="http://ingvararni.blogspot.com/2017/02/metal-nurse-health-tourism-red-herring.html" target="_blank">to travel</a>. Services range from antenatal to palliative care. From routine health screenings to cancer care. Mental health services. Learning Disabiliy services. Organ Transplants, IVF and much much more. With over 16 million hospital admissions, over 23 million attending to our Accident & Emergency departments, and so on and so forth. The <a href="http://www.nhsconfed.org/resources/key-statistics-on-the-nhs" target="_blank">statistics </a>regarding the NHS just general boggles the mind. All funded directly from taxation. There are few services that will be charged and those include prescription charges, opticians, and dentists. Probably the biggest socialized program ever put in place. It is for everyone in the UK. As far as I am aware it is the only type of healthcare system in the world, most other ones tend to be largely government funded but some sort of payment is usually needed when people access them. I know for example in Iceland you'd have to pay a small fee to see your GP, and also foot part of the bill for any type of procedure that was not an emergency. All in all, it's an amazing system. It works extremely well, not perfect obviously.<br />
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The NHS consistently performs highly when compared to <a href="http://www.bbc.co.uk/news/health-40608253" target="_blank">other systems</a>. In terms of finances, it is cheaper to run than the US system, for example, the US spends 16.6% of its GDP on their system whereas the UK spends 9.9%. These were <a href="http://www.commonwealthfund.org/~/media/files/publications/fund-report/2017/jul/schneider_mirror_mirror_2017.pdf#page=5" target="_blank">findings</a> from the <a href="http://www.commonwealthfund.org/" target="_blank">Commonwealth Fund</a>, an American Think Tank that performs these sort of studies on a regular basis, and the NHS has regularly ranked highly.<br />
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And yet. And yet. It is in trouble from powers that be. Every successive government seems to want to use the NHS as some sort of a political football to kick around in order to gain more votes. This is especially evident with the current Conservative government that seems to be hell-bent on austerity policies even though it looks like austerity is making good on <a href="https://theconversation.com/sharp-rise-in-uk-mortality-rate-may-be-due-to-austerity-measures-72984" target="_blank">killing people off</a>. There is this need to streamline everything and making savings on every single front, without actually taking into account that as medical science advances the population ages, and with that the average 80 year old costs the NHS 5 times more than a 30 year old. Even according to the <a href="https://www.ifs.org.uk/" target="_blank">Institute of Fiscal Studies</a> have stated that this low level of funding from the UK will be below what is needed come the <a href="https://www.ifs.org.uk/publications/9186" target="_blank">year 2020</a>. Our population is getting top heavy with age. Essentially this government, like so many others, is only looking at the short term even though it means that we all lose in the long term. This isn't helped by the fact that the last Labour government, even though they spent considerably more on the NHS, started saddling a lot of NHS trusts with PFI agreements. Which has led to a lot of other <a href="http://www.telegraph.co.uk/news/nhs/11748960/The-PFI-hospitals-costing-NHS-2bn-every-year.html" target="_blank">financial </a><a class="" href="http://www.telegraph.co.uk/news/nhs/11748960/The-PFI-hospitals-costing-NHS-2bn-every-year.html" target="_blank">issues</a>. The number of nurses is <a href="https://fullfact.org/health/whats-happening-nursing-numbers/" target="_blank">falling</a>, for the first time since forever. Student nurses will not receive any bursaries, which has lead to decreased number of student nurses both due to lack or places and due to lack of interest of people actually applying to do <a href="https://www.rcn.org.uk/news-and-events/news/rcn-concerned-at-fall-in-nursing-degree-applications" target="_blank">those courses</a>. All in all some reports indicate that there are <a href="http://www.bbc.co.uk/news/health-40715955" target="_blank">86000 vacancies </a>within the NHS.<br /><br />What I personally would like to see is more money being spent on public health and preventative care. Because that is one avenue that the NHS could save money on in the long term, as well as a bigger increase in social care spending. Because most people who end up with long term conditions can be managed in either their own homes or in special social care settings, but more often than not they end up in a hospital which can be disastrous for them. And this is without touching upon what has been happening to mental health services under the Conservatives, that have said all the good talk but haven't performed any of the good deeds. The number of nurses working in mental health settings has gone down dramatically and the funding has been <a href="http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2016-01-07/21586/" target="_blank">severely reduced</a>. Patients who are going through acute psychiatric episodes are being treated more and more in places that are not <a href="http://www.bbc.co.uk/news/health-38576368" target="_blank">suited to their needs</a>.<br />
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But even with all of these issues, we still strive towards providing the best care available. Because that is what we do. The NHS is the perfect example of that good healthcare is not a <a href="http://ingvararni.blogspot.com/2014/03/privatization-is-not-answer.html" target="_blank">privilege</a>, but a right. To be able to live a healthy life without having to worry about how much you have to pay for your health. A good healthcare system <a href="https://www.quora.com/What-are-the-economic-benefits-of-providing-universal-health-care" target="_blank">pays for itself</a> in the long term, as will a good educational system (But I am not getting into that just yet). Thankfully, hopefully, there will be enough people in the UK who will fight to keep the NHS as it is. I am extremely proud of working for it and I will continue to do so for as long as I can. I am not a nurse to take care of those who pay the best, I am a nurse because I want to take care of people because they need it. The NHS gives me the best platform to do so. Because at the end of the day we are all just people on this same planet trying to get through lives the best we can, and we should all help each other doing so.</div>
IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-40600045911722863132017-09-11T16:06:00.001+01:002017-09-11T19:23:46.209+01:00Metal Nurse: Alternative Medicine scam<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibYY-YRJFpRc-Tmtm-6KUhT_pCUW8fs5vL4pUQBIhdTMXHnYKwnjOQBMy_C028LzhQpSbEH0fdueiZT0-fNBFy8dMO16oz7fFdsaUB9ZZdpmguJssBkAi8zH22JbtHx1kDV4QKlwLnKRc/s1600/nursestation.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: inherit;"><img border="0" height="72" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibYY-YRJFpRc-Tmtm-6KUhT_pCUW8fs5vL4pUQBIhdTMXHnYKwnjOQBMy_C028LzhQpSbEH0fdueiZT0-fNBFy8dMO16oz7fFdsaUB9ZZdpmguJssBkAi8zH22JbtHx1kDV4QKlwLnKRc/s200/nursestation.png" width="200" /></span></a></div>
<span style="font-family: inherit;">Before I get right into it. Maybe have a read of my little <a href="http://ingvararni.blogspot.com/2014/10/statement.html" target="_blank">confessional</a>. There was a time where I had a fairly sizeable collection of herbal medicine books. Even went as far and bought a couple of equipment to assist (which now live in the kitchen and I use on a semi-regular basis). When I started my nursing I had sort of hoped to integrate herbal medicine into it. But since then, my belief in it has taken a nosedive. I had aspirations to try and do "<a href="https://en.wikipedia.org/wiki/Bullshit" target="_blank">Evidence based Herbal Medicine</a>" only to discover that the evidence base was practically none existent. So here I am wanting to write about alternative medicine. Or as it's also known as, <a href="https://en.wikipedia.org/wiki/Snake_oil" target="_blank">Snake Oil</a>.</span><br />
<span style="font-family: inherit;"><span style="font-family: inherit;"><br /></span> <span style="font-family: inherit;">Let's get it out there. Alternative medicine harms people. <a href="http://whatstheharm.net/alternativemedicine.html" target="_blank">Every day</a>.</span></span><br />
<span style="font-family: inherit;"><span style="font-family: inherit;"><br /></span> <span style="font-family: inherit;">There is this misconception that Alternative medicine is more natural, more holistic. I hate the fact that these quacks have hijacked the word holistic. They somehow imply that the care given by doctors, nurses, occupational therapists, physiotherapists, psychologists, dieticians, etc etc etc are not holistic. Oh, and as for natural? Nature tries to kill humans every day. Volcanos are natural. Adders are natural. Hurricanes are natural. Homoeopathy is not. Chiropractic "care" is not. </span></span><br />
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<span style="font-family: inherit;">This argument is pure fallacy, known as <a href="https://en.wikipedia.org/wiki/Appeal_to_nature" target="_blank">'Appeal To Nature</a>' fallacy. I hate to break it to these people but a large portion of ACTUAL medicine is based on nature. Most famous example is of course <a href="https://en.wikipedia.org/wiki/Aspirin" target="_blank">aspirin</a>, it's proper name being acetylsalicylic acid. Which was originally first extracted from the leaves of a willow tree. It is now used to treat patients who have ischaemic strokes and myocardial infarctions. There has been some evidence that it might prevent certain cancers, and of course, it works great for hangovers. There is also <a href="https://en.wikipedia.org/wiki/Digoxin" target="_blank">digoxin</a>, derived from the foxglove plant. That is used to treat atrial fibrillation and/or atrial flutter with rapid heart beats. Opioids are commonly used painkillers that we get from <a href="https://en.wikipedia.org/wiki/Papaver_somniferum" target="_blank">poppies</a>. The list just goes on and on and on. A Huge number of our cancer treatments are plant based. For example, <a href="https://en.wikipedia.org/wiki/Paclitaxel" target="_blank">Taxol</a>, which is used to treat ovarian cancers, breast cancers, and lung cancers, is derived from Pacific Yew. So I suppose in a way you could say I did end up working in an evidence based herbal medicine field. The problems with naturopathic remedies is that they are not studied nearly <a href="https://thoughtscapism.com/2016/04/27/has-alternative-medicine-been-studied-enough/" target="_blank">well enough</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3887317/" target="_blank">regulations</a> are few and far between if any. For example, <a href="https://www.mja.com.au/" target="_blank">Medical Journal of Australia</a> published a <a href="https://www.mja.com.au/journal/2017/206/2/what-risks-do-herbal-products-pose-australian-community" target="_blank">study</a> on how dangerous some of them are, causing acute hepatic and renal failure. Some herbal preparations having ingredients that are <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-222" target="_blank">not listed</a>, or not in the quantities advertised. Others containing toxic chemicals and heavy metals, and illegal ingredients derived from endangered animals like snow leopards. So they don only harm people but nature as well. Who would've thunk that?</span><br />
<span style="font-family: inherit;"><span style="font-family: inherit;"><b><br /></b></span> <span style="font-family: inherit;">To quote <a href="https://www.youtube.com/watch?v=YMvMb90hem8" target="_blank">Dara O'Briain</a>:</span></span><br />
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<span style="font-family: inherit;">“I'm sorry, 'herbal medicine', "Oh, herbal medicine's been around for thousands of years!" Indeed it has, and then we tested it all, and the stuff that worked became 'medicine'. And the rest of it is just a nice bowl of soup and some potpourri, so knock yourselves out.”</span></blockquote>
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<span style="font-family: inherit;">Now, I work as a nurse in the NHS, which provides free care to the point of delivery. So you can guess how much it irks me when I hear these people complaining about how evidence based medicine is about profit. Like they give out their homeopathic/naturopathic advice for free. Just a quick Google search will show that these people charge anywhere between £25-£59, and that's only for consultation. Chiropractors charge £75 for the initial visit than £35 there after, and all they are are glorified masseurs. The tinctures and everything else that goes with it is charged at premium rate. Then these people ask their sucke... custo... Sorry, patients to come again in a week or two for more. In the US the alternative medicine market was valued at $40 billion due to rise up to <a href="http://www.prnewswire.com/news-releases/alternative--complementary-medicine-market-worth-19687-billion-by-2025-grand-view-research-inc-619591673.html" target="_blank">$192 billion</a> by 2025. Worldwide we are looking at <a href="https://www.globalwellnessinstitute.org/wellness-now-a-372-trillion-global-industry/" target="_blank">£2.</a><a href="https://www.globalwellnessinstitute.org/wellness-now-a-372-trillion-global-industry/" target="_blank">8 trillion</a>! And these people have the nerve to criticise pharmaceutical companies for earning profit. The most recent numbers I can find for the UK are from 2012 and even that shows an eye watering <a href="https://uk.finance.yahoo.com/news/uk-herbal-products-market-worth-000000887.html" target="_blank">£485 million</a>. All in all the European market is due to get bigger and <a href="https://www.cbi.eu/market-information/natural-ingredients-health-products/trends/" target="_blank">more profitable</a>. So for these hack-jobs to claim that proper medicine is all about money and that their treatment isn't, is just amazingly disgusting. </span><br />
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<span style="font-family: inherit;"><br /></span> <span style="font-family: inherit;">Then there is the fact that these horse-shit peddlers try and elbow their way into proper medicine by calling it "Complimentary" medicine. Others who want to somehow call it integrative medicine. All that these people do is get in the way of real physicians, by masquerading as real physicians. As <a href="https://sciencebasedmedicine.org/editorial-staff/mark-a-crislip-md-associate-editor/" target="_blank">Mark Crislip MD</a>, from my favourite <a href="https://sciencebasedmedicine.org/" target="_blank">science blog</a> says:<span style="font-family: inherit;"> </span></span><br />
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<span style="font-family: inherit;"><span style="font-family: inherit;">"<span style="background-color: white;">If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse."</span></span></span></blockquote>
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<span style="font-family: inherit;"><span style="font-family: inherit;"><span style="background-color: white;">This apple-cow pie trend is especially prevalent in cancer care, but that's a whole blog entry of it's own. </span></span></span><br />
<span style="font-family: inherit;"><span style="font-family: inherit;"><span style="background-color: white;"><br /></span></span></span> <span style="font-family: inherit;"><span style="font-family: inherit;"><span style="background-color: white;">These people will try and say that al they do is provide service to those who want it, which would be all fine and dandy if it wasn't for the fact that an awful lot of these people and their sucke... Sorry. Customers also are then hellbent on turning other people AWAY from medicine that actually works. Take for instance vaccinations. Now because of these arseholes we are having more and more cases of illnesses like measles, whopping cough and mumps because they deter new parents from vaccinating their kids. And that is not on. That is putting their own false ideology above others safety. And then these bastards will wash their hands of those cases and say that they were only offering a different opinion, or that it wasn't their doing. Like that fraudster Andrew Wakefield denying that he had any kind of responsibility of the low uptake of the MMR following his "<a href="http://tallguywrites.livejournal.com/148012.html" target="_blank">study</a>". Or when he visited <a href="https://www.washingtonpost.com/national/health-science/anti-vaccine-activists-spark-a-states-worst-measles-outbreak-in-decades/2017/05/04/a1fac952-2f39-11e7-9dec-764dc781686f_story.html" target="_blank">Somalian people in Minnesota</a> to "warn" them about the supposed dangers of the MMR vaccine, sparking a huge measles epidemic in that community. Or when these people tell cancer victims that they should spend their last money and last months using bogus therapies like the <a href="http://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/complementary-alternative-therapies/individual-therapies/gerson" target="_blank">Gerson Protocol</a>. I've even come across quacks encouraging diabetics to come off their insulin!</span></span></span><br />
<span style="font-family: inherit;"><span style="font-family: inherit;"><span style="background-color: white;"><br /></span></span></span> <span style="font-family: inherit;"><span style="font-family: inherit;"><span style="background-color: white;">These people are no better than those who call themselves psychics or mediums. These people feed on the vulnerable in our society and then deny any responsibility for their words and actions. These people need to be stopped, or at the very least ignored. They do not deserve to be listened to. They do not deserve any kind of false equivalency, if I want to know about how to give a good massage, or which herbs to put in my roast or how to grow my garden then I'd consider asking them. But health advice? No, these people do not deserve to be put on the same platform as those who do provide real, evidence based holistic care. They come into people's lives when they have the least mental ability to fight off, offer hope in exchange for money. Then they leave taking the money away with all hope. And for that alone these people need to be stopped.</span></span></span>IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-48862832025489396132017-08-09T15:54:00.002+01:002017-08-09T15:54:18.383+01:00Metal Nurse: Pus, slough, silver, honey and maggots<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJXvmjrTrobhDGPHrVKghI5ZDDJdptmgAKZxm82MG9Iq4LiStMQb06jXlXWawqJ0gu8Uqduro0Xnh3VXkaqJwx5QST_weY3rT09X1rvOyHwInFwo8wyf2L2vh9SumMOfxMbqSKlhltxZw/s1600/nursestation.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="350" data-original-width="960" height="116" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJXvmjrTrobhDGPHrVKghI5ZDDJdptmgAKZxm82MG9Iq4LiStMQb06jXlXWawqJ0gu8Uqduro0Xnh3VXkaqJwx5QST_weY3rT09X1rvOyHwInFwo8wyf2L2vh9SumMOfxMbqSKlhltxZw/s320/nursestation.png" width="320" /></a></div>
As a nurse, I flit from one passion to another. All in all, my passion for good nursing has not diminished, but subjects tend to vary from one to the other. Whilst I was a student I had a very, very acute interest in diabetes. Especially how much being diabetic can affect and impact on nearly every single aspect of your life. I've dabbled a little bit in cardiac care. I still enjoy advocating for <a href="http://ingvararni.blogspot.com/2017/02/metal-nurse-edward-jenner-healthcare.html" target="_blank">vaccines</a>, especially for <a href="http://ingvararni.blogspot.com/2016/10/metal-nurse-importance-of-flu-vaccine.html" target="_blank">healthcare workers</a>, <a href="http://ingvararni.blogspot.com/2017/02/metal-nurse-physical-health-within.html" target="_blank">mental health</a> still <a href="http://ingvararni.blogspot.com/2016/09/metal-nurse-self-harm-and-suicide.html" target="_blank">remains</a> at the forefront of my mind, I got extremely interested in <a href="http://ingvararni.blogspot.com/2015/01/student-nurse-perspective-stroke-and.html" target="_blank">stroke</a> if only because my first job offer was within an acute stroke setting, and so on and so forth. All in all, I do generally enjoy almost every aspect of nursing. Currently, my biggest passion involves wound care. In all its gory and gooey glory. The sloughier, the better. The deeper the cut, the more I have fun. I am not saying that I want people to get hurt... But when they do, I want to be there. To help obviously...<br />
