Continence Management in MS Special Feature Pressure ulceration
Transcription
Continence Management in MS Special Feature Pressure ulceration
ISSN 1361 -4177 Vol. 10 - Issue 11 June/July 2007 Parkinsons Disease Nurse Specialists in Scotland Infection Control Urinary catheterisation Continence Management in MS Fat Happens Anne Diamond part 4 DVT Treatment & prevention Diabetes part 4 Complications Turn to page 39 Anemia Classification 8BOUUPOVSTFJOUIF64" Go to page 45 5SVTUUIFFYQFSUT JOJOUFSOBUJPOBMOVSTFSFDSVJUNFOU Special Feature Pressure ulceration Various opportunities on page 54 Recruitment section General & Overseas www.scottishirishhealthcare.com 1 NHS 24 is driving forward with the future Health Care Agenda, in tele-nursing. Come and join us in the next generation of nursing, be part of our vision and grow your skills. Nurse Advisors Salary: Band 6 (£22,886 - £31,004) with substantial financial & personal benefits for Out of Hours Working. Location: Aberdeen, Clydebank & South Queensferry You will be a valued and autonomous practitioner, using your depth and breadth of knowledge to make a real difference to patients’ lives particularly in the out of hours period. We in return will give you the opportunity to enhance your current skills and acquire new ones, which will benefit your nursing career, wherever it takes you. NHS 24 is committed to your ongoing continued Professional Development. We will actively support your career through a range of resources such as Bursary Award & Study Leave Schemes, E-learning, Clinical Supervision and our Coaching Programme. All new recruits are also supported by an initial 6 month development programme. Join us on a part-time or full-time basis working mainly in the evenings, nights, weekends and public holidays. Various hours of employment are available. We at NHS 24 believe in joint working and, if you choose, we will work in partnership with your current employer to support you working with us whilst maintaining your current role. OPEN DAYS Interested in exploring how to grow your career with us? Come and chat to nurses, just like you, who are doing exactly that. ABERDEEN - 24th July 10am - 8pm SOUTH QUEENSFERRY - 12th July 4pm - 9pm, 18th July 2pm - 6pm CLYDEBANK - 11th July 10am - 8pm, 26th July 10am - 8pm For more details visit our website www.nhs24.com or contact us on 0141 225 0078 www.scottishirishhealthcare.com NHS 24 is committed to an equal opportunities policy. Contents 4 10 14 18 20 22 24 28 32 36 38 43 44 46 48 53 58 59 62 S N SCOTTISH NURSE Published by: Strathayr Publishing Ltd Gibbs Yard Auchincruive Estate Ayr Ayrshire Scotland KA6 5HN Managing Director: Jim Brown Distribution Manager: Jim Brown Editor & Graphic Design: Hamish Bell Clinical Editor: Charlie Bloe Assistant Clinical Editor: Scott Kane Sales Manager: Michelle Emberson Admin/Clerical: Morag McLeish Sales Representatives: John McConnachie Elaine Paterson Suzelle Murray Anthony Springer Gordon Smith Telephone: +44 (0)1292 525970 Fax: +44 (0)1292 525979 Website: www.scottishirishhealthcare.com Email: [email protected] stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopy or otherwise without prior written permission of the publisher. International and local news What’s On Find out what’s on in and around your area Parkinsons Disease Nurse specialists in Scotland Infection Control part4 Urinary catheterisation Continence Management in MS Nutrition & Obesity Fat Happens part 3 by Anne Diamond DVT Treatment & diagnosis Diabetes part3 Diabetic complications Anaemia Classification Special Feature The cost of pressure ulceration Nursing in Australia Opportunities and information General Recruitment Various job opportunities Nursing in America Opportunities and information Nursing in New Zealand Opportunities and information Nursing in Canada Opportunities and information Nursing in Ireland Opportunities and information Product focus Products & services Education & Training Opportunities and information Skills for Nurses 2007 Scotlands Biggest & Best Nursing Exhibition www.scottishirishhealthcare.com Copyright Warning: All rights reserved. No part of this publication may be copied or reproduced, News As a reader of Scottish Nurse we value your input and are always looking for new articles to appear in our publication. Please send your editorial, news articles, event details, press releases etc., to the Editor at the address opposite. Subscriptions . . . You can have your own personal copy of Scottish Nurse magazine mailed to your home each month. For a full year’s subscription, please send a cheque for £25 along with your name, address and job title to our address opposite. (Please ensure cheques are made payable to Strathayr Publishing). www.scottishirishhealthcare.com Deadline date for redundancy retirement protection for NHS Hard-up NHS trusts cut back on unproven homoeopathy treatment New retirement protection for NHS staff means those who are over the age of 50 and made redundant before 30 June 2007 will be in no worse a position than if they had been made redundant on 30 September 2006. The NHS is turning its back on homoeopathy and other unproven alternative medicines in the face of a financial crisis and pressure from doctors. The retirement protection, which is effective from 1 October 006, ensures that the over-50s continue to have their NHS service enhanced for retirement purposes and those made redundant after June will have their entitlement to enhanced service reduced; with the reduction in enhancement increasing the later redundancy occurs after the June deadline. Staff who are made redundant who are not seeking retirement but a redundancy payment under the new arrangements will not be affected by the deadline. RCN requests an extended protection period The NHS staff side unions wrote to Lord Philip Hunt, Minister of State at the Department of Health, asking that the 0 June date be extended to 1 September 007, but in his letter of 5 April 007 he refused the application on the grounds that it would not comply with the EU Directive on Age Discrimination. More than half of the primary care trusts (PCTs) in England are now refusing to pay for homoeopathy or severely restricting access a year after The Times revealed that 1 senior doctors had urged them to fund only therapies that were backed up by scientific evidence. Figures obtained by Les Rose, one of the doctors, and The Times under the Freedom of Information Act show that at least 86 of the 147 trusts have either stopped sending patients to the four homoeopathic hospitals, or are introducing strict measures to limit referrals. Another 40 trusts have yet to provide data. More than 0 have taken action since receiving a letter organised a year ago today by Professor Michael Baum, a cancer specialist at University College London, which argued that “unproven or disproved treatments” such as homoeopathy and reflexology ought not to be available free to patients. The RCN is against compulsory redundancies and is continuing to fight to keep members in work. However, some organisations have yet to resolve their service re-organisations, which means there is still no final decision about redundancies and the date of these. The NHS should not be funding such therapies while it had to refuse or ration access to effective cancer drugs such as Herceptin and Velcade, the authors said. Financial issues have also contributed to the trend. The NHS overspent by £547 million in 005-06 and many trusts have made savings on homoeopathy to avoid cuts. Although the RCN does not want undue delays in redundancy decisions, where there is clearly no suitable alternative employment available, it wants to ensure that staff being made redundant get the best possible benefits. And for those aged over 50 that is likely to mean ensuring their employment is terminated by 0 June this year. The move away from homoeopathy has been so significant that two homoeopathic hospitals are threatened with closure. West Kent PCT is consulting over plans to shut Tunbridge Wells Homoeopathic Hospital and the Royal London Homoeopathic Hospital (RLHH) has asked supporters to lobby trusts and MPs. The RCN and other unions will continue to work at a local level with employers to ensure that reorganisation is concluded in a timely manner before 0 June 007 and that any necessary termination of employment is dealt with before June 0. London trusts have been particularly tough, partly as they have had to reduce some of the largest deficits in the country. Six trusts, including some of the RLHH’s most important financial backers such as Barnet and Islington, have introduced referral management systems that will restrict spending. Who will pay for long-term care? At least ten more from London and southeast England have cancelled their contracts. The RCN has joined forces with 14 other organisations to launch a national initiative looking at the future funding of long-term care in the UK. Caring Choices: who will pay for long-term care? is a nationwide initiative to help shape future policy on long-term care for older people. It focusses on asking the key question: “Who will pay for long-term care?”. Along with a website, a series of events will be held across England and Scotland over the next seven months. The events will give older people, carers and individuals working in long-term care to consider strategies for better care and give their views on how it could be funded in a way that is fair and equitable. To join the debate, take part in the online survey, and find out more about the campaign go to the website: www.caringchoices.org.uk. 4 www.scottishirishhealthcare.com Homoeopathy involves treating patients with substances that have been diluted so many times that there is often no active ingredient left. It is popular with members of the Royal Family but derided by most scientists. Research suggests that it has no benefits beyond being a placebo. Doctors behind the original letter sent a second document to PCTs yesterday, providing a sample commissioning paper that many trusts have used to reduce homoeopathy funding. Gustav Born, Emeritus Professor of Pharmacology at King’s College London, its lead author, said: “Progress has been slower than we’d like and there are still trusts that continue to use these unproven remedies through clinics and prescriptions. That is why we have written again to all the PCTs urging them to follow the commissioning example set by others.” News Hilary Pickles, director of public health at Hillington PCT, said: “It isn’t just that there is no evidence base for homoeopathy; it is also a question of spending priorities. Every time you decide to spend NHS money on one thing, something else is losing out. It is completely inappropriate to spend money on homoeopathy that is unproven, as it means less money for other treatments that are known to be effective.” One person who could benefit from a switch is Anne Fleming, 58, who had multiple myeloma diagnosed 2½ years ago. She has been told that she will need treatment with Velcade, an anticancer drug that costs up to £25,000 for eight cycles. Her primary care trust in South Cambridgeshire has diverted funds from homoeopathy to conventional medicine. She said that the NHS should also abandon non-essential treatments. “I feel very strongly about using public money on tattoo removal. Things on the national health should be about life or death,” she said. 2EDUCE&ALLSATA'REAT0RICE Offering a full line of quality low cost bed and chair monitors to help manage fall risk. Freephone: 0800 032 4789 • MORE FEATURES • Half the cost of leading fall monitors • Connects to most nurse call bell systems • For Bed, Chair, Toilet or Floor Sensors • Battery or Mains Powered • Easy to Use – Installs in Minutes • One Year Limited Warranty Breakthrough in fight against healthcare associated infections NHS Lothian staff have developed a successful new approach to tackling dangers faced by intensive care units across the world. A new education and care package for the insertion of central venous catheters has achieved a dramatic fall in the number of infections related to the use of these important devices. The education package has been developed by staff at the Royal Infirmary of Edinburgh (RIE), in consultation with NHS Education for Scotland. It was initially trialed in the Intensive Care Unit at the RIE and is now being rolled out to intensive care units at the Western General Hospital and St John’s Hospital in Livingston. Carol Fraser, Interim Associate Director for Health Protection, NHS Lothian, said: “Intensive care units face big challenges in preventing infections. They are obviously dealing with the sickest patients and devices such as central lines are vital to the patients’ management. “The Intensive Care Unit of the RIE has participated in HELICS (Hospital in Europe Link for Infection Control through Surveillance) surveillance for the past two years. The second annual report from HELICS has been published and it highlights the achievement of NHS Lothian staff in reducing the incidence of central venous catheter line infection to seven cases in 2006/7 compared to 22 the previous year.” Details of this achievement are contained in a report to the board of NHS Lothian, which meets on Wednesday, the 23rd of May. The report states that the level of healthcare associated infectionssuch as MRSA has remained stable in NHS Lothian, as has been the case for the last five years. The report also details progress made on NHS Lothian’s Cleanliness Champions initiative, the national healthcare associated infection education programme that provides key staff with enhanced education in infection control which they can share with colleagues. Two study days are being held by the Cleanliness Champions organisers, with the first, being held on the same day as the board meeting, having over 170 delegates registered to attend. www.fallsavers.co.uk [email protected] The HeART Health Wallchart A new wallchart highlighting the importance of heart health is to be offered free of charge to healthcare professionals (HCPs). The HeART Health Wallchart is an interactive tool for use in practices and with patients. Developed with experts in heart health, the A1-sized chart offers clearly outlined tips to help deliver the message of heart health to patients. Designed in a visual, question and answer format, the chart provides answers to common queries concerning dietary choices, helping HCPs advise their patients on healthier nutritional alternatives. The Wallchart will be included free of charge within the next edition of the heart health publication Spread It. It will also be available to download at www. proactivscience.com www.scottishirishhealthcare.com News Fizz taken out of sugary drinks sale in hospitals HOSPITALS are to be banned from selling sugar-laden fizzy drinks to staff and visitors in the Lothians as part of a new health drive. The soft drinks will be removed from canteens and cafeterias, while vending machines will be ditched or re-stocked with healthier alternatives. Local celebrities the McDonald Brothers, contestants on the TV show the X Factor, have opened the newly refurbished day room in the Buchanan Ward, Biggart Hospital. Craig and Brian took time out of their busy schedules to cut the tartan ribbon and spent time chatting with patients and staff. There was a real buzz of excitement around the ward as both staff and patients had been keen supporters of the boys during their time on the X Factor. The move has been ordered by NHS Lothian in an effort to help improve the health of staff and patients. The ban covers full sugar soft drinks such as Coca-Cola and Irn-Bru, but not diet versions of the same brands. The only hospital to escape the crackdown is the ERI. Staff and visitors will continue to get a choice there, because its shops, cafés and vending machines are operated by private firms. However, NHS Lothian may approach the private operators at a future date. Dr Allan Gunning, Chief Operating Executive commented: “We would like to thank the McDonald Brothers for taking the time to come and visit Biggart Hospital. They signed autographs, posed for photos and went for a walk around the hospital, it certainly brightened up the day for both patients and staff.” Health chiefs hope the initiative, to be in place by the start of July, will win the hospitals an award for encouraging healthy living. But it has angered many staff, who have described it as “a dictatorial measure” and say it is treating them “like babies”. Gene offers hope of progress on cancer A patients’ watchdog, however, has supported the move. The ban will affect all shops and canteens run by the NHS, as well as those operated by volunteers from the WRVS, at the Western General, Liberton, St John’s, Astley Ainslie and Royal Edinburgh hospitals. SCIENTISTS are a step closer to finding out why some people get cancer, thanks to research unveiled today. The move has been announced in an e-mail to staff, which states: “NHS Lothian catering services are pursuing the Healthy Living Award, promoting healthy choices to staff and visitors. A team from Dundee University discovered that people who carry a variant of a specific gene are less likely to develop cancer of the lung. The experts found that the changed gene results in the potentially cancer-producing protein it makes being broken down and rendered harmless at a much faster rate. So far the discovery applies to lung cancer only, but researchers now want to find out if the gene’s mechanism has implications for other forms of the disease. All humans have the unaltered gene, CYP1B1, while fewer than 10 per cent of people carry its variant. Dr Thomas Friedberg, who has led the work at Ninewells Hospital, Dundee, said the dangerous protein is broken down three times as fast in people with the altered gene. “As part of that process it is the wish of the board to remove carbonated, sugary drinks from sale within NHS Lothian’s catering outlets and to promote the sale of perceived healthier options.” Reacting to the move, one nurse said: “Don’t we have a right to choose anymore? Sometimes you want to have a fizzy drink even though you know it’s not good for you. I know some of the doctors like to have an Irn-Bru when they are hung over.” Another said: “Where is it going to end? Are they going to ban crisps and chips too? It’s treating us like babies not offering us a choice.” But Margaret Watt, chairwoman of the Scotland Patients Association, said that the move was a “step in the right direction”. Having lower levels of the protein corresponds to a lower risk of developing cancer, he said, although the precise relationship is not yet known. “These fizzy drinks can cause a lot of health problems, which the older generation didn’t know about when they were children,” she said. Dr Friedberg, 56, added: “We found that the levels of this protein in cells differed depending on the type of the CYP1B1 gene. “Nowadays it is appropriate to educate youngsters that these drinks are not good for them.” “This was because some varieties of the CYP1B1 protein were broken down much faster by cellular enzymes. “This in turn results in individuals in the metabolism of cancer-causing substances, leading to differences in cancer susceptibility.” He added: “We believe our findings will lead to novel approaches in treatment.” James McCaffery, NHS Lothian’s director of human resources, said: “The removal of sugary drinks is just one way we can encourage our staff, patients and visitors to enjoy a healthier diet while in our premises. In the past, women who carry the one changed form of the gene have been found to have lower incidence of the disease compared with individuals with the other forms of the CYP1B1, but the reason was not known. 