Letter of the week
Dear Editor
In my hospital, the average time for an outpatients appointment is half an hour and if someone doesnt keep the appointment and doesnt tell us in advance, we cannot usually fill the slot. About one in every ten appointments is missed and patients who do not appear (DNAs) waste a great deal of time and money.
In my opinion, persistent DNAs are people with behavior problems. They are excessively self-centred, have a total disregard for others, demand major attention for minor illnesses, and are often rude to the receptionist, but smile sweetly at the doctor. They are careless about medical services and dont think twice about making emergency calls or using out-hours services. They miss appointments quite freely and then complain loudly that they cant get to see a doctor. Oh yes, they know a lot about their rights, but they have no idea about their responsibilities.
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| 7 ___ ____ 2016 . | _ 2 _ : : | . . () |
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Letter of the week
Dear Editor
It must be said that 95% of our patients are perfectly reasonable, decent people who may sometimes simply forget an appointment we all do it from time to time and sometimes, admittedly, its the fault of the system. I can understand why someone might forget an appointment if its weeks or months into the future or if there is a complicated procedure for confirmations. Persistent DNAs are actually stealing time from other people and sometimes I wish I could refuse them treatment, but I know thats not practical because it just passes on the problem to someone else. So we should make them pay. My solution is this: we provide patients with an answering service so they can leave messages and on top of this we send a text message reminding them of their appointment time. After that though. Anyone who misses two appointments should deposit a sum of money before making their next appointment. The money would be returned to them if they turned up. If they dont turn up, the money would go to a local hospice.
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| 7 ___ ____ 2016 . | _ 3_ : : | . __ .. () |
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Pneumonia
Pneumonia is an acute inflammation of the lung. It may be caused by bacteria or viruses. It may follow a cold and bronchitis, or may come on suddenly. It may also be a complication of measles or whooping cough. The child looks ill, has fever, cough, and very rapid breathing. He may also complain of pneumonia. A doctor should be consulted, and depending on the severity the child may be treated at home or admitted to a hospital. If his breathing is very rapid, he may need oxygen. Most pneumonias can be treated with antibiotics. Pneumonia can be dangerous in a malnourished child, or in very young children, especially if it is due to an organism called staphylococcus. Viral pneumonia cures gradually The child should be kept in bed, given plenty of and a highly nourishing diet.
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| 7 ___ ____ 2016 . | _ 4_ : : | . __ . () |
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Diphtheria
Diphtheria is a highly contagious disease, which mainly affects the throat. The symptoms are sore throat, fever and headache. There is difficulty in swallowing. There is a whitish patch in the throat and if it spreads to the windpipe, there is difficulty in breathing. The child looks ill and toxic. The disease can lead to many complications of nerves, heart and kidneys. The child will have to be hospitalized in an infectious diseases hospital for 3-4 weeks, and then convalescence proceeds at home for a few weeks more. This disease can be prevented by immunizing the child.
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| 7 ___ ____ 2016 . | _ 5_ : : | . .. () _______ |
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The plague
A) Over the course of human history, the bubonic plague has killed 200 million people. In one pandemic around 1347, over half the population of Europe died and along with their deaths came economic collapse, food shortages, and a breakdown of law and order.
B) The first sign that the plague had arrived was the rats that came out into the streets to die in huge numbers. The people fled their homes, isolated themselves from other people, or prepared for likely death. When they died, it was in a particularly horrible way. Initial symptoms were chills, then fever. Within hours victims would be doubled up with stomach pains, and unable to lie down with terrible headaches. Then came large red swellings hard painful lumps on the neck, arms, and inner thighs, some as big as oranges. There was bleeding and a horrible swell.
The medicine of the time could not explain it. Doctors tried blood letting draining the illness out by cutting a vein and letting it bleed. It didnt work. Because it was obvious that you could get the disease from contact with victims and their clothing, the response of most people was to abandon anyone who caught it. There were very few qualified doctors, but there were plenty of quack doctors who would. For a very high price, care for the sick. They wore long gowns and bird-like masks filled with herbs and oils and they washed in vinegar for protection. Though strange, these measures were actually quite effective
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| 7 ___ ____ 2016 . | _ 6_ : : | . __ .. () _______ |
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The plague
C) Though it was known that survivors of an infection didnt catch it an second time, the random way that one person could be struck down by disease and another survive was explained in terms of Gods will, not immunity. People believed that a loving god would not create anything so bad unless it was to punish those who had done some kind of wrong. The Italian writer Giovanni Boccaccio lived through the epidemic and described peoples reactions to the death all around them. He described the Flagellants, for example, who believed that if they walked from town to town and beat themselves in public, then they would escape the disease.
