Thursday, November 20, 2014

Caring for the caregivers

Long-term clinical and cost-effectiveness of psychological intervention for family carers of people with dementia: a single-blind, randomised, controlled trial


Summary

Background

Two-thirds of people with dementia live at home supported mainly by family carers. These carers frequently develop clinical depression or anxiety, which predicts care breakdown. We aimed to assess the clinical effectiveness (long-term reduction of depression and anxiety symptoms in family carers) and cost-effectiveness of a psychological intervention called START (STrAtegies for RelaTives).

Methods

We did a randomised, parallel-group trial with masked outcome assessments in three UK mental-health services and one neurological-outpatient dementia service. We included self-identified family carers of people with dementia who had been referred in the previous year and gave support at least once per week to the person with dementia. We randomly assigned these carers, via an online computer-generated randomisation system from an independent clinical trials unit, to either START, an 8-session, manual-based coping intervention delivered by supervised psychology graduates, or treatment as usual (TAU). The primary long-term outcomes were affective symptoms (Hospital Anxiety and Depression Scale total score [HADS-T]) 2 years after randomisation and cost-effectiveness (health and social care perspectives) over 24 months. Analysis was by intention to treat, excluding carers with data missing at both 12 and 24 months. This trial is registered ISCTRN70017938.

Findings

From November 4, 2009, to June 8, 2011, we recruited 260 carers. 173 carers were randomly assigned to START and 87 to TAU. Of these 260 participants, 209 (80%) were included in the clinical efficacy analysis (140 START, 69 TAU). At 24 months, compared with TAU the START group was significantly better for HADS-T (mean difference −2·58 points, 95% CI −4·26 to −0·90; p=0·003). The intervention is cost effective for both carers and patients (67% probability of cost-effectiveness at the £20 000 per QALY willingness-to-pay threshold, and 70% at the £30 000 threshold).

Tuesday, November 18, 2014

Medicinal marijuana for PTSD study

SMITHS FALLS, ONNov. 19, 2014 /CNW/ - Tweed Marijuana Inc. ("Tweed" or "the Company") is pleased to announce that its wholly owned subsidiary Tweed Inc. has successfully renewed its license to cultivate and sell marijuana under the Marihuana for Medical Purposes Regulations (MMPR).

Despite the fact that the Canadian Medical Association physicians don't tend to like the use of medical marihuana (MM), many people say that they find it works for them. Despite the fact that Health Canada granted permission for Canadians to access marijuana for medical purposes, doctors seem to fear it. They don't know how much, or when or why to prescribe it to patients.

Tweed Inc.
Thankfully, private businesses, like Tweed, have budtenders who are familiar with the variety or strains and how people with various health issues will benefits from specific applications.

They provide MM for chronic pain, muscle spasms, seizures, nausea and loss of appetite. They recommend ingesting it by vaporizing.
"Vaporizing is an effective alternative to smoking which provides the same therapeutic effect without exposure to irritant compounds resulting from the burning of plant matter."

EVIDENCE

McPartland, J. M., & Russo, E. B. (2001). Cannabis and cannabis extracts: greater than the sum of their parts?. Journal of Cannabis Therapeutics, 1(3-4), 103-132.
Vaporizer
Hazekamp, A., Ruhaak, R., Zuurman, L., van Gerven, J., & Verpoorte, R. (2006). Evaluation of a vaporizing device (Volcano®) for the pulmonary administration of tetrahydrocannabinol. Journal of pharmaceutical sciences,95(6), 1308-1317.

Abrams, D. I., Vizoso, H. P., Shade, S. B., Jay, C., Kelly, M. E., & Benowitz, N. L. (2007). 
Vaporization as a smokeless cannabis delivery system: a pilot study. Clinical Pharmacology & Therapeutics, 82(5), 572-578.

Medicinal marijuana grower and UBC hope to test pot as PTSD treatment 

No more do patients have to walk the streets
to find medical marijuana.