6 www.scottishirishhealthcare.com “Low-calorie carbonated drinks will still be available in shops, snack bars and vending machines. People who still want to have sugary fizzy drinks will not be prevented from bringing them into our facilities. “Research has shown us that reducing intake of sugary drinks can help in maintaining a healthy weight.” News Roger Daltrey unveils Scotland’s first Teenage Cancer Trust unit Roger Daltrey CBE launched Scotland’s first Teenage Cancer Trust unit at the Beatson West of Scotland Cancer Centre in Glasgow. The 6-bed ward, funded by Teenage Cancer Trust, will treat patients from West of Scotland. This is Teenage Cancer Trust’s eighth ward in the UK and, like other TCT units, it is expected to improve survival rates by as much as 15%. The unit will give teenagers going through cancer treatment the opportunity to be treated with people their own age and help them to come to terms with the disease and its effects. State-of-the-art equipment such as flat-screen TVs, computers, game consoles and internet access will keep patients occupied during long hospital stays and allow them to stay in touch with friends and family. The unit, which cost TCT £500,000 to build, has 6 beds, 4 of which are on one level with the remaining on a lower level, connected via a lift which goes directly onto a day room. The day room has panoramic views across the city and contains a cafe-style space for patients to take part in various activities. There are also two giant TVs - one for playing computer games and the second to watch films, with comfy seats around it. When well enough, patients will be encouraged to get out of bed and socialise. Each bedroom has a flat screen TV, internet access and a game console with wireless controls. Special attention has been paid to the furnishings, making each room feel more like a teenager’s bedroom or hotel room, than a hospital. For example, clinical functions such as piped gases have been hidden behind smart wooden panels and each bathroom has unique vinyl wraps on the walls. Each day in the UK, 6 teenagers will find out they have cancer – that is over ,000 diagnoses a year. Around 160 of those live in Scotland. Seventy per cent of teenagers with cancer in the UK still do not have access to a specialist TCT facility and will receive treatment on wards with young children or the elderly. To date, TCT has built units in London, Leeds, Liverpool, Birmingham, Manchester, Newcastle and Sheffield and desperately needs more so that every teenager in the UK can have access to one. Plans for further TCT units in Glasgow and in Edinburgh are at an early stage. Roger Daltrey CBE, Who frontman and TCT patron said, “Teenage Cancer Trust units give our teenagers the moral support to help fight this terrible disease. It’s great we’ve been able to open a ward in Glasgow but we need more of them so that every teenager in the UK can have access to one”. Simon Davies, CEO, Teenage Cancer Trust said, “We are delighted to have opened Scotland’s first Teenage Cancer Trust unit at the New Beatson in Glasgow. The facility will ensure that Scottish teenagers with cancer are getting the best possible treatment. “We are grateful to all at the New Beatson for their continued support and assistance in creating this state-of-the-art facility”. Professor Alan Rodger, Medical Director of the new Beatson West of Scotland Cancer Centre, said: “The Teenage Cancer Trust unit is a magnificent new facility for young people. We very much hope that this unit will provide a home away from home for young people, so they will feel more relaxed while receiving treatment and hopefully recuperate more quickly. “The new Beatson has benefited from many additional facilities, features and other enhancements made possible by our charitable partners. We are very grateful to Teenage Cancer Trust for funding this state-of-the-art centre of excellence for young people with cancer.” Healthcare Professionals Invited to Nominate Their Specialist Colitis and Crohn’s Nurses for NACC Nursing Award As part of NACC’s ongoing campaign to raise awareness of the important role played by Specialist Nurses in the quality and continuity of care for Colitis and Crohn’s patients, NACC is inviting Gastroenterologists, General Physicians, Surgeons and Nursing Staff to nominate their Specialist Colitis and Crohn’s Nurse for the 2007 NACC Nursing Award. Previously, this Award was nominated by the NACC membership who responded enthusiastically by explaining how and why their Specialist Nurse had gone beyond the normal call of duty to provide and in many cases set-up new nursing-led patient initiatives. With over 140 excellent nominations, the judges had an extremely difficult task in deciding upon a winner but after careful deliberation they all agreed that Belle Gregg, IBD Nurse Specialist and Nurse Endoscopist of the Royal Liverpool University Hospital was the 005 Award winner. This year NACC is inviting all healthcare professionals involved in the care of patients with Colitis and Crohn’s Disease to download a nomination form from the NACC website and tell us why the Colitis and Crohn’s Nurse in your hospital deserves this Award. The specialist nurse(s) in your hospital may be Colitis and Crohn’s Nurses, IBD Nurses, Gastroenterology, Colorectal or Stoma Care Nurses – their titles are unimportant. As long as they play a specialist nursing role in the care of people with Colitis and Crohn’s Disease, they are eligible for nomination. The entries will be judged by NACC and a small expert panel with an award of £1,000 for further education being presented to the winning Nurse in the Autumn of 007. Richard Driscoll, Director of NACC explains, “We are delighted to be offering this award in recognition of the essential role played by specialist nurses within the IBD team. We look forward to receiving a high level of nominations from healthcare professionals in hospitals throughout the country, and raising awareness of the importance of the Specialist Nurse in the care and management of Colitis and Crohn’s disease.” To nominate your Specialist Nurse simply log on to www.nacc.org.uk and download the nomination form. www.scottishirishhealthcare.com 7 News Concerns over decontamination of reusable medical devices Decontamination of reusable medical devices is a key service supporting primary care in Scotland. But it is a service that has caused considerable concerns in recent years. These concerns have grown since identification in the mid-nineties of the potential risk of transmission of vCJD by inadequately decontaminated medical devices. Suspicions that something might be wrong in decontamination practices nationally were emphatically confirmed in the Old Report of 2002, which described widespread failings in facilities, equipment and decontamination training of staff in primary and secondary care services in Scotland. This followed the 2001 report The Decontamination of Surgical Instruments and other Medical Devices, which included a review of procedures in general practices. In addition, a large-scale observational survey of 179 dental practices in Scotland, published in 2004, highlighted many shortcomings in the cleaning and sterilization of dental instruments and low levels of support and training for the dental team. These reports and the concerns that preceded them emphasise just how vital it is for staff who are involved in decontamination processes to practice in a safe and effective manner. The health and well-being of their patients, their colleagues and themselves depends upon it. Although primary care staff works hard at providing a good service, there are strong indications that they are unaware of what constitutes good decontamination practice and what guidance, standards and formal quality management systems are available to support them. This lack of awareness needs to be addressed through appropriate education and training. And a new online programme is being developed precisely to meet that need by supporting practitioners in primary care to gain the knowledge and skills necessary to carry out decontamination processes safely and effectively. The programme - Education and Training Programme on Decontamination for Primary Care Staff in NHS Scotland - is the product of a partnership involving NHS Education for Scotland (NES), Health Protection Scotland (HPS) and a specialist e-learning organisation. It is based on a combination of current policy, practice, standards and guidelines, both national and international, and reflects existing education models in Scotland and elsewhere. A wide range of topics focusing on key issues vital to ensuring patient safety is presented in the programme (see text box). Coverage is given to all aspects of the decontamination lifecycle through the provision of essential information and advice on best practice. Programme topics include… •Decontamination – An Overview •Acquiring Medical Devices •Protecting Yourself & Others •Microbiology •Cleaning & Disinfection •Inspection •Packaging •Sterilization •Disposal •Transport •Storage •Ensuring Quality www.scottishirishhealthcare.com Programme developers recognised that while practitioners working in dental, podiatry and GP clinics or practices face very different clinical issues and challenges on a day-to-day basis, the fundamental principles underpinning their decontamination practices are the same. This provided an opportunity to create a learning resource that has equal value and validity across a range of professions and practitioners working in primary care settings, including dental nurses, practice nurses, practice managers and podiatrists. Each study unit should take approximately one hour of computer time to complete. Support from managers will be an essential prerequisite for taking the programme, and potential participants will have to ensure this is in place prior to registering. Participants won’t be asked to sit any exams, but their learning will be assessed through a series of online questions to help them identify how well they have understood the theory component of each learning unit. The online delivery mode is considered ideal in that it allows participants to learn at their own pace and in their own time and gives programme developers the opportunity to quickly update the resource to reflect new guidelines and evidence. But while the online programme will provide the theoretical knowledge practitioners need to recognise good decontamination practice, the most important priority is to ensure new knowledge is translated into their everyday work. For this reason, suggestions will be offered on issues participants might like to consider as work-based activities to be included in a special ‘folder of evidence of learning’ which will be available to those registering for the programme. Work-based activities may include initiatives related to, for instance, performing workplace audits, creating development plans or maintaining a reflective log or learning diary. Central to both theoretical and practical components of the programme will be mentors appointed to support practitioners in their learning. The mentors are likely to be experienced colleagues who have either completed the programme previously or who have a strong background in decontamination. They will help participants with the theoretical elements of the programme and in choosing appropriate work-based activities, and will assess their folders of evidence of learning to make sure they are achieving programme and personal objectives. The expectation is that the programme will enable practitioners who have responsibility for decontamination in primary care areas to practice from a better-informed base, leading to an improved and safer standard of care for patients. The programme will go to pilot with a view to the first of the learning units being available in the spring, with any lessons learned from the pilot feeding into revisions. In the meantime, interested individuals can find out more and register their interest at [email protected] Evidence based new roles for Older Peoples Care Skills for Health competences bring new roles in NHS Forth Valley With a growing population of older people, planning to ensure community infrastructure and supports are able to meet their healthcare needs is vital. NHS Forth Valley recognised this need in their Healthcare Strategy for Older People, with particular focus on shifting the balance of care in rehabilitation and intermediate care from acute to community hospitals. As part of the Workforce Plan, they decided to carry out a workforce planning project, using Skills for Health’s competence tools to ensure that the planned move from existing models of care to smaller community units could be achieved safely and smoothly, thereby supporting the “Delivering for Health” policy. News Identifying skills gaps The project began with the Skills Mapping Project Manager, Katie Callaghan mapping the future care needs, using a variety of methods including Skills for Health’s Older People’s Framework, which covers the competences needed to care for older people with age related needs. Using similar methods Katie then mapped the skills of the staff currently delivering care within existing Older Peoples wards. Awareness sessions provided by Maggie Havergal, Skills for Health Scotland Director, were held for staff who would be involved to encourage participation. Cooperation from staff throughout the project was excellent. The advantages of using a competence based approach to workforce planning soon became clear. The Team Assessment tool on the Skills for Health website was used to highlight development needs. This ensured that patient needs and pathways were matched with appropriate care related competences from the Skills for Health database. The outcome was the creation of some new roles with competence profiles to ensure that the patient and service needs were met e.g. Rehabilitation Support Worker and Senior Clinical Nurse. New roles emerge from the evidence Another advantage of using the competence based approach to workforce planning was that it helped to identify where future development needs should be concentrated. The project identified areas where existing staff roles could be enhanced to meet the needs of patients in the future Community Hospitals. The competence profiling provided evidence to support the development of trained nurses to minimise the impact of Modernising Medical Careers. Some ‘tasks’ carried out by medical staff, which are at KSF levels 3 and 4, could be done by qualified nurses with additional development, for example; advanced clinical examination and extended nurse prescribing. With approximately 400 Nursing, Allied Health Professionals and Medical staff currently supporting services for older people, the new competence based approach is a powerful tool for healthcare managers responsible for workforce planning and development at NHS Forth Valley. The success of this project has resulted in the organisation’s continued use of the Skills for Health Competences to create profiles to support KSF Post Outlines, advise staff recruitment and induction needs and is now informing many other areas of staff development. Skills for Health have a range of electronic tools that support the database of competences available on their website. The tools are there for designing roles, services, education, training, and forecasting future needs, and designed specially for the health sector. “This has been a tremendously useful project not just for the patients, service users and health care managers of Forth Valley, but it has demonstrated how useful Skills for Health’s products are for organisations that have to implement Delivery for Health.” Argyll helps LSMS get tough on violence locally and provide a single point of contact for staff and the police. A network of 179 accredited specialists is currently in place across the country, with many more being trained. They work with all staff in the Trust and the NHS CFSMS as well as external organisations including the local police services, professional representative bodies and trade unions. “My role is to investigate, advise and bring those who are violent to NHS staff to court”, says Henry Grant, LSMS at North Middlesex University Hospital NHS Trust, a busy acute general hospital serving the communities of the London Borough of Enfield and Haringey and surrounding areas. “The objective is to deliver an environment that is safe and secure so that the highest standards of clinical care can be made available to patients”. Whilst the Panorama investigation focused on the violence to NHS staff in hospitals, NHS lone workers are even more vulnerable to verbal and physical abuse having no direct support from colleagues. Midwives, health visitors, GPs, district nurses and paramedics are in the front line everyday often facing potential violence from patients and their families. “There are times when lone workers may be faced by an extremely disturbed person”, continued Henry Grant. “Simply being out and about on some of the estates our staff have to visit, where alcohol and other substances are consumed, can in itself feel threatening”. Faced with the need to support NHS lone workers, LSMS like Henry Grant are turning to companies such as Argyll Telecom that can offer a range of lone worker products to safeguard lone workers and help combat increasing poor staff moral. After investigating a range of safety systems, Henry Grant, selected a mix of solutions from Argyll Telecom from which the Trust’s managers could choose. These included Argyll’s IdentiCare‘ lone worker device which looks like a normal ID card-holder but is equipped with mobile telephone technology and its CommuniCare‘ service which enables lone workers to summon assistance from a mobile phone or specialist device should they find themselves in a potentially abusive situation. Both solutions are monitored by Argyll’s integrated control room through which the Trust manages and monitors lone worker locations, time at risk and provides them with an effective duress facility 4/7. Should a member of staff experience a potentially hazardous situation, they are a single button-press away from quickly and discreetly summoning assistance. When an alert is received, Argyll’s trained operators put into effect an agreed incident management procedure, and if required, use existing links with the police to ensure a swift response. Sophisticated voice recording ensures that every incident is captured and can be produced as evidence if required. “Lone worker devices supplied by companies like Argyll Telecom are helping us in the fight to stop violence against NHS staff”, concluded Henry Grant. They are giving us the technology to record violent behaviour, bring successful prosecutions and improve moral amongst staff”. Violent and abusive patients attacked an estimated 75,000 NHS staff last year costing the NHS more than £100 million, according to a recently televised Panorama investigation. To help combat the growing rise of attacks on NHS staff, a new role has been created within the NHS - that of Local Security Management Specialist (LSMS). They are turning to companies such as Argyll Telecom to provide state-ofthe-art technology to help in the fight against violence. LSMS are trained and accredited professionals who have been appointed in health bodies across England to tackle security issues To help combat the growing rise of attacks on NHS staff, a new role has been created within the NHS - that of Local Security Management Specialist (LSMS). They are turning to companies such as Argyll Telecom to provide state-of-the-art technology to help in the fight against violence. www.scottishirishhealthcare.com 9 Healthcare Events ......... in and around your area • 24th August 2007 Energising Modern Midwifery Conference Venue: The Robert Gordon University, Faculty of Health and Social Care, Garthdee Road, Aberdeen The 4th annual RGU Midwifery Conference is to be held at the University on Friday the 4th August. • 22nd June 2007 Understanding Rape & Sexual Abuse Cost: £100 per person (includes coffee & lunch) Venue: School of Health, Nursing & Midwifery University of Paisley Paisley PA1 BE Understanding Rape & Sexual Abuse offers delegates the opportunity to participate in a thought provoking one-day conference. The Conference aims to bring together key professionals working in this specialised field to share their expertise. For further information / enquiries, please contact: Irene McKeown, School Administrator School of Health, Nursing & Midwifery, University of Paisley Paisley PA1 BE Tel: 0141 848 968 E-mail: [email protected] • 23rd August 2007 Nurse Practitioners: Back to the Future One-Day Conference Venue: The Robert Gordon University, Faculty of Health and Social Care, Garthdee Road, Aberdeen The role of Nurse Practitioners in advancing nursing practice has evolved over the last 0 years in the UK and, more recently, in Scotland, particularly the North and North East of Scotland. Many opportunities exist for nurses and other health professionals to further develop their knowledge and clinical skills by integrating these with skills from the medical domain. For further information / enquiries, please contact: Jean Cowie School of Nursing and Midwifery School of Health and Social Care Garthdee Road Aberdeen Tel.: 014-6616 E-mail: [email protected] 10 www.scottishirishhealthcare.com For further information / enquiries, please contact: Lynn Grove - Midwifery Lecturer School of Nursing and Midwifery School of Health and Social Care Garthdee Road Aberdeen Tel: 014 66 Email: [email protected] Barbara Jones - Events/PR Co-ordinator Communications Dept The Robert Gordon University Schoolhill Aberdeen Tel: 014 604 Email: [email protected] • 5th September 2007 Annual Immunisation Update Day Annual conference Venue: Glasgow Royal Concert Hall This annual conference will address a wide range of issues that have arisen in the past year and appraise recent developments in immunisation and the epidemiology of vaccine preventable disease.It will also examine issues related to the effectiveness of immunisation services and facilitate debate about these in Scotland and work towards their improvement. We hope to target all those involved in the delivery of immunisation throughout Scotland, and particularly those involved in advisory/educational roles, for example Public Health Practitioners, Paediatricians and those working in NHS Boards such as CPHMs and Public Health Nurses. The format will comprise presentations from national and international speakers, with opportunity for questions and discussion. For further information, contact: Courses & Conferences Team Health Protection Scotland, nd Floor Clifton House, Clifton Place, Glasgow, G 7LN 0141 00 1100 [email protected] Healthcare Events ......... • 20th September 2007 Group-working Skills One-Day Course A 1 day course Free to Stewards, Learning & Safety Reps, £25 to RCN Members Venue: RCN Scotland 42 South Oswald Road Edinburgh EH9 2HH How should you summarise discussions? How do you select key points? How do you hold the interest of other groups while you feedback? If you’ve ever wondered, or you’d like a chance to practice – come along and develop skills that will ensure your feedback is heard. For further information, contact: Ali Shire, Administrative Assistant 42 South Oswald Road, Edinburgh, EH9 2HH Tel: 0131 662 6165 Fax: 0131 662 1032 E-mail: [email protected] • 24th October 2007 DUBLIN • 6th November 2007 GLASGOW Skills for Nurses 2007 2 x One-Day Events Skills for Nurses are pleased to announce the latest One day Nursing Exhibitions which will be held in Dublin and Glasgow. (See pages 62 - 63) fit and well But what if something goes wrong We are presently helping a number of Nurses both young and elderly. If you know someone who you think needs our help contact: Margaret Sturgeon 15 Camp Road Motherwell ML1 2RQ Telephone: 01698 252034 Venues: RDS, Shelbourne Hall, Dublin SECC, Glasgow Previous events have helped many NHS, international recruiters and employers in the private sector to fill posts and the latest events promise to do even better. As with all our events we have a full range of seminars and workshops featuring prominent speakers and celebrities including Anne Diamond. This year we are having skills challenges with large cash prizes. Entry is free, log on to www.scottishirishhealthcare.com to find out more. Enquiries from Nurses and other Healthcare professionals please contact: Tracy Hamilton on 01324 411013 or email [email protected] Exhibitors please contact: Scottish & Irish Nurse magazines on tel. +44 (0)1292 525 970 email. [email protected] Donations required to continue the work of the Fund Visit our website for more details www.bfns.org.uk Registered charity no. SC006384 www.scottishirishhealthcare.com 11 Clinical Articles Wanted At Scottish & Irish Nurse we are always interested in good quality clinical editorial. We’d love to hear from you regardless of whether you’ve had work published before. Your submission needn’t be a very detailed clinical paper. For example you can forward: • A review of a local initiative that has delivered best practice leading to an improvement in patient care. • Results of an audit or survey that has led to an improved service to patients and their relatives • An article relating to an area of particular interest to you or involving your specialist area. We are particularly keen to receive articles related to Cardiology, Respiratory, Diabetes, Nutrition, Midwifery, Mental Health, Intensive Care and Dementia • A service redesign initiative that has achieved demonstrable results • Or just anything that’s going on locally or that you and your team has achieved that you’d like to share with over 0,000 Nurses fortnightly. Our articles are typically 1500 words, although there is a fair degree of flexibility, and fully referenced where appropriate. Don’t worry about pictures and graphics as we can insert these for you. For authoring guidelines or to submit editorial e-mail: [email protected] Postal address: Charles Bloe Training Ltd, Editorial Dept, 15 Highland Dykes Drive, Bonnybridge. FK4 1PE. Or if you have any queries give me a call on 01324 814946. Clinical Editorial Board Charles Bloe BSc RN NDN ITU cert Clinical Editor CEO Charles Bloe Training Ltd Charlie graduated with a BSc in Social Sciences and Nursing Studies from the University of Edinburgh in 1984 and spent much of his clinical career as a senior nurse in Cardiac Care and Medical High Dependency. He is now CEO of Charles Bloe Training Ltd. who deliver onsite and online clinical updates to healthcare staff across the UK and beyond. Scott Kane RMN MSc Assistant Clinical Editor Clinical Nurse Specialist in Liaison Psychiatry, Tayside Health Board Scott undertook his RMN training in Dundee, qualifying in 1991. Since that time has worked in acute, long-term, rehab and supported accommodation. He was appointed Clinical Nurse Specialist in Liaison Psychiatry in 1996. Michael Canavan Dip N RN ALS Lead Resuscitation Training Officer Ayrshire & Arran NHS Trust After a period of 7 years as senior Staff Nurse in Coronary Care Michael was appointed Resuscitation Training Officer in Forth Valley Acute Hospitals NHS Trust. He has since moved to Ayrshire where he is lead Resuscitation Training Officer at Ayrshire & Arran NHS Trust. Michael is a Resuscitation Council (UK) approved Advanced Life Support Instructor and ALS course Director. Sheenagh Orchard RN RNT Cert Ed (FE) DN (Lond) Moving & Handling Consultant Sheenagh qualified in 1975 and is currently a Moving & Handling of People Specialist undertaking assessment, training and a number of speaking appointments at National Conferences. She is one of the co-authors of ‘The Guide to the handling of People’ 5th edition. Deborah Ward MA, BSc (Hons), RN Infection Control Nurse Specialist Deborah has worked as an infection control nurse since 1998, working both inside and outside the NHS in both acute and non-acute settings. She now works outside the NHS for a national organisation across England, Scotland and Wales. 