D) According to Boccaccio, many people adopted a fatalistic attitude leaving it in Gods hands. The hedonists, he said, dedicated their lives to pleasure eating, drinking, and casual sex while they had the chance. They were going to die anyway. Others, like nuns, applied fatalism to its logical extreme and ignored the risks involved in having close contact with the dying. They actually nursed the sick. Nuns (women living in religious communities) have an important place in the history of professional nursing, and though during the plague epidemics they said were only doing Gods will and had no choice in the matter, they were much admire for their charity and courage
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| 7 ___ ____ 2016 . | _ 7_ : : | . .. () |
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Ask the Nurse
Nurse Anthea answers your questions
Q. Im worried about my baby. She is crawling around on the floor and putting all sorts of things into her mouth.
Dont worry. Children who live in spotlessly clean houses do not have much exposure to bacteria, so their immune systems dont get the practice of fighting bacteria. Research shows that children living in houses than are not spotlessly clean, who have contact with animals and faecal matter, get fewer illness than children living in spotless homes. And theres evidence that children who live with pets get fewer allergies.
Q. Ive heard that we shouldnt use too many antibiotics. Why is this?
Antibiotics kill the weak bacteria but allow the strong ones to survive and get stronger. This means that there are more and more bacteria around that are resistant to antibiotics.
Q. Is there a cure for MRSA?
Theres an antibiotic called Vancomycin. This is our last weapon against MRSA, but in time it will be useless too. One type of Staphylococcus aureus is now resistant to Vancomycin so it is VRSA Vancomycin resistant. There is a possibility of bacterium which will be resistant to all antibiotics.
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We have been winning the war against bacteria for about fifty years, but soon bacteria will make a comeback and we will be where we were in nineteenth century with no protection from bacteria.
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| 7 ___ ____ 2016 . | _ 8_ : : | . .. () _______ |
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Inquest Told Of Hospital Error. Text 1
A hospital error left a dying man on the wrong ward for two days as deep vein thrombosis (DVT) ravaged his body, an inquest heard. Stephen Melvin Newbold suffered massive brain damage when a blood clot formed in his veins. Now his family are considering legal action against York Hospital, saying that his death was untimely and unnecessary.
Mr Newbold, a 52-year-old maintenance worker, went to York Hospital on November 3 complaining of a swollen right foot. He should have been sent to a surgical ward where he would have been treated with Fragmin, a drug which counters the effects of DVT. However, hospital staff wrongly admitted him to an orthopaedic ward, where he stayed for two days, before finally being transferred to the care of a consultant vascular surgeon. Twenty-four hours later, on November 6, doctors decided they would have to operate to remove his leg below the knee.
The operation went ahead on November 10, but two days later Mr Newbold suffered a cardiac arrest. A scan revealed he had had a pulmonary embolism, a condition related to DVT. Mr Newbold suffered brain damage and died in the hospital on November 16.
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| 7 ___ ____ 2016 . | _ 9_ : : | . __ .. () _______ |
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The Hope Children`s Hospice
A home from home
The Hope Children`s Hospice provides free specialist care for children with life-limiting conditions who are not expected to live into adulthood. It cares for up to eight terminally-ill children at one time, and aims to care for them in the same way their families would care for them at home. When families prefer to do the caring themselves, a hospice carer will go to their home and help them.
Helping the family
Life-limiting conditions present many long-term medical and emotional problems not only for the children, but for parents and siblings too. So the hospice offers respite care short stays for the children alone or for the whole family together. At these times, parents hand over responsibilities to the staff and have a holidsay. Short stays give terminally-ill children an opportunity to meet others with similar conditions.
Personal care
Each child at the hospice has their own carer and their own care plan. A normal day might start with a jacuzzi bath followed by a massage from a complementary therapist. Some children go to school, while others play with the hospice play specialists.