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Wound care has gone through some major changes over the years and will no doubt continue to do so, just like any other aspect of health. Wounds account for a huge portion of the NHS budget, <a href="http://bmjopen.bmj.com/content/5/12/e009283" target="_blank">a study published</a> in the <a href="http://www.bmj.com/" target="_blank">BMJ</a> estimated that wound care along with associated co-morbidities accounted for £5.3 billion. This is on par with obesity which costs £5.1 billion, a little less than cancer which costs £5.6 billion. But considerably less than <a href="http://ingvararni.blogspot.com/2017/02/metal-nurse-health-tourism-red-herring.html" target="_blank">health tourism</a>.<br />
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<a href="https://www.researchgate.net/profile/Eric_Haertel/publication/260251657/figure/fig1/AS:392520799408147@1470595659675/Fig-1-Different-stages-of-the-wound-healing-process-Full-thickness-excisional-mouse.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="800" data-original-width="389" height="320" src="https://www.researchgate.net/profile/Eric_Haertel/publication/260251657/figure/fig1/AS:392520799408147@1470595659675/Fig-1-Different-stages-of-the-wound-healing-process-Full-thickness-excisional-mouse.jpg" width="155" /></a></div>
There are several myths that persist regarding wounds. The biggest one being "Let the wound breathe", it is one of those exceptionally persistent old wives tales that every (grand) parent tell their children when they fall and scrape their knees whilst being too busy playing on their mobile devices (I jest, I jest). The idea being that the air will dry it out and let it heal faster. This is just patently wrong. The best healing environment is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842869/" target="_blank">moist environment</a>. Moist environment reduces the time it takes for the wound to heal, leads to less inflammation and necrosis, and also reduces scar formation. Leaving the wound open just increases the risk of infection, slows healing rate and scars more prominently.<br />
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Wounds tend to be fairly simple in of themselves. But any healing can be delayed by a lot of reasons. Present co-morbidities, certain medications, <a href="http://www.woundsresearch.com/article/nutrition-wound-care-management-comprehensive-overview" target="_blank">dietary intake</a>, mobility, <a href="https://www.ncbi.nlm.nih.gov/pubmed/1323208" target="_blank">smoking</a>, <a href="https://www.sciencedaily.com/releases/2014/04/140408154109.htm" target="_blank">alcohol drinking</a>, etc etc. One of the biggest factors that can delay healing is being <a href="http://www.diabetes.co.uk/symptoms/slow-healing-of-wounds.html" target="_blank">diabetic</a>. The reason for this is because diabetes oft leads to neuropathy, which in turn leads to blood circulation, which makes it difficult for the blood with it's associated macrophages, fibrinogens and platelets from reaching the wound <span id="goog_1791797679"></span><a href="https://www.blogger.com/"></a><span id="goog_1791797680"></span>area.<br />
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But enough about that. Due to increased prevalance of antibiotic resistant bacteria we have now started to look more at alternative ways of treating wounds. As can be imagined antibiotic resistant bacteria will wreak havoc on wounds and will turn acute wounds into chronic ones purely because we don't have the antibiotics to give either in IV, oral form or as a topical cream. The three major components that are being used more and more of are: <a href="https://woundcare-today.co.uk/categories-pyramid/silver-dressings" target="_blank">Silver</a>, <a href="https://www.advancedtissue.com/honey-can-help-wound-healing/" target="_blank">Honey</a> and <a href="https://en.wikipedia.org/wiki/Maggot_therapy" target="_blank">Maggots</a>. Oh, and seaweed. We use a lot of seaweed in wound care. Sadly due to the lack of real hardcore double blinded studies it is hard to ascertain how effective these methods are in speeding up wound healing process. Anecdotally I have come across excellent results with maggot therapy, but more mixed experience with either silver or honey. Good wound care is more based on how cleanly the dressing is done, with minimal dressing changes. Plus also making sure that the patients holistic assessment is complete, because there are so many other factors that can affect wound healing mentioned previously. The key component being actually cleaning the wound before covering it up, now here is something that I personally found interesting but every community nurse knew but needs to be reiterated, using <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472650/" target="_blank">normal tap water</a> is just as effective as using <a href="http://www.cochrane.org/CD003861/WOUNDS_the-effects-of-water-compared-with-other-solutions-for-wound-cleansing" target="_blank">pods of normal saline</a>.<br />
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Now those three things that I mentioned before, Silver, Honey and Maggots are largely on the rise because of <a href="http://www.who.int/mediacentre/factsheets/fs194/en/" target="_blank">antibiotic resistance</a>. Which was first detected when antibiotics first came on the market, but has since been on the rise. Without effective antibiotics we are looking at a very bleak future indeed, hence the need to look beyond antibiotics for infected wounds. <br />
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Silver dressings had been on the rise until fairly recently when study after study found that it was not that effective in preventing infections in chronic wounds or increasing healing rate. There had been reports that silver inhibits bacterial growth in petri dishes, but human beings are not petri dishes and this unfortunately not been replicated properly in real life situations. In fact in some cases it seemed to <a href="https://www.ncbi.nlm.nih.gov/pubmed/23543513" target="_blank">delay healing times</a>. On the other hand it is quite effective in odour control, but in all honesty I'd rather stick with charcoal dressings as they do it even better and are overall cheaper. There are of course those in the "alternative medical" business who insist on pushing <a href="https://www.quackwatch.org/01QuackeryRelatedTopics/PhonyAds/silverad.html" target="_blank">colloidal silver</a> for everything. But beware of this quack remedy. It is not natural as claimed, nor is it effective. And as a side note, ingesting colloidal silver can and does lead to a condition called <a href="https://en.wikipedia.org/wiki/Argyria" target="_blank">Argyria</a>. Having said all of that, when/if antibiotic resistance becomes the overwhelming reality then we will have to reevaluate the use of silver in dressings and wound care.<br />
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Honey on the other hand has been showing some benefit in real life situations. Honey had been a stable in folklore and "natural" medicine, up until the 19th century when medical doctors decided to put it to the test. Today it isn't just any old honey that is used, it is <a href="https://en.wikipedia.org/wiki/M%C4%81nuka_honey" target="_blank">manuka honey</a>. This honey is generally derived from New Zealand and Australia, collected by bees that forage on tea tree. The oil of which has also been found to be a fairly effective antimicrobial agent, <a href="http://www.sciencedirect.com/science/article/pii/S0195670104000167" target="_blank">even against antibiotic resistant bacteria like MRSA</a>. Though again most of the positive findings tend to be <a href="http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502015000700491&lng=en&nrm=iso&tlng=en" target="_blank">in vitro</a>. These dressings have been found to be as effective in small scale studies, but (again) large scale studies need to be done in order to establish whether they are superior to <a href="https://www.ncbi.nlm.nih.gov/pubmed/23450557" target="_blank">traditional dressings</a>. But on the whole honey dressings are good because the provide moist healing environment, debridement, deodorizing and are also anti-inflammatory, all factors that assist with good healing environment. <br />
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Maggot therapy is back in vogue, and in recent years has seen increase in usage on especially wounds that take a long time to heal for example <a href="https://en.wikipedia.org/wiki/Diabetic_foot_ulcer" target="_blank">diabetic foot ulcers</a>, <a href="https://en.wikipedia.org/wiki/Pressure_ulcer" target="_blank">pressure ulcers</a> and <a href="https://en.wikipedia.org/wiki/Venous_ulcer" target="_blank">venous stasis ulcers</a>. Whilst maggot therapy had been in fairly common usage up until 1930's, the advent of antibiotics made maggots look obsolete. It wasn't until the 1980's when the danger or antibiotic resistant bacteria started truly rearing it's ugly head when maggots were reconsidered for wound care. Just to be clear it can't just be any maggots. For preference the larvae of the <a href="https://en.wikipedia.org/wiki/Common_green_bottle_fly" target="_blank">green bottle fly</a> is used. These little beauties are tiny and feast on necrotic flesh, which makes them perfect for debridement of wounds. They do their stuff by secreting enzymes that break down the necrotic tissues into juices from them to drink. These enzymes also have the added benefit being broad spectrum anti-microbial, making this therapy also suited for those whose wounds have been colonised by <a href="https://www.ncbi.nlm.nih.gov/pubmed/17259512" target="_blank">antibiotic resistant bacteria</a>. They can come in either a teabag or loose, and left on the wound for up to three days. Along with cleaning out the wound, the larvae also <a href="https://www.ncbi.nlm.nih.gov/pubmed/16675968" target="_blank">stimulate the healing process</a>, they managed that by stimulating <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226391/" target="_blank">fibroblasts</a> which synthetize into collagen and extracellular matrix, and by providing those elements it supports other cells with wound healing. A <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2168.2000.01420-42.x/abstract" target="_blank">small randomized study</a> done in 2000 that involved 12 patients did indicate that larval therapy could be more cost-effective than using the standard hydrogel. But as with an study like this it makes it hard to replicate and do on a larger scale. <br />
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As mentioned previously, the dressings that I have mentioned to have their place within the toolkit of wound dressings. None should be completely dismissed unless there has been a large scale studies performed in showing either ineffectiveness or in fact make the problems worse. For example, "letting the wound breath", just stop it. </div>
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What is most important when dressing a wound is consistency, rather than any fancy pancy dressings.</div>
IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-33341236092640584392017-02-22T21:21:00.000+00:002017-02-22T21:21:54.943+00:00Metal Nurse: Health Tourism, Red Herring.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibYY-YRJFpRc-Tmtm-6KUhT_pCUW8fs5vL4pUQBIhdTMXHnYKwnjOQBMy_C028LzhQpSbEH0fdueiZT0-fNBFy8dMO16oz7fFdsaUB9ZZdpmguJssBkAi8zH22JbtHx1kDV4QKlwLnKRc/s1600/nursestation.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: inherit;"><img border="0" height="72" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibYY-YRJFpRc-Tmtm-6KUhT_pCUW8fs5vL4pUQBIhdTMXHnYKwnjOQBMy_C028LzhQpSbEH0fdueiZT0-fNBFy8dMO16oz7fFdsaUB9ZZdpmguJssBkAi8zH22JbtHx1kDV4QKlwLnKRc/s200/nursestation.png" width="200" /></span></a></div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidOWZdHRoMKAHwTxqncqGmtpQtpatAELdXHmCPgSirzUAlx9o-pyFBdOv40QTVmV1I2GoVEgszMpXKw5j9Gt9EzDZ3L8yrdP1C3rrN4oVBfhvZn6qvMfEfyrJjaI-Pj2iqV2YCijiK_sE/s1600/RED+HERRING.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidOWZdHRoMKAHwTxqncqGmtpQtpatAELdXHmCPgSirzUAlx9o-pyFBdOv40QTVmV1I2GoVEgszMpXKw5j9Gt9EzDZ3L8yrdP1C3rrN4oVBfhvZn6qvMfEfyrJjaI-Pj2iqV2YCijiK_sE/s1600/RED+HERRING.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-family: inherit;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidOWZdHRoMKAHwTxqncqGmtpQtpatAELdXHmCPgSirzUAlx9o-pyFBdOv40QTVmV1I2GoVEgszMpXKw5j9Gt9EzDZ3L8yrdP1C3rrN4oVBfhvZn6qvMfEfyrJjaI-Pj2iqV2YCijiK_sE/s200/RED+HERRING.png" width="200" /></span></a><span style="font-family: inherit;">During the whole Brexit election I got into some heated debates, especially about the </span><a href="https://en.wikipedia.org/wiki/National_Health_Service" target="_blank"><span style="font-family: inherit;">National Health Service</span></a><span style="font-family: inherit;">. For years and years there has been this myth that the UK was being flooded with health tourists, who would take advantage of the free care provided by the NHS. Never mind that one of the founding principles of the NHS is "Free to the point of delivery" and never mind that the whole "Health Tourist" concept is a </span><a href="https://en.wikipedia.org/wiki/Red_herring" target="_blank"><span style="font-family: inherit;">red herring</span></a><span style="font-family: inherit;">. This is generally to distract people from real problems that actually affect their lives, </span><a href="https://theconversation.com/sharp-rise-in-uk-mortality-rate-may-be-due-to-austerity-measures-72984" target="_blank"><span style="font-family: inherit;">like austerity</span></a><span style="font-family: inherit;">. Because in the last couple of years mortality rate <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/weeklyprovisionalfiguresondeathsregisteredinenglandandwales" target="_blank">has risen</a>, while <a href="https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Deficits_in_the_NHS_Kings_Fund_July_2016_1.pdf" target="_blank">NHS</a> and <a href="https://www.adass.org.uk/media/5379/adass-budget-survey-report-2016.pdf" target="_blank">Social Care</a> has been getting less funding.<br /><br /><br />It should be noted that <a href="https://www.kingsfund.org.uk/projects/verdict/what-do-we-know-about-impact-immigration-nhs" target="_blank">immigrants use less services</a> within the NHS than their British counterparts. The reason for that is immigrants (like myself) tend to be younger and healthier. Even being admitted to hospital is <a href="http://journals.sagepub.com/doi/full/10.1258/jhsrp.2010.010097" target="_blank">rarer amongst immigrants</a>.</span><br />
<span style="font-family: inherit;"></span><br />
<span style="font-family: inherit;">But let's for a moment pretend that health tourism is a problem. To do that I'll just check out some numbers... Now currently the NHS budget is around </span><a href="http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx" target="_blank"><span style="font-family: inherit;">£116.4 billion</span></a><span style="font-family: inherit;"> (2015-2016), the best estimate that the </span><a href="https://www.gov.uk/government/organisations/department-of-health" target="_blank"><span style="font-family: inherit;">Department of Health</span></a><span style="font-family: inherit;"> can come up with regarding the cost of health tourists is somewhere between </span><a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/251909/Quantitative_Assessment_of_Visitor_and_Migrant_Use_of_the_NHS_in_England_-_Exploring_the_Data_-_FULL_REPORT.pdf#page=85" target="_blank"><span style="font-family: inherit;">£110 - £280 million</span></a><span style="font-family: inherit;">. Now those do sound like big numbers, and they are. But that accounts for 0.0945% - 0.24%. Are we seriously going to worry about those numbers? </span><span style="font-family: inherit;">Now those are for what DoH call deliberate health tourists, i.e. those who come to the UK specifically to obtain treatment. Should they be charged, sure of course they should be and most are. But on the other side of the coin is how much they bring into the economy whilst they come to the UK for treatment. Health Tourists also bring somewhere around £219 million back into the economy, by paying into hotels, shopping, transport and suchlike. All of those are VAT'd so that gets back into the economy, and those who work in the industries get paid and thus also pay taxes. So swings and roundabouts. These are people who come to the UK for specific treatments as well. </span><br />
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<span style="font-family: inherit;">But then what to do with health tourists from the UK? Because according to this rather interesting research published by </span><a href="http://journals.plos.org/plosone/" target="_blank"><span style="font-family: inherit;">PLOS</span></a><span style="font-family: inherit;"> entitled "</span><a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0070406" target="_blank"><span style="font-family: inherit;">Medical Tourism: A Cost of Benefit to the NHS</span></a><span style="font-family: inherit;">" they state:</span><br />
<blockquote class="tr_bq">
<span style="background-color: white; color: #333333;"><span style="font-family: inherit;">Our analysis of data suggests that the UK is now a net exporter of medical tourists. While incoming medical tourists may be less likely to declare treatment as primary purpose for their visit to the UK than outbound tourists, data over time clearly shows a greater acceleration in outbound over inbound medical tourists. Despite the variations in numbers of patients visiting different hospitals and in the income per patient, the number of medical tourists was comparatively smaller than the percentage of income generated by them (7% of patients generating close to 25% of private income). These figures suggest that non-UK residents travelling to the UK for medical treatment seek high-end specialist expensive procedures, and may generate substantial revenue. Additional numbers of patients for specialist procedures may also help NHS doctors with surgical learning curves.</span></span><br />
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<span style="font-family: inherit;">But let's take a case study on one of these awful health tourists. As mentioned above I got into some heated debates with a lot of racist people regarding the NHS usage by foreigners. Their favourite story was about this Nigerian lady who came to England to give birth to four children and then left with an unpaid bill. The one issue they didn't seem to understand is that Nigeria isn't in Europe, let alone in the EU. But they also either deliberately left out details or never got around to reading the full story because their lizard brains couldn't handle it. This </span><a href="http://www.politics.co.uk/blogs/2017/02/01/britain-saved-the-life-of-two-babies-the-sun-is-mad" target="_blank"><span style="font-family: inherit;">story</span></a><span style="font-family: inherit;"> has since been touted by media outlets like </span><a href="http://rationalwiki.org/wiki/The_Sun" target="_blank"><span style="font-family: inherit;">The S*n</span></a><span style="font-family: inherit;">, </span><a href="http://rationalwiki.org/wiki/The_Daily_Mail" target="_blank"><span style="font-family: inherit;">Daily Heil</span></a><span style="font-family: inherit;"> and Sky. Talking about the horror of the cost to the common man, even the </span><a href="http://www.bbc.co.uk/news/uk-politics-38809530" target="_blank"><span style="font-family: inherit;">BBC headline</span></a><span style="font-family: inherit;"> is focused on the financial cost, as opposed to the human cost. For those who need a quick update on the actual story I'll summarise it:</span><br />
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<blockquote class="tr_bq">
<span style="font-family: inherit;">Nigerian woman was pregnant with 4 children. She got told by her doctors that she'd be better off giving birth elsewhere as it would be safer for her. So she decides to go to the US where a large portion of her family lives. She gets there only to find out that her paperwork is wrong. So she has to turn back, with a stop in the UK, where she has no relations. While en-route she was taken ill. As the plane lands she is taken to hospital, where she gives birth prematurely. One child died at birth, the remaining three were taken into Intensive Care. Another child dies shortly after. The patient herself got discharged after 6 weeks. Quite frankly the headlines shouldn't be about the cost, the headlines should read about how well the NHS staff did in saving both mother and children. She didn't want to give birth in the UK. She didn't want two of her babies to die whilst in a land she doesn't know and has no one in.</span></blockquote>
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<span style="font-family: inherit;"><span style="font-family: "inherit" , "serif"; font-size: 12pt; margin: 0px;">But then you do have those who come to travel to the UK, because you
know people like to travel. And you can't always account for if you get ill
during your travels or not. Now this is where it gets a little bit trickier.