1 www.scottishirishhealthcare.com Greig Ferguson BSc RN DSc MD ATLS ALS EPLS Registered Nurse Accident & Emergency Critical Care Greig initially trained as a Royal Marines Commando, undertaking the military Paramedic course in 1992. On attachment he attended Chicago Medical School 1993 at the Rosalind Franklin University of Medicine and Science. Completed initial internship at the Department of Emergency Medicine. Maureen Benbow MSc BA RN HERC Senior Lecturer, University of Chester Maureen worked as a Tissue Viability Nurse at Mid Cheshire Hospital Trust, Crewe for 14 years and in 2004 transferred to the University of Chester. Her clinical background is in orthopaedics and accident and emergency. Steven Morrison Dip N Bachelor Nursing RN ALS Hospital at Night Practiitoner, Forth Valley Acute Hospitals Steven has spent much of his clinical career in Coronary Care and has been particularly proactive in the development & implementation of Acute Coronary Syndrome management programmes. Kirsten Ramsay RN DipN ALS Hospital at Night Practitioner, Fife Acute Hospitals NHS Trust Kirsten spent much of her early clinical career as Staff Nurse in Coronary Care and Medical High Dependency. She was among the first Nurses in the UK to undertake the role of nurse initiated coronary thrombolysis. Jamie Jones RN (Adult) BSc DipHE PGDip ALS(I) APLS(I) Emergency Nurse Practitioner, Pontypridd & Rhondda NHS Trust. Jamie has spent his career working in the Accident & Emergency environment. He has held Staff Nurse, Deputy Charge Nurse and Charge Nurse Positions before moving onto his current position as an Emergency Nurse Practitioner. Heather Liddell BSc RN ALS SPQ Senior Charge Nurse, CCU, Wishaw General Hospital Heather has spent much of her senior clinical career working in Cardiac Care and Medical High Dependency. She is currently a chest pain assessment practitioner at Stirling Royal Infirmary. Write letter to friend in large, shaky print Dictate letter to husband for the umpteenth time Simply drop friend a line Lose touch ropinirole PUT THEIR LIVES BACK IN THEIR HANDS REQUIP® (ropinirole hydrochloride) Prescribing Information (Please refer to the full Summary of Product Characteristics before prescribing. Presentation ‘ReQuip’ Tablets, PL 10592/0085-0089, each containing ropinirole hydrochloride equivalent to either 0.25, 0.5, 1, 2 or 5 mg ropinirole. Starter Pack (105 tablets), £40.10. Follow On Pack (147 tablets), £74.40; 1 mg tablets – 84 tablets, £47.26; 2 mg tablets – 84 tablets, £94.53; 5 mg tablets – 84 tablets, £163.27. Indications Treatment of idiopathic Parkinson’s disease. May be used alone (without Ldopa) or in addition to L-dopa to control “on-off” fluctuations and permit a reduction in the L-dopa dose. Dosage Adults: Three times a day, with meals. Titrate dose against efficacy and tolerability. Initial dose for 1st week should be 0.25 mg t.i.d., 2nd week 0.5 mg t.i.d., 3rd week 0.75 mg t.i.d., 4th week 1 mg t.i.d. After initial titration, dose may be increased in weekly increments of up to 3mg/day until acceptable therapeutic response established. If using Follow On Pack, the dose for 5th week is 1.5mg t.i.d., 6th week 2.0mg t.i.d., 7th week 2.5mg t.i.d., 8th week 3.0mg t.i.d. Do not exceed 24 mg/day. Concurrent L-dopa dose may be reduced gradually by around 20%. When switching from another dopamine agonist follow manufacturer’s guidance on discontinuation. Discontinue ropinirole gradually by reducing doses over one week. Renal or hepatic impairment: No change needed in mild to moderate renal impairment. Not studied in severe renal or hepatic impairment – administration not recommended. Elderly: Titrate dose in normal manner. Children: Parkinson’s disease does not occur in children – do not give to children. Contra-indications Hypersensitivity to ropinirole or to any excipients, pregnancy, lactation and women of child-bearing potential unless using adequate contraception. Special warnings and precautions Caution advised in patients with severe cardiovascular disease and when co-administering with anti-hypertensive and anti-arrhythmic agents. Patients with a history or presence of major psychotic disorders should be treated with dopamine agonists only if potential benefits outweigh the risks. Pathological gambling, increased libido and hypersexuality reported in patients treated with dopamine agonists for Parkinson’s disease, including ropinirole. Ropinirole has been associated with somnolence and episodes of sudden sleep onset. 01506_igreqp_ad_adapt_fa.indd 1 Patients must be informed of this and advised to exercise caution while driving or operating machines during treatment with ropinirole. Patients who have experienced somnolence and/or an episode of sudden sleep onset must refrain from driving or operating machines. Caution advised when taking other sedating medication or alcohol in combination with ropinirole. If sudden onset of sleep occurs in patients, consider dose reduction or drug withdrawal. Drug interactions Neuroleptics and other centrally active dopamine antagonists may diminish effectiveness of ropinirole – avoid concomitant use. No dosage adjustment needed when co-administering with L-dopa or domperidone. No interaction seen with other Parkinson’s disease drugs but take care when adding ropinirole to treatment regimen. Other dopamine agonists may be used with caution. In a study with concurrent digoxin, no interaction seen which would require dosage adjustment. Metabolised by cytochrome P450 enzyme CYP1A2 therefore potential for interaction with substrates or inhibitors of this enzyme – ropinirole dose may need adjustment when these drugs are introduced or withdrawn. Increased plasma levels of ropinirole have been observed with high oestrogen doses. In patients on hormone replacement therapy (HRT) ropinirole treatment may be initiated in normal manner, however, if HRT is stopped or introduced during ropinirole treatment, dosage adjustment may be required. No information on interaction with alcohol – as with other centrally active medications, caution patients against taking ropinirole with alcohol. Pregnancy and lactation Do not use during pregnancy – based on results of animal studies. There have been no studies of ropinirole in human pregnancy. Do not use in nursing mothers as lactation may be inhibited. Effects on ability to drive and use machines Patients should be warned about the possibility of dizziness (including vertigo). Patients being treated with ropinirole and presenting with somnolence and/or sudden sleep episodes must be informed to refrain from driving or engaging in activities where impaired alertness may put themselves or others at risk of serious injury or death (e.g. operating machines) until such recurrent episodes and somnolence have resolved. Adverse reactions Psychiatric disorders; common: confusion, hallucinations, uncommon: Psychotic reactions including delusion, paranoia, delirium. Patients treated with dopamine agonists for treatment of Parkinson’s disease, including ropinirole, especially at high doses, have been reported as exhibiting signs of pathological gambling, increased libido and hypersexuality, generally reversible upon reduction of the dose or treatment discontinuation. Nervous System Disorders; very common: somnolence, dyskinesia, common: dizziness (including vertigo), syncope, uncommon: extreme somnolence, sudden onset of sleep, Vascular disorders; common: hypotension, postural hypotension. Gastrointestinal disorders; very common: nausea, common: abdominal pain, vomiting dyspepsia. General disorders and administrative site conditions; common: leg oedema. Hepatobiliary disorders; very rare: hepatic enzymes increased. Overdosage Symptoms of overdose likely to be related to dopaminergic activity. POM Legal category Marketing Authorisation Holder SmithKline Beecham plc t/a GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex UB11 1BT. Further information is available from: Customer Contact Centre, GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex UB11 1BT; [email protected]; Freephone 0800 221 441. Prescribing information last revised: April 2007. In order to continually monitor and evaluate the safety of ReQuip®, we encourage healthcare professionals to report adverse events, pregnancy, overdose and unexpected benefits to GlaxoSmithKline on 0800 221 441. Please consult the Summary of Product Characteristics for full details on the safety profile of ReQuip®. Information about adverse event reporting can also be found at www.yellowcard.gov.uk. ReQuip® is a Registered Trademark of the GlaxoSmithKline Group of Companies. Date of preparation: June 2007 REQ/FPA/07/31357/1 www.scottishirishhealthcare.com 1 6/13/07 12:24:11 PM The role of Parkinson’s • Help support self care and preserve patients’ sense of wellbeing • Assist unpaid carers to care effectively • Deliver education to all health and social care professionals involved along the patient care pathway How a PDNS can make cost savings Parkinson’s Disease Nurse Specialists (PDNS) offer great potential for NHS providers and commissioners to improve quality of care while at the same time contributing to the achievement of healthcare targets and reducing costs. Introduction Parkinson’s disease is a progressive, neurological condition that affects approximately 120,000 people in the UK , with 10,000 new diagnoses each year. It is estimated that over 10,000 people are living with Parkinson’s in Scotland alone. The principle signs of Parkinson’s disease are rest tremor, rigidity and slowness of movement. However, although the condition is predominantly a movement disorder, non-motor symptoms, such as cognitive damage and dementia, bladder and bowel problems, and sleep disturbance, are also widely associated with Parkinson’s. These symptoms often increase and become more severe as the condition progresses, as do the needs and costs of the care of people with Parkinson’s. In the absence of a cure, provision of information throughout the course of the condition, from diagnosis onwards, regular reviews of patients’ symptoms and medication, and access to appropriate health and social care services are all important in keeping the patient’s condition under control. Specialist health professionals therefore play a key role in managing Parkinson’s, especially in helping the patient come to terms with their diagnosis and being a source of support. Indeed evidence suggests that people with Parkinson’s have improved health outcomes and a better quality of life when they are able to access prompt and ongoing advice and support from practitioners with dedicated neurological expertise, such as a specialist nurse. Parkinson’s Disease Nurse Specialists People with Parkinson’s can live a full and active life with the proper support and access to appropriate services, and a Parkinson’s Disease Nurse Specialist (PDNS) is crucial in maintaining an independent lifestyle. A PDNS has a wide role, contributing to the management of care, providing support for carers, educating health care professionals, patients and their families. By providing expert advice and support to patients, they promote selfcare and ensure patients are able to manage their symptoms effectively. This leads to a more appropriate use of health and social care services. One man in his forties, who has had Parkinson’s for five years, is keen to highlight the importance of a Parkinson’s Disease Nurse Specialist. He said: “I was having a nightmare with my Parkinson’s medication after the doses had been changed. My PDNS came and sorted me out quickly, adjusting the doses so that I could get back to normal. At other times, she has used her in-depth knowledge of the condition and measured judgement to determine which therapies and services are right for me. My PDNS has given me both the emotional and medical support I have needed since being diagnosed with Parkinson’s, has helped me to take control of my own condition and encouraged me to live my life to the full.” Using their in-depth knowledge of the condition, Parkinson’s Disease Nurse Specialists work hard to understand the needs of individual patients and advise and link them to appropriate therapies and services at all stages of the disease. They provide the continuity of care for a person with Parkinson’s, as they join together the many healthcare professionals involved in the management of the condition, and often work as part of a multi-disciplinary team alongside neurologists, geriatricians, general practitioners, therapists and social care professionals. In addition, a PDNS will also: • Contribute significantly to improved symptom control and the general health of people with Parkinson’s • Maintain people in the community and contribute to a reduction in hospital admissions • Divert appointments away from consultants, helping them to meet outpatient waiting times for diagnosis and complex cases 14 www.scottishirishhealthcare.com In a healthcare organisation with a population of 500,000 people, there may be approximately 1,000 patients with Parkinson’s, and between 0 and 100 people will be diagnosed each year . Not surprisingly, this has significant cost implications to health and social services. However, it has been estimated that by developing and funding community-based services for people with Parkinson’s, the savings in health costs would be around £56 million . Although this figure applies to England and Wales, it is evident that Parkinson’s Disease Nurse Specialists are fundamental in achieving healthcare targets and reducing costs, regardless of their location. An example of how these cost savings are possible is in Harlow. For two years before the PDNS came into post, Harlow Primary Care Trust (PCT) had established robust data on hospital admissions for primary and secondary diagnosis of Parkinson’s. When the nurse came into post, she was able to identify trigger factors for hospital admissions. She worked with the multidisciplinary team to ensure early therapy interventions and established herself with patients as the first port of call in a crisis. She was also able to use daily admissions reports and PARR reports (patients at risk of readmissions) to allocate her resources to where they were most needed. Ten months after the post was created, recorded data clearly indicated the upward trend in admissions and length of stay was reversed, with a saving to the PCT of £80,000. The Role of a Parkinson’s Disease Nurse Specialist in Scotland Systematic support for people with long-term conditions is a key pillar of Delivering for Health , the Scottish Executive’s vision for the NHS. The overall direction of the policy is moving towards early interventional, community-based health services with multidisciplinary teams delivering patient-centred care. This contrasts with the traditional model of doctor-led, hospital-focused services, with high levels of unplanned admissions. Parkinson’s Disease Nurse Specialists can help make this vision a reality for people with Parkinson’s in Scotland by managing patients throughout the course of the condition and by acting as a regular point of contact, enabling them to pick up potential problems before they occur. The work of a Parkinson’s Disease Nurse Specialist There are a number of ways a Parkinson’s Disease Nurse Specialist can help to achieve the Scottish Executive’s vision for the NHS, which are explained below. Empowering patients Parkinson’s Disease Nurse Specialists play an important role in empowering patients and families to become experts in the condition. Evidence suggests that people with long-term neurological conditions such as Parkinson’s have improved health outcomes and a better quality of life when they are able to access prompt and ongoing advice and support from practitioners with dedicated neurological expertise, such as specialist nurses . The PDNS in Fife believes this to be the case, saying: “We are there as an ongoing source of support for the patient in whatever setting that may be. Patients say they value having someone to support them through their diagnosis, and also during the changes in their condition as it progresses, who understands their condition.” Reducing the need for outpatient care Expert opinion suggests that access to specialist Parkinson’s nursing care and therapy services may potentially reduce outpatient attendance by a staggering 40%. A large part of outpatient attendance for people with Parkinson’s is for clinical monitoring and medical adjustment. The NICE Guideline, although only relevant for England and Wales, recommends that these services may be provided by specialist nurses, which has been the case in Tayside. The PDNS for Perth and Kinross has established a nurse-led clinic at Perth Royal Infirmary for regular medication reviews, and continues home visits for new referrals and for those who cannot make the clinic. She works alongside GPs, Neurologists and Geriatricians to get patients with Parkinson’s as independent as possible. Disease Nurse Specialists in Scotland Author: Andrea Sim, PDS Manager of Scotland Management of Parkinson’s medication can be complex, and regular clinical reviews and medical adjustments are therefore key to keeping patients in control of their symptoms. Parkinson’s Disease Nurse Specialists are ideally placed to be available to patients when they are needed. If patients do not have access to a specialist Parkinson’s nurse, hospital based specialists will need to conduct these reviews, which takes up clinic time that could be used to shorten waiting times for referrals and to deal with complex cases. Another PDNS in Fife also plays a role in reducing the need for outpatient care. She says: “We work with many consultants, both Geriatricians and Neurologists, to run nurse-led clinics and visit patients in hospital. Waiting times for the clinics are very short because we are reviewing patients that were previously being reviewed more frequently by the consultants. Our service is available to anyone with a confirmed diagnosis of Parkinson’s and their relatives, carers or anyone involved in the care and management of someone with Parkinson’s.” Reducing unplanned admissions Expert opinion estimates that PDNS care, as part of a multidisciplinary team, can reduce admission for Parkinson’s disease by 50%. Although there are no official figures for Scotland as yet, this estimation is reinforced by a local Audit conducted in Fife regarding the role of their PDNS over three years. The results clearly indicated that patients who had access to a PDNS were four times less likely to be admitted to hospital. Preventing unnecessarily extended stays in hospital Keeping people with Parkinson’s out of hospital is not always possible, and in those cases, Parkinson’s Disease Nurse Specialists can be instrumental in preventing unnecessarily extended hospital stays by educating other hospital staff about the condition and the need for medication to be administered on time. People with Parkinson’s will often be on a number of drugs, each of which must be taken throughout the day at specific times. If a person is unable to take their prescribed medication at the right time, the balance of chemicals in their bodies can be severely disrupted – and this will lead to their Parkinson’s symptoms being uncontrolled with a possible lengthy recovery time. Inflexible drug rounds, low levels of support for self-administration processes and lack of understanding among ward staff can all lead to problems for patients. Disruption of an individual’s medication regimen can have serious consequences for ward management and the treatment for which the person was originally admitted. Therefore, a PDNS is crucial in improving the management of medication in hospital for people with Parkinson’s. When the PDNS for Perth and Kinross was appointed in 006, she immediately recognised the importance of timely medication management, and has been instrumental in disseminating information and educating hospital and care home staff. Upon admission of a patient with Parkinson’s, she will contact the ward staff to explain the need for medication to be administered on time, and will provide them with information sheets with further details. She identified link nurses in Medicines for the Elderly, acute wards, community hospitals and psychiatry to raise awareness of the issue in the hope that they can then pass on their knowledge in these areas. Investing in a Parkinson’s Disease Nurse Specialist With NHS reforms pointing the way to more healthcare activity in the community, now is an excellent time for commissioners in Scotland to create specialist Parkinson’s nursing posts. Local cost pressures need not prevent the creation of these posts, as there is no investment needed upfront. The Parkinson’s Disease Society will fund a new PDNS post for two years, providing the local health board confirms it will pick up the funding after this point. This gives the local health organisations time to evaluate for themselves the clinical and financial value of having a specialist nurse. The PDS, Parkinson’s Disease Nurse Specialist Association (PDNSA) and the Royal College of Nursing (RCN) have collaborated as one body to produce an integrated career and competency framework for nurses working in Parkinson’s disease management . These competencies have been produced to maintain