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| 7 ___ ____ 2016 . | _ 10_ : : | . __ .. __ () |
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Inquest Told Of Hospital Error? Text 2
Giving evidence, the surgeon said he could not explain why Mr Newbold had been admitted to an orthopaedic ward where it was not policy to administer Fragmin. He did not know why his medical team had not given Mr Newbold the drug later.
York coroner Donald Coverdale said, From November 3 until the day of the operation, no Fragmin was given to Mr Newbold. If he had been admitted to a consultant vascular surgeons care from day one, it is clear that Fragmin would have been prescribed. Fragmin reduces the risk DVT, but does not eliminate it. It is impossible to say whether Mr Newbold would have suffered this DVT if he had received the Fragmin. He recorded a verdict of death by misadventure.
Kim Daniels, Mr Newbolds family lawyer, said, The family hope that the hospital will learn from the errors, and that no other families will have to suffer in the future.
A spokeswoman for York Hospitals NHS Trust said, We would like to extend our sincere sympathies to the family of Stephen Newbold during this difficult time.
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| 7 ___ ____ 2016 . | _ 11_ : : | . __ .. () |
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HIPPOCRATES
"THE FATHER OF MEDICINE"
Hippocrates was born in 460 . on the island () of Cos. He was the son of a doctor. Hippocrates studied medicine and then he went from town to town where he practiced the art of medicine. Hippocrates was known as an excellent doctor and a teacher of medicine. He established medical schools in Athenes and in other towns. He wrote several books and many case histories ( ). He created medicine on the basis of experience. Hippocrates treated diseases by exercise, massage, salt water baths, diet and suitable () medicine.
Hippocrates made medicine an art, a science and a profession. Hippocrates is the most famous of all the Greek doctors. He is often called "the father of Meducine" and some of his ideas are still important.
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The Hope Children`s Hospice
Personal care
Each child at the hospice has their own carer and their own care plan. Some children go to school, while others play with the hospice play specialists.
Using the senses
The hospice has a multi-sensory room. This is a special room which stimulates the children`s senses with lights, music, touch and smell. It has touch-screen computers, video games, paddling pools and space for wheelchair dancing. Children have music therapy and can record their own music, not only as a way to express their feelings, but to leave something for their family and friends to listen to in the years to come.
Saying goodbye
The hospice has a number of queit rooms where we care for children during and after death. These are places where families and friends can say goodbye. Our support does not end with death. We help not just grieving parents, but also siblings who are experiencing bereavement. We give everyone opportunities to discuss their fears about death and dying.
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| 7 ___ ____ 2016 . | _ 13_ : : | . __ .. () |
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Wild treatments
A lot of knowledge which we call alternative medicine has come from watching animals, because not every pharmacist is a human being animals treat themselves with medicines too. You may have seen a dog or a cat eat grass, for example. They do this because it makes them sick and clear their stomachs of worms.
When African elephants are going to give birth, they will walk many kilometres to eat the leaves from a certain tree that will help labour. The leaves are used by Kenyan women for the same thing.
Clay is eaten by many animals, from cows to rhinoceroses, because it breaks down poisons in the stomach. It is also the main ingridient of kaolin, which is used in treatments for stomach illnesses in humans.
When some birds build their nests, they choose aromatic plants that wiil keep their babies healthy. The plants chosen by the birds are also used by herbalists for skin problems such as ulcers, sores, and eczema.
Because bacteria are becoming resistant to antibiotics, it is becoming more and more important to find alternatives, and zoopharmacognosy a word from Greek meaning animals knowledge of medicine may give us important new information about very old ways of dealing with illness.
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| 7 ___ ____ 2016 . | _ 14_ : : | . __ ..__ () ._______ |
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Accidents In The Home
In The UK, about 2,8 million people every year seek treatment at an Accident and Emergency department after an accident in the home. More than 3,000 people die every year as a result of home accidents, and the total cost of home accident injuries has been estimated at £25 billion per year.
Research shows that most home accidents occur in the following categories:
falls, poisoning, fires, DIY accidents, choking, packaging accidents, burns and scalds, garden accidents, drowning.
Many of these accidents could be prevented by following simple guidelines. With this in mind, the government produces a range of safety campaigns and advice leaflets to warn people about dangers around the home. This would clearly reduce the load on Accident and Emergency departments and emergency services, such as police, fire and ambulance, allowing them to use their limited resources for other work.
2: Which of the categories in the text do these home accidents belong to?