Because when you are travelling in a different country you don't really expect
to have to get any sort of treatment. But normal use is estimated to be around
£1.8 billion, still a tiny 1.15% of the total NHS budget. And most of that can
be recovered through </span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; margin: 0px;"><a href="https://en.wikipedia.org/wiki/European_Health_Insurance_Card"><span style="color: blue; font-family: "inherit" , "serif"; margin: 0px;">European Health Insurance
Scheme</span></a></span><span style="font-family: "inherit" , "serif"; font-size: 12pt; margin: 0px;"> (well for now anyway). Other countries do
seem to be better at claiming money back for when British tourists take ill in
the EU, then the NHS. But that is more due to </span><span style="font-family: "times new roman" , "serif"; font-size: 12pt; margin: 0px;"><a href="https://theconversation.com/is-it-worth-making-health-tourists-pay-for-nhs-care-52607"><span style="color: blue; font-family: "inherit" , "serif"; margin: 0px;">administration costs</span></a></span><span style="font-family: "inherit" , "serif"; font-size: 12pt; margin: 0px;">.</span></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 12pt; margin: 0px;"><b><i><u><sub><sup><strike><br /></strike></sup></sub></u></i></b>
<span style="font-family: inherit;"></span><br />
<span style="font-family: inherit;">Now let's compare those numbers to something that does have real impact on the NHS. According to the latest numbers I can find (from 2012) </span><a href="https://en.wikipedia.org/wiki/Diabetes_mellitus" target="_blank"><span style="font-family: inherit;">diabetes</span></a><span style="font-family: inherit;"> and diabetic care costs </span><a href="http://www.diabetes.co.uk/cost-of-diabetes.html" target="_blank"><span style="font-family: inherit;">£13.750 billion</span></a><span style="font-family: inherit;">. 85% of which </span><a href="https://en.wikipedia.org/wiki/Diabetes_mellitus_type_2" target="_blank"><span style="font-family: inherit;">Type 2 Diabetes</span></a><span style="font-family: inherit;"> is accounted for. </span><span style="line-height: 18.4px; margin: 0px;"><span style="font-family: inherit;">And this is expected to be increased to </span><a href="https://www.diabetes.org.uk/About_us/News_Landing_Page/NHS-spending-on-diabetes-to-reach-169-billion-by-2035/" target="_blank"><span style="color: blue; font-family: inherit;">£39.8 billion</span></a><span style="font-family: inherit;"> by 2035/36. T2DM is largely preventable through healthier living and better lifestyle choices.</span></span><br />
<span style="font-family: inherit;"><br />Obesity is also largely preventable through healthier living and better lifestyle choices and that costs the NHS an estimated </span><a href="http://www.publications.parliament.uk/pa/cm200304/cmselect/cmhealth/23/23.pdf" target="_blank"><span style="font-family: inherit;">£6.8 billion</span></a><span style="font-family: inherit;">. Within the EU the citizens of United Kingdom have the <a href="http://www.euro.who.int/en/data-and-evidence/european-health-report/european-health-report-2015/ehr2015" target="_blank">highest rate of obesity</a>. </span><br />
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<a href="http://www.alcoholconcern.org.uk/alcohol-statistics" target="_blank">Alcohol costs society</a> as a whole £21 billion per year, £3.5 billion of those to the NHS. Again this is through lifestyle choice of those who live in the UK.<br /><br />Then there's smoking. Which costs the society upwards to £14 billion, with £2.7 billion costing the NHS. Bear in mind that those numbers were calculated in <a href="http://www.policyexchange.org.uk/images/publications/cough%20up%20-%20march%2010.pdf" target="_blank">2010</a>.</span><br />
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<span style="font-family: inherit;"><span style="font-family: "inherit" , "serif"; font-size: 12pt; margin: 0px;">In conclusion is it really worth hounding and demonising people coming into the UK for medical treatment when the UK citizens themselves take it for granted and should we not also be as disparaging to the UK citizens who leave the country to seek treatment elsewhere? In my opinion, as a healthcare professional and as an NHS employee, the
fact that people actually want to come to the UK to receive their treatment
makes me proud. And it should make the citizens of the UK proud because it
shows that we are doing something right.<br /><br />Other sources include:<br /><br /><a href="tps://fullfact.org/" target="_blank">Full Fact</a><br /><br /><a href="http://diabetes.co.uk/">Diabetes.co.uk</a><br /><br /><a href="https://theconversation.com/uk" target="_blank">The Conversation</a><br /><br /><a href="https://www.kingsfund.org.uk/" target="_blank">King's Fund</a>.</span></span></div>
<span style="font-family: inherit;">
</span>IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-19455236472028816372017-02-16T22:22:00.000+00:002017-02-20T14:00:34.374+00:00Metal Nurse: Edward Jenner healthcare hero<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhU5PzzoDcs7ccFc7NqW52xks92EFkj3E3oNB9LQ76q_1P6d3RGP2Pwy6lwFK4jUjelFHOM_oClBmaI5X4KPupXHrdiI3hgwOIlBpuXfbht_xqpqFx4ge7cv3zmVo7C0PJ4CIfZOw6tj0E/s1600/2017-01-27+16.27.15.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="112" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhU5PzzoDcs7ccFc7NqW52xks92EFkj3E3oNB9LQ76q_1P6d3RGP2Pwy6lwFK4jUjelFHOM_oClBmaI5X4KPupXHrdiI3hgwOIlBpuXfbht_xqpqFx4ge7cv3zmVo7C0PJ4CIfZOw6tj0E/s200/2017-01-27+16.27.15.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Me in Hyde Park, with Edward Jenner</td></tr>
</tbody></table>
Some time ago I went to London with my beloved to spend the weekend. Whilst there I visited Hyde Park for the first time where I came across this monument of a man who changed the landscape of healthcare indefinitely. For the better. I am of course talking about one of the great pillars of public health, <a href="https://jennermuseum.com/" target="_blank">Edward Jenner</a>. The father of vaccinations. You will undoubtedly read many many ‘<a href="http://www.urbandictionary.com/define.php?term=Alternative%20facts" target="_blank">Alternative Facts</a>’ by anti-vaxxers. But as usual they tend to be more confined within the fiction section of third hand bookshops. They lie about vaccines in <a href="https://www.tavs.info/" target="_blank">general</a>, but some of the lies they repeat over and over again about <a href="https://en.wikipedia.org/wiki/Edward_Jenner" target="_blank">Edward Jenner</a> are astounding. There is a made up story that his son died after receiving the smallpox vaccine. He died at 21 from<a href="https://en.wikipedia.org/wiki/Tuberculosis" target="_blank"> tuberculosis</a>, which incidentally we now have a pretty effective <a href="https://en.wikipedia.org/wiki/BCG_vaccine" target="_blank">vaccine</a> for. They also lie about <a href="https://en.wikipedia.org/wiki/Smallpox" target="_blank">smallpox</a>, alternating between it being <a href="http://www.who.int/bulletin/volumes/86/12/08-041208/en/" target="_blank">never eradicated</a>, just renamed, or simply never that bad in the first place. Yeah, between 300-500 million people died from it in the 20th century alone (until it was eradicated of course), it had 20-30% mortality rate, couldn't have been too bad a disease.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIudVF9-Kgf1javggC7HrrYCMlv6XNs_gAdmxZgL0AD168AAcZXRJyM-hjjfR5NRfcgDpNEmqpL4UQC4gfKpc1-oUsDw8OLQpMCiU8vferKgzZPcDgP1iC2QtRPsFEs-r-C-GYEJncHFk/s1600/small-pox-770x392.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="101" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIudVF9-Kgf1javggC7HrrYCMlv6XNs_gAdmxZgL0AD168AAcZXRJyM-hjjfR5NRfcgDpNEmqpL4UQC4gfKpc1-oUsDw8OLQpMCiU8vferKgzZPcDgP1iC2QtRPsFEs-r-C-GYEJncHFk/s200/small-pox-770x392.png" width="200" /></a>Smallpox had been a scourge on mankind throughout written history. Ancient writings about it were found in a medical book from India, dating from as early as 1500 BC. King Ramses V had been infected by it, cases found in China dating at least 1100 BC. It made no distinction between classes, <a href="http://www.unofficialroyalty.com/royal-illnesses-and-deaths/smallpox-knew-no-class-boundaries/" target="_blank">it knew no boundaries</a>, afflicting the poor and rich alike. Those who were "lucky" enough to survive would be left with permanent scarring. It is a virus mostly transmitted via close contact and droplets coughed by the infected individual. The virus could even be spread via infected cloths, incidentally how the British <a href="https://www.varsitytutors.com/earlyamerica/early-america-review/volume-11/native-americans-smallpox" target="_blank">conquered the Americas</a> when <a href="http://www.umass.edu/legal/derrico/amherst/lord_jeff.html" target="_blank">General Jeffrey Amherst</a> gave Native Americans blankets carrying the smallpox virus, <a href="http://www.pbs.org/gunsgermssteel/variables/smallpox.html" target="_blank">quickly decimating</a> the previously unexposed population. The afflicted remained contagious until the last scab healed. There was no treatment available. The only way it could be controlled was with vaccination. And thanks to extensive immunisation programmes the <a href="http://www.who.int/csr/disease/smallpox/en/" target="_blank">last known wild case</a> of smallpox was in Somalia, in 1977. But it is known that there are vials of smallpox left in both <a href="https://en.wikipedia.org/wiki/Smallpox_virus_retention_controversy" target="_blank">the US and in Russia</a>.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDqNo4ohjC1UDdECeMFTdo24gP_e5duE-nklTXuK-IaGu-kUhp9m8kbhJB3-VmqnMlHHZxoLvjgfvmjopo88lA2JE4bKw3zceDgQr2jsbTAAaRVAbVDBxw3It0wIR0pSvhubK2cFJMVA4/s1600/chinesevaccination.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="105" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDqNo4ohjC1UDdECeMFTdo24gP_e5duE-nklTXuK-IaGu-kUhp9m8kbhJB3-VmqnMlHHZxoLvjgfvmjopo88lA2JE4bKw3zceDgQr2jsbTAAaRVAbVDBxw3It0wIR0pSvhubK2cFJMVA4/s200/chinesevaccination.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px; text-align: center;">Chinese Variolation</td></tr>
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In itself the idea of immunisations wasn't anything new, an immunising technique called <a href="https://en.wikipedia.org/wiki/Variolation" target="_blank">variolation</a> had been practised in China and Turkey and some parts of Africa since at least 1000 BC. That form of immunization was introduced to England by the 1700's. It wasn't a particularly safe practice, though safer than getting the disease itself. It involved drying the scabs of previously infected individuals and blowing them up people noses. (Which admittedly is awfully similar to the flu nasal mist spray we use today.) In Sudan and Turkey this practice consisted of collecting fluids from the smallpox postules and rubbing the pus into a cut on the person receiving it. Uptake of either practice in Europe was lacking because the medical establishment had dismissed the practices as witchcraft or folklore. It wasn't until the 1700's that an Italian doctor by the name of <a href="https://fr.wikipedia.org/wiki/Emmanuel_Timoni">Emmanuel Timoni</a> witnessed the practice in Constantinople and then wrote about it and got it published in Philosophical Transaction in 1714, that it received some attention from the higher classes of Europe. Mostly thanks to <a href="https://en.wikipedia.org/wiki/Lady_Mary_Wortley_Montagu">Lady Montagu</a> who had been permanently scarred by smallpox herself and lost her brother to the same illness.<br />
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Edward Jenner was a doctor hailing from England. Jenner himself had been inoculated when he was 8 years old via the practice of variolation. During his medical apprenticeship he took a keen interest in cowpox and how it might possibly lead to protection against smallpox, something that had been taken note of before, specifically by another English physician <a href="https://en.wikipedia.org/wiki/John_Fewster" target="_blank">John Fewster</a>, a friend of Jenner's, and a farmer named <a href="https://en.wikipedia.org/wiki/Benjamin_Jesty" target="_blank">Benjamin Jesty</a>. They had observed and reported that milkmaids infected with cowpox were invariably immune to smallpox, this essentially started the mass immunization programs. In essence he didn't discover vaccinations, he popularised it.<br />
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Jenner first experimented on eight year old <a href="http://www.sciencemuseum.org.uk/broughttolife/people/jamesphipps" target="_blank">James Phipps</a>, injecting a small amount of cowpox into his arm. After James had recovered from the inoculation Jenner attempted to infect him with smallpox. Neither James nor the children who shared his bed developed smallpox, thus discovering <a href="https://academic.oup.com/cid/article/52/7/911/299077/Herd-Immunity-A-Rough-Guide" target="_blank">herd immunity</a>. His theories were revolutionary for the time and a lot of people refused to believe them. With the advent of vaccinations came the <a href="http://www.historyofvaccines.org/content/articles/history-anti-vaccination-movements" target="_blank">Anti-Vaccine Movement</a>. Because the idea was so mind blowing even the establishment initially refused to believe it, leading Edward Jenner to do further experiments with more children, including his own child. <br />
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By today's standards these were extremely <a href="https://theconversation.com/judging-jenner-was-his-smallpox-experiment-really-unethical-54362" target="_blank">unethical experiments</a>. But thanks to these experiments Jenner managed to convince the establishment of the effectiveness of his method, replacing the more dangerous variolation. Jenner was reportedly an extremely generous man, when James Phipps had married later in life and had children of his own, Jenner gave him a free lease on a house. He refused to use the discovery to make himself rich. Instead he'd devote his time to vaccinating as many people as possible, even negotiating to vaccinate French soldiers in exchange for British Prisoners of War. By 1840 variolation was confined to the past and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373148/" target="_blank">Jenner's form of immunisation</a> had taken over. <br />
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In addition to his research on vaccinations he also made some great headway <a href="https://www.ncbi.nlm.nih.gov/pubmed/3929726" target="_blank">into research</a> on <a href="http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Angina-Pectoris-Stable-Angina_UCM_437515_Article.jsp" target="_blank">Angina Pectoris</a>. <br />
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Without Edward Jenner there is a very good chance that we would still be dealing with mass epidemics of deadly, dangerous and disfiguring illnesses like smallpox, measles and polio. I believe Jenner's research into vaccinations was as important as <a href="https://en.wikipedia.org/wiki/John_Snow" target="_blank">John Snow</a>'s <a href="https://en.wikipedia.org/wiki/1854_Broad_Street_cholera_outbreak" target="_blank">sanitation investigation</a>, <a href="https://en.wikipedia.org/wiki/Joseph_Lister,_1st_Baron_Lister" target="_blank">Joseph Lister</a>’s insistence on equipment sterilisation, <a href="https://en.wikipedia.org/wiki/Ignaz_Semmelweis" target="_blank">Ignaz Semmelweis</a> preoccupation with the importance of hospital staffs hand-washing and <a href="https://en.wikipedia.org/wiki/Alexander_Fleming" target="_blank">Alexander Fleming's</a> discovery of penicillin.<br />
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Vaccines save lives. <br />
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Edward Jenner was a hero. Even Napoleon accepted that.<br />
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Sources:<br />
<a href="http://www.historyofvaccines.org/timeline" target="_blank">History Of Vaccines</a><br />
<br />
<a href="http://www.bbc.co.uk/history/historic_figures/jenner_edward.shtml" target="_blank">BBC: History, Edward Jenner</a>.<br />
<br />
<a href="https://www.amazon.co.uk/History-Immunology-Arthur-M-Silverstein/dp/012370586X/ref=sr_1_1?ie=UTF8&qid=1487243733&sr=8-1&keywords=history+of+immunology" target="_blank">History of Immunology by Arthur Silverstein</a><br />
<br />
<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/" target="_blank">Edward Jenner and the History of Smallpox and Vaccination, by Stefan Riedel</a>.IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-76983564515543623572017-02-06T14:50:00.000+00:002017-02-06T14:50:51.339+00:00Metal Nurse: Loss of Liverpool Care Pathway<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibYY-YRJFpRc-Tmtm-6KUhT_pCUW8fs5vL4pUQBIhdTMXHnYKwnjOQBMy_C028LzhQpSbEH0fdueiZT0-fNBFy8dMO16oz7fFdsaUB9ZZdpmguJssBkAi8zH22JbtHx1kDV4QKlwLnKRc/s1600/nursestation.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="72" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibYY-YRJFpRc-Tmtm-6KUhT_pCUW8fs5vL4pUQBIhdTMXHnYKwnjOQBMy_C028LzhQpSbEH0fdueiZT0-fNBFy8dMO16oz7fFdsaUB9ZZdpmguJssBkAi8zH22JbtHx1kDV4QKlwLnKRc/s200/nursestation.png" width="200" /></a></div>