the highest level of standard, competence and professional integrity within Parkinson’s disease nurse management. The gap in specialist nurse care in Scotland Although there have been some clear examples of the benefits of Parkinson’s Disease Nurse Specialists, and what help is available to fund their posts, there are only 16 specialist nurses dealing with a caseload of approximately 10,000 people living with Parkinson’s in Scotland. The recommended caseload of a PDNS is around 00 people, but this clearly isn’t the case in Scotland, with some areas not having access to a specialist nurse at all. This is further compounded by the fact that the land mass of Scotland is two-thirds that of England, with a population one-tenth its size. This means that each PDNS would need to cover a much larger area than his or her equivalent in England and Wales. For example, the PDNS for the Highland Health Board encompasses an area from Wick, right down to Campbelltown, including all the islands, with over 00 miles between the two furthest points. Conclusion The benefits of a PDNS are countless, from cost savings to health services, to empowering and educating patients with Parkinson’s to become experts in their condition. However, in Scotland there is clearly a shortage of Parkinson’s Disease Nurse Specialists, despite overwhelming evidence of the need and importance of their role, the support of Hospital Consultants and years of hard campaigning. This continues with the Parkinson’s Disease Society’s willingness to fund new posts for the first two years. Although a key pillar of Delivering for Health, the Scottish Executive’s vision for the NHS, is focused on early interventions and community-based health services, a comprehensive clinical guideline is still needed for clinicians and health commissioners in Scotland to use as a basis to design high-quality health services for people with Parkinson’s. The Scottish Intercollegiate Guideline Network (SIGN) is due to start developing a Guideline in June, but it appears it will be narrowly focussed on medication. To fully meet the needs of people with Parkinson’s in Scotland, we believe the Guideline should be expanded to cover diagnosis and management of this complex condition, including therapies and specialist nurses. Indeed, using available evidence, the National Institute for Health and Clinical Excellence acknowledged the central role of specialist nurses in its Guideline for Parkinson’s published last year for England and Wales. References i Parkinson’s Disease Society estimate ii Dodel RC et al (1998) ‘Costs of drug treatment in Parkinson’s Disease’ Movement Disorders; 13(2):249-254 iii Thomas S et al on behalf of the PDS UK Primary Care Task Force (2006) Moving and Shaping, A Guide to commissioning integrated services for people with Parkinson’s disease, Parkinson’s Disease Society, London iv Scottish Executive (2005) Delivering for Health v Hutwitz B et al (2005) ‘Scientific evaluation of community-based Parkinson’s disease nurse specialists on patient outcomes and healthcare costs’ Journal of evaluation in Clinical Practice; 11:97-110 vi NICE (2006) Parkinson’s disease diagnosis and management in primary and secondary care National Cost-impact report, NICE, London vii NICE (2006) Parkinson’s disease diagnosis and management in primary and secondary care National Cost-impact report, NICE, London viii Royal College of Nursing, Parkinson’s Disease Society, Parkinson’s Disease Nurse Specialist Association (2005) Competencies: an integrated career and competency framework for nurses working in Parkinson’s disease management, PDS, London The Society has helped many local health organisations scope their nurse services, and will help local teams find a model of specialist Parkinson’s nursing that works for them and works for the needs of people with Parkinson’s in their area. Employers of specialist nurses can also be confident that support is available throughout their career. Both formal and informal PDNS networks exist across the UK, which promote best practice and provide mentorship. Healthy Alliance is a unique collaboration between the PDS and GlaxoSmithKline to provide a dedicated package of support and training for PDNSs across the UK, carrying out nurse inductions, running conferences and providing training materials. www.scottishirishhealthcare.com 15 Experts from two European paediatric groups have issued a framework for vaccination of babies against rotavirus, the most common cause of gastroenteritis in infants and children.1 At its annual conference this week, the European Society for Paediatric Infectious Diseases (ESPID) joined with the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) to issue the first European evidence-based recommendations on rotavirus vaccination. Professor Adam Finn, Professor of Paediatrics at the University of Bristol and ESPID Secretary welcomed the recommendations: “ESPID and ESPGHAN have concluded that the logical way to deploy the new safe and efficacious rotavirus vaccines now available is through universal immunisations of infants in Europe. As a practising paediatrician, I look forward to seeing these vaccines being used in the UK in the not too distant future.” New data shows rotarixTM vaccine could reduce nhs costs of treating rotavirus gastroenteritis New data presented at the ESPID conference predicted that universal vaccination against rotavirus could reduce NHS costs by over 85 per cent from £27.4M to £4M over five years.2 The modelling study, sponsored by GlaxoSmithKline, suggested that immunisation with the oral rotavirus vaccination, Rotarix™, could reduce hospitalisations, hospitalacquired infections, A&E visits and cases seen by GPs, at a cost per Quality Adjusted Life Year (QALY) of £27,522. 2 This cost compared favourably with the recently adopted pneumococcal conjugate vaccine, suggested the study. 2 New information on the burden of rotavirus infections across Europe was also presented which found high levels of hospitalisations for rotavirus gastroenteritis (RVGE) in children under 5 years of age over a 19-month period. 16 www.scottishirishhealthcare.com The study of 12 centres from the UK, France, Germany, Italy, and Spain concluded that rotavirus accounted for 56.2% of hospitalisations due to acute gastroenteritis.3 The study found that RVGE was more common in younger children, with a majority of cases occurring in children under 2 years and 18% of cases occurring in babies less than 6 months old. 3 Previous studies have reported that the duration of hospitalisation is longest in young infants, particularly those who are under 4 months of age. 4 A further study showed that Rotarix™ provided sustained protection against RVGE in vaccinated infants who were monitored after the first dose at between 6-24 weeks of age and up to two years of age. 5 In the pan-European study, Rotarix™ prevented 96% of hospitalisations due to rotavirus gastroenteritis and reduced the need for medical attention by 84%.5 Given in a convenient two-dose schedule from the age of six weeks, the oral vaccine offers early protection, before the peak incidence of the disease at 6-24 months. 6 Principle investigator, Prof. Dr. Timo Vesikari, commented, “The new data substantiate the evidence for Rotarix™ showing that the vaccine’s efficacy is proven over two years, which covers the peak age for RVGE episodes.” References 1.Van Damme P. Evidence based recommendations for the use of rotavirus vaccines in Europe. ESPID ESPGHAN Rotavirus Expert Working Group, ESPID Abstract 2. Martin A, et al. Cost-effectiveness of infant vaccination with RotarixTM in the UK. Abstract, ESPID annual meeting, May 2007. 3. Forster J, et al. Hospital-based surveillance to estimate the burden of rotavirus gastroenteritis among European children aged <5 years. Abstract, ESPID annual meeting, May 2007. 4. Berner R , Schumacher RF, Hameister S et al. Occurrence and impact of community acquired and nosocomical rotavirus infections-a hospital-based study over 10 years. Acta Paediatr Suppl 1999;88 (426):48-52. 5.Vesikari T, et al. Human rotavirus vaccine RotarixTM is highly efficacious in Europe during the first two years of life. Abstract, ESPID annual meeting, May 2007. 6. Linhares AC, et al. Rotavirus vaccines and vaccination in Latin America. Pan Am J Public Health 2000;8(5):305-331. 7. RotarixTM Summary of product characteristics. December 2006. “Rotarix provides early protection from rotavirus gastroenteritis, pass it on.” Winner of the UK Prix Galien 2006 Medal engraved by Albert de Jaeger Only two ORAL doses1 Provides highly effective protection from rotavirus gastroenteritis2 Has a good tolerability and safety profile1 ® rotavirus vaccine Rotarix is not currently part of the routine UK childhood immunisation programme Rotarix is only available direct from GlaxoSmithKline - Call the dedicated Customer Contact Centre on 0808 100 9997 Prescribing information (Please refer to the full SPC before prescribing) ROTARIX® Live attenuated human rotavirus oral vaccine. Composition: Each 1 ml dose contains not less than 106.0 CCID50 human rotavirus RIX4414 strain (live attenuated). Uses: Active immunisation of infants from 6 weeks of age against gastroenteritis due to rotavirus infection. Dosage and administration: Two oral doses. First dose can be administered from 6 weeks of age. Minimum interval of 4 weeks between doses. Vaccination course must be completed by 24 weeks of age. Rotarix should under no circumstances be injected. Contraindications: Hypersensitivity to the active substance or any of the excipients, or after previous administration of rotavirus vaccines. Previous history of intussusception or uncorrected congenital malformation of the gastrointestinal tract that would predispose for intussusception. Known or suspected immunodeficiency. Asymptomatic HIV infection is not expected to affect the safety or efficacy of Rotarix. However, in the absence of sufficient data, administration to asymptomatic HIV subjects is not recommended. Administration should be postponed in subjects with acute severe febrile illness, diarrhoea or vomiting. Presence of a minor infection is not a contra-indication for immunisation. Precautions: Administer with caution to individuals with gastrointestinal illness, growth retardation, and individuals with immunodeficient close contacts. FOR ORAL USE ONLY. Interactions: No interactions with co-administered paediatric vaccines. Pregnancy and Lactation: Not intended for use in adults. Breastfeeding may be continued during the vaccination schedule. Adverse reactions: Irritability, loss of appetite, diarrhoea, vomiting, flatulence, abdominal pain, regurgitation of food, fever, fatigue. Legal category: POM. MA number: EU/1/05/330/001-004. Presentation and basic NHS cost: 1 dose powder in a vial; 1ml of solvent in glass container; oral applicator; transfer adapter for reconstitution. NHS Cost £41.38 MA holder: GlaxoSmithKline Biologicals s.a., Rue de l’Institut 89 1330 Rixensart, Belgium. Further information is available from: Customer Contact Centre, GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex UB11 1BT; [email protected]; Freephone 0808 100 9997. Date of preparation of PI: December 2006 Rotarix® is a registered trademark of the GlaxoSmithKline Group of companies ROT/PRI/06/27986/2 GlaxoSmithKline encourages healthcare professionals to report adverse events, pregnancy, overdose and unexpected benefits to the company on 0808 100 9997. Information about adverse event reporting can also be found at www.yellowcard.gov.uk References 1. Rotarix Summary of Product Characteristics 2. Vesikari T, Karvonen A, Prymula R et al. Human rotavirus vaccine RotarixTM (RIX4414) is highly efficacious in Europe. 24th European Society for Paediatric Infectious Diseases (ESPID), Basel, May 2006 © GlaxoSmithKline group of companies ROT/FPA/07/27148/3 - Feb 2007 www.scottishirishhealthcare.com 17 Infection Control Urinary catheterisation Infection Control Part 4 Author: Deborah Ward MA, BSc (Hons), RN, Infection Control Specialist Nurse. Deborah has worked as an infection control nurse since 1998, working both inside and outside the NHS in both acute and non-acute settings. She now works outside the NHS for a national organisation across England, Scotland and Wales Learning objectives for this section: By the end of this section the student will be able to: • Describe the role of urinary catheterisation in urinary tract infection • Describe the indications for urinary catheterisation • Describe and demonstrate the correct technique for insertion and after care of a urinary catheter • Describe the signs and symptoms of a urinary tract infection INFECTION CONTROL IN URINARY CATHETERISATION Urinary tract infections are the most common type of hospital acquired infection. Catheterisation When inserting a urinary catheter for short or long term use the following should be considered: • TOnly use a urinary catheter after considering other less hazardous alternatives • TReview the need for catheterisation regularly and remove catheters at the earliest possible opportunity • TCatheterisation should be performed by suitably trained and skilled personnel adhering to a strict aseptic technique. • TAccurately document insertion and care of the catheter in patient notes • TSelect the smallest gauge catheter that will allow free urinary flow • TThe catheter balloon should be inflated with 5 – 10 mls o sterile water in adults and 3 – 5 mls in children • TCatheterisation is an aseptic procedure • TClean the urethral meatus prior to insertion as per local guidelines • T Use an appropriate lubricant from a single use container to minimise trauma and infection e.g. sterile Lignocaine gel Intermittent self catheterisation The NICE guidelines mention intermittent self catheterisation in the community context as an option which should be used in preference to an indwelling catheter, as long as this is appropriate for the individual patient. While insertion of an indwelling catheter is an aseptic procedure, insertion of an intermittent catheter is actually a clean procedure. Reusable catheters used intermittently should be cleaned with water and dried according to the manufacturer’s instructions. Post Catheterisation Once an indwelling catheter has been inserted, it should be connected to a sterile closed drainage system. The connection between the catheter and drainage system should not be broken except for good clinical reasons. UTI – urinary tract infection LRTI – Lower respiratory tract infection There are numerous factors which predispose a patient to UTI, including: • • • • • • • • • • Urinary Catheterisation Surgical instrumentation Prostatic disease Abnormalities of the urinary tract Ageing process Diabetes Pregnancy Altered bladder control Urinary calculi Functional disability Indications for Catheterisation There are several reasons why a patient may require catheterisation, Such as urinary retention, pre-operative drainage, post-operative drainage, paralysis and spinal cord injury, bladder irrigation, measurement of urinary output, urodynamic investigations, diagnostic purposes, administration of medication, care of debilitated patients with incontinence (only after considering other options first) Why do catheters predispose to UTI? • The catheter is a foreign body • It interferes with the normal flow of urine • The catheter and drainage system become a culture reservoir • Biofilms form on the catheter which interfere with normal flora and antibiotic therapy Points of entry for infective agents. There are numerous points of entry for infection in a catheterised patient. A: Catheter tip on catheterization B: Urethral meatus around catheter C: Catheter/drainage bag junction D: Sampling sleeve or port E: Reflux from bag to tubing F: Drainage bag tap 18 www.scottishirishhealthcare.com After several days the urinary catheter may become encrusted and blocked. The use of bladder washouts in preventing this is not clear. After insertion observe the patient for any signs of urinary tract infection such as: • TPyrexia and raised white cell count in blood • TLower abdominal pain • TOffensive smelling urine, cloudy urine, particles of blood in urine • TConfusion in elderly • TDischarge around catheter site • TBypassing of urine Prior to manipulating a urinary catheter, hands should be appropriately decontaminated and clean gloves should be worn. The drainage bag should be positioned below the level of the bladder but not be in contact with the floor. The bag must be emptied sufficiently frequently to maintain urine flow. Catheters should not be changed unnecessarily and routine personal hygiene is all that is needed. Where an overnight bag is used, it should be attached to the bottom of the day bag as a linkage system to avoid breaks in the system. In general, catheter drainage bags are single use only. Patients with a long term catheter in place, and their carers, should be educated in hand decontamination and any procedures such as intermittent catheterisation prior to discharge. Follow up support should be provided. Catheters are changed when clinically indicated or according to manufacturers recommendations. Work based activities • Identify a patient with a urinary catheter in place and discuss with them the reasons for this and any other options that were considered. • TObserve a skilled practitioner as they insert a urinary catheter and ask them to supervise you if your role involves insertion of a urinary catheter • TIdentify the brands of urinary catheter and drainage bags that are used in your clinical areas and discuss the qualities of these devices with the manufacturers representative • TKeep a log of any infections that occur in patients that you have cared for over a period of time e.g. 2 weeks and identify which type are most common • T Identify the ongoing tests and observations that are undertaken to identify infection of the urinary tract e.g. observations, obtaining urine samples etc. Here’s a new idea that really holds water Now on contract with NHS Scotland Prevents infection outbreaks associated with plastic bowls (and soap) Saves nurse time and money The Vernaclean Bowl is unique, the only maceratable pulp bowl that holds warm water and detergent. Now, isn't that a good idea? Ideal for: Bed baths l Hand washing l General surface cleaning I Wound care I Shaving I Continence care For your free sample, call 01204 555999 or email [email protected] www.scottishirishhealthcare.com 19 Introduction Multiple Sclerosis (M.S.) is one of the most common neurological disabling conditions. It is one of the primarily frequent causes of disability in young adults with a mean onset age of 0 (Sadonick and Ebers, 199). It has been recognised by the Department of Health as a chronic long-term condition in the Long – term Conditions National Service Framework (2005). Prevalence is higher in northern Europe 10 per 100,000 population compared to southern Europe and the Mediterranean 0 per 100,000 population (Roberts et al, 1991). The British Society of Rehabilitation Medicine (199) suggests that this could equate to 5-8 new cases per 100,000 per annum. The National Institute for Clinical Excellence (NICE) 2003 have calculated that about 52,000 – 62,000 suffer with M.S. NICE also estimated that 1800 – 3400 people are newly diagnosed with M.S. per annum. Within Cardiff and Vale there is an estimated population of over 500,000 this could liken to between 500 – 700 patients who suffer with M.S. with between 15 – 35 new patients per annum. With these statistics in mind the Continence Service and the Helen Durham Multiple Sclerosis service both of Cardiff and Vale NHS set about creating a unique post of a Multiple Sclerosis Continence Nurse Specialist. Background to the disease M.S is a disease of the central nervous system. It is when the white matter within the brain or spinal cord becomes inflamed and destroys the person’s own immune system (Nice 00). The cause is unknown although both genetic and environmental factors are said to contribute (Barnes, Gilhus and Wender, 001). Diagnosis can be made accurately with modern techniques such as MRI scanning. However, there are no precise prognostic indicators for disease progression. M.S. usually starts in adult life; the diagnosis is for life with no known cure. There are recognised ways of describing the patterns of M.S. (table 1). Table 1. Secondary progressive M.S. – follows on from relapsing/remitting M.S. There are gradually more or worsening symptoms with fewer remissions (about 50% of those with relapsing/remitting M.S. develop secondary progressive M.S. during the first 10 years of the illness). Primary progressive M.S. – from the beginning, symptoms gradually develop and worsen over time (10 – 15% of people at onset). NICE 00 www.scottishirishhealthcare.com Table . Common symptoms of Multiple Sclerosis Visual – loss /double vision Cerebella – in coordination Mood – depression/anxiety Cognition – concentration Motor – weakness/ spasticity Sensory – loss of sensation Sexual dysfunction – loss of libido Fatigue – lassitude, reduced endurance Bladder – urgency, frequency, hesitancy, retention and/or incontinence Bowel – constipation, urgency and/or faecal incontinence Bladder / bowel problems have been highlighted as having major implications on the quality of life of M.S sufferers. Goldman et al suggest that up to 90% of M.S. patients will have bladder dysfunction, which can exacerbate the underlying disease via secondary infection (Bradley, 1978), which can be associated with lower limb deficit (Betts et al, 1993). Bowel dysfunction although not as common will have an even greater impact on quality of life. Chia et al (1995) identify incidents of 68% of M.S. sufferers who report bowel dysfunction with 36 – 53% having constipation and 50% faecal incontinence. The problems with continence in M.S. have been identified in national documentation including National Institute of Clinical Excellence (00) and the National Service Framework Long Term Conditions – Good Practice Guide for People with Neurological Conditions (006). These documents highlighted to both services the need to improve continence care to patients with M.S. within the Cardiff and Vale area. The Project Both services had realised that care of the M.S. patient with continence problems was uncoordinated and referrals were inconsistent (table ). Both services wanted the patients journey to be more direct and less duplication of referrals. Table . Patterns of Multiple Sclerosis. Relapsing/remitting M.S. – symptoms come and go. Periods of good health or remission are followed by sudden symptoms or relapse (80% of people at onset) 0 Goldman et al (2006) have identified common symptoms associated with M.S., which can be addressed with simple interventions or may need a more complex approach via a multidisciplinary team (table ). Referral patterns of M.S. patients for continence services prior to 2004. M.S. Patient Continence service (0%) Urology Urodynamics Gynaecology urodynamics M.S. Team neurology (50%) Continence Physio Continence