1. Lucy Mann left a candle burning when she went to bed.
2. Two-year-old boy Toby Smith fell into a neighbours swimming pool.
3. 76-year-old Eric Baker slipped on a wet bathroom floor.
4. One-year-old Ben Brown put a small toy in his mouth and it lodged in his throat.
5. Jasvinder Singh cut hishand badly while opening a tin of peaches.
6. Ten-year-old Jasen Gold swallowed some of his fathers medicine
7. 82-year-old Iris Watts dropped a pan of boiling water on her foot.
8. Nick Young suffered cuts, brulses and a broken arm when he was putting up some shelves in his home.
| 7 ___ ____ 2016 . | _ 15_ : : | . .. () |
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Rescue From The Air.
When you cannot move treatment fast to sick people, you have to move sick people fast to treatment. The problem is that when someone is severely injured, movement can kill and so anything that can both speed up the journey and minimize the shock is a life-saver. This is why, over a hundred years ago, a long time before the development of aircraft, someone came up with a desigh for an air ambulance. The idea was to put wounded people on a stretcher which was held in the air by balloons and pulled along by horses.
Warfare has encouraged progress in ambulance technology. It is expensive and wasteful to let soldiers die on a battlefield and saving their lives justifies the expense of using aircraft (particularly helicopters) to transport casualties to hospital. In fact, the first time a helicopter was used for a medical rescue was in Burma in 1945 by the American military. A soldier on a jungle-covered mountain accidentally shot himself with a machine gun. There were no medics and the area was so wild that it would have taken ten days for a rescue party to reach the wounded man. A Sikorsky YR-4 helicopter very basic by modern standarts was sent out. It had no radio and navigated by flying low over the treetops, but the pilot completed his mission and the soldiers life was saved.
Even today, helicopters are limited by weather and darkness. Unlike aeroplans, which have radar and computers, many helicopters have only essential flight equipment and pilots have to fly VFR (Visual Flight Rules) which means they can only fly when they can see. However, the great value of a helicopter is that it can land and take off vertically and provide speed and comfort, which are not luxuries when it comes to saving lives and a helicopter can make a huge difference in a rural area where response time is normally slow. Air ambulances can increase the chances of survival of patients whose injuries are severe but survivable: an important factor to consider when sending one out.
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| 7 ___ ____ 2016 . | _ 16_ : : | . __ ..__ () ._______ |
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A less invasive surgery
Surgery the repair of a body with knives and stitches is thousands of years old, and in the past it was performed by unqualified men whose other job was cutting hair. For a long time, surgery was limited to amputations which were performed incredibly fast, without anesthetic, and without knowledge of microbes. Success rates were low and many patients died from shock or post-operative infections.
Despite the many innovations that have made surgery safer, open surgery has remained a bloody business which involves cutting open the body, holding it open with metal retractors, and putting both hands into the hole. However, the invention of the laparoscope a tubefor looking inside the body has led to the development of a whole new way of doing things, commonly known as keyhole surgery. Now, complex operations are done through small incisions using instruments at the ends of long tubes. It is precise and delicate work and involves the minimum of invasion.
Refinements in technology mean that now surgeons dont have to hold a tube in one hand and look down it they see images on screens made by a tiny video camera at the end of the laparoscope. The surgeon moves the precision instruments using two sets of controls like the handles of scissors. It has been compared to painting the hallway of your house using a brush on a long stick pushed in through the letter box. It demands a lot of practice both in hand-eye coordination and in depth perception (most video screens are two-dimensional) in order to accurately navigate around the internal organs. Surgeons who grew up with computer games take to it quite naturally.
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| 7 ___ ____ 2016 . . | _ 17_ : : | . _ ...__ () |
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A less invasive surgery
Refinements in technology mean that now surgeons dont have to hold a tube in one hand and look down it they see images on screens made by a tiny video camera at the end of the laparoscope. The surgeon moves the precision instruments using two sets of controls like the handles of scissors. It has been compared to painting the hallway of your house using a brush on a long stick pushed in through the letter box. It demands a lot of practice both in hand-eye coordination and in depth perception (most video screens are two-dimensional) in order to accurately navigate around the internal organs. Surgeons who grew up with computer games take to it quite naturally.