<a href="http://taxpayersalliance.org/images/mail2.gif" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a>I've tried not to be too political on this blog, for mostly professional reasons. It has happened at least <a href="http://ingvararni.blogspot.co.uk/2014/03/privatization-is-not-answer.html" target="_blank">once</a>. But seeing as this is my blog I thought that this one time (and possibly more often after) I can be. Because this is one topic that really riles me and gets me going. The loss of the <a href="https://www.whatdotheyknow.com/request/169193/response/419788/attach/4/CPME146%20V1.3%20Liverpool%20Care%20Pathway%20V12%20updated%20Jan%202012%201.pdf" target="_blank">Liverpool Care Pathway</a>. I have written previously about how <a href="http://ingvararni.blogspot.com/2016/08/but-on-most-basic-levels-nurse-has-2.html" target="_blank">Dying Matters</a>, it is a fundamental part of all good nursing. How we treat the dying patient. How we help the bereaved family. <a href="https://en.wikipedia.org/wiki/Cicely_Saunders" target="_blank">Because how you die stays in people's memory. </a><br />
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For those who don't know. The Liverpool Care Pathway was set up in the late 90's in Liverpool. The aim of it was to provide the best possible care for those who were dying. It provided a framework on how to assess the patients condition, when to continue treatment, when to discontinue treatment and when to provide <a href="https://en.wikipedia.org/wiki/Palliative_care" target="_blank">palliative care</a>. To provide a review of whether further tests and examinations were needed, if artificial hydration should be started when the patient refused diet and/or fluid intake. In other words when to provide comfort care for those in their last hours of living, to provide them with a pain-free, and most importantly, a dignified death. It was a way to provide hospice care in a hospital.<br />
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Since 2014 we have not been able to use it. It was completely phased out with the order that each Trust should develop their own pathway, funny considering that the report that the <a href="https://www.gov.uk/government/organisations/department-of-health" target="_blank">DoH</a> published a document called "<a href="https://www.gov.uk/government/publications/review-of-liverpool-care-pathway-for-dying-patients" target="_blank">More Care, less pathway</a>.". This the Daily Hatreds concluded was victory for the public. Even though the review stated that that LCP was model of good practice, but because of individual mistakes it had to be discontinued. The pathway was excellent, and continually updated. But as usual human beings are fallible. Talking about death and dying is not easy, especially when the family are hellbent on that their relative should live forever. Some people had complained that it was a tick box exercise, which as usual misses the point of these documents. They are there to assist doctors and nurses in providing good care, making sure that all the best care was provided. But as with all good pathways the LCP was proactive, as the patients condition changed for better or for worse, their care and treatment would be re-evaluated. No one stayed on the LCP indefinitely, if someone made a recovery, which does happen because the human body is an <a href="http://www.medicaldaily.com/pulse/human-anatomy-facts-amazing-abilities-human-body-head-toe-360672" target="_blank">amazing thing</a>, then those patients would be re-examined, re-evaluated and and treated accordingly. It was never a "one-size-fits-all". It was a dynamic pathway like all good care pathways are.<br />
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All thanks to rags of hate like <a href="http://rationalwiki.org/wiki/Daily_Mail" target="_blank">Daily Mail</a>, <a href="http://www.badscience.net/category/media/papers-telegraph/" target="_blank">Daily Telegraph</a> and <a href="http://rationalwiki.org/wiki/Daily_Express" target="_blank">Daily Express</a> (The triumvirate of Gentleman's Hate). These papers started reporting that there was a widespread misuse of the LCP, that healthcare professionals were using it as a means of euthanasia, and so on and so forth. The Daily Hate was especially gleeful in publishing false news about doctors withdrawing <a href="http://www.nhs.uk/news/2012/11November/Pages/What-is-the-Liverpool-Care-Pathway.aspx" target="_blank">hydration of neonatal patients</a>. For a whole year Daily Nazi went on and on about the LCP, stating that families weren't consulted, that patients were put on it without their consent. That patients were put on it to speed up their death. For a whole year the Daily Triumvirate of Gentleman's Hatred continually on a near daily basis misinterpreted proper healthcare decisions, using their misguided (broken) moral compass on how <a href="https://www.nursingtimes.net/clinical-archive/end-of-life-and-palliative-care/90-of-doctors-support-liverpool-care-pathway/5055940.article" target="_blank">doctors</a> and nurses should do their work and how they should come to their decisions. Contrary to popular belief, the LCP was never misused, <a href="http://www.newstatesman.com/voices/2012/12/where-did-hysteria-over-liverpool-care-pathway-originate" target="_blank">just grossly misunderstood</a>.<br />
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Quite frankly the only truth was poor communication on the professionals part, which is not unusual. Talking about dying in hospital is often very hard, not just for relatives. But also for those professionals, because you don't want to be seen like you are failing in your job by letting someone die. Good communication is of course key to all good care. This comes with experience and training. It does not come from reading the Daily Triumvirate of Gentleman's Hatred. But the <a href="https://en.wikipedia.org/wiki/Fallout_(series)" target="_blank">fallout</a> has been such that some relatives seem to think that <a href="http://compassionindying.org.uk/making-decisions-and-planning-your-care/planning-ahead/dnar-forms/" target="_blank">DNACPR</a> and <a href="http://patient.info/doctor/advance-care-planning" target="_blank">Advanced Directive</a> are somehow Liverpool Care Pathway remade and should not be considered at all. But since scrapping the LCP we have got better at talking to <a href="https://www.rcplondon.ac.uk/news/new-rcp-end-life-care-audit-shows-steady-progress-care-dying-people" target="_blank">relatives and patients</a> regarding end of life care has improved, but the availability of said services have not. I know there was much rejoicing when it was scrapped, but when <a href="https://www.nice.org.uk/" target="_blank">NICE</a> published <a href="https://www.nice.org.uk/guidance/ng31" target="_blank">new guidelines</a> on end of life care. It was all very much a rehash of the LCP, it just can't be called that now. We provided individual care to all patients before and we still do so.<br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJNfTxFkeNg7cEORiQg50IvYf8txm8IHc5r49YJcepWiJr-YVBy18NQMlBkhgqGGqJD_wEMNYjq3wM4s07OsrZjFQ-RO3VCyEC4PWY9AYwhkBHWU-raxP4RqlS1Cj91cQM4tRyncqdpX8/s1600/paediatric-palliative-Myths-and-Facts-English.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJNfTxFkeNg7cEORiQg50IvYf8txm8IHc5r49YJcepWiJr-YVBy18NQMlBkhgqGGqJD_wEMNYjq3wM4s07OsrZjFQ-RO3VCyEC4PWY9AYwhkBHWU-raxP4RqlS1Cj91cQM4tRyncqdpX8/s320/paediatric-palliative-Myths-and-Facts-English.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">From <a href="http://www.icpcn.org/world-hospice-day-2013/" target="_blank">ICPCN</a></td></tr>
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And the fallout didn't just affect adult nursing, it also affected paediatric nursing. Paediatric Nursing had been trying to develop a <a href="https://www.ncbi.nlm.nih.gov/pubmed/16518947" target="_blank">similar pathway</a> for years. Seeing as there was the need for one. Palliative care for children is not as well known, generally again this is not a subject that a lot of professionals want to have. They will, but no parent actually wants to hear that there is nothing that the hospital can do for their child and that they would benefit from palliative care, rather than active treatment. The need for a tool for healthcare professionals to use in order to assist them with making those decisions and the rationale for those decisions was lacking. It's a conversation that neither party wants to have, but both desperately need.<br /><br />Sometimes further treatment is just inflicting pain on children, with no hope of either cure or reprieve. Extending hope when there is none. Children, like adults, need and deserved tender loving care. And like with adults, how children die stays in the memory of those who live on. But again, thanks to the triumvirate of gentlemans's hatred, the development of said pathway for England(and Wales) was halted almost indefinitely. NICE since have published up <a href="https://www.nice.org.uk/guidance/ng61" target="_blank">guidelines</a> on how manage and plan end of life care for children. Scotland have also been developing an <a href="http://www.gov.scot/resource/0040/00408254.pdf" target="_blank">excellent one</a>.<br /><br />As healthcare professionals we really could do without all the blame and suspicion that is cast on us by paper of Gentlaman's Hatred. It gets in the way of good care when patients and relatives judge our actions based on lies and falsehoods that are propagated by those papers. The readers and writers of said newspapers looked at the loss of the LCP as some sort of victory for the common people, when it was anything but. It was the common people who lost out on a very effective, very good tool that was made for them. It's the common people that lost out. No one goes into healthcare with the thought of making money, they go into it for fulfilment of the job. But it's hard to do the job when writers who don't know anything about healthcare cast doubt and aspersions about your reasoning for being a nurse or a doctor. My job is hard enough as it is, please stop making it harder. I want to care for my patients, not for rumours.IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-17227395142552090092017-02-01T18:35:00.001+00:002017-02-01T18:35:45.505+00:00Metal Nurse: Physical health within mental health<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibYY-YRJFpRc-Tmtm-6KUhT_pCUW8fs5vL4pUQBIhdTMXHnYKwnjOQBMy_C028LzhQpSbEH0fdueiZT0-fNBFy8dMO16oz7fFdsaUB9ZZdpmguJssBkAi8zH22JbtHx1kDV4QKlwLnKRc/s1600/nursestation.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: inherit;"><img border="0" height="116" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibYY-YRJFpRc-Tmtm-6KUhT_pCUW8fs5vL4pUQBIhdTMXHnYKwnjOQBMy_C028LzhQpSbEH0fdueiZT0-fNBFy8dMO16oz7fFdsaUB9ZZdpmguJssBkAi8zH22JbtHx1kDV4QKlwLnKRc/s320/nursestation.png" width="320" /></span></a></div>
<span style="font-family: inherit;">One of the many healthcare areas that hold great interest to me is mental health. Prior to starting my nurse training I had worked in secure services mental health for 6 years. It was an eye opener. It was essentially what lead me to doing my general health training as opposed to mental health training. This article should tie with my previous article on <a href="http://ingvararni.blogspot.com/2016/09/metal-nurse-self-harm-and-suicide.html" target="_blank">self harm</a>. The focus here is of course on how patients physical health should also be the focus within a mental health setting. What was often not always noted is that physical health problems can manifest as mental health issues. For example infections can and do lead to <a href="http://patient.info/doctor/delirium-pro" target="_blank">delirium</a>, especially <a href="https://en.wikipedia.org/wiki/Urinary_tract_infection" target="_blank">Urinary Tract Infections</a>. Even <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017427/" target="_blank">constipation</a> will cause confusion and mood swings.<br /></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYreZTQV5slIgHL0O0tk8OVfjNzOQLzPGS_73OAmRTvjrQ3FKvQvLzB44oalR4hxBHhemfhMTF2IE3-Bd3noINr7tmgHRiGC10ldwtF0ZSaQ81W11xkL1yLNZkYUpmIOmqDo_qeoWpAHY/s1600/Quit-smoking-by-the-time-you%25E2%2580%2599re.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: inherit;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYreZTQV5slIgHL0O0tk8OVfjNzOQLzPGS_73OAmRTvjrQ3FKvQvLzB44oalR4hxBHhemfhMTF2IE3-Bd3noINr7tmgHRiGC10ldwtF0ZSaQ81W11xkL1yLNZkYUpmIOmqDo_qeoWpAHY/s200/Quit-smoking-by-the-time-you%25E2%2580%2599re.jpg" width="140" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="https://quitsmokingcommunity.org/" target="_blank"><span style="font-family: inherit; font-size: small;">Quitting Smoking</span></a></td></tr>
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<span style="font-family: inherit;">My main interest at the time though was the physical well being for those patients. The lack of physical health care for patients in long term mental health institutes has been <a href="http://apt.rcpsych.org/content/aptrcpsych/10/2/107.full.pdf" target="_blank">recognised for a long time</a>. Patients with <a href="http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/schizophrenia.aspx" target="_blank">schizophrenia</a> are for example known to die from natural causes sooner than <a href="http://bjp.rcpsych.org/content/177/3/212" target="_blank">the general public</a>. Hence the need for mental health nurses to be trained better in order to recognise and <a href="https://www.nursingtimes.net/roles/mental-health-nurses/call-for-mental-health-nurses-to-recognise-patients-poor-physical-health/5027416.article" target="_blank">tackle physical health issues</a>. The most common causes for the mortality rates are smoking and obesity.</span><br />
<br />
<span style="font-family: inherit;">The <a href="http://apt.rcpsych.org/content/6/5/327#sec-2" target="_blank">rates of smoking</a> are two to three times more common within patients who have schizophrenia than the general public, two out of every five cigarettes are smoked by people who suffer from mental health problems. And people who have <a href="http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/bipolardisorder.aspx" target="_blank">bipolar disorder</a> have also been known to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3729285/" target="_blank">2 to 3 times more likely</a> to smoke. Not only that but those with mental health problems <a href="http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/smokingandmentalhealth.aspx" target="_blank">smoke more</a> than the general public that smoke. So the dangers of smoking are enhanced and the importance of <a href="https://en.wikipedia.org/wiki/Smoking_cessation" target="_blank">smoking cessation</a> becomes even more important. The <a href="https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/" target="_blank">dangers of smoking</a> cannot be over stressed, and the <a href="http://www.nhs.uk/Livewell/smoking/Pages/Betterlives.aspx" target="_blank">benefits of quitting smoking</a> cannot be underlined often enough. According to a <a href="http://www.bmj.com/content/348/bmj.g1151" target="_blank">systematic review</a> by the <a href="http://www.bmj.com/company/" target="_blank">BMJ</a>, quitting smoking has not only physical health benefits but also mental health benefits. And that's across the board. Or as the meta-analysis says itself: </span><br />
<div style="text-align: center;">
<blockquote class="tr_bq">
<span style="font-family: inherit;">"<span style="background-color: #eeeeee; color: #333333;">Both psychological quality of life and positive affect significantly increased between baseline and follow-up in quitters compared with continuing smokers. </span> </span></blockquote>
<blockquote class="tr_bq">
<span style="font-family: inherit;"><span style="background-color: #eeeeee; color: #333333;">There was no evidence that the effect size differed between the general population and populations with physical or psychiatric disorders.</span><span style="background-color: #eeeeee; color: #333333;"> "</span> </span></blockquote>
<div style="text-align: left;">
<span style="font-family: inherit;">Essentially. Anxiety went down, depression went down and stress
all significantly decreased AFTER quitting smoking. Which all in all
just says to me that mental health care facilities should place a