WENCY LEUNG

After developing post-traumatic stress disorder during his second deployment in Afghanistan in 2007, Canadian army veteran Fabian Henry tried numerous anti-depressants to quell his suicidal thoughts and violent rages. For three years, he was on as many as nine pills a day. But only one drug worked for him: marijuana.

Monday, November 17, 2014

Palliative care experts say it's time for Canadians to talk about end of life care


Quality of life over quantity

My hubby and I have talked about what we expect from end-of-life, even in an emergency. We both agree that we must be content, comfortable, and have realistic hopes. No tube feeding for us. No time hooked up to machines. I've made this clear to my adult children, as well.

The media is full of great examples of people living long, productive lives:
  • Tommy Chong is 76, on Dancing With the Stars.
  • Betty White is 91.
  • Queen Elizabeth is 88. 
  • Jimmy Carter just turned 90.
But these entertainment examples are outliers. It isn't the norm. You must give your family and children an explanation of what life is like and what you expect to get out of life.
I hear, often, of families who run for yet another health intervention, which has little likelihood of success and simply prolongs a terrible living situation.

What is it you hope for in your life?


  • Creativity? 
  • Being outdoors?
  • Happiness: what does that look like? 
  • Productivity: what would you like to accomplish? 
  • Friends: do you want to be with them? 
  • Do you prefer being solitary, with books and music?
  • Do you have things to do, things to see, people to love?

Physician-assisted Suicide

Those who promote the physician-assisted suicide movement perhaps are in the minority. Perhaps, we should question more the efficacy of particular interventions at particular points in our lives.

  • The question is, do you have dementia? 
  • Are you fully present in your life, able to enjoy life with little pain or mobility issues. 
  • Are you able to fulfill your ADLs? Banking, shopping, cooking, doing laundry, cooling, cleaning. These are chores that, if you are physically disabled, fall to others late in life. 
  • Caregivers are stressed and at risk. Family members, often daughters, pick up the slack.

The discussions on health and healthcare begin with your physician

It was an excellent discussion on palliative care, and humane care by physicians.
  1. Firstly, physicians should explain the patient's condition.
  2. Next, outline treatment options: i.e., surgery, chemo, radiation, feeding tube, etc.
  3. The side effects of the various treatments should be clear.
  4. Then, they should give the statistics according to the disease trajectory, including the efficacy of certain treatments, including no treatment. 
  5. The impact of quality of life vs. the quantity of life.
Families should have these discussion before it becomes an issue. That said, they answers can change, depending upon circumstances, but it should be ongoing. I don't want to lie, paraplegic in a bed for years. Some want to go when they are not functioning mentally anymore. 

These are the questions physicians must ask their patients

  • What is your understanding of your condition?
  • What are we working towards? 
  • Which goals do you aspire to: i.e., being social, being able to drink beer and watch TV, being ambulatory and mobile, being able to communicate with family and friends, or read a book? 
  • What are your fears, and your worries?

Questions patient must ask their doctors

A 2014 book, Being Mortal, by Atul Gawande, speaks to these concerns. Too many people die in hospital, uncomfortable, or end up in the ER. He explains the reasons why this happens.
He tells us that terminal lung cancer patients who had end-of-life talks started hospice sooner, stopped chemo earlier, and lived 25% longer.
He tells us that those who are given the option of heavy drugs, often do not need them, because they worry less about being in pain since they have the perception of control. I find this is true with my clients who speak realistically about their conditions with healthcare professionals. They may connect with Symptom Management nurses who prepare them, protect them and advocate for them, either at home or in hospital.

Care for the dying needs more imagination – and less hospitalisation. A review of Being Mortal by

Dr. Ezekiel Emanuel, an oncologist and one of the country's leading health care experts, says by age 75 he would opt out of medical treatments in order to not prolong his life in favor of letting nature take its course. Emmanuel joins Judy...
TO.PBS.ORG

Sunday, November 16, 2014

Assistive devices: text to speech

I've been searching for the right speech-to-text tool. My students were given devices back in 2005. It was difficult, since no one else was supposed to use them. My sweet kids felt badly that they were centred out. This system read the text for them, or they did speech-to-text, but the support staff didn't have time to figure it all out. I found it hard to juggle the computers, and then the rest of the class.