Keyhole surgery means less pain and scarring. In conventional heart bypass surgery, for example, the surgeon has to open the patients chest with a 30 cm long incision, whereas keyhole surgery involves just three one-centimeter cuts. Recovery time is much faster with keyhole surgery, which frees up hospital beds, and disrupts the patients life less. There are fewer wound complications like infections, hematoma, and hernias, and because a patient is active soon after surgery, there is less risk of a potentially fatal blood clot in the veins.
Further advances in keyhole surgery are being made with robots. Robots hands have a greater range of movement and dont shake. In a recent trial, their accuracy was measured against surgeons. In a test to insert a needle into an exact spot in a dummy patients kidney (the first stage in removing kidney stones), the human hand found the exact spot 79% of the time. The robots score was 88%.
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| 7 ___ ____ 2016 . | _ 18_ : : | . __ .. () _______ |
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Case study
Katie Martin is a nine-year-old female who was in car crash. At the scene her Glasgow coma scale was 3. She was intubated and transported by helicopter to hospital. She was taken to the intensive care unit due to her intracranial haemorrhage which 24 hours later resulted in evacuation. She was placed on a ventilator and a tracheostomy was performed. Katies pre-operative diagnosis was left frontal haemorrhagic contusion and multiple skull fracture. She had a left frontal craniotomy with evacuation of the intracerebral haematoma. The dural tear suffered lacerations to the liver, face, left eyelid, and a right femur fracture. Four months after the accident, her mental and physical state have improved, as outlined below.
A) Katie is able to reposition herself in bed. She can ambulate 10-15 feet with maximal assistance, but locomotes in a wheelchair. She will need physical therapy to improve coordination and balance. She requires moderate assistance transferring in and out of the bed, chair, and car. Her hearing is adequate, but she has lost the vision in her left eye. She is unable to write, but can hold a pen, so she will need physical therapy to restore her fine motor coordination and strength.
B) She needs assistance for grooming and hygiene care. She will need occupational therapy to help restore her dressing, grooming, and hygiene skills. She needs assistance using the toilet. Katie shows little interest in food, but feeds herself with small bites and has a G-tube for supplemental nutrition. She has moderate problems with both her bladder and bowel management.
C) Katies frontal lobe syndrome has left her unable to produce abstract reasoning, logical concept formation, and planning. She is no longer spontaneous and creative. She does not possess the judgement and insight required to make safe or reasonable social and personal decisions. Her memory has been compromised for both auditory and visual processing of stimuli and retrieval of information. Although she is alert, she cannot sustain concentration sufficiently in order to learn. She is able to count, but has difficulty identifying objects. She can follow simple commands.
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| 7 ___ ____ 2016 . | _ 19_ : : | . __ ..__ () ._______ |
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What faeces reveal
A) Eliminating the waste products of metabolism is an essential process for all forms of life. Defecating is as natural as breathing and it one of the first things we do when we are born. However, we grow to dislike our own excrement and flush it away as soon as we produce it. Other animals dont worry so much. The way that cats, hippopotami, and bears, for example, use faeces and urine has been compared to writing - providing information without actually being present and reading it by smell and taste.
B) In contrast, humans generally leave the job of examining faeces to medical professionals who analyse its contents as well as its appearance, smell, frequency, and quantity to get information about illness. The faeces of healthy babies are a yellow-green color and many people rather like their smell. However, as they are weaned, babies faeces become brown and acquire that nasty smell of bile and bacteria. Healthy adult faeces are 75 per cent water. The rest is bacteria, indigestible food matter, fats, inorganic substances, and protein. They should be semi-solid and coated with mucus.
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What faeces reveal
C) Abnormal faeces are assessed using the Bristol Stool Scale which puts them into seven groups ranging from seven constipation (separate hard lumps) to diarrhea (watery, no solid pieces) Faeces can be analysed to screen for cancer using the Faecal Occult Blood Test (FOBT). In this test, chemicals are added to a small sample of stool in order to identify the existence of microscopic amounts of blood which way indicate a cancer somewhere in the bowel. Feaces with a high fat content tend to float and usually indicate disease of the pancreas or small intestine.
D) It is perfectly to produce a lot of gas, and nervousness which causes us to swallow more air creates more flatulence. The distinctive smell of flatulence is hydrogen sulphide and the more sulphur in our diet, the stronger our flatulence smells. However, very smelly faeces and gas indicate that fat is not being digested because enzymes are blocked from getting into the intestines and there is something wrong.
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