<a href="http://www.ncsct.co.uk/publication_Smoking_cessation_and_Mental_Health_briefing.php" target="_blank">stronger focus on smoking cessation</a> then they already do. What should also be added is that if you are on medication for your psychiatric issues, you take less medication if you quit smoking. The <a href="http://www.psychiatrictimes.com/addiction/coffee-cigarettes-and-meds-what-are-metabolic-effects" target="_blank">reason being</a> is that <a href="https://www.ncbi.nlm.nih.gov/pubmed/11524025" target="_blank">smoking increases the body's metabolism</a> of most of those drugs. This is <a href="http://www.mdedge.com/currentpsychiatry/article/81961/practice-management/what-do-when-your-patient-who-takes-clozapine" target="_blank">especially apparent</a> in those who take <a href="https://en.wikipedia.org/wiki/Clozapine" target="_blank">clozapine</a>. For example when the <a href="https://en.wikipedia.org/wiki/Smoking_ban_in_England" target="_blank">smoking ban</a> came into effect within UK's mental health facilities the plasma serum levels went up, because of patients reduced smoking. But that often wasn't accounted for when considering the patients medication dosages.<br /><br />Quitting smoking isn't easy, I know that from personal experience, and in I would imagine that those who already have diagnosed mental health problems will find it more difficult hence the need for more robust support during the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249833/" target="_blank">smoking cessation</a>. Which also just brings the point that nurses should also work as role models in terms of their <a href="http://www.who.int/topics/health_promotion/en/" target="_blank">health promotion</a>. <a href="http://newsroom.ucla.edu/releases/new-ucla-study-reveals-smoking-71590" target="_blank">Seeing as there are so many</a> <a href="https://www.nursingtimes.net/nurses-health-study-shows-nurses-smoke-more-than-doctors/1934686.article" target="_blank">nurses that still smoke</a>. It is pretty difficult to provide good support if you aren't willing to seek out support for it yourself. We also have to smash the preconception that drinking coffee and smoking cigarette first thing in the morning is something that is okay, and think that it is a safe and effective way of getting someone to calm down when they are having a psychological breakdown. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298202/" target="_blank">Verbal de-escalation</a> works a lot better then the offer of a cigarette and a cup of coffee.<br /></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0UgNqVo4dXAxTVN_YPivcOzAmgsWgvRJjhdvhXAqodqFIchA_Q5Hw0aRA6PNUK5TR0MflxEK-smqAZzjiIVr0vOU4yv00k4ymvBqUDFdj8Y9QAchPnDYWZlq_6jpLBg76lAdHz7Rvxls/s1600/icn-food.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="185" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0UgNqVo4dXAxTVN_YPivcOzAmgsWgvRJjhdvhXAqodqFIchA_Q5Hw0aRA6PNUK5TR0MflxEK-smqAZzjiIVr0vOU4yv00k4ymvBqUDFdj8Y9QAchPnDYWZlq_6jpLBg76lAdHz7Rvxls/s200/icn-food.png" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="http://www.learnhowtobecome.org/make-a-difference-careers/obesity/" target="_blank">Learn How To Become...</a></td></tr>
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<div style="text-align: left;">
As mention previously <a href="https://en.wikipedia.org/wiki/Obesity" target="_blank">obesity</a> is the other big(no pun intended) issue for mental health patients. It is well known that certain psychiatric medication induce weight gain and in longer term <a href="https://www.oakwood.org/what-is-morbid-obesity" target="_blank">morbid obesity</a>. Obesity leads to several physical health related issues as well as <a href="https://www.mentalhelp.net/articles/psychological-consequences-of-being-overweight/" target="_blank">mental health</a>. This would include, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193776/" target="_blank">Type 2 Diabetes Mellitus</a>, <a href="http://stroke.ahajournals.org/content/44/1/278" target="_blank">Stroke</a>, <a href="http://circ.ahajournals.org/content/96/9/3248" target="_blank">Coronary Heart Diseases</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/17982356" target="_blank">Infertility</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866035/" target="_blank">Loss of Bladder Control</a>, and many many more.<br />
<br />
Regarding T2DM, it becomes a big issue within a hospital setting as often the health care staff looking after patients with diabetes sometimes <a href="http://www.priory.com/psych/hypg.htm" target="_blank">mistake hypoglycaemic</a> episodes with delirium or psychological breakdown, hence delay of proper treatment. With patients who suffer from schizophrenia they also often suffer from defective <a href="https://en.wikipedia.org/wiki/Impaired_glucose_tolerance" target="_blank">glucose tolerance</a> and <a href="https://en.wikipedia.org/wiki/Insulin_resistance" target="_blank">insulin resistance</a>. Which makes recognising diabetic crisis hard to tell from psychological crisis, for those who are not appropriately trained.</div>
<div style="text-align: left;">
<br />Then there the psychological issues. Being obese can lead to depression, anxiety, <a href="https://en.wikipedia.org/wiki/Body_dysmorphic_disorder" target="_blank">body dysmorphia</a>, low self esteem, and many more. Of course if you already do have those issues being obese will exacerbate those issues.<br />
<br />
Since weight gain is a <a href="http://onlinelibrary.wiley.com/wol1/doi/10.1111/j.1467-789X.2004.00141.x/abstract" target="_blank">very common side effect</a> of psychiatric medication, and well known by mental health care professionals, I do wonder why rolling out weight management plans alongside starting the drugs isn't done. Because <a href="https://www.nimh.nih.gov/news/science-news/2013/nih-study-shows-people-with-serious-mental-illnesses-can-lose-weight.shtml" target="_blank">losing weight is not an impossibility</a> like a lot of professionals seem to believe.<br /><br /> The medications will increase their appetite, but that is not the only reason for it. Whilst in a secure setting patients become more idle, and their diet intake tends to be very poor. I remember watching patients eating increbile amounts of takeaway foods, sweets and gulped vast quantities of soft drinks. But on the flip side I don't remember an awful lot of healthy food stuff being promoted, like the 5 a day fruit and veg intake.Or just the whole <a href="https://www.nhs.uk/change4life-beta/be-food-smart#efSaEiuifZqB6KUo.97" target="_blank">Change4Life</a> campaign. Or drink to water. Or even <a href="http://www.meatfreemondays.com/">Meat Free Monday</a>'s.<br /><br />In a <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1214530#t=article" target="_blank">large study</a> published by <a href="http://www.nejm.org/" target="_blank">NJEM</a>, it was shown that with the right plan and the right intervention, patients with serious mental health problems could lose weight and not just that but keep their weight down following lessening of weight loss sessions. Even with obstructions like hospital attendence's, breakdown in mental health and so forth. Of course like with smoking, it is sometimes <a href="https://www.ncbi.nlm.nih.gov/pubmed/18460166" target="_blank">hard for nurses</a> to be role models for life style changes when they also feel like they can't tackle the subject due to their own life style.<br /><br />All in all, what I personally would like to see more of is further physical health training for mental health nurses, and of course vice versa for general nurses. Because all training for either will only improve both professionals healthcare practice.</div>
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</style>IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com1tag:blogger.com,1999:blog-2425917353589217044.post-68868238505867303062016-10-07T17:39:00.001+01:002016-10-09T13:24:10.603+01:00Metal Nurse: The importance of the flu vaccine<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibYY-YRJFpRc-Tmtm-6KUhT_pCUW8fs5vL4pUQBIhdTMXHnYKwnjOQBMy_C028LzhQpSbEH0fdueiZT0-fNBFy8dMO16oz7fFdsaUB9ZZdpmguJssBkAi8zH22JbtHx1kDV4QKlwLnKRc/s1600/nursestation.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="72" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibYY-YRJFpRc-Tmtm-6KUhT_pCUW8fs5vL4pUQBIhdTMXHnYKwnjOQBMy_C028LzhQpSbEH0fdueiZT0-fNBFy8dMO16oz7fFdsaUB9ZZdpmguJssBkAi8zH22JbtHx1kDV4QKlwLnKRc/s200/nursestation.png" width="200" /></a></div>
<span style="font-family: inherit;">In my second year as a student nurse I decided to write a blog that pretty much transformed my musings from music to health care related stuff. It was about the <a href="http://ingvararni.blogspot.com/2014/01/student-nurse-perspective-flu-vaccine.html" target="_blank">flu vaccine</a>. I think it was pretty good and so did others, to the point where one of my favourite internet pages, <a href="http://www.skepticalraptor.com/skepticalraptorblog.php/" target="_blank">Skeptical Raptor</a>, <a href="http://www.skepticalraptor.com/skepticalraptorblog.php/student-nurse-perspective-flu-vaccine/" target="_blank">reblogged it</a>. <a href="https://twitter.com/sarah4irving/status/784055111597363200" target="_blank">So here I am</a>, nearly 2 years later having been qualified for over 18 months. Still having to refute <a href="http://www.npr.org/sections/health-shots/2014/10/10/354627818/32-myths-about-the-flu-vaccine-you-dont-need-to-fear" target="_blank">myths</a> about this vaccine. If you work in health care there is no good excuse to refuse the vaccine. You do not have an excuse. Lets begin with a few quotes from the <a href="https://www.nmc.org.uk/" target="_blank">NMC</a> <a href="https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf" target="_blank">Code of Conduct</a> from 2015:</span><br />
<span style="font-family: inherit;"><br /></span>
<br />
<ul>
<li><span style="font-family: inherit;">"Always practise in line with the best available evidence."</span></li>
</ul>
<ul>
<li><span style="font-family: inherit;">"Act without delay if you believe that there is a risk to patient
safety or public protection."</span></li>
</ul>
<ul>
<li><span style="font-family: inherit;">"Be aware of, and reduce as far as possible, any potential for
harm associated with your practice."</span></li>
</ul>
<ul>
<li><span style="font-family: inherit;">"Take all reasonable personal precautions necessary to avoid
any potential health risks to colleagues, people receiving
care and the public."</span></li>
</ul>
<span style="font-family: inherit;">Those are the points that I feel are the most important. </span><span style="font-family: inherit;"><br />And of course according to the <a href="http://www.gmc-uk.org/" target="_blank">GMC</a> <a href="http://www.gmc-uk.org/guidance/good_medical_practice/your_health.asp" target="_blank">Good Medical Practice</a>:</span><br />
<ul>
<li><span style="font-family: inherit;"> If you know or suspect that you have a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague. You must follow their advice about any changes to your practice they consider necessary. You must not rely on your own assessment of the risk to patients</span></li>
</ul>
<ul>
<li><span style="font-family: inherit;">You should be immunised against common serious communicable diseases (unless otherwise contraindicated).</span></li>
</ul>
<br />
<br />
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<tr><td class="tr-caption" style="text-align: center;"><a href="http://www.giantmicrobes.com/us/products/swineflu.html" target="_blank">Swine Flu plush toy</a>.</td></tr>
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<span style="color: #1d2129; font-family: inherit;">I would like to introduce the concept "<a href="http://rationalwiki.org/wiki/Post_hoc,_ergo_propter_hoc" target="_blank">Post hoc, ergo propter hoc</a>.". Translates as "after this, therefore, because of this.". Basically it is when you want to connect one event to another because of reasons to make the world seem like a logical place. You see a <a href="http://wiki.lspace.org/mediawiki/Quantum_weather_butterflies" target="_blank">butterfly</a>, then a thunderstorm happens. That kind of thing. It's not a very rational thinking process. </span><span style="color: #1d2129; font-family: inherit;">Okay, why am I talking about it here? One of the many many excuses I hear regarding the flu vaccine has</span><span style="color: #1d2129; font-family: inherit;"> </span><span class="text_exposed_show" style="color: #1d2129; display: inline; font-family: inherit;">been "My relative had the vaccine, then they ended up with a cold."</span><span style="color: #1d2129; font-family: inherit;"><br />One thing does not have to correlate with the other. Especially when the common cold is caused by </span><span style="color: black;"><a href="https://en.wikipedia.org/wiki/Coronavirus" target="_blank">coronaviruses</a></span><span style="color: #1d2129; font-family: inherit;"> and </span><a href="http://jid.oxfordjournals.org/content/195/6/765.full" target="_blank">rhinoviruses</a><span style="color: #1d2129; font-family: inherit;">. The flu is only caused by the </span><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504709/" target="_blank">influenza virus</a><span style="color: #1d2129; font-family: inherit;">. And the<a href="http://emedicine.medscape.com/article/219557-overview?pa=3WAacfgewnqEXS5EQ9b7MbVjfadEWEg4vv3aIajch6Updz7yawK9IpA46KWHJAedUlv7aktu%2BNqcAQJmcnSziuejCO3Rk4DWsD37DrSZWvU%3D" target="_blank"> flu kills</a>. On a </span><a href="http://www.who.int/mediacentre/factsheets/fs211/en/" target="_blank">regular</a> <a href="http://ecdc.europa.eu/en/healthtopics/seasonal_influenza/epidemiological_data/Pages/Annual-Epidemiological-Report.aspx" target="_blank">basis</a><span style="color: #1d2129;"><span style="font-family: inherit;">. According to </span><a href="http://www.who.int/" style="font-family: inherit;" target="_blank">WHO</a><span style="font-family: inherit;">, the flu kills between 250.000 and 500.000, every year. In England in 2013-2014 the <a href="https://www.gov.uk/government/organisations/public-health-england" target="_blank">Public Health England</a> recieved 904 <a href="https://www.gov.uk/government/news/public-health-england-and-the-nhs-prepare-for-unpredictable-flu-season" target="_blank">reports of patients</a> being admitted to ICU, out of those 98 died. That's a whopping 11% mortality rate. According to the <a href="http://ecdc.europa.eu/" target="_blank">European Centre For Disease Prevention and Control</a>, the season between 2014 and 2015:</span></span><br />
<br />
<ul>
<li><span style="color: #1d2129; font-family: inherit;">"</span><span style="color: #333333; font-family: inherit;"><span style="font-family: inherit;">In 15 European countries that report mortality data to the EuroMOMO project, an excess winter mortality rate of 231.3 per 100 000 above the seasonal baseline was observed. This excess was noted for more than 11 consecutive weeks and was the highest of the last five winter seasons."</span></span></li>
</ul>
<br />
<span style="color: #1d2129;"><span style="font-family: inherit;">No, the flu is not just a <a href="https://www.scientificamerican.com/article/cold-flu-difference/" target="_blank">bad cold</a>. It's a killer. But not just deaths that we should be concerned about it's the complications that follow having the flu, the complications that arise for those who suffer from chronic illnesses, like </span><a href="https://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease" style="font-family: inherit;" target="_blank">COPD</a> or <a href="https://en.wikipedia.org/wiki/Diabetes_mellitus" target="_blank">diabetes</a>.<span style="font-family: inherit;"> For those who have pre-</span>existing<span style="font-family: inherit;"> lung conditions, the flu is even more deadly. Not just deadly it also </span>exacerbates<span style="font-family: inherit;"> the disease and they rarely every recovered back to baseline. But it has been found that the vaccine <a href="http://www.cdc.gov/flu/about/qa/vaccineeffect.htm" target="_blank">reduces hospitalisations</a> of diabetics by 72%, and up to 52% of those who suffer from chronic lung disease. <a href="http://circ.ahajournals.org/content/105/18/2143.short" target="_blank">It reduces mortality</a> and ischaemic episodes in those who are recovering from angioplasty. It also prevents <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC387426/" target="_blank">cardiacvascular events</a>. Some of the rarer but also dangerous complications from the flu include:</span></span></div>
<ul>
<li><span style="color: #1d2129;"><a href="https://en.wikipedia.org/wiki/Encephalitis" target="_blank">Encephalitis</a>.<span style="font-family: inherit;"> </span></span></li>
<li><span style="color: #1d2129;"><a href="https://en.wikipedia.org/wiki/Meningitis" style="font-family: inherit;" target="_blank">Menigitis</a><span style="font-family: inherit;">.</span></span></li>
<li><span style="color: #1d2129;"><span style="font-family: inherit;"><a href="https://en.wikipedia.org/wiki/Guillain%E2%80%93Barr%C3%A9_syndrome" target="_blank">Guillan-Barre Syndrome</a>.</span></span></li>
</ul>