Service (5%) conservative therapies Thus the problems were identified with the referral system and streamlining the service was implemented (table 4). find the consultation and did the service offered improve the problem. The results are shown in the following graphs. Table 4. Graph 1. Do your Bladder/Bowel problems impact on your quality of life? N = 1 Referral patterns of M.S. patients for continence services after 2004. M.S. Patient M.S. team (100%) M.S. continence nurse specialist (90%) Continence Team Urology Gynaecology Physio The post was designed in response to a Welsh health circular (00) and funded by the Neurology department. The post was established in 004 and was initially an 18.5 hour permanent post. To prepare for the post the nurse specialist had to under go set training which included the M.S. trust clinical development module,Trust continence module, digital rectal course and catheterisation course. Mentorship was provided by the Director of continence service and M.S service manager. The Current Service We now provide an exclusive continence service for M.S. patients offering nurse led clinics within both community settings and hospitals, home visits for patients who cannot attend clinics, ward based assessments and a direct access for patients via telephone. Full continence assessments are offered for both bladder and bowel continence dysfunction. Interventions include conservative therapies such as intermittent self-catheterisation, pharmacology and pelvic floor rehabilitation. Specialist interventions include electrical stimulation and direct access into specialist secondary care services for Botox or anal physiology investigations. To monitor the success of the service an audit over 1 year was undertaken in 005 showing that the M.S continence nurse specialist saw 109 patients in the nurse led clinics, 00 patients seen in their own homes and 50 patients reviewed in the multi disciplinary team neuro – inflammatory clinic (chart 1). Chart 1 Activity over one year NURSE LED CLINIC 109 HOME VISITS 00 NEURO INFLAMITORY CLINIC 50 WARD VISITS 50+ A survey was undertaken of 1 patients looking at the impact bladder/bowel problems on quality of life, how useful did they 5 4.5 4 .5 .5 1.5 1 0.5 0 Not at all Sometimes Often/most days All the time Graph 2. How helpful did you find the consultation? N =12 9 8 7 6 5 4 1 0 Not at all Minimal help Quite helpful Extremely helpful Graph . How did the service/treatment received improve your problem and therefore quality of life? N = 1 6 5 4 No sign of improvement Minimal improvement Moderate improvement greatly improved 1 0 Benefits to patients have been significant and include direct access to the M.S. team and better communication between the M.S. service and the continence team including the M.S. nurse specialist attending a multi disciplinary meeting every week.This has provided more continuity of care and a streamline service. The Trust is fully in line with the national guidance from both the NICE guidelines and NSF for long-term conditions. Both services are keen to take this development forward. We have already due to demand increased the nurse’s hour to 5 hours per week. We are already benchmarking the service to see where we can make improvements. We are undertaking routine audits and patients evaluating patient satisfaction and are interfacing with the local M.S. society to provide details about the service and what it can offer. References Barnes MP, Gilhus NE,Wender M (2001) European Federation of Neurological Societies.Task force on minimum standards for health care of people with multiple sclerosis: June 1999. European Journal of Neurology.Vol 8: 215 –221. Betts CD, D’Mellow MT, Fowler CJ, (1993). Urinary symptoms and the neurological features of bladder dysfunction in multiple sclerosis. J.Neurol Neurosurg Psychiatry. 56: 245 – 250. Bradley WE (1978) Urinary bladder dysfunction in multiple sclerosis. Neurology 29: 52-58. British Society of Rehabilitation Medicine (1993). Multiple Sclerosis:- a working party report of the British society of Rehabilitation Medicine. British Society of Rehabilitation Medicine, London. Chia YW, Fowler CJ, Kamm MA et al (1995) Prevalence of bowel dysfunction in patients with multiple sclerosis and bladder dysfunction. J Neurol 242: 105 –108. DOH National Service Framework long term conditions (2005) Dept of Health. London. Goldman MD, Cohen JA, Fox RJ, Bethoux FA (2006) Multiple Sclerosis: - Treating symptoms and other general medical issues.Cleveland clinical journal of medicine, 73,2:177-186. NHS National Institute for clinical excellence (2003) Multiple Sclerosis: - management of M.S. in primary and secondary care. London. Roberts MHW et al (1991) Prevalence of multiple sclerosis in the Southampton and South West Hampshire health district. J. Neurol Neurosurg Pyschiatry. 54:55 – 59. Sadovnick AD, Ebers GC (1993) Epidemiology of multiple sclerosis: a critical overview. Can J Neurol Sci 20:17 – 29. www.scottishirishhealthcare.com 1 Nutrition & Obesity Part 4 Last week I claimed a breakthrough in my fight to get fit and lose weight. I ran 3km every day, something I thought I’d never do. Now I’m wondering (though please don’t hold me to it yet) if I’ll ever be able to run a fun-run or even a mini marathon, perhaps even this year? Before I get too excited, though, let me quickly remind myself that it wasn’t quite a continuous run, it was three minutes running followed by two minutes walking, so completing the km in thirty minutes or so. But it’s a major milestone for me, because I remember adding a ten second run to my daily walk just six months ago, and feeling that I’d die from exhaustion. I really did sit on the edge of the treadmill, purple faced and panting, thinking of reporting myself to the RSPCA for cruelty to beached whales and almost giving up. But I stuck at it, added five seconds every fortnight and, it worked! Perhaps I wouldn’t have stuck at it so grimly if I hadn’t had a buddy, in this case my trainer, Steve. It helps if you have someone else egging you on (not nagging you, just encouraging your own ideas!). Anyone who might have watched me in that awful programme on ITV (Celebrity Ugh Club), will remember that I really hate being told what to do. And I loathe even more being ordered to do it. But I wanted to prove to myself that I could jog. Besides, I would go to the gym, and walk for thirty minutes, whilst watching slim, lithe, young ladies do a quick ten minute run, work off more calories than I did in my half hour of walking, and then buzz off. That’s for me, I thought. If I can get my daily exercise into a ten minute jog, then I might be able to fit it into my daily routine, as the experts recommend. A buddy is also great for stopping you from fooling yourself. You can’t boast you exercise every day, or you eat a totally healthy diet, if you have a buddy who knows that she last saw you at the gym six weeks ago and then you were helping yourself to a chocolate muffin at the coffee bar! According to a recent study in America, we weight losers are brilliant at deluding ourselves. They asked 11,000 seriously overweight adults about their eating and exercising habits. Three quarters of them said they had healthy diets and 40 per cent of them reckoned they did vigorous exercise at least three times a week. When their families were asked about them, it appeared that these men and women were kidding themselves. Former President Bill Clinton admitted the same when he recently launched a ten year initiative to reverse America’s trend in childhood obesity. He was a fat kid, and hated it. He grew up in America’s deep south, with an abiding love of all things fried and super-sized. It is said that whenever he flew in Air Force One, he ordered the galley filled with McDonald’s and Kentucky Fried, and he was particularly partial to jalapeño cheeseburgers and pork rinds. When Hillary flew too, it was Caesar salads and grilled fish! He did pride himself on being fairly fit, though, and would run regularly. But, he admits, he was kidding himself that he was healthy, because of his eating habits. It certainly took its toll. Last year, he had a quadruple heart bypass, lost over a stone in weight, and says it’s given him a new insight into America’s obesity crisis. Everything he says on the subject shows he really understands www.scottishirishhealthcare.com BY ANNE DIAMOND and knows how hard it is to lose weight. “When I was a little boy, if you grew up in a place that was as poor as Arkansas was, it was generally believed that the best evidence of a baby’s health was how fat it was,” he said recently when he pledged to get soft drinks and junk foods out of US schools and campuses. “My grandmother, who was a nurse, would have thought I was terribly anaemic or something was wrong with me if I was normal. Now we know if you are normal size you are healthy.” His “Alliance for a Healthier Generation”, formed by his own foundation and the American Heart Association, say they’re in this for the long haul, and Clinton admits it’s not a glamorous cause: “I got into it knowing I have a higher risk of not being effective and a higher risk of not being able to prove it than anything else I have done,” he says, “because it requires millions upon millions upon millions of people and a long time frame.” Interesting what he said about babies, because American studies show that their babies are getting bigger and bigger, and paediatricians are wondering whether intervention, at baby clinic level would be intrusive or helpful. True, many chunky babies grow into slim, healthy adults. But if a baby comes from a family which is predisposed to obesity, should questions then be asked about the family’s lifestyle and eating habits? No-one’s suggesting putting babies on diets, but does a family’s eating habits become ingrained in that infant from day one? And should we be thinking of ways to stop bad habits taking root? Or is that Nanny State gone too far? I keep quoting studies from America (because, let’s face it, that’s where the obesity volcano started and is still erupting) but this week, there was more research from Bristol and Glasgow universities showing a distinct link between childhood obesity and watching TV. Perhaps Nanny State has to find a way to lure us from our TV sets and play (and exercise) outdoors, though with the tragic disappearance of little Madeline McCann, I suspect more parents will prefer to keep their children inside, passively ogling The Tweenies. It’s clear that we can no longer afford to talk about the child obesity epidemic without factoring in screen time, and the Americans have even come up with an initiative for that, a family based programme called “Switch”, working with schools and communities to give kids advice about food, something to do, and a reason NOT to watch TV all the time! I must say, I rather like the slogan - “Switch what they Do, View, and Chew!” We’re going to need that sort of thing here very soon. I hope Bill Clinton comes with it! Recently, hospital infection outbreaks caused by organisms such as Clostridium difficile, Acinetobacter, M.R.S.A. and Norovirus have highlighted the need for cleaner, properly disinfected hospital wards. The following products supplied by Inverclyde Biologicals are the quality products of choice when dealing with infection control. Haz-Tab Tablets The use of chlorine-release tablets to make up environmental disinfectant solutions is now well established throughout the United Kingdom. Chlorine is recommended for the disinfection of blood and body fluids and for general environmental disinfection. This is due to its proven broad spectrum of activity against bacteria, spores and viruses. The non-effervescent formulation of NaDCC (sodium dichloroisocyanurate) used in the 4.5g Haz-Tab is the most cost effective way of buying chlorine. Effervescing agents only take up space in the tablet that could otherwise be chlorine, hence for tablets of the same size and weight you need less non-effervescent tablets to make up a given strength of solution. For example, four 4.5g Haz-Tabs added to a litre of water will make a solution of 10,000 p.p.m. available chlorine. It is vitally important to ensure that the acorrect strength of chlorine solution is made up for disinfection purposes. That is 10,000 p.p.m. for blood and body fluid spills or 1,000 p.p.m. for general environmental disinfection. Using the Haz-Tab Diluter made for the specific tablet, staff can now simply and easily make up the correct strength of solution by following the simple instructions printed on the label. The design of the diluter makes it easy and safer for staff to mix the solution after the tablets have dissolved. Haz-Tab Granules Spills of high-risk body fluids present a serious hazard to the staff who are delegated to mop up the spill and disinfect the affected area. Haz-Tab Granules will absorb the spill (thus safely containing it) and release a minimum of 10,000 p.p.m. available chlorine to disinfect the area. The granules are made from NaDCC, a powerful and effective chlorine producing agent. To use the granules simply sprinkle over the spill until all the moisture is absorbed, leave for two minutes and then collect the granules and spilt matter with paper towels, or scoops and scrapers. Chlor-Clean Cleaning and effective disinfection in one operation Chlor-Clean has proved its effectiveness in many hospitals during the outbreak of norovirus that have been sweeping up and down the country over the last few years; more recently it has become part of the regime used by those hospitals that have been successful in significantly reducing their Clostridium difficile infections including the particularly virulent 07 strain. Chlor-Clean tablets have been developed using a special surfactant (or cleaning agent) that will actually work with the chlorine disinfectant that is bound into the same tablet. Thus, once the tablet has been dissolved in one litre of water the resultant solution will both clean and disinfect the environment in one go, reducing cleaning time but, at the same time, providing effective disinfection of the area. The product is simple and pleasant to use. Chlor-clean tablets have been formulated to work in cold water thus reducing the chlorine smell in use whilst still retaining the effective cleaning action of the surfactant. A diluter is available to make it easy for staff to obtain the correct dilution of 1,000 p.p.m. available chlorine with surfactant action. Once made up the solution will last for up to 4 hours. All of the above products are distributed in Scotland by Inverclyde Biologicals, Bellshill. Other products available include Biohazard spills kits, Urine and vomit spills kits and a variety of Alcohol hand rubs. For more information please telephone 01698 74968, email: [email protected] or visit www.inverclydebiologiclas.co.uk. www.scottishirishhealthcare.com DVT Author: Dr Greig Ferguson, MD, DSc, BN (Hons), RN, BSc (Hons), ATLS, ALS, EPLS INTRODUCTION Deep Venous Thrombosis or DVT’s are not acutely life threatening per se however they are associated with complications, which can be acutely fatal (1). Venous thrombosis is a condition in which a blood clot (thrombus) forms in a vein. This clot can limit blood flow through the vein, causing swelling and pain. Most commonly, venous thrombosis occurs in the “deep veins” in the legs, thighs, or pelvis. When this occurs, it is called a deep vein thrombosis, or DVT. Vein within calf muscle Vein wall Part of the clot may break off and travel up the vein DIAGNOSIS If the patient’s history, symptoms, and physical exam suggest a venous thrombosis, tests are needed to establish a diagnosis (5,6). Diagnosing DVT — Tests used to establish a diagnosis of DVT may include compression ultrasonography, contrast venography, magnetic resonance imaging (MRI), computerised tomography (CT scan) and a blood test called D-dimer. D-dimer — D-dimer is a substance that is often found to be elevated in the blood of people with venous thromboembolism or PE. It can be used to eliminate the possibility of deep venous thrombosis. If the D-dimer test is negative and the patient is thought to be at low probability of DVT or PE on the Wells score, DVT or PE are unlikely and further testing may not be needed (9). Clot Blood clot stuck to inside lining of the vein Deep Vein Thrombosis If a part or all of the blood clot breaks off from the site where it was created, it can travel through the venous system this. If the clot lodges in the lung, it is called pulmonary embolism (PE), a serious condition that led to over 100,000 deaths in an 8-year period in the United Kingdom and it is estimated that at least 60,000 a year can be attributed to DVT (7) . In most cases, PE is caused by a DVT between one in three and one in four cases of DVT (6). Venous thrombosis can form anywhere in the venous system. However, DVT and PE are the most common manifestations of venous thrombosis. RISK FACTORS There are a number of factors that increase a person’s risk of developing a venous thrombosis. At least one risk factor can be identified in over 80 percent of patients who develop a venous thrombosis. An increased risk of developing a blood clot is sometimes referred to as a “thrombophilia” or a hypercoagulable disorder (1,2). • Previous surgery (especially orthopaedic surgery and neurosurgery) • Trauma • Pregnancy (Hypercoagulable state) • Obesity • Use of certain medications (e.g., Oral Contraceptive Pill, HRT) • Immobilisation or prolonged bed rest • Cancer • Heart failure • Elevated blood levels of homocysteine (genetic) • Certain disorders of the blood, such as polycythaemia vera • Kidney problems, such as nephrotic syndrome • Antiphospholipid antibodies (antibodies that affect the clotting process). • A previous episode of a clot in the leg (deep vein thrombosis) or PE. Smoking and increased age may also increase the risk of venous thromboembolism, but it is not clear what role these factors play. SIGNS AND SYMPTOMS There are signs and symptoms of DVT and PE; these may be caused by the thrombus, or maybe related to another condition. In most cases, testing is needed to determine if a clot is present (7,8). Deep vein thrombosis — Classic symptoms of DVT include swelling, pain, warmth and discoloration in the involved leg however this pain occurs in 50% of patients and is entirely non-specific. Pain can occur on dorsiflexion of the foot (Homans sign) (6). Homan’s sign is described, as discomfort in the calf muscles on forced dorsiflexion of the foot with the knee straight has been a time-honoured sign of DVT. However, this sign is present in less than one third of patients with confirmed DVT. The Homan’s sign is found in more than 50% of patients without DVT and therefore is very non-specific (5). Pulmonary embolism - The most common symptoms of pulmonary embolism are difficulty breathing, chest pain while taking a deep breath, cough and coughing up blood. The most common physical findings are an increased rate of breathing, abnormal lung sounds heard with respiration and a rapid heart rate (3,4). 4 www.scottishirishhealthcare.com TREATMENT The treatment of deep vein thrombosis and pulmonary embolism is similar. In DVT, the main goal of treatment is to prevent a PE (10). Other goals of treatment include prevention of further clot extension, prevention of a recurrence of thrombosis, and the prevention of complications, such as the postphlebitic syndrome and chronic high blood pressure in the vessels between the heart and lungs (pulmonary hypertension). The mainstay of treatment for venous thrombosis is anticoagulation . Other treatments may include thrombolytic therapy or inferior vena caval interruption. If a reversible risk factor, such as immobility, exists in a particular patient, the clinician may opt to treat the patient until the risk factor is resolved. (11,12) • Patients with a first episode of venous thrombosis without an apparent cause should be treated for a minimum of six months. • Patients who have recurrent venous thrombosis should be treated for a minimum of 12 months. Treatment may be continued indefinitely in patients with three or more episodes of venous thrombosis and in patients with a risk factor that cannot be reversed (6). PREVENTION Surgical patients — Certain high-risk patients undergoing surgery (especially orthopaedic surgery and cancer surgery) may be given anticoagulants to decrease the risk of blood clots. Anticoagulants may also be given to women at high risk for venous thrombosis during and after pregnancy (8). In surgical patients with a moderate to low risk of blood clots, other preventive measures may be used. For example, some surgical patients are fitted with inflatable compression devices that are worn around the legs and periodically fill with air; these exert gentle pressure to improve circulation and help prevent clots (10). Low risk and some moderate risk patients may be asked to wear graduated compression stockings. For all patients, walking as soon as possible after surgery can decrease the risk of a blood clot. REFERENCES & FURTHER READING 1. Bertina, RM. Genetic approach to thrombophilia. Thromb Haemostat 2001; 86:92. 2. Martinelli, I. Risk factors in venous thromboembolism. Thromb Haemost 2001; 86:395. 3. Prandoni, P, Lensing, AW, Cogo, A, et al. The long-term clinical course of acute venous thrombosis. Ann Intern Med 1996; 125:1. 4. Hyers, TM. Venous thromboembolism. Am J Respir Crit Care Med 1999;159:1. 5. Donnelly, R, Hinwood, D, London, NJ. ABC of arterial and venous disease. Non-invasive methods of arterial and venous assessment. BMJ 2000; 320:698. 6. Mannucci, PM, Poller, L. Venous thrombosis and anticoagulant therapy. Br J Haematol 2001; 114:258. 7. Turpie, AG, Chin, BS, Lip, GY. ABC of antithrombotic therapy: Venous thromboembolism: treatment strategies. BMJ 2002; 325:948. 8. Turpie, AG, Chin, BS, Lip, GY. Venous thromboembolism: pathophysiology, clinical features, and prevention. BMJ 2002; 325:887. 9. Stein, PD, Fowler, SE, Goodman, LR, et al. Multidector Computerised Tomography for Acute Pulmonary Embolism. N Engl J Med 2006; 354:2317. 10. Bates, SM, Ginsberg, JS. Clinical practice. Treatment of deep-vein thrombosis. N Engl J Med 2004; 351:268. 