This senior in long-term care loved solitaire!

One of my clients, with ALS, used a text-to-speech application with me. She was given it by her grandchildren. She worked hard, in her senior years, to master it. She was over 70 years old!
Unfortunately, it is $159.99, but it is an amazing iPad appPredictable. by Therapy Box Limited
https://appsto.re/ca/pD1gy.i

Text-to-voice application on iPad

Speech to text: Dragon Naturally Speaking



This app is a bit more expensive than most apps, but it does allow you to use cursive writing!

HandySpeech was created by 12-year-old software developer Eric Zeiberg, who was inspired to create the application by his sister -- an autistic individual with speech disabilities.  “The application is dedicated to courageous people who struggle every day to overcome their disabilities.”


 

To learn more about the HandySpeech applications and download it via the Apple App Store for $29.99, visit the iSpeak4u Web site at www.ispeak4u.com. The HandySpeech application was created by iSpeak4U, LLC., a Connecticut software development company offering mobile, web and server applications for customers worldwide.

Saturday, November 15, 2014

Report: Long-Term Care in Ontario: Fostering Systemic Neglect

Focus Group Study Report
Lifts require two PSWs

Long-Term Care in Ontario: Fostering Systemic Neglect (PDF)

The average hours of direct care per resident per day in Ontario long-term care homes increased to 3.4 in 2013, up from 3.2 in 2008.

Workers reported what they considered to be dangerously high resident-to-staff ratios in long-term care homes. Some personal support workers said, at times, they are left to care for up to 42 residents, while nurses said they are sometimes responsible for between 30 and 42 residents.

Thursday, November 13, 2014

High-tech in the doctor's office

Dr. Jim Legan uses the Amazing Charts Electronic Health Record (EHR) system. He recently discovered a clever way to improve patient engagement and workflow in the exam room. In this video, Dr. Legan demonstrates how he connects his Chromebook with a flat screen TV, allowing patients to view their medical charts, prescriptions, lab reports, radiology images, and more. He's able to do all this in real time while also remaining HIPAA compliant.

 

The effects of depression on the body

The Effects of Depression on the Body

Friday, October 31, 2014

Get a flu shot! It can't hurt, might help

Fluwatch season
What do you think? I think too many have been harmed by clueless public celebrities who do not know the truth.
Get a shot.
get a flushot!
Week 42


Three Albertans have died from the flu this season

Three Albertans — two in Edmonton and one in the province’s South zone — have died from the flu so far this season. Nearly two weeks after flu vaccination clinics opened across the province, Alberta Health Services issued its first numerical flu update of the season on Thursday.
  • three deaths,
  • 30 Albertans have been admitted to hospital
  • 66 laboratory confirmed cases of influenza A so far
  • 8 laboratory confirmed cases of influenza B


  1. This year's more virulent Eterovirus seems on the wane

    Toronto Star-Oct 19, 2014Share
    By: Joseph Hall News reporter, Published on Sun Oct 19 2014 ...Ontario has had more than 160 confirmed cases. It has been linked to seven deaths in the U.S., though none in Canada. ... yet far less ballyhooed viral threat — the annual influenza that kills tens of thousands across the continent each year — is in the offing.


Flu shot promotion goes 'viral'

The Sudbury Star-Oct 28, 2014Share
Ontario offers a free flu shot to individuals aged six months and older. ... universal influenza immunization program prevents 300 deaths, 1, 000 ...