<span style="color: #1d2129;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082798/" style="font-family: inherit;" target="_blank">Influenza associated encephalopathy</a><span style="font-family: inherit;"> is a rare complications. But it does have up 30% fatality rate. It is most likely to affect babies from 6 to 18 months old. With one third of those affected will suffer from neurodisabilites. </span><br /><br /><a href="https://en.wikipedia.org/wiki/Viral_meningitis" style="font-family: inherit;" target="_blank">Meningitis</a><span style="font-family: inherit;"> is a complication that occurs due to a viral infection. The influenza virus being one of the more common virus that can cause it. </span><br /><br /><a href="http://www.ninds.nih.gov/disorders/gbs/detail_gbs.htm" target="_blank">Guillan-Barré syndrome</a>, has long been associated with the flu vaccine. But there is a story behind that. All in all it's the story that sort of defines everything about science, how science develops knowledge and improves on what it knows and continues to define how we as healthcare professionals should follow the evidence. In 1976 there was a case of where it was linked to the flu vaccine, so researchers concluded that there might be a <a href="https://www.ncbi.nlm.nih.gov/pubmed/19388722" target="_blank">casual link </a>between then the swine flu vaccine and GBS. The most <a href="http://cid.oxfordjournals.org/content/57/2/197" target="_blank">current research</a> fails to find any link between them. If you get infected by the flu you are at an <a href="http://cid.oxfordjournals.org/content/48/1/48.full" target="_blank">increased risk</a> of developing Guillan-Barré Syndrome, <a href="http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(13)70104-X/abstract" target="_blank">17 times</a> more likely to develop it in fact.<br /><span style="font-family: inherit;"><span style="font-family: inherit;"><br /></span></span></span><br />
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<a href="http://i.imgur.com/NAJE0d0.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://i.imgur.com/NAJE0d0.png" height="200" width="136" /></a><span style="color: #1d2129;"><span style="font-family: inherit;"><span style="font-family: inherit;"></span></span></span></div>
<span style="color: #1d2129;"><span style="font-family: inherit;"><span style="font-family: inherit;">But why do I rail against health care staff who refuse to be vaccinated. Simple. We take care of acutely ill </span></span></span><span style="color: #1d2129;"><span style="font-family: inherit;">patients. We are around them all the time. We take care of people who are infected with some nasty nasty illnesses. One in three people who get infected by this virus are </span><span id="goog_52497383"></span><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646474/" target="_blank">asymptomatic</a><span style="font-family: inherit;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646474/" style="font-family: inherit;" target="_blank"> carriers</a><span id="goog_52497384" style="font-family: inherit;"></span><span style="font-family: inherit;">. So the danger of </span></span></span><span style="color: #1d2129;"><span style="font-family: inherit;"><span style="font-family: inherit;">infecting those who are vulnerable increases. Because you can pass on the virus </span><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646474/" style="font-family: inherit;" target="_blank">without ever showing</a><span style="font-family: inherit;"> symptoms yourself. It is infectious for at least 24 hours prior to any symptoms developing and is infectious <a href="http://www.cdc.gov/flu/about/disease/spread.htm" target="_blank">5-7 days during the infection</a>. Which is why </span><a href="http://vk.ovg.ox.ac.uk/herd-immunity" style="font-family: inherit;" target="_blank">herd immunity</a><span style="font-family: inherit;"> is so important, or </span><a href="http://www.communityimmunity.com.au/" style="font-family: inherit;" target="_blank">community immunity</a><span style="font-family: inherit;"> for those who like concepts that rhyme. In a nutshell <a href="http://cid.oxfordjournals.org/content/52/7/911.full" target="_blank">herd immunity</a> is where there is enough people vaccinated against a contagious diseases to protect those who cannot be vaccinated and/or are vulnerable to disease that are easily spreadable. And (I will be repeating this point) healthcare professionals are a big part of that <a href="http://cid.oxfordjournals.org/content/52/7/911.full" target="_blank">herd</a> (or community) in hospitals. This is important to remember, there are people who rely on this. And all of </span></span></span><span style="color: #1d2129;"><span style="font-family: inherit;"><span style="font-family: inherit;">them </span></span></span><span style="color: #1d2129; font-family: inherit;">will be in our care. The list includes:</span><br />
<span style="color: #1d2129;"><span style="font-family: inherit;"></span></span><br />
<ul>
<li><span style="color: #1d2129;"><span style="font-family: inherit;"><a href="http://www.webmd.com/cold-and-flu/flu-guide/fact-sheet-elderly-people" target="_blank">Elderly</a></span></span></li>
<li><span style="color: #1d2129;"><span style="font-family: inherit;"><a href="http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/infectionsinpeoplewithcancer/should-i-get-a-flu-shot" target="_blank">Patients who are undergoing chemotherapy</a></span></span></li>
<li><span style="color: #1d2129;"><span style="font-family: inherit;"><a href="http://www.cdc.gov/flu/protect/hiv-flu.htm" target="_blank">Patients with HIV</a></span></span></li>
<li><span style="color: #1d2129;"><span style="font-family: inherit;"><a href="http://www.immunize.org/catg.d/p4047.pdf" target="_blank">Patients without</a> a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775097/" target="_blank">fully functioning immune system.</a></span></span></li>
<li><span style="color: #1d2129;"><span style="font-family: inherit;">Patients who are <a href="https://www.ncbi.nlm.nih.gov/pubmed/19822627" target="_blank">acutely ill in hospital.</a></span></span></li>
</ul>
<span style="color: #1d2129;">The list is of course not exhaustive.<br /><br />Most healthcare workers seem to have no objections to vaccinating against other illnesses, like <a href="https://en.wikipedia.org/wiki/Measles" target="_blank">measles</a> or <a href="https://en.wikipedia.org/wiki/Hepatitis_B" target="_blank">hepatitis B</a>. But somehow they seemed to have this blind spot when it comes to the flu vaccine.</span><br />
<span style="color: #1d2129; font-family: inherit;">The </span><span style="background-color: white; color: #1d2129;"><span style="font-family: inherit;">"I've never had the flu, so I don't need the vaccine" excuse doesn't work. For the same reason as "I never got pregnant, so I don't need contraceptives." Or "I've never been in a car crash, so I don't need a seat belt." Don't work. I've never had hepatitis B, you can be sure that I'd have that vaccine again. Same goes for all of them. </span></span><span style="font-family: inherit;"><span style="background-color: white; color: #1d2129;">I've never had Tetanus, but you can bet your bloody arse that I'd get the Tdap if I've had a serious cut when walking around mother nature. </span><span style="background-color: white; color: #1d2129;">I've never had Yellow Fever, Typhoid, Cholera, Japanese Encephalitis or Hepatitis A but yes I'd have that vaccine if I was travelling to those countries where they are prevalent.</span></span><br />
<span style="color: #1d2129;"><br /></span><span style="color: #1d2129;"><span style="font-family: inherit;">And honestly I struggle to understand why, most of the time I think it is purely out of sheer bloody mindedness rather than actual facts. Some people see it as a form or rebellion against a higher authority. It's one small needle. Once a year. And it's there to protect us, our loved ones and those who we are taking care of. There is not beating around the bush about this. At worst we will get a sore arm, 24 hours sniffles and an immune system that will know how to battle the flu. <a href="http://www.health.harvard.edu/diseases-and-conditions/10-flu-myths" target="_blank">It's a myth</a> that you get a cold after a vaccine and it's a myth that healthy people don't need a vaccine.</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgu9AeinbXbjZ6wik-R5vSqmNIwYIowXQVkMwIAYPFejy5D5hrKjgMbXh8x9yA65EUwYyUj2TLAksV8cMTqbYEVnD-XtcPySqBajstn-jkSf9c4jMkImmydiUxd-DxydAVHxwv-VkCdiZ8/s1600/shame.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgu9AeinbXbjZ6wik-R5vSqmNIwYIowXQVkMwIAYPFejy5D5hrKjgMbXh8x9yA65EUwYyUj2TLAksV8cMTqbYEVnD-XtcPySqBajstn-jkSf9c4jMkImmydiUxd-DxydAVHxwv-VkCdiZ8/s200/shame.png" width="136" /></a></div>
<span style="color: #1d2129;">I have come across people who just flat our state "I don't agree with it." What is there not to agree with? It's a low risk thing to do. Even young health people have <a href="http://www.cdc.gov/media/releases/2014/p0220-flu-report.html" target="_blank">died from the flu</a>. In fact if you look at the greatest epidemic in human history, the Spanish flu, <a href="http://www.flu.gov/pandemic/history/" target="_blank">majority of those who died were aged between 20-50</a>. The more I listen to people who object to it, the more I get convinced that it should be <a href="http://cid.oxfordjournals.org/content/50/4/459.long" target="_blank">mandated as a requirement</a> to work in healthcare, like they do in America. Require those who don't vaccinate to <a href="http://www.medscape.com/viewarticle/812959" target="_blank">wear masks</a> if necessary. We are there to take care of the patient. Not our ego. Our egos will heal, some of our patients might not because of ill-thought out refusals.<br /><br />"What about my right to refuse?" Well, what about it. Yeah, sure you do have the right to refuse it. But what about the right of the patient to be taken care of by someone who works within evidence based practice? What about the right of the patient to be taken care of by someone who takes every step to make sure that THEIR health and well-being is the centre of their care?<br /><br />Is the vaccine perfect? No, sadly it isn't. But it still offers the best protection available. Currently it offers between <a href="http://www.cdc.gov/flu/about/qa/vaccineeffect.htm" target="_blank">50% and 60% protection</a>, which is damn sight better than 0%. Though currently there are some great developments in terms of developing a <a href="http://medicalxpress.com/news/2016-10-closer-universal-flu-vaccine.html" target="_blank">universal flu vaccine</a>. The issue is that there is <a href="http://cid.oxfordjournals.org/content/33/11/1879.full" target="_blank">more money for pharmaceutical companies</a> in people getting ill with the flu, rather than the vaccine. But as an organisation like the NHS, we save money on people getting the vaccine. There is a reason why every medical organisation in the world recommends that their staff have the annual flu vaccine. And it's all about protection.<br /><br /><a href="http://www.livescience.com/40279-flu-shot-information.html" target="_blank">Are there complications</a> with the vaccine? Certainly, but they are rare. Redness, soreness and localised swelling are most common. 1-2% of those who get the vaccine might get a fever. Rarer side effects include hives, urticaria, racing heart and high fever. Anaphylaxis might occur in 1 case per million doses given. But </span><span style="color: #1d2129;">compared to the </span><a href="http://www.webmd.com/cold-and-flu/flu-statistics" target="_blank">chances of getting the flu</a><span style="color: #1d2129;">, I'd rather have the vaccine.</span><br />
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<span style="color: #1d2129;"><br />We are there to take care of and protect our patients from harm. We barrier nurse them. We gown up and use face masks when needed. We use gloves, we wash our hands. We give intravenous antibiotics and anti-virals. But a small needle that will protect you from a dangerous disease is somehow a step too far? Really? </span><br />
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IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.comtag:blogger.com,1999:blog-2425917353589217044.post-77562527714968177362016-09-29T14:20:00.003+01:002016-09-29T15:11:44.153+01:00Metal Nurse: Sexual Health Care for the Older Generation<div class="separator" style="clear: both; text-align: center;">
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Everybody likes sex. Everybody likes to read up on sex. Everyone should have sex. On some level we should be more open about talking about sex. In recent years we also have been able to open up about one ageing taboo: <a href="https://theconversation.com/the-secret-sex-lives-of-older-people-that-can-make-us-rethink-our-idea-of-intimacy-47329" target="_blank">Old people having sex</a>. Now, it's is something that needs to be tackled but no one really wants to talk about it. Why? Well, who wants to imagine their parents having sex? I don't. I am pretty sure that my kids don't either. But it is quite frankly beautiful to know of, that people in their twilight years are still enjoying themselves. More and more people seem to be enjoying their retirement age having <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2524.2001.00285.x/full" target="_blank">lots and lots of sex</a>. And who can blame them? Now that it's all out in the open the next thing we have to discuss is <a href="http://www.ageuk.org.uk/latest-news/archive/rise-in-stis-among-over-50s/" target="_blank">the rise of STD's</a> in the <a href="http://theeroticsalon.com/blog/sti-rising-among-sexually-active-older-adults/" target="_blank">50+ population</a>.<br />
<br />
During my university years I volunteered in the Chlamydia Screening project which was part of <a href="http://www.best2know.co.uk/" target="_blank">Best2Know</a>. So I got to know about how <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/437433/hpr2215_STI_NCSP_v6.pdf" target="_blank">common STD's</a> are in the university student population. There's a big focus in getting the 18-24 to get tested for chlamydia and give free condoms in order to stave infections. It was interesting and fun to assist with, but since most of the people I take care of are a lot older, I started wondering how common STD's are in that age group. Turns out it is <a href="http://www.ncbi.nlm.nih.gov/pubmed/21165756" target="_blank">quite a lot</a>. I had read that currently the over 55's are <a href="http://abcnews.go.com/Health/MindMoodNews/swinger-shock-older-swingers-high-risk-stds/story?id=10996369" target="_blank">second highest group</a> in terms of increase in new <a href="https://www.stdcheck.com/blog/std-and-sti-whats-the-difference/" target="_blank">STD's</a> diagnoses.<br />
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><span style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><a href="http://www.fpa.org.uk/middle-age-spread-stis-over-50s/campaign-posters" target="_blank"><img border="0" src="http://www.fpa.org.uk/sites/default/files/sexual-health-week-2010-poster-woman-in-mac-large.jpg" height="200" width="141" /></a></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="http://www.fpa.org.uk/middle-age-spread-stis-over-50s/campaign-posters" target="_blank">Middle Aged Spread</a></td></tr>
</tbody></table>
So now that we've managed to open the discussion about older <a href="https://theconversation.com/the-secret-sex-lives-of-older-people-that-can-make-us-rethink-our-idea-of-intimacy-47329" target="_blank">adults having sex</a>. Maybe we should start talking about contraception with the elderly. Some survey's done show that a lot of those who are still sexually active do want to find out <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2524.2001.00285.x/pdf" target="_blank">more about STD's</a>, but often don't feel like that can. In recent years cases of STD's has rise in the population aged 50 and over. According to the <a href="http://www.cdc.gov/" target="_blank">CDC</a>, <a href="https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiey-PmsrTPAhUhKMAKHXkrCxgQFgg_MAE&url=https%3A%2F%2Fen.wikipedia.org%2Fwiki%2FHIV&usg=AFQjCNHWy-dhkvjAstTCH5-L6nz2aP-VSg&sig2=-tbq_JDdGkO8k7JMKEEhlw" target="_blank">HIV</a> alone as increased by 15% from 2000 to 2010 in that particular age group. <a href="https://en.wikipedia.org/wiki/Syphilis" target="_blank">Syphilis</a> has been on the rise again, even though you would have thought that that one was gone the way of the smallpox. Gonorrhea and chlamydia have both seen <a href="http://webarchive.nationalarchives.gov.uk/20140714084352/http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1215589014186" target="_blank">big increases</a> in the older generation. Now the issue we have with these numbers is because it is based on people who seek treatment, so there is a big danger that the number of infected individuals is much higher.<br />