11. Geerts, WH, Pineo, GF, Heit, JA, et al. Prevention of Venous Thromboembolic Disease: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. CHEST 2004; 126:338S. 12. Blann, AD, Lip, GY. Venous thromboembolism. BMJ 2006; 332:215. Our rapid tests? They’re clearly working. Clearview Simplify D-dimer Rapid testing at the point of care to aid the safe rule out of venous thromboembolism* Now includes capillary blood application giving greater sampling flexibility at the point of care. When minutes matter and quality counts. Simple manual test no automation required Rapid 10 minute test Bedford, MK44 3UP, UK Tel: 01234 835000 * Clearview Simplify D-dimer combined with a validated pre-test probability score helps to risk stratify patients suspected of DVT/PE. www.clearview.com www.scottishirishhealthcare.com 25 Preventing a Crisis! Best selling confere n in the U ce .S.! Subclinical Signs of Impending Doom Conference Speaker Carol Whiteside, MSN, PhD, has been a nurse in the U.S. for over 35 years. She is a clinical nurse specialist and a cardiovascular nurse specialist. Carol has been a staff nurse, cath lab manager, nursing supervisor and director of education. She previously worked in a trauma unit, medical surgical unit, cardiac ICU, medical ICU, adult and pediatric open heart surgery, neonatal ICU and a burn unit. She has also educated nurses internationally and is an extremely talented and entertaining presenter. Carol has also been a preceptor and a clinical nursing instructor. Additionally, she is a nurse entrepreneur presenting courses in critical care topics, EKG interpretation, ACLS, critical thinking and a variety of other nursing topics. Carol has been a sought-after speaker for many years. She has the unique ability to combine her vast clinical background and information with critical thinking strategies. You will leave with the skills and techniques to anticipate the subclinical signs of impending doom and therefore improve the care you provide your patients. N See the signs of compensation in the body — before the patient crashes N Know when to call the rapid response team N Goal setting and priorities for decisive action To register, or for more information: web: www.cb-training.com Phone: 01324-411013 Conference Objectives 1. Recognize the signs of compensation in the human body before illness appears. 2. Interpret what is happening in the body physiologically when the heart rate and respiratory rate go up. 3. Identify the components of cardiac output. 4. List three signs of left heart failure and describe the physiology behind them. 5. Describe two symptoms that differentiate ARDS from other forms of respiratory failure. 6. Identify the level of oxygen to be given a CO2 retaining COPDer in crisis. 7. Recognize three ways that CHF differs from the other forms of shock. 8. Explain two ways in which benign and malignant headaches differ in their presentation. 9. Relate four signs found through the look test indicating a change in the patient’s condition. 10. Describe the physiological mechanism driving the changes seen in patients after surgery. 11. Identify the first sign of compartment syndrome. 12. List three components of “painting the picture”. Conference Fee: £125 + VAT (£146.87) single registration postmarked by 8/31/07 • OR • £145 + VAT (£170.37) standard seminar tuition Glasgow, Stobhill Hospital October 23, 2007 Dublin, Royal Dublin Showground (RDS) October 24, 2007 London, Hammersmith Hospitals NHS Trust October 25, 2007 made possible by a joint venture between: 26 www.scottishirishhealthcare.com www.scottishirishhealthcare.com 27 Diabetes Author: June Currie, Lead Specialist Nurse in Diabetes, Forth Valley Acute Hospitals Diabetes Service Part of 4 Abstract: Diabetes Mellitus (DM) is known to have a significant impact on the morbidity and mortality of those people who suffer from this condition, resulting in a higher incidence of premature death, often from cardiovascular disease. Early detection of problems and stricter control of risk factors and glycaemia are essential in reducing complications. The chronic complications associated with DM can be broadly divided into macrovascular and microvascular disease. Macrovascular disease (macroangiopathy) The formation of atherosclerotic plaques occurs more frequently and at an earlier age in those people with DM. The arterial endothelium, known to be more fragile, is more likely to rupture allowing the accumulation of lipoproteins high in cholesterol. Accelerated atheroma formation in medium and large sized arteries is responsible for the presence of premature and excessive cardiovascular, cerebrovascular and peripheral vascular disease (1). Microvascular disease (microangiopathy) Microangiopathy is fundamentally the narrowing of the vascular lumen, due to a thickening of the basement membrane within the blood vessels. The major pathogenic factors associated with the development of microangiopathy are blood flow and clotting abnormalities, and hormonal and biochemical disorders. This condition is responsible for retinopathy, nephropathy and neuropathy (1). What causes micro/macrovascular disease? One of the major underlying causes of diabetic complications would appear to be prolonged exposure to hyperglycaemia. This is particularly significant in the case of Type 1 DM. Continued exposure to hyperglycaemia causes both acute and cumulative changes to cellular metabolism, which will eventually result in chronic and irreversible tissue damage. The acceleration of atherosclerotic changes within larger blood vessels, which occurs in macroangiopathy, is affected by a combination of metabolic and hormonal imbalances, dyslipidaemia and decreased antioxidant defence mechanisms. Environmental and genetic factors also play a significant role in the development of macrovascular disease. Contributing factors are no different as for the general population, and include diet (ie. increased fat intake) and known hyperlipidaemia; excessive weight; hypertension, smoking and lack of exercise (1). Cardio- & Cerebrovascular complications Evidence from a large trial carried out in the UK and published in the 1990s – the UKPDS () – highlighted that 50% of people with Type 2 DM had complications at the time of diagnosis, with symptoms of the condition evident for up to 10 years prior to formal diagnosis. It is also widely accepted that there is an increased risk of cardiovascular (CV) complications developing during the ‘pre-diabetic’ stages known as impaired glucose tolerance or impaired fasting blood glucose (). Approximately 80% of those people with Type DM will die prematurely from CV complications (4), with a -4 times increase in the likelihood of a cerebrovascular event, such as a stroke or TIA (). It is clearly recognised that aggressive management of hypertension in the person with DM is essential to reduce both cardio- and cerebrovascular damage. A reduction of 5-6 mmHg in the diastolic BP can lead to a 8% reduction in stroke, a 16% reduction in MI and a 1% reduction in all cause mortality (). Increasing exercise, dietary changes, reducing excessive alcohol and stopping smoking are also essential. 8 www.scottishirishhealthcare.com The use of multiple drug therapy in the treatment of hypertension has been identified by NICE and the Joint British Societies as required to reach ever tighter targets (5) [see table below]. Guideline Optimal BP target Audit standard BP target (mmHg) (mmHg) 1. NICE (00) (National Institute for Health and Clinical Excellence) ≤ 135/75 (People with T and microalbuminuria) ≤ 140/80 . BHS (004) (British Heart Society) < 10/80 < 140/80 . JBS- (005) (Joint British Societies) < 10/80 < 140/80 There have been a number of clinical trials carried out over the last 5-10 years identifying which combinations of anti-hypertensive medications are beneficial for those people with DM. ACE inhibitors (such as Ramipril and Perindopril) and Angiotensin-II receptor blockers (such as Irbesartan and Losartan) have been proven to be successful in the Prevention and treatment of hypertension, whilst also providing a renoprotection benefit (5). It is often necessary to include diuretics (such as Bendrofluazide), calcium channel-blockers (such as Amlodipine and Felodipine) and also alpha-blockers (such as Doxazosin) in order to achieve ideal BP targets. Traditional beta-blockers (such as Atenolol) are less frequently used as evidence now suggests that this group of drugs is more likely to cause hyperglycaemia. Lipid management is seen by many as the single most effective intervention in reducing CV risk in those people with DM (). Many studies have again provided the evidence to back this up, including the 4S trial, 1994 (Scandinavian Simvastatin Survival Study Group), the Heart Protection Study, 00 and CARDS, 004 (Collaborative Atorvastatin Diabetes Study). Cardio- & Cerebrovascular complications The most recent guidelines produced by the JBS in 005 suggested a total cholesterol (TC) level of less than 4 (or a 5% reduction in TC), with a low-density lipoprotein (LDL) level of less than . It is widely accepted that these levels will be extremely difficult to achieve unless aided by lipid-lowering medication, with statins still considered the first-line choice in DM. All people with DM (regardless of type of DM and ‘starting’ cholesterol level) aged 40 years and over should be commenced on lipid-lowering medication as a matter of course. Those people younger should be assessed on an individual basis, with emphasis still on initiating medication if the TC level is sub-optimal. Maintaining good glycaemic control was confirmed by the UKPDS as beneficial in reducing CV risk in patients with Type 2 DM. A 1% reduction in the HbA1c level was shown to reduce the incidence of myocardial infarction by 14%, with a 1% reduction in stroke (). The Diabetes Control and Complications Trial (DCCT) for Type 1 DM was carried out in the USA and published it’s findings in 1993. During the initial period of 10 years, this particular trial concentrated on the link between improved glycaemic control and significant reduction in microvascular complications. However, on follow-up of the participants, a 57% reduction in non-fatal MIs, stroke or CV death was identified (). Peripheral vascular disease Peripheral vascular disease (PVD) can be a major complication for those people with DM and is recognised as the greatest single cause of lower limb amputation, second only to traumatic injury (6). Prevalence of PVD in the diabetic population in the UK has been Diabetes estimated to be up to %. Diabetic foot ulceration is often associated with a combination of PVD and peripheral neuropathy, with contributing factors including a known history of CV disease and smoking (7). It is recommended that all people with DM should have an annual foot screening by an appropriately trained health care professional, with appropriate education regarding maintaining good glycaemic control, reducing risk factors, appropriate footwear and general care of the foot (7). Nephropathy It is estimated that 40% of all Type 1s will develop nephropathy within 5 years of diagnosis. Although a lower number of Type s go on to develop the same condition, this is due to the fact that many of this group will die prematurely as a result of CV disease. 5-10% of Type s will already have evidence of nephropathy at diagnosis, thought to be as a result of prolonged and undetected hyperglycaemia (8). Early detection and treatment of this condition is crucial in avoiding progression to eventual dialysis, with DM identified as being the leading cause of end-stage renal failure. Renal function should be assessed at least annually, with microalbuminuria and glomerular filtration rates checked as standard. Strict management of CV risks and control of hypertension is essential, with tighter BP targets for those people diagnosed with early stage nephropathy. The use of multiple drug therapies is commonplace, with strong evidence that the use of ACE inhibitors and Angiotensin-II receptor blockers delays the progression of this condition (8). Retinopathy The prevalence of diabetic retinal disease increases with the duration of DM, with approximately a 0% risk to this population of developing moderate to severe retinopathy. Retinopathy remains the commonest cause of blindness worldwide, with an incidence of between 50-65% per 100,000 diabetic population per year in Europe (7), (9). Retinal capillary damage occurs as a result of microangiopathy and prolonged hyperglycaemia and can lead to retinal oedema and exudates, the formation of new vessels and the potential for haemorrhage (1). Diabetics also have a two-fold risk of developing cataracts at an accelerated rate and this risk is further exacerbated by poor glycaemic control (7). of the causes of ED has led to an increase in effective treatments for this condition, although often a reluctance to discuss ED by both the diabetic male and the health care professional does remain an issue. Conclusion Complications of DM can have a major impact on the quality of life of the diabetic individual and can result in a significant reduction in overall life expectancy. Evidence has shown, however, that with early detection of both the condition and complications, followed by the appropriate and, in some cases, intensive therapeutic input, outcomes can be improved dramatically. References 1. Pickup J. C.,Williams G.Textbook of Diabetes, 3rd Edition Oxford: Blackwell Science 2003 2. UKPDS Group Complications in newly diagnosed type 2 patients… Diabetes Res 1990: 13: 1-13 3. Morrissey J. et al JBS 2 guidelines: A strategy to prevent CVD in diabetes Diabetes & Primary Care 2006: 8 (2): 82-92 4. Barnett A.H., O’Gara G. In Clinical Practice Series: Diabetes and the Heart London: Churchill Livingstone 2003 5. Gadsby R. Managing CV risk in type 2 diabetes:Towards best practice Diabetes & Primary Care 2006: 8 (4): 182-192 6. Scottish Intercollegiate Guidelines Network (SIGN) Cardiac Rehabilitation, Clinical Guideline 57 Edinburgh 2002 7. Scottish Intercollegiate Guidelines Network (SIGN) Management of Diabetes, A National Clinical Guideline 55 Edinburgh 2001 8. Harris H. et al Diabetic nephropathy: Implications for the renal NSF for primary care Diabetes & Primary Care 2007: 9 (1): 50-57 9. Swindlehurst H., Prasad S. Importance of screening and early treatment of diabetic retinopathy Cardiabetes 2002: 3: 26-33 10. Jude E. Management of diabetic neuropathy Modern Diabetes Management 2003:4 (2): 6-9 11. Heald A.H.,Young R.J. Diabetic autonomic neuropathy presenting early in the course of DM Diabetes Today 2001: 4 (1): 6-8 12. Mills L. Erectile dysfunction: assessment and treatment in diabetes Journal of Hypofit advert 9/3/07 2:58 pm Page 1 Diabetes Nursing 2003:1.03.07 7 (4): 146-149 Flavours available: Mint Orange Tropical Annual retinal screening is accepted as ‘gold-standard’ practice, with the use of highly specialised digital cameras now commonplace. Early detection and treatment of contributing risk factors, such as poor glycaemic control and hypertension, are again essential in reducing both the incidence of background retinopathy and the advancement of this condition to a sight-threatening stage. Neuropathy Peripheral neuropathy (PN) is known to affect 0-50% of the diabetic population, occurring in both Type 1s and Type s and more commonly in those diagnosed for more than 10 years. PN causes sensory deficits in the extremities (mainly the feet), often resulting in pain and discomfort which can be difficult to manage and can lead to an increased risk of foot ulceration, infection and ultimately amputation. Charcot foot, associated with PN, is a severely debilitating condition resulting in destructive arthropathy and significant deformity (10). Both metabolic and vascular factors are present in PN, with restricted blood flow to the nerve fibres and prolonged hyperglycaemia recognised as causes. Registered with the Vegan Society Each batch tested for the presence of substances banned by the World AntiDoping Association Abnormal autonomic function is present in a significant number of people with DM, with severe cases of this type of neuropathy leading to postural hypotension, gastroparesis and impotence (11). Whilst regarded by many as a late complication of DM, it is not unknown for symptoms to present early in diagnosis, suggesting again that any delay in this diagnosis can result in significant life-affecting complications. Erectile dysfunction At least 50% of men aged 40-70 years with DM develop erectile dysfunction (ED) at some stage (1). Metabolic effects of persistent hyperglycaemia, vasculopathy and smooth muscle myopathy are all considered to be factors in this condition, with the increased incidence of hypertension and subsequent treatment of same recognised as a contributing cause (1). An improved understanding t: +44 (0)1303 298 286 f: +44 (0)20 7900 2255 e: [email protected] www.arcticmedical.co.uk Arctic Medical Limited Folkestone Enterprise Centre Shearway Business Park Shearway Road Folkestone, Kent. CT19 4RH www.scottishirishhealthcare.com 9 P14898_Scott Nurse_267x92_5aw.qxd 5/4/07 16:02 Page 1 Diabetes Prescribing Information For Avandamet Use In Dual and Triple Therapy Refer to full Summary of Product Characteristics before prescribing AVANDAMET Rosiglitazone/metformin HCl Presentations AVANDAMET 2mg/500mg film-coated tablets containing 2mg rosiglitazone with 500mg metformin HCl. AVANDAMET 2mg/1000mg & 4mg/1000mg film-coated tablets containing 2mg or 4mg rosiglitazone respectively with 1000mg metformin HCl. Indications Treatment of Type 2 diabetes mellitus patients, particularly overweight patients: • who are unable to achieve sufficient glycaemic control at their maximally tolerated dose of metformin alone. • in triple oral therapy with sulphonylurea in patients with insufficient glycaemic control despite dual oral therapy with their maximally tolerated dose of metformin and a sulphonylurea. Posology & administration 4mg rosiglitazone/2000mg metformin with food. Can be increased to 8mg rosiglitazone/2000mg metformin if greater glycaemic control is required. For patients on metformin and sulphonylurea: when appropriate Avandamet may be initiated at 4 mg/day rosiglitazone with the dose of metformin substituting that already being taken. For patients on triple oral therapy Avandamet may substitute rosiglitazone and metformin doses already being taken. Caution is advised when using the 8mg rosiglitazone/ 2000mg dose in triple therapy as there is an increased risk of heart failure. Elderly Renal function should be monitored regularly. Children & adolescents Not recommended. Contraindications Hypersensitivity; history of cardiac failure (NYHA stages I to IV); diseases which may cause tissue hypoxia; hepatic impairment, acute alcohol intoxication/ alcoholism, diabetic ketoacidosis/pre-coma; renal impairment; acute conditions that may alter renal function; lactation. Special warnings & precautions Lactic acidosis can occur as a result of metformin accumulation, primarily in patients with significant renal failure. Renal function serum creatinine concentrations should be determined regularly (see SPC). Hypoglycaemia Triple oral therapy with a sulphonylurea increases risk of dose-related hypoglycaemia. A reduction in the dose of the sulphonylurea may be necessary. Increased risk when used in combination with insulin; dose adjustment of insulin may be necessary. Fluid retention & cardiac failure Rosiglitazone can cause dose-related fluid retention that, may very rarely be associated with rapid & excessive weight gain, & may exacerbate or precipitate heart failure. Monitor signs & symptoms of fluid retention. Discontinue if deterioration in cardiac status. Heart failure reported more frequently when history of heart failure, elderly, or mild or moderate renal failure, or when used in combination with a sulphonylurea or insulin. Concomitant administration with NSAIDs may increase risk of oedema. The use of rosiglitazone in triple therapy with a sulphonylurea is associated with increased risk of fluid retention. Increased monitoring is recommended and doseadjustment of the sulphonylurea as is necessary. Increased monitoring of the patient is also particularly recommended if AVANDAMET is used in combination with insulin. Monitoring of liver function Rare reports of hepatocellular dysfunction. Therapy should not be initiated when increased baseline ALT levels (>2.5xULN), or other evidence of liver disease. Liver enzymes should be checked prior to therapy initiation and periodically thereafter based on clinical judgement. Discontinue if jaundice is observed. Eye disorders Reports of new or worsening diabetic macular oedema with rosiglitazone. Commonly occurs with concurrent peripheral oedema. Ophthalmologic referral should be considered where reported. Surgery AVANDAMET should be discontinued 48 hrs before elective surgery with general anaesthesia & not be resumed earlier than 48 hrs after. Iodinated contrast agents Discontinue prior to/at time of tests & do not reinstitute until 48 hrs after & only after renal function has been found to be normal. Interactions Caution when administering CYP2C8 inhibitors (e.g. gemfibrozil) or inducers (e.g. rifampicin), concomitantly. Caution when administering cationic drugs eliminated by renal tubular secretion (e.g. cimetidine). Increased risk of lactic acidosis in acute alcohol intoxication. Avoid consumption of alcohol and medicinal products containing alcohol. If needed adjust dosage when used with agents that effect blood glucose levels e.g. glucocorticoids, beta-2 agonists, diuretics & ACEinhibitors. Pregnancy & lactation Do not use. Rosiglitazone has been reported to cross the placenta. Risk unknown. Ability to drive & use machines No effects observed. Undesirable effects Adverse reactions identified from clinical trial data (frequencies: very common, ≥1/10; common, ≥1/100 to <1/10; uncommon, ≥1/1000 to <1/100; rare, ≥1/10,000 to <1/1000; very rare, <1/10,000): Rosiglitazone+metformin (AVANDAMET or as separate components): Common: anaemia, hypercholesterolaemia, hyperlipaemia, weight increase, hypoglycaemia, dizziness, cardiac ischemia, constipation, oedema. Rosiglitazone+metformin+sulphonylurea (as separate components or as AVANDAMET + sulphonylurea): Very common: hypoglycaemia, oedema. Common: anaemia, granulocytopenia, hypercholesterolaemia, hyperlipaemia weight increase, headache, cardiac ischemia, constipation, myalgia. Uncommon: cardiac failure. Additional information on individual active substances Rosiglitazone Hypercholesterolemia reported in up to 5.3% of all patients treated with rosiglitazone. Increases were generally mild to moderate and usually did not require discontinuation. Elevations of ALT >3xULN were equal to placebo in double-blind clinical trials. Adverse events reported post-marketing with rosiglitazone treatment: Rare: macular oedema, congestive heart failure & pulmonary oedema, elevated liver enzymes & hepatocellular dysfunction (in very rare cases fatal outcome reported). Very rare: anaphylactic reaction, rapid & excessive weight gain, angioedema & skin reactions. Adverse events reported in clinical trials and postmarketing with metformin treatment: Very common: GI symptoms (most frequent at initiation of therapy, resolving spontaneously in most cases). Common: Metallic taste. Very rare: Lactic acidosis, vitamin B12 deficiency (very rarely resulting in clinically significant vitamin B12 deficiency, e.g. megaloblastic anaemia), liver function disorders, hepatitis, urticaria, erythema, pruritis. Overdose No data for AVANDAMET. Basic NHS cost: AVANDAMET: 2mg/500mg – 112 film-coated tablets £52.45 (EU/1/03/258/006); 2mg/1000mg – 56 film-coated tablets £27.71 (EU/1/03/258/009); 4mg/1000mg – 56 film-coated tablets £52.45 (EU/1/03/258/012). Marketing Authorisation holder: SmithKline Beecham plc, 980 Great West Road, Brentford, Middlesex TW8 9GS. Legal category: POM Date of preparation: February 2007. Further information is available from: Customer Contact Centre, GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex UB11 1BT; [email protected]; Freephone 0800 221 441. AVANDAMET is a registered trademark of the GlaxoSmithKline Group of Companies. © (March 2007) GlaxoSmithKline. References: 1. Avandamet Summary of Product Characteristics, November 2006. 