Thursday, October 30, 2014

Guest Post: A Forensic/Medical Author’s Take on Ebola and the CDC

Outbreak… Breakdown
A Forensic/Medical Author’s Take on Ebola and the CDC

My book, Louisiana Fever, involves the spread of a bleeding disease known as Crimean Congo hemorrhagic fever. This is a real disease that, like its close relative, Ebola, is caused by an infectious virus.  And having researched this thoroughly (and having come from a forensic/health background) I feel compelled to weigh in on the Ebola outbreak.

When I was plotting Louisiana Fever, I figured I ought to have a character in the book that was once an infectious disease specialist at the CDC.  It seemed like a logical idea because the CDC is this country’s unquestioned champion against virulent organisms, an organization staffed with experts that know every nuance of tropical viruses and how they can be controlled.

To make sure my writing about the CDC would have an authentic ring to it, I asked the public relations office of the CDC if I might be given a tour of the place.  “Sorry,” I was told.  “We don’t give tours.” Considering how many dangerous viruses are stored in the various labs there, that seemed like a good policy, even to me.  So there would be no tour.  But then I heard from someone in my department at the U. of Tennessee Medical Center that one of our former graduate students now worked at the CDC.  I began to wonder if this connection might work to my advantage. 

And it certainly did.  The former student was now a virology section chief. A SECTION CHIEF…. Holy cow! This could be my way in.  But would the man be generous by nature and sympathetic to writers? He proved to be both of those.

On the day of my visit, I reported to the security office as instructed. There, I had to wait until my host came to escort me into the bowels of the place… no wandering around on my own with a visitor’s badge. That day I saw the hot zone in action and spoke with experts in many fields of virology, even spent some time with the world expert on porcine retroviruses.  At the end of my visit—including all the cumbersome clinical protocols I had to engage in both before and during said visit—I not only left feeling more educated, but actually more safe and secure that no tropical virus would ever be a threat to this country… not with the meticulous, detail-oriented, security conscious, microbe fighters at the CDC watching out for us.      

So, it’s with much regret and… yes, even a little fear, that I witnessed the head of the CDC recently assuring us that the Ebola virus is very difficult to transmit and that we know exactly how to control it. Instead of (what looked like) his clumsy attempts to soothe an ignorant and paranoid public, the CDC head should have given a blunt assessment, educated everyone like adults, and encouraged them to exercise precaution. Then, seemingly in answer, two nurses who cared for the index patient from Liberia become Ebola positive.  And the CDC clears one of those nurses to take a commercial airline flight, even though she was in the early stages of Ebola infection…depressing.  From a medical professional standpoint, this was practically criminal negligence. At present, the disease is not transmitted by air ("airborne"), but any scientist worth his/her salt cannot account for mutations the virus may undergo.  This is why the job of the CDC is to contain harmful microbes, issue protocols to protect the public against them and ultimately eradicate them... period.  It is not to be PR professionals for television cameras and fostering carelessness.
Guest author: D.J. Donaldson


I’m still convinced that the combined knowledge and brainpower of the CDC staff will be a major impediment to any virus taking over this country.  But Ebola probably has some tricks we haven’t seen yet. That means we may lose a few more battles before we can declare that this particular threat is behind us.

Meanwhile, how is development of that Ebola vaccine coming?

~~~~~~~~~~~~~~~~
D.J. Donaldson is a retired professor of Anatomy and Neurobiology at the University of Tennessee, Health Science Center—where he taught and published dozens of papers on wound-healing and other health issues.  He is the author of Louisiana Fever, one of the seven in the Andy Broussard/Kit Franklyn series of forensic mystery thrillers.

Louisiana Fever  |  Amazon  |  B&N      |  Apple   |  Kobo   


Wednesday, October 29, 2014

This is my stress test


Stress test from Jennifer Jilks on Vimeo.
Caregivers really need to look after themselves. I had a Stress test, as I was getting high blood pressure, and chest pains. The stress test told us that it is, indeed, stress and I'm working on bringing down my BP.

I'm doing massage, relaxation, lots of quiet walks in the forest. Just sitting, petting the cat helps, too.
When worries pop in my mind, I blow them away and live in the present.