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But why is this an issue? People of that generation tend to not want to talk about it. Unless it's about bragging rights, they like to talk about being in a new relationship. But don't want to talk about the potential consequences of being in a new relationship. With a partner they might not know the past sexual history off. Women in particular after menopause think that they won't need contraceptives like the condom because they won't get pregnant. But condoms are not just there to prevent pregnancy, they are the <a href="https://www.nichd.nih.gov/health/topics/contraception/conditioninfo/Pages/std-prevention.aspx" target="_blank">ONLY contraceptive</a> on the market that prevents STD's. And you are<a href="https://www.youtube.com/watch?v=XBNldAMWW64" target="_blank"> never too old</a> to use a condom. Maybe the conversation needs to be about how to <a href="https://theconversation.com/how-to-get-more-men-using-condoms-put-the-pleasure-back-into-sex-44275" target="_blank">use them correctly</a>. Because it is a myth that sex is less <a href="http://www.medicaldaily.com/sex-myth-busted-condoms-dont-take-away-bedroom-pleasure-244373" target="_blank">pleasurable with a condom</a>, but this <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302567" target="_blank">myth persists</a>. Besides this generation is the one that grew up with the contraceptive pill, so the talk for condoms most likely didn't happen, and research has shown that those <a href="http://health.usnews.com/health-news/family-health/sexual-and-reproductive-health/articles/2010/10/04/condom-use-lowest-among-adults-over-40" target="_blank">over 40 are less likely</a> to use condoms. Mostly I'd imagine it is because they are just so damn embarrassed about it, they shouldn't be. They've been given a new lease of life. You can get <a href="https://en.wikipedia.org/wiki/Sildenafil" target="_blank">Viagra</a> pretty easily (just don't buy them online) to help with erections, lubricants to help with vaginal dryness and meeting new people has never been easier thanks to the internet.<br />
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What would help, as we open up and talk more often course, is if doctors and nurses started incorporating sex education into our <a href="https://www.ncbi.nlm.nih.gov/pubmed/21839545" target="_blank">health promotion</a>. Or maybe GP's could include <a href="https://www.ncbi.nlm.nih.gov/pubmed/24517714" target="_blank">sexual health checks</a> with their annual physical assessments. Especially if we suspect that some individuals are practising unsafe sex. Maybe it's time to introduce <a href="https://www.ncbi.nlm.nih.gov/pubmed/25544829" target="_blank">sex education for over 50's</a>, there is plenty of focus on sex education with teenagers. But in reality how much do adults know about safe sex? Should we really presume that as people get older the stop enjoying sex altogether? The urge to have sex might decrease but that is not the same as stopping altogether. It isn't just infectious diseases that they could discuss, this could be incorporated with talking about erectile dysfunction and vaginal dryness. What medication they could take to alleviate those symptoms and/or what medication they are taking could cause those symptoms. Because I don't don't know how often those side effects are discussed or even contemplated when new medication is being prescribed to patients. Us health professionals also have to do our bit and confront our fears and prejudice regarding sexual health, especially with people who are old enough to be our parents.<br />
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The focus on safe sex campaigns and use of contraception has been always on the younger age group, if only because they remain the group that contract most STD's on the <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/534601/hpr2216_stis.pdf" target="_blank">most frequent basis</a>. They tend to also be the most likely to seek out help if/when they are aware that there is a problem with their genitalia. They get free chlamydia screening kits and they get free condoms given on a regular basis. The other reason of course why the focus has been on this group is because they will hopefully be paying taxes for a long time, well up until they reach retirement age, and have children. But they won't be able to do any of that if they don't get their various STD's sorted and treated quickly. Because the <a href="https://www.ncbi.nlm.nih.gov/books/NBK232938/" target="_blank">economical factor of neglected cases</a> is immense. The other reason why the focus is on the younger age group is because some STD's like the <a href="https://en.wikipedia.org/wiki/Human_papillomavirus_infection" target="_blank">Human Papillomavirus</a>, if left untreated, can lead to people <a href="https://en.wikipedia.org/wiki/Human_papillomavirus_infection#Cancer" target="_blank">developing assorted cancers</a>. <a href="http://www.who.int/mediacentre/factsheets/fs380/en/" target="_blank">Up to 70% of cervical cancers</a> have been attributed to an chronic and untreated HPV infection. Up to 25% of <a href="https://en.wikipedia.org/wiki/Oropharyngeal_cancer" target="_blank">oropharyngeal cancers</a> have been linked to HPV. But of course the problem doesn't just lie with cancer. Then there is also the cases of infertility, because fertility treatments are <a href="http://ivf.org.uk/about-us/fertility-treatment-prices" target="_blank">extremely expensive</a> and time consuming.<br />
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Then there is the issues of <a href="https://en.wikipedia.org/wiki/Differential_diagnosis" target="_blank">differential diagnosis</a>. With all this in mind various <a href="http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=23" target="_blank">STD's</a> should be considered as such. <a href="http://emedicine.medscape.com/article/218059-differential" target="_blank">Gonorrhoea</a>, <a href="http://emedicine.medscape.com/article/214823-differential" target="_blank">Chlamydia</a> and <a href="http://emedicine.medscape.com/article/229461-differential" target="_blank">Syphilis</a>, all have various signs and symptoms that go with other diagnoses.<br />
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But why neglect those over 50's? Because as the populace get older they will need more treatment for long-term illnesses, and adding something that can be both treated and prevented so easily into the mix is just going to cost the society more. As <a href="http://www.kingsfund.org.uk/" target="_blank">The Kings Fund</a> has pointed out, patients with long term conditions could cost the UK an additional <a href="http://www.kingsfund.org.uk/time-to-think-differently/trends/disease-and-disability/long-term-conditions-multi-morbidity" target="_blank">£5 billion by 2018</a>. So why add untreated STD's into the mix?<br />
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<br />IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-72021306660460378302016-09-27T13:43:00.000+01:002016-09-29T14:37:47.510+01:00Metal Nurse: Self Harm and Suicide Attempts<div class="separator" style="clear: both; text-align: center;">
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This isn't a topic that I read an awful lot about until relatively recently. Maybe it's because I've got two daughters and I worry about their well-being especially seeing as one of them is approaching the age where self harming is most common. Maybe it's because as I get older I meet more people who have self harmed one way or another. Whilst this article will mostly focus on self-harm, I will also touch base on suicide attempt since they often overlap. And because of having a <a href="http://ingvararni.blogspot.com/2013/10/time-doesnt-heal-all-wounds.html" target="_blank">personal history</a> of it.<br />
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According to a report by <a href="http://www.hbsc.org/" target="_blank">Health Behaviour in School-Aged Children</a> up to 1 in 5 children aged 15 self harm and a large proportion of those are girls. That's not to say that boys don't self harm, they do. But either they are less willing to admit to do doing do or they do in a way that most people don't consider to be self harming. We still don't expect boys to be as emotional mature as girls, so there might be a case of easy dismissal when they feel the need to offload their burdens but can't because they are boys. And boys don't <a href="https://theconversation.com/why-boys-need-to-have-conversations-about-emotional-intimacy-in-classrooms-54693" target="_blank">talk about feelings</a> instead they <a href="http://www.independent.co.uk/voices/male-suicide-is-a-public-health-crisis-so-why-are-we-still-ignoring-it-a6737681.html" target="_blank">commit suicide</a>.<br />
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My interest in writing this particular article was not so much the self harming itself, but the attitude I have come across. The attitude that self-harming is somehow all about attention, that people who attempt suicides are just time wasters, essentially that people who suffer from various mental health issues do not deserve medical treatment. The problem with that attitude is that it invalidates how these patients feel. They need help, we might not always be able to provide that help, but what we should be able to provide them with is environment that feels safe. Where they feel not so much like a burden, somewhere where they don't feel judged by their actions and decisions. As healthcare professionals we are not only responsible for our patients physical well-being but also their emotional well-being.<br />
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<tr><td class="tr-caption" style="text-align: center;">Quote from <a href="http://goo.gl/V0euAU" target="_blank">Mind</a></td></tr>
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So maybe if we start with the basics.<br />
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What is self harm? <br />
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It's a fairly self-descriptive phrase. But for those who need it said, it is the act of harming oneself. Self-harm can come in form of intentional overdose, harming yourself by cutting, burning and punching yourself. There are of course other more subtle ways of harming yourself, for example by starving yourself, over eating, practising unsafe sex, binge drinking, etc.<br />
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<tr><td class="tr-caption" style="text-align: center;">Self harm cycle</td></tr>
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We also have to remember is that people who do self-harm are not doing so in order to commit suicide. In most cases this is to assist them with coping with their heightened emotional states. It is a form of distraction. It is a way of coping. It can also be looked as an act of self-preservation, as some people do it as an emotional release.<br />
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Bear in mind is that self-harming is usually an indication of a problem rather then the problem. It is mostly a manifestation of that persons personal circumstances, whether they are under unusual amount of stress, depression, past abuse, some form of past trauma, neglect, loss, etc, the list is pretty endless. It is essentially a cycle of self torture. Some people use it as self punishment for when they feel they have done something wrong to someone else. Some patients also plan on their self harm, whilst others do it more spontaneously. <br />
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Why do people self harm?<br />
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Now then, this is were it gets a little trickier. And for some a little harder to understand. As I mentioned previously, it is essentially a way to cope with external circumstances and internal turmoil. For some it is a form of release. Like opening up a valve full of pent up rage, stress, self-doubt and so on. Others have said that it makes them feel more alive after feeling numb for so long. That the negative emotions they were experiencing before a self harming <a href="http://www.sciencedirect.com/science/article/pii/S0272735806000961" target="_blank">incident was reduced</a>. For others it feels like the only aspect that they can control in their lives, when there are issues occurring that they feel is out of their control. For some it feels like the closest they can do to suicide without dying, a form of prevention so to speak. These individuals might be feeling low, and do not know how else to cope with pressures that are surrounding them. Whether it's due to social pressure, family, education, etc. There will always be outside stress factors that will contribute to a person self-harming.<br />
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How common is self harm?<br />
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Well. That is something that is pretty hard to put a finger on. It is in the top five of reasons for acute medical admissions, with <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2010.01600.x/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=" target="_blank">over 150,000 attendances per year</a>. The exact figure of how many people self harm is hard to find out, most studies have been done in form of survey's and questionnaires after an admission to hospital due to self harming and/or attempted suicide. But the <a href="http://www.rcpsych.ac.uk/default.aspx" target="_blank">Royal College of Psychiatrists</a> put the figure somewhere around 400 in 100,000. According to the RCPsych people of all social groups and all ages engage in self-harm and/or suicidal behaviour, but teenagers, veterans and prisoners are at particular risk.<br />
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In America for example the suicide rate amongst 15-19 year old has doubled since the 1960's, in the UK self-harm is largest cause of <a href="http://www.thelancet.com/commissions/adolescent-health-and-wellbeing" target="_blank">death amongst 20-24 year olds</a>. As I stated earlier, girls are more likely to self-harm and contemplate about suicide. But boys are more likely to commit suicide. Sadly some research from Australia has shown that the younger the patient who presents with self harm and/or suicide ideation, the lower priority they are given compared to those who are aged <a href="http://www.ncbi.nlm.nih.gov/pubmed/24175184" target="_blank">between 35-44</a>, this is broken down even more in terms of method. Patients who self harmed with blades are deemed as less of an emergency compared to those who expressed the idea of self harming, with a greater preference also being given to male patients.<br />
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What can be done?<br />
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There is plenty of improvement that needs to be done regarding the care of patients who present with self-harm. Generally the lack of documentation is pretty shocking to start with. In 2009 a <a href="http://www.ncbi.nlm.nih.gov/pubmed/21057397" target="_blank">small retrospective study</a> pulled 25 patient records from various A&E. These patients had presented into Emergency Departments with self harm. None of those records had documented mental state examinations. Suicide risk and risk factors had either been poorly documented or not at all. So obviously documentation needs to be improved upon, but mostly what is probably more important in my opinion is to raise the staffs awareness of the importance of those details. Yes, some of these patients will be calling for help and that is something that should not be ignored. Why are they crying for help? What is their story? What has lead to them presenting with self harm and/or suicide attempt? <a href="https://www.nice.org.uk/" target="_blank">NICE</a> provide excellent <a href="https://www.nice.org.uk/guidance/qs34" target="_blank">guidelines</a> on initial management of patients who present in A&E with self harm. Which includes assessment of physical and mental health well-being, as well as safeguarding status. To be taken to a place of safety, or at least taken care of in a place of safety.<br />
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The biggest difference we can make is not to take self harm lightly. Which is what majority of these patients <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2010.01600.x/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=" target="_blank">express their disappoint</a> about. We need to <a href="https://www.youtube.com/watch?v=TYgxqnJPkFw" target="_blank">stop, look and listen</a>. But it is getting harder and harder to give these patients the treatment they need and deserve. Funding for Mental health services continue to be <a href="http://www.huffingtonpost.co.uk/entry/government-to-slash-mental-health-funding-again-figures-show_uk_57e29667e4b004d4d8618eb3?" target="_blank">cut down</a>. Waiting time for counselling is <a href="https://www.theguardian.com/society/2014/jan/19/mental-therapy-waiting-times-concern" target="_blank">sadly going up</a>. According to <a href="https://www.mind.org.uk/media/280583/We-Need-to-Talk-getting-the-right-therapy-at-the-right-time.pdf" target="_blank">this report</a> by <a href="http://www.mind.org.uk/" target="_blank">MIND</a>, 1 in 5 have been waiting for over a year to receive some sort of treatment and 1 in 10 have waited for over 2 years. This is not acceptable. As general nurses who work in A&E and Medical Assessment Units, we do not get enough time to help. Generally we end up taking care of up to eight patients, each who have varying degrees of <a href="http://www.americansentinel.edu/blog/2014/02/05/using-patient-acuity-to-determine-nurse-staffing/" target="_blank">acuity</a>. Most of the time we end up neglecting those with mental health problems because they appear physically healthy.<br />
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If in our care what we can do, or at least should make an attempt to is to talk. I know I keep on repeating myself. But this is important. If they don't want to talk, but want to continue self harm instead, with blades for example. Then at the very least we should be able to make sure that they use clean blades and have equipment ready to clean their wounds and put on clean dressings on. Teach them how to dress the wounds properly. Teach them how to perform first aid. Provide them with a safe space. And then be available to talk, or make sure there is someone there that they can talk to and/or want to talk to. We can provide paper and pens if that helps, so that they can write out their thoughts and frustrations. We can provide a marker pen for them to use on their skin instead of a blade. We can give them ice cubes, elastic bands, etc etc. If we can't <a href="http://www.rcpsych.ac.uk/pdf/self-harm%20distractions%20and%20alternatives%20final.pdf" target="_blank">prevent the damage</a>, <a href="http://www.rcpsych.ac.uk/pdf/Self-harm%20-%20%20Limiting%20the%20Damage%20Final.pdf" target="_blank">we should limit it</a>.<br />
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In recent years we have become very good at bereavement and know who to contact for those type of situations. We have become very good at comforting relatives when we know that that their loved ones are getting closer to leaving the realm of the living. But we haven't become so good at referring people to counselling, there doesn't seem to be a way to refer patients straight from ED or Medical Assessment straight to counselling. Or <a href="http://www.iapt.nhs.uk/" target="_blank">IAPT</a>. We also either deny ourselves the time or just plainly don't have the time to sit down and talk to them. What they do get often is a referral to mental health services, they get to speak to mental health practitioners about their initial problems. But then they get put on a waiting list. And more often than not, they return. And they return again. And in the long term if this cycle isn't stopped will lead to <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001931" target="_blank">more potentially preventable deaths</a>.<br />
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<tr><td class="tr-caption" style="text-align: center;">Taken from <a href="http://www.sane.org.uk/" target="_blank">SANE</a></td></tr>
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The point is that we shouldn't judge people because they self-harm, because we don't know what lead to that decision. We don't know what kind of experiences would lead to someone to put a knife on themselves and slice over and over again, or take XX amount of paracetamol, or stub out cigarettes on themselves. As nurses it is not for us to decide that they are weak, or seeking attention. In fact if they are seeking attention then we should do our best and find out why they are doing so. We are there to assist people at their weakest moment, whether that be physical or mental. We are there to care for those who need it. We are there to support and hopefully heal our patients.<br />
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<br />IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-27484435540190707312016-09-17T16:44:00.001+01:002016-09-20T07:22:42.311+01:00Life was not always better.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq4RYpNY5si5A7nw3nHU9TryUCoXWC5QOmUmd37WgYAMi5guCfsol-WfH20Cv2U_ysn0V7xhB93ooin8QXMRUNQtDG-yyoKFozjls2AfMAnGh1aE4VkVtSJaW6xbrt5uszDuhRHUlyNHQ/s1600/WP_20160912_12_43_51_Pro.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq4RYpNY5si5A7nw3nHU9TryUCoXWC5QOmUmd37WgYAMi5guCfsol-WfH20Cv2U_ysn0V7xhB93ooin8QXMRUNQtDG-yyoKFozjls2AfMAnGh1aE4VkVtSJaW6xbrt5uszDuhRHUlyNHQ/s200/WP_20160912_12_43_51_Pro.jpg" width="112" /></a></div>
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Me and me other half went for a bit of a walk not that long ago. During that walk we decided to have a walk through one of the cemeteries in Lancaster. Don't judge, we just wanted to have some romantic Gothic time.</div>
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I find it fascinating walking through some of these cemeteries. The information you can get just glancing at some of the headstones is pretty interesting. Especially when you find head<span class="text_exposed_show" style="display: inline;">stones like this one. Listing 4 children that died before reaching their second birthday. </span></div>
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This used to be the reality not that long ago. Couples would have hordes of children. In the hope that at least some of those would reach adulthood. And this is still the reality in certain areas of the world.</div>
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Today this isn't the reality. Today the reality is that we have 2 sometimes 3 children and we can be pretty damn certain that they will reach adulthood. Go to university, get married, have children of their own, get divorced and hope for grandchildren of their own. </div>
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And why is this? Well there are few factors. The biggest ones being improved healthcare. Both public and private. We have vaccines for illnesses that used to maim and/or kill children in their droves. We have antibiotics. We have ventilators. We have bronchodilators. We have defibrillators. We have radiotherapy. We have chemotherapy. We have insulin! We have some of the most amazing medicine in history that ever existed. With more on their way. </div>
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We have more food today thanks to modern agriculture and genetic modifications. We can now feed more then we ever could. Thanks to lest pesticide usage. Thanks to being able to use less space that grows more per acre.<br />
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Public sanitation is of course miles better than it used to be. Again, thanks to modern technology and science. Drinking water is safer and better than it used it be.<br />
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Dentistry is at it's best today. With fluoridation of water and more. </div>
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And yet... And yet we have people who want to demonise today's technology. In some cases they actively campaign against them, and want to make sure that less fortunate countries don't get them. They somehow think that everything was nice and rosy in the old days. That everything was so much better in the days before modern technology.<br /></div>
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No, it was not. Life was dirty and short. You died. And you died horribly.</div>
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Vaccines save lives. Medicine save lives. GM technology save lives. Hippies and luddites don't.</div>
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IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-50488879907406187302016-09-14T18:59:00.001+01:002016-09-14T18:59:31.820+01:00A cult is a cult is Soka Gakkai<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQfe4Pp7BEmZewPNnZqjXak15JJJ8-jmvHcgqwxfosUExKQrtviWZbJGh111lFFCcm5Rhej0cek6yXbLOPcLozfuK-S6xGbjEikz5Bvpwu4DRdMMOm1rQck_StAigUCXfiugCFjRmhae0/s1600/image+%25281%2529.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQfe4Pp7BEmZewPNnZqjXak15JJJ8-jmvHcgqwxfosUExKQrtviWZbJGh111lFFCcm5Rhej0cek6yXbLOPcLozfuK-S6xGbjEikz5Bvpwu4DRdMMOm1rQck_StAigUCXfiugCFjRmhae0/s200/image+%25281%2529.jpg" width="149" /></a></div>
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Before moving to the UK I used to be affiliated with a Buddhist organization called <a href="https://en.wikipedia.org/wiki/Soka_Gakkai" target="_blank">Soka Gakkai</a>. I used to practice my Buddhism religiously. But since moving to the UK, I haven't practised it with any degree for 10-11 years now. I still got the books. I still got the beads. I’ve still got most of the paraphernalia that came with it. But now they are all collecting dust. Sitting there and reminding me of the good times I had with them and the bad times that <a href="http://goo.gl/5iV2Mj" target="_blank">lead me to them</a><span class="text_exposed_show" style="display: inline; font-family: inherit;">.</span></div>
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I still identify myself as a Buddhist, but now I prefer to use the term <a href="http://www.urbandictionary.com/define.php?term=fair-weather%20christian" target="_blank">Fairweather Buddhist</a> as coined by my former boss and current friend. Sometimes I identify myself as Angry Buddhist as my other half sometimes does.</div>
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Since de facto <a href="https://flylikeacrow.wordpress.com/tag/leaving-the-sgi/" target="_blank">leaving</a> the whole group, it’s been interesting to watch and reflect on my days with them. The reason I joined them in the first place was that I was quite keen on the idea that I and everyone around me had the potential of reaching Buddhahood. Basically I could be better than I am and so can everyone else. This intrigued me on the most basic level and also on a more philanthropical level. Helping others has always been something that I’ve wanted to do. And besides at the time I was in a bad bad place mentally and being a group of like minded people helped. And the chanting as well.</div>
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What didn’t help was being told that it was the only true Buddhism. That always grated for the same reason as hearing people that their religion is the one true religion. It doesn’t work like that. You find something that will help YOU. Not to help someone else’s ego.</div>
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When I asked what the words meant that I was chanting I was told that there was no need to understand them. Just that I chanted them. Studying was encouraged. But only as far as the SGI curriculum was concerned.</div>
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You could only have the <a href="https://en.wikipedia.org/wiki/Gohonzon" target="_blank">Gohonzon</a>, every thing else were false idols. Including my little Buddha statues (That I still own).</div>
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Then there were the pilgrimages. And make no mistake that’s what they were. People HAD to make trips to XYZ to attend a conference. That also grated.</div>
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It is the cult of personality <a href="https://goo.gl/U5DO5P" target="_blank">that Soka Gakkai</a> is. Currently Soka Gakkai seems to be the podium for a gentleman called <a href="https://en.wikipedia.org/wiki/Daisaku_Ikeda" target="_blank">Daisaku Ikeda</a>. Who writes books, delivers sermons and travels the world and provides words of (<a href="https://twitter.com/contrivedplatit" target="_blank">contrived platitudes</a>) inspiration. But no one is allowed to dispute his words. <a href="http://www.forbes.com/forbes/2004/0906/126.html" target="_blank">He is the messiah</a>. He is the modern day Buddha and no one else is.</div>
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And that is just not on. I don't hold with those "qualities" in other religions, why should I tolerate it in mine?</div>
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I still got friends involved in the group. And they all do strive for peace and harmony. And that is good. But it all still reeks a little bit of the exchange that Brian (Not the Messiah) had with his followers regarding <a href="https://www.youtube.com/watch?v=KHbzSif78qQ" target="_blank">individuality</a>.</div>
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IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0tag:blogger.com,1999:blog-2425917353589217044.post-42024388278383646442016-08-04T17:06:00.002+01:002016-08-16T17:51:54.340+01:00Metal Nurse Spaketh: Dying Matters<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEil4smR8RhNcfDt1Pdgh0H13y0Jto2L8t_gWJaoVTCHRlkgScQ9s3oKDxv4EetVuIieR7S5-sDfM9s2aLUyaBgP_XgaStm_X34Seiu8LMRTPgLGep-4EGrdLy_-L_0Hq0rkL3RohUTUNcY/s1600/12366015_10153775242789154_2945079897052973228_o.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEil4smR8RhNcfDt1Pdgh0H13y0Jto2L8t_gWJaoVTCHRlkgScQ9s3oKDxv4EetVuIieR7S5-sDfM9s2aLUyaBgP_XgaStm_X34Seiu8LMRTPgLGep-4EGrdLy_-L_0Hq0rkL3RohUTUNcY/s200/12366015_10153775242789154_2945079897052973228_o.jpg" width="160" /></a></div>
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<u>"<span style="background-color: white; color: #1d2129; font-family: "helvetica" , "arial" , sans-serif; font-size: 14px; line-height: 19.32px;">But on the most basic levels a Nurse has 2 roles</span></u></div>
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<u>They impact people in positive ways not limited to and as far as saving someone's life in the very literal sense</u></div>
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<u>And comforting someone as their candle light flickers out."</u></div>
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I've worked in healthcare for a long time. <a href="http://ingvararni.blogspot.com/2015/09/metal-nurse-spaketh-15-years-in.html" target="_blank">Nearly 16 years</a> now. And I have seen a lot of people dying. I've been there when the last light flickers out. I have been present when patients families are surrounding there loved one, saying goodbye one by one. I have performed more <a href="https://en.wikipedia.org/wiki/Last_offices" target="_blank">last offices</a> than I've been able to keep count off. And here's the kicker. It never gets any easier. My experiences as a nurse aren't unique. We all go through this. Every time it happens when I'm on shift, my mind invariably turns to mortality. Mine, my children's, my loved ones, my family, my parents. We all know that life is finite, that it will end at some point. But it never feels right, it never feels like it should happen. But it does and it will.<br />
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Thinking about how I would like to end my life. I am sure I would not want it to end in a hospital or a nursing home.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvR_78ek-9aZgzEFb0omN0ju5q75YPSkD2C6mKR9sWjFZrB7qQSx8pLhmEBq8L1Z4UF5JgTPd4ShgAVciWuXREGg7aHoRDYlqb7FGX3Fo2G0Spz8dQ8lpNG_RHGwDVWwHnBk0Z11jy0vU/s1600/palliation-ehart-2-638.jpg" imageanchor="1" style="line-height: 19.32px; margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvR_78ek-9aZgzEFb0omN0ju5q75YPSkD2C6mKR9sWjFZrB7qQSx8pLhmEBq8L1Z4UF5JgTPd4ShgAVciWuXREGg7aHoRDYlqb7FGX3Fo2G0Spz8dQ8lpNG_RHGwDVWwHnBk0Z11jy0vU/s400/palliation-ehart-2-638.jpg" width="400" /></a><br />
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Currently we have a document called "<a href="https://en.wikipedia.org/wiki/Do_not_resuscitate" target="_blank">Do Not Resuscitate</a>". This is often done by the elderly since their chances of surviving a heart attack is so very very slim and resuscitation is brutal on the human body. There is this misconception that DNR also means that no treatment will be given for various illnesses, this is not true. DNR is only in case the patient has a cardiac and/or respiratory arrest from which they are unlikely to survive.<br />
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But what a lot of older people are also taking out alongside it is something called "<a href="https://en.wikipedia.org/wiki/Advance_healthcare_directive" target="_blank">Advanced Directive</a>" or "Living Will". These can be about where they'd like to be cared for at the end of life. Or it could be about not wanting to go to hospital for treatment. Not because they think they will get bad care. But more because they feel like that they've seen enough of life and their end is coming then it should be spent in familiar surroundings.<br />
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But far too often those Living Wills are not adhered to. Family members beg for their relatives to be saved. To be cured. They put the doctors and nurses into position they shouldn't be pushed into. Because they cannot bear to be without their relatives, which is understandable. But if your relative has made their wishes known, then you should go by those wishes. I cannot think of a worse death than dying where you don't want to be. Surrounded by people in uniforms. They might be caring<span style="font-family: inherit; line-height: 19.32px;">, but they are also prolonging the inevitable. </span></div>
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I would rather die at my preferred place than at a hospital. I like most of the people I work with, but not enough to spend my dying moments with them. <a href="https://www.theguardian.com/society/joepublic/2010/aug/11/dying-end-of-life-choices-home-hospital" target="_blank">Far too many people die in hospital rather then their preferred place of care</a>. Those dying moments should, realistically, be shared by those who you love and care for. Those last moments are important, because those are the moments that stay with those who have been left behind.<br />
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IngvarArnihttp://www.blogger.com/profile/02401976924708974436noreply@blogger.com0