2. Avandia Summary of Product Characteristics, November 2006. 3. Jones TA et al. Diab Obes Metab 2003; 5: 163-170. 4. Fonseca V et al. JAMA 2000; 283(13): 1695-1702. 5. Bailey CJ et al. Clin Ther 2005; 27(10): 1548-1561. 6. Rosak C et al. Int J Clin Pract 2005; 59(10): 1131-1136. AVM/ADO/07/29443/1 GlaxoSmithKline encourages healthcare professionals to report adverse events, pregnancy, overdose and unexpected benefits to the company on 0800 221 441. Information about adverse event reporting can also be found at www.yellowcard.gov.uk 30 www.scottishirishhealthcare.com When metformin is no longer enough*, help him use his body’s own insulin again. • Avandamet makes use of the body’s own insulin:1-5 – Improve β-cell function1,3-5 – Achieve and maintain glycaemic control1,6 rosiglitazone maleate/metformin HCI *When at maximal tolerated dose. Freephone: 0800 221 441 Fax: 020 8990 4328 [email protected] Prescribing information appears on the next page. AVM/ADO/07/29443/1 www.scottishirishhealthcare.com 31 The cells that make up human blood are suspended in a fluid medium in which they circulate through veins and arteries. Blood cells are produced in the bone marrow. The main blood cells are: • Red Blood Cells (erythrocytes) Responsible for transport of oxygen • White Blood Cells (leukocytes) Provide an immune defence • Platelets (thrombocytes) Provide blood clotting mechanism Erythrocytes are the most abundant blood cell numbering about 5 million per microlitre blood. They are small, biconcave disc shaped cells that contain haemoglobin. The average lifespan for an erythrocyte is 10 days. The main function of the Red Blood Cells is to transport oxygen around the body to fuel metabolising tissues. Oxygen is carried around the body in two ways: • Dissolved in the plasma (1–2%) • Chemically bound to the haemoglobin molecule in red blood cells (98–99%) Haemoglobin is a complex protein molecule that carries oxygen. It consists of four iron containing haem groups and the protein, globin. Oxygen molecules are carried attached to the haem groups. Haemoglobin with no oxygen attached is said to be unsaturated whereas haemoglobin that is carrying oxygen (oxyhaemoglobin) is saturated Haemoglobin Levels: A normal haemoglobin level varies between the sexes as testosterone stimulates red blood cell production. Lower levels are also to be expected in menstruating women. Normal haemoglobin (Hb) values: Male: 13.0–18.0g/dL Female: 12.0–16.5g/dL The Haematocrit is the proportion of whole blood that is taken up by all of the blood cells and is normally expressed as a percentage. As red blood cells are the most abundant cells in the blood they account for most of the haematocrit. Normal Haematocrit (Hct) values: Male: 40 – 50% Female: 37 – 47% The relationships between the haemoglobin level and haematocrit are converted through mathematical formulas to give the Red Blood Cell Indices. Anaemia meaning “without blood”, refers to a condition where there is a deficiency of red blood cells and / or haemoglobin.Values have to be adjusted for a number of factors such as age and sex but Hb values below 1.0g/dL in males and below 1.0g/dL in females are suggestive of anaemia. www.scottishirishhealthcare.com Fig 1. Blood cells Anaemia is the most common disorder of the blood. The main causes are: • Excessive blood loss e.g. acute or chronic bleeding • Diet deficiency: e.g iron, vitamin B12 and folate • Deficient red blood cell production by the bone marrow: e.g infiltrating cancer such as leukaemia, drug side effects • Excessive blood cell destruction e.g. haemolysis Symptoms of Anaemia: • Fatigue • Breathlessness • Palpitations • Headaches • Faints / collapse • Worsening angina Signs of Anaemia: • Pale skin, lips and conjunctiva • Tachycardia • Dyspnoea • Peripheral oedema • Extended peripheral capillary return There are numerous causes of anaemia. The morphology / size of the red blood cells often gives us a clue as to the cause of the anaemia. Red blood cells can be: • Normal sized (80–99fL) i.e. Normocytic red blood cells • Larger than normal (greater than 99fL) i.e. Macrocytic red blood cells • Smaller than normal (less than 80fL) i.e. Microcytic red blood cells Normocytic red blood cells are normal sized i.e. 80–99fL Red blood cells are normal but the patient may still be anaemic due to a lower overall Haemoglobin level Fig . Normocytic red blood cells. Table 1: Causes • • • • • • of normocytic anaemia: Acute blood loss e.g. gastrointestinal bleeds Anaemia of chronic disease Rheumatoid arthritis Chronic infection Renal failure Malignancy Iron deficiency anaemia (IDA) is often an inadequately managed condition which can seriously affect patients’ quality of life. Its effect may be compounded by underlying pathology e.g. heart failure, cancer or inflammatory disease or from insidious blood loss from the gastro intestinal tract. The physiological demand for iron can sometimes be met by supplementation with oral iron but often parenteral iron therapy is more appropriate. Microcytic red blood cells are smaller than normal i.e. smaller than 80 fL Fig . Microcytic red blood cells Table : Causes of microcytic anaemia: Iron deficiency due to: • Insufficient dietary intake • Malabsorption • Chronic blood loss e.g. menstruation Macrocytic red blood cells are larger than normal i.e. greater than 99 fL Fig 4. Macrocytic red blood cells Table : Causes of macrocytic anaemia: Vitamin B12 deficiency due to: • Insufficient dietary intake • Malabsorption in the stomach and terminal ileum • Gastrointestinal surgery • Pernicious anaemia ~ autoimmune condition Folate deficiency due to: • Insufficient dietary intake e.g. green leafy vegetables • Malabsorption e.g. coeliac disease • Alcoholism Charles Bloe Training Limited has developed a suite of online training programmes, including Interpretation of Blood Results. These courses are currently available for half-price. For further details visit: www.cb-training.com The bone marrow produces - million red blood cells per second, requiring 0-40mg of iron per day which is virtually all derived from red cell breakdown. In the anaemic patient the supply of iron from the old red cells is often dramatically reduced and rates of absorption of oral iron, even if not impaired, often cannot be upregulated enough to meet the iron demands of erythropoiesis. The rate of absorption is often insufficient in the time frame available. This commonly occurs in the patient who presents for elective surgery at the pre-assessment clinic. Equally, in the latter stages of pregnancy an iron deficit occurs when demand exceeds supply. In inflammatory conditions such as chronic kidney disease (CKD) and inflammatory bowel disease oral iron is particularly poorly absorbed resulting in a minimal haemoglobin improvement. The recent NICE guidelines (006) for Anaemia Management in CKD1, recognises that normal serum ferritin levels >0µg/l are inadequate in renal patients, and 100µg/l is considered as the lower limit of normal. The Renal Association and Royal College of General Practitioners guidelines (006) on the management of CKD specify that where a patient’s Hb<11g/dl they should be referred for intravenous iron with or without an ESA. Historically, there have been concerns over anaphylaxis with intravenous iron. However, the use of iv iron sucrose (Venofer®) has been associated with far fewer serious adverse events than iron dextran (Cosmofer®), and iron sucrose has come to be the most widely prescribed iv iron preparation in both the UK and Ireland. References 1. Anaemia Management in Chronic Kidney Disease www.nice.org.uk/cg39 2. RCP/RA CKD Guidelines www.renal.org/eGFR/anaemia.html 3. Chertow GM et al (2006) Nephrol Dialysis Transplant 21: 378-382 www.scottishirishhealthcare.com Treating iron deficiency anaemia in 1o & 2o care: • intolerance to oral iron • pregnancy (2nd & 3rd trimester only) • chronic blood loss “Life threatening ADE’s are 5.5x less likely with Venofer ® than Cosmofer ®” Parenterally administered iron preparations can cause severe allergic or anaphylactoid reactions, which may be fatal. A test dose, and facilities for cardio-pulmonary resuscitation (including administration of intramuscular adrenaline) is required with Venofer ® Chertow, 2006. based on 30 million doses of iv iron [Nephrology, Dialysis, Transplantation (2006) 21:378-382] Information about adverse event reporting can be found at www.yellowcard.gov.uk Adverse events should also be reported to Syner-Med (PP) Ltd. Tel: 0845 634 2100 Abbreviated Prescribing Information. Active ingredient iron sucrose. Presentation. Solution for injection or concentrate for infusion. Product name Venofer®. Active ingredient (qualitative, quantitative). 5 ml ampoules containing 100 mg iron as iron sucrose corresponding to 2% iron w/v. Indications. Demonstrated intolerance to oral iron preparations, where there is a clinical need to deliver iron rapidly to iron stores, in active inflammatory bowel disease where there is intolerance to oral iron preparations, demonstrated patient non-compliance with oral iron therapy. Contraindications. Venofer® must not be used in cases of: anaemias not attributable to iron deficiency, iron overload or disturbances in iron utilisation, a history of hypersensitivity to parenteral iron preparations, a history of asthma, eczema, or other atopic allergies, history of cirrhosis or hepatitis or the presence of serum transaminases at three times the upper limit, acute or chronic infection and in the first trimester of pregnancy. Adverse drug reactions in clinical trials were transient taste perversion, hypotension, fever and shivering, injection site reactions and nausea, occurring in 0.5 to 1.5% of the patients. Non serious anaphylactoid reactions occurred rarely. Interactions. Venofer® should not be administered concomitantly with oral iron preparations. Oral iron therapy should be started at least 5 days after the last injection of Venofer®. Pregnancy and lactation. Data on a limited number of exposed pregnancies indicated no adverse effects of iron sucrose on pregnancy or on the health of the foetus/new born child. Pregnancy first trimester is contraindicated. Non-metabolised iron(III)-hydroxide sucrose complex is unlikely to pass into the mother’s milk. Therefore, Venofer® should not present a risk to the suckling child. Warnings and special precautions for use. Use Venofer® only in the approved indications. Parenterally administered iron preparations can cause severe allergic or anaphylactoid reactions. Facilities for cardio-pulmonary resuscitation must be available. In the event of a serious anaphylactic or allergic reaction, administration of Venofer® must be stopped, intramuscular adrenaline should be administered immediately and other supportive cardio-pulmonary resuscitation procedures initiated. Mild allergic reactions should be managed by stopping the administration of Venofer® and administering antihistamines. Hypotensive episodes may occur if the injection is administered too rapidly. Patients with low iron binding capacity and/or folic acid deficiency are particularly at risk of an allergic or anaphylactoid reaction. Paravenous leakage must be avoided because leakage of Venofer® at the injection site may lead to pain, inflammation, tissue necrosis, sterile abscess and brown discolouration of the skin. Dosage and duration of treatment. Adults and the elderly only: The total cumulative dose of Venofer® is determined by the haemoglobin level and body weight. The dose and dosage schedule of Venofer® must be individually estimated for each patient based on a calculation of the total iron deficit. Refer to the summary of product characteristics for the calculations. The normal recommended dosage schedule is 100 mg of iron (1 ampoule of Venofer®) administered not more than 3 times per week. However if clinical circumstances require rapid delivery of iron to the body iron stores, the dosage schedule may be increased to 200 mg of iron not more than 3 times per week. Children: Venofer® is not recommended for use in children. Method of administration. Venofer® must only be administered by the intravenous route. Before administering the first dose to a new patient a test dose should be given. Facilities for cardio-pulmonary resuscitation must be available. Intravenous drip infusion. This is the preferred route of administration as this may help to reduce the risk of hypotensive episodes and paravenous leakage. Venofer® must be diluted only in 0.9% sodium chloride solution (normal saline). One 5ml ampoule (100mg iron) may be diluted in 100 ml of 0.9% saline. The first 25 mg of solution should be infused as a test dose over 15 minutes. If no adverse reactions occur during this time then the remaining portion of the infusion should be given at an infusion rate of not more than 50 ml in 15 minutes. Intravenous injection. Slow intravenous injection at a rate of 1 ml undiluted solution per minute (i.e. 5 minutes per ampoule), not exceeding 2 ampoules Venofer® (200 mg iron) per injection. The test dose is 1 ml (20 mg of iron) injected slowly over a period of 1-2 minutes. If no adverse events occur within 15 minutes of completing the test dose, then the remaining portion of the injection may be given. After an IV injection extend and elevate the patient’s arm and apply pressure to the injection site for at least 5 minutes to reduce the risk of paravenous leakage. Injection into dialyser. Administer Venofer® during the middle of a haemodialysis session directly into the venous limb of the dialyser under the same procedures as for IV administration. Venofer® must never be administered by the subcutaneous or intramuscular routes. Legal category: POM. Packaging and NHS Price Pack 5 x 5 ml type 1 glass ampoules, £42.50. MA number. PL 15240/0001. Marketing authorisation holder. Vifor France S.A., 123 rue Jules Guesde, F-92300 Levallois-Perret, France. Distributed in the UK by Syner-Med (Pharmaceutical Products) Ltd., Beech House, 840 Brighton Road, Purley, Surrey, CR8 2BH, UK. The word Venofer® is a registered trademark. Date of first authorisation: 8th June, 1998. Lasted revised: 27th October, 2003. Code /date of preparation: V10/21-05-07. Syner-Med (PP) Ltd, Beech House, 840 Brighton Road, Purley, Surrey CR8 2BH United Kingdom, Tel: +44 (0)845 634 2100 Web: www.syner-med.com 34 www.scottishirishhealthcare.com NEW See what Gelling Foam can do for your patients New Versiva® XC™ Gelling Foam Dressing— The only dressing with the gelling foam advantage, redefining patient care • Designed to protect periwound skin and reduce the risk of maceration • Comforts patients over time whilst the dressing is in situ and upon removal1 • Offers more for wound management than just a moist wound environment • Gel cushions in a way that only a Gelling Foam dressing can2 For more information, please contact ConvaTec Wound Therapeutics™ Helpline Freephone quoting VXC1 on 0800 289 738 (UK) 1 800 946 938 (Republic of Ireland) References: 1. A phase II non-comparative study of non-adhesive Versiva® XC™ on leg ulcers (N=46). CW-501-04-U331. April 29, 2005. Data on file, ConvaTec. 2. Bishop S. Versiva® XC™ Gelling Foam Dressing cushioning and protection claims R&D justification. June 2005. Data on file, ConvaTec. ®/TM The following are trade marks of E.R. Squibb & Sons, L.L.C.: Versiva XC and Hydrofiber. ConvaTec is an authorised user. ©2007 E.R. Squibb & Sons, L.L.C. January 2007. GB-07-354.1 www.convatec.com www.scottishirishhealthcare.com 35 Special Feature Peter J Franks Professor of Health Sciences & EWMA President Centre for Research & Implementation of Clinical Practice Faculty of Health & Human Sciences, Thames Valley University, 32-38, Uxbridge Road, London W5 2BS Tel: 0208 280 5020 Fax: 0208 280 5285 e-mail: [email protected] Introduction Pressure ulcers are a major cause of morbidity in the population, yet it is largely an unseen problem. It is known that the treatment and prevention of pressure ulcers is costly to health services, but as yet there is still little information on precise costs. Moreover, there is a cost to patients of pressure ulceration, both in financial terms, but also in terms of their quality of life. This paper will review some of the key evidence in respect to both the costs to society and the costs to individual patients. Measuring the burden of pressure ulceration on relatives and carers It is important examine both the costs of providing the health services to patients suffering from the disease in question, but also to determine the costs to patients and relatives since care falls increasingly outside the formal health services, and on to patients and their families. Indirect costs should be derived from estimates of lost production by the patient or family members caused by the disease, losses to society caused by the patient being unable to function to their potential, and quality of life issues, particularly problems associated with pain, poor mobility, discomfort and distress. Relatives and carers provide substantial support to health services, without which it is argued that health and social services would collapse under the burden if such informal care was not available. In is estimated that some 6.8 million people in the UK could be defined as carers1. These carers provide support and care to relatives and friends who are unable to care for themselves independently. In England the value of informal carers providing care in the community is estimated to be £57 billion per year2. The Financial Costs of Pressure Ulceration The costs of pressure ulcer care and prevention are largely unknown, perhaps due to the fact that it is a condition largely secondary to other diseases. However, there has been a long-standing interest in estimating the costs of pressure ulcers, sometimes using these costs to calculate which other services (surgery and bed stays) could instead be provided3. In 1993, the UK government commissioned accountants Touche Ross to provide them with an estimate of health service costs of pressure ulcers4. They used existing research where available and expert opinion where necessary to provide a theoretical cost of prevention and treatment of pressure ulceration in an average 600 bedded hospital. Different models were proposed, 36 www.scottishirishhealthcare.com depending on whether the hospital was high or low cost, and depending on whether there was an active prevention strategy with treatment, or treatment alone. The final estimates indicated that with a treatment strategy alone a low cost hospital would spend €901,000 (£644,000) per year on pressure ulcers whilst a high cost hospital would spend in the region of €1,614,000 per year in 1993. When including a prevention strategy into the care of patients the low cost hospitals used a similar budget (€901,000), but the high cost hospitals used €3,794,000. Most the excess cost associated with prevention was consumed by additional nursing time spent assessing and turning the patients. This report concluded that the cost of pressure prevention and treatment would cost the UK health service approximately 0.4-0.8% of the total annual budget. This analysis was limited in that it only estimated costs in the acute (hospital) services and was unable to estimate costs in the community. Moreover, there was no attempt to estimate indirect costs, costs to patients, nor any value placed on the patients’ quality of life. A more global investigation of cost of pressure ulceration was undertaken in the Netherlands, examining the costs in different care settings including home care; nursing homes; general hospitals and university hospitals5. Prevalence figures for different pressure ulcer stages were determined from estimates given by the Health Council for the Netherlands on Pressure Ulcers6.These data were combined with expert opinion (Dutch Society of Pressure Ulcer Experts) to determine personnel time, extra days of care, use of special beds and medical materials. Both low and high estimates were given to indicate the potential range of costs. Costs were dependent not only on ulcer stage, but were also highly dependent on where care took place. As an example of this mean low and high daily costs of stage II pressure ulcers were highest when treated in a university hospital (low €71.6, high €110.2) and lowest in the general hospital (low €23.7, high €25.1) with conversion factor €1= $1.3. Home care was similar to University Hospital costs whereas nursing home care was similar to that of the general hospital costs. The authors estimated annual costs of pressure ulcer care to be in the range €371 million to €1,695 million per annum for a country with a population of just 16.5 million, or 1% of the Dutch health care budget. More recently, a model of costs of pressure ulcers has been developed in the UK,which adopted a more epidemiological approach7. It also looked at different health states for pressure ulcers, namely normal healing; critical colonisation, cellulitis and osteomyelitis. Each health state and pressure ulcer grade was ascribed a cost based on the research evidence and/or expert opinion. The average cost of healing the different pressure ulcer grades was estimated at €1489 for a grade I, €6,162 for grade II, €10,238 for grade III and €14,771 for grade IV. In the UK (population 60 million) annual incidence (new cases) was estimated at 140,000 for grade I, 170,000 for grade II, 50,000 for grade III and Special Feature 50,000 for grade IV based on available incidence data8. By combining average costs and number of cases the total cost of pressure ulcers was estimated at €214 million (grade I), €1047 million (grade II), €544 million (grade III) and €670 million (grade IV), giving a total cost of all pressure ulcers at €2,473 million. This is equivalent of approximately 2.6% of the total current NHS budget. As expected most cost (90%) was associated with nursing time, though in-patient stays accounted for 8% of overall costs and 30% for grades III and IV. Cost for antibiotics, dressings and pressure relieving equipment was all relatively low. Other studies have concentrated on specific costs of pressure ulceration. In Australia a study was undertaken to examine the bed days lost to pressure ulceration in 2001-2. It was estimated that a pressure ulcer led to an extra 4.31 days per patient leading to 398,432 bed days lost and an opportunity cost of AU$ 285 million (€170.7 million) in a population of 20.3 million9,10. Costs to the patient: Quality of life Health related quality of life (HRQoL) is an important measure of the impact of a condition on the patient’s physical and mental well being and their ability to function socially. While most clinicians would accept that HRQoL is an important measure to determine the impact of disease on the patient relatively few studies have been undertaken to assess this. One influential qualitative study used a phenomenology approach to determine the impact of the condition on 8 subjects who mostly were suffering (or had suffered from) a stage IV pressure ulcer in the USA11,12. Key themes identified were: • Perceived aetiology of the ulcer • Life impact and changes • Psycho spiritual impact • Extreme painfulness associated with the PU • Need for knowledge and understanding • Grieving process grade II to IV experienced pain, even at rest, with 18% reporting this as excruciating14. In addition 88% reported pain at dressing change. Only 6% reported pain relief being prescribed, with nursing staff frequently denying the pain their patients’ experienced. A further study was undertaken using a generic quality of life tool (SF-36) in 60 patients in the community15. Compared with the general population, patients with pressure ulcers experienced greater problems with physical and social functioning. At present no studies have examined utility scores of patients with pressure ulceration to determine the potential deficit associated with the condition and the potential cost in terms of QALYs (Quality adjusted life years). Discussion. In the area of pressure ulceration there has been some interest in the evaluation of outcomes of treatment, but very little attention to the overall cost of care, nor impact on the patients’ quality of life. Surprisingly, health services do not appear to be aware of the financial burden that pressure ulceration causes. As an example, the €2.5 billion spent on pressure ulceration is equivalent to the cost of treating mental health in the UK or all community health services7. The cost estimates are highly dependent on the incidence of pressure ulcers, although few studies have been undertaken on a population basis to determine this important aspect of pressure ulcer evidence. The results from studies so far undertaken have shown that pressure ulcers lead to a clear deficit in quality of life, though again, these are based on small local studies of patients. There is a clear need for governments to understand that pressure ulceration causes a major financial burden on them and on patients’ lives. Until the magnitude is appreciated it is hard to push for cost effective treatments and prevention strategies on a national basis to rationalise the care of patients who suffer from this distressing condition. References. The pressure ulcer had effects on the patients in terms of their physical, ability, their ability to function socially, their financial situation, changes in their perceived body image, and loss of independence and control of their own lives. Patients who had an ulcer for longer than six months experienced pessimism and a poorer adherence to treatment, which left them feeling depressed and frustrated. Coping with the pressure ulcer was difficult, and patients felt isolated, particularly when they were often left in a side room on their own. Patients felt humiliated that health care professionals were seeing parts of their body which were normally kept private. The odour from the pressure ulcer made them feel dirty and they often resorted to deodoriser to mask the smell. Financial costs were associated with having to miss work, for medical care, prescriptions and travel. The theme of living a restricted lifestyle was examined more recently, with more detail given for the impact on families13. 1. Maher, J., Green, H. (2000) Carers 2000. London, Office of National Statistics 2. Carers UK (2002a) Without us carers. London, Carers UK. 3. Hibbs, P. (1990) The Economics of Pressure Sore Prevention. In: Pressure Sores: Clinical Practice and Scientific Approach. Ed Bader, D. London, Macmillan Press Ltd. 4. Touche Ross ‘Pressure sores: a key quality indicator’ Department of Health, Heywood 1993 5. Severens JL Habraken JM, Duivenvoorden S, Frederiks CMA.The cost of illness of pressure ulcers in the Netherlands. Adv Skin & Wound Care 2002; 15: 72-77. 6. Health Council of the Netherlands. Pressure Ulcers. The Hague: Health Council of the Netherlands 1999 (In Dutch). 7. Bennett G, Dealey C & Posnett J The cost of pressure ulcers in the UK. Age & Ageing 2004; 33(3):230-5 8. Clark M Watts S. The incidence of pressure sores within a national health service trust hospital during 1991. 9. Graves N, Birrell F,Whitby M Effect of pressure ulcers on length of hospital stay. Infect Control Hosp J Adv Nurs 1994: 20; 33-6 Epidemiol 2005; 26(3): 293-7 10. Graves N, Birrell FA Whitby M Modelling the economic losses from pressure ulcers among hopsitalized patients in Australia. Wound Repair Regen 2005; 13 (5):462-7 11 Langemo DK, Melland H, Hanson D, Olson B, Hunter S The lived experience of having a pressure ulcer: a qualitative analysis Adv. Skin Wound Care 2000; 13: 225-35 12. Langemo DK Psychosocial aspects in wound care. Quality of life and pressure ulcers: what is the impact? Wounds 2005 17(1): 3-7. 13. Hopkins A, Dealey C, Bale S, Defloor T,Worboys F. Patient stories of living with a pressure ulcer J Adv Nurs. 2006 56(4):345-53. 14. Szor JK, Bourguignon C. Description of pressure ulcer pain at rest and at dressing change. J Wound Ostomy Pain associated with the the pressure ulcer appears to have a substantial impact on patients and their lives13,14. In the study by Szorall 84% of patients with a Continence Nurs. 1999; 26(3):115-20. 15. Franks PJ,Winterberg H, Moffatt CJ Health related quality of life and pressure ulceration: assessment in patients treated in the community. Wound Repair & Regeneration 2002; 10 (3): 133-140. www.scottishirishhealthcare.com 37 Overseas educated nurses must be able to speak English for working in Australia. Nurses from countries where English is not the first language are required to complete and pass either the Occupational English Test (OET) for Nurses or the International English Language Testing System (IELTS). Australia’s strong economic performance over the last decade is clearly seen through its economic growth, low inflation, low unemployment and low interest rates. The Australian economy is open and competitive, aided by a dynamic private sector and a skilled, flexible workforce. economic stability, and a general quality of life envied by many around the world. The appeal of Australia is evident in the large number of people who migrate under the Department of Immigration and Citizenship (DIAC) Migration Program every year. Over 100,000 people will migrate to Australia every year for the next four years, further enhancing the existing multicultural population. The Australian Government seeks skilled workers & professionals to fill shortages created by the growing Australian economy. 97,500 work rights visas will be made available between July 006-June 007, allowing skilled workers to work and live in Australia. Despite being the sixth largest country in the world, Australia has a lot of space but not many people. It has the lowest population density in the world - only .5 people per square kilometre - a far cry from the packed cities of other countries ! Aussie lifestyle is arguably the finest in the world and is the number one reason that most people flock to its sandy shores to live and work. Over 150,000 jobs are advertised each week, and the current unemployment rate at its lowest level in 10 years. Australian Government statistics confirm 89% of Skilled Visa holders gain employment within 6 months. Australia is often referred to as “The Lucky Country”, with its spacious surroundings, high standard of living, excellent health and education systems, temperate climate, wide and varied landscape, political and Australia’s not a place where you stand on the sidelines and simply watch - there is so much on offer for you to see, do, and experience. There are two levels of nurse in Australia: registered and enrolled nurses. Registered nurses are educated in degree level courses at universities. Enrolled nurses are primarily educated through advanced certificate or diploma level courses in colleges of technical and further education. There are six states and two territories in Australia. Each have a nurse regulatory authority which maintains its own register of qualified nurses. Each nurse must be registered or enrolled in the state or territory in which they intend to practice. 8 www.scottishirishhealthcare.com OVSTFT /08 3&$36*5*/( '03 'BDFUPGBDFJO UF JO6,XJUIMBSH SWJFXT F5FBDIJOH )PTQJUBMJO1F SUI #PPLJOUFSWJF XUJNFOPX BVTUSBMJB (EALTH3TAFF2ECRUITMENTIS!USTRALIAS(EALTHCARE 2ECRUITMENTORGANISATIONANDWEHAVETHEWIDESTCHOICEOF .URSINGJOBSIN!USTRALIA 9OUROPTIONSAREENDLESS s-ELBOURNE s!DELAIDE s!LICE3PRINGS s"RISBANE s0ERTH s$ARWIN s3YDNEY s(OBART s+ALGOORLIE /URSUPPORTMAKESALLTHEDIFFERENCEANDOUR&2%%SERVICETOYOUINCLUDES s!SSISTANCEWITHYOURREGISTRATION s!SSISTANCEWITHTEMPORARYACCOMMODATION SOMECOUNTRYHOSPITALSOFFERWKSFREEACCOMMODATION s!SSISTANCEWITH7ORK6ISASIFAPPLICABLE s0ERSONALISED@-EET'REETSERVICE ANDMANYOTHEROPENINGSINRURALANDCOUNTRYAREAS !LLOFOURVACANCIESAREGENERALLYHOSPITALBASEDINANACUTEWARDSETTING4OBEELIGIBLE YOUAREREQUIREDTOHAVEATLEASTMONTHSCURRENTHOSPITALBASEDEXPERIENCE 6ACANCIESAREINALLCLINICALAREASANDCONTRACTSAREFROM MONTHSUPTOPERMANENTPOSITIONS #ALLOURCONSULTANTSTODAYTOFINDOUTMOREABOUTYOURJOBOPPORTUNITIES %MAILYOUR#6TOINFO HSRCOMAUORAPPLYTHROUGHOURWEBSITETODAY $BMMPVSDPOTVMUBOUTJO"VTUSBMJB'3&&$"-- 'SPN*SFMBOE 'SPN6, äÇx{{ XXXIFBMUITUBGGSFDSVJUNFOUDPNBV www.scottishirishhealthcare.com 9 Put yourself in this picture Make your next career move to the Royal Children’s Hospital in sunny Brisbane, Australia. Positions are now available for experienced paediatric nurses in Perioperative, Intensive Care, Neurosurgery, Oncology, Orthopaedic, Medical, Emergency, Community Child and Youth Mental Health. Health visitors may apply. to stimulating continuing education, career development and active nursing research mentorship programs. Up to $5,000 (AU) relocation and accommodation assistance is available on successful appointment (conditions apply). Sponsorship to Australia is also available. The Royal Children’s Hospital Brisbane offers the opportunity to work across acute and community settings in supportive team environments, with access This is destination nursing at its best. It’s one hour to the world renowned beaches of the Gold and Sunshine Coasts and only ten minutes to the city centre. A green sub-tropical environment and active cafe society makes this one of the most liveable cities in the world where sunny winter days average 11-21° C. In five years, following a major redevelopment, the hospital will merge with other facilities, expanding to a 400-bed world class paediatric hospital. The time is right to make your career move to the Royal Children’s Hospital, Brisbane, Australia. Photos courtesy of Tourism Queensland Enquiries and applications to: [email protected] or visit our website www.health.qld.gov.au/rch health • care • people 40 www.scottishirishhealthcare.com Nursing in Australia Life’s a beach! Good weather…Great food…Beach barbecue … Good salaries…low cost of living…and lots m o re . CCU,ICU, CTICU, CathLab, Midwives, OT/PACU, Surgical, M e d i c a l , Oncolog y, Rehab, Or thopaedics, MentalHealth, AgedCare… … A L L A re a s Locations all over Australia & New Zealand avai l a b l e A l l ove r s e a s ap p l i c a n t s w i l l b e o f fe re d : • M i n i mu m 2 y r s p o n s o r s h i p + r e s i d e n c y v i s a •Full time positions • 4 - 6 we e k s l e ave + 1 0 d ay s s i c k l e ave •Assistance with Registration,Visas & airpor t pick up •Assist with accommodation on arrival C o n t a c t u s n ow f o r m o re i n f o r m a t i o n D F Re c ru i t i n g & N u rs i n g S e r v i c e - A u s t ra l i a Apply online w w w. d f rc . c o m . a u E m a i l Re s u m e - m a rc i a w @ d f rc . c o m . a u - t h e re s e w @ d f rc . c o m . a u Te l e p h o n e + 612 66286438 It pays to travel Down Under. 7 7 7 7 General and Mental Health Specialists Top rates paid weekly Sponsorships available Enjoy shift flexibility Experience Nursing Australian-Style with one of Australia’s Largest Private Healthcare Groups. One of the most respected private healthcare groups in Australia is seeking interest from qualified and experienced RGN’s from the UK. It is an ideal opportunity for those RGN’s with a valid UK PIN Number to widen their horizons on a working holiday or to start a brand new life with adventure doing important work in beautiful Australia. Questions? Call us on 007 9944 or 0115 877 199 or 0780819151 to learn more Call us on +61 3 9481 7222 or visit us at www.australiannursingagency.com and have your questions answered. Alternatively, for a free consultation forward your CV to [email protected]. We look forward to hearing from you soon! Madeleine, from Rothley, Leicestershire, disappeared from an apartment in the resort of Praia da Luz. Madeleine has a very distinct birth mark on her right eye Rewards totalling £.5m have been offered to anyone who can help with information leading to the safe return of Madeleine McCann. The News of the World and businessmen including Sir Richard Branson have jointly pledged £1.5m. Scottish tycoon Stephen Winyard has offered £1m. British and Portuguese police are also asking anyone to contact them on the numbers below if they have seen anything suspicious related to the disappearance of Madeleine or if you believe you know where Madeleine is being concealed or hidden. Portuguese police have searched extensively around Praia da Luz and she has not been found. It is possible that she is being hidden or concealed in some way and if you know where then by now you may have realised that it is in everyone’s interest that she is returned to her family. The family of Madeleine McCann have launched the Madeleine’s Fund: Leaving No Stone Unturned appeal. The funds will be used to help find Madeleine McCann, support her family and bring her abductors to justice. Any surplus funds will be used to help families and missing children in United Kingdom, Portugal and elsewhere in similar circumstances. Members of the public will be able to make donations to ‘Madeleine’s Fund : Leaving No Stone Unturned Limited’ over-the-counter in any branch of NatWest and The Royal Bank of Scotland. Postal Donations can be made with cheques payable to ‘Madeleine’s Fund : Leaving No Stone Unturned’. Cheques should be posted to the following address: ‘Madeleine’s Fund’ c/o The International Family Law Group 6 Southampton Street Covent Garden London WCE 7RS www.scottishirishhealthcare.com 41 42 www.scottishirishhealthcare.com General Recruitment Vacancies to Fill Advertise your jobs here and have in excess of 0,000 healthcare professionals reading your ad. Contact our recruitment section on 019 55970 or email [email protected] -- ÊÊ£ÎÈ£Ê{£ÇÇ ÊÊÊÊÊÊÊÊÊ6°Ê£äÊÊÃÃÕiÊn ISSN 1361 -4177 Vol. 10 - Issue 10 Scottish Nurse magazine is the most widely read Nursing journal in Scotland - and it is FREE! Prostate Cancer Sitting on the Fence? Subscribe today, receive every issue direct to your home for only £25.00 for one whole year. See page 57 Share in our Success story Scotland: Occupational Health Opportunities Inventive Solutions/Refer2Us are part of the Healthcare At Home Group a nationwide supplier of healthcare services. We are developing our bank and permanent nursing resources in the area of Occupational Health throughout Scotland; as such are looking for experienced OHN or nurses that have OH experience to register their interest with us for forthcoming contracts. Experience in the Rail/ Public sector/ Police and local government would be of an advantage. These are exciting positions for Nurses to gain experience of working in a travelling capacity across a range of contracts Nationwide. Salary negotiable but an excellent package is available for the right candidate. Exciting career path, prospects and development. Elements of the role will include the following provision for our clients: Assessing Fitness for work Prevention and Promotion Rehabilitation � Pre Employment screening � Health surveillance � Management referrals � Workplace visits / assessments and advice � Health Promotion � Management referrals � Occupational Therapy Alcohol Infection Control part 1 Consumption & Consequences Trauma Management part 1 Infection Control Hand Hygiene Group Psychotherapy parts1 & 2 ECG Rhythms part 5 (final assesment) ECG Rhythms part 3 Trauma Part2 Care Planning in long-stay care Nutrition & Obesity ‘Fat Happens’ part 3 Diabetes part 2 Clinical feature: Warts & Verrucas Recruitment section www.scottishirishhealthcare.com General & Overseas Specialised Services Division Brain Injury Rehab. Centres 1 Recruitment section General & Overseas www.scottishirishhealthcare.com 1 Central Scotland Brain Injury Rehabilitation Centre, Murdostoun Castle, Newmains,Wishaw ML2 9BY. Situated between Glasgow and Edinburgh, we are now recruiting the following staff: CLINICAL NURSE MANAGER We are seeking a nurse manager with experience at ward manager level, preferably in a related field. You will be a dynamic individual, taking a lead role in managing our nursing services and being a member of the multi-disciplinary team.You will focus on the management and development of the nurses and in the continuous improvement of standards in line with best practice.You will also have the opportunity to participate in clinical care of the patients. An attractive package of remuneration will be offered to the successful candidate. For informal enquiries and application form please contact: Ann Hunter, Centre Manager: 01698 384055 (Mon-Thurs). Email: [email protected] Visit our website: www.huntercombe.com Closing date: Monday 23rd July 2007. Full time and part time will be considered All discussions we have with you are in total confidence For further information on these positions and to find out how we can work towards successfully placing you in a new position contact Inventive Solutions 0845 1298582 9am-5.30pm or email a CV to [email protected] quoting Ref. ScotOH06/07. www.huntercombe.com a division of Healthcare at Home Inventive Solutions committed to equal opportunities www.scottishirishhealthcare.com 4 The United States is attracting over a million immigrants a year - a greater number than at any time in its history. Nearly eleven million newcomers have made their home here during the past decade. Those serious about working in America need to know how to go about acquiring a green card or visa that will grant them both residency and employment rights in the USA. If you’re a nursing professional looking for a change in lifestyle, new opportunities or simply a career that stands out from the others, you could find everything you’re looking for in America. Currently experiencing a major shortage of trained Nurses, employers in the USA now place a high value on overseas nursing professionals, offering them a variety of opportunities that just can’t be found in other countries. And because working abroad demonstrates real self-motivation and adaptability to change, it’s a move that will only help to boost your career prospects back home - should you ever decide to return. Add to all this the chance of choosing a new home that perfectly suits your lifestyle needs, and you’ll understand why so many Nurses are crossing the pond to start a new life in the States. Generally speaking when we think about America we think about a first world country where the standard of living is incredibly high, employment opportunities abound and where one can live a good life in a free thinking society. Many of US industries are the leaders in their particular field and so are its academic institutions. It remains one of the world’s leading economies, politically it is the most powerful country on earth and it is a trendsetter in many ways. Working in a U.S. hospital introduces nurses to cutting edge technology; the ability to work with top-notch professionals; terrific benefits; respect by patients, peers and administrators and the chance for increased responsibility. Enhance your career by doing something many others only dream of. Come to America and work among the world’s finest health care professionals. The U.S. hospital — it’s waiting for you! 44 www.scottishirishhealthcare.com Naturally enough these features of the American way of life are highly attractive to immigrants from across the world. In a country as geographically and demographically diverse as the United States, you will find great variety in the landscape, climate, culture and lifestyles. Some of the most breathtaking sites of natural beauty in the world are located in the States. There are large metropolitan cities, sprawling suburban towns and countless rural communities. 8BOUUPOVSTFJOUIF64" 5SVTUUIFFYQFSUT JOJOUFSOBUJPOBMOVSTFSFDSVJUNFOU Under the guidance of its membership, the National Council of State Boards of Nursing, Inc. (NCSBN) develops and administers the national nurse licensure examination NCLEX-RN (®) (the National Council Licensure Examination for Registered Nurses). This examination is used by the Boards of Nursing to test entry-level nursing competence for licensure as a Registered Nurse. The NCLEX-RN examination is provided exclusively as a computerized adaptive test and may be taken in many countries outside of the U.S. – go to www.pearsonvue.com and click on Locate a Test Center for details on a test center close to you. America has always been known as the land of the free, a place where theoretically anyone from any back ground can achieve anything! A country seemingly without personal restrictions and one that promotes liberty and freedom of speech so vociferously, America naturally draws thousands of applications for residency and working visas annually. www.scottishirishhealthcare.com 45 i n g n i N s r ew Zealand u N New Zealand offers a great climate with a diverse and sophisticated society. There are just over four million New Zealanders, and every single one is either an immigrant or descended from one. English is the main written and spoken language in New Zealand – with a number of different accents! New Zealand needs skilled people to drive its development. Its relatively small population and low unemployment means specialist talent and skills are always welcome and encouraged. The presence of comminities with experience and skills from around the world strengthens new Zealand . New Zealand offers unique opportunities for registered nurses to practice in a diverse range of nursing practice areas, in a variety of settings. New Zealand’s health system is comprehensive and modern and is renowned for the quality of its health professionals. Since 000, registered nurses in New Zealand are educated in a three year Bachelor of Nursing degree. The role of the nurse practitioner has recently been introduced in New Zealand’s health and disability system, offering for the first time a clear clinical career pathway for nurses in clinical practice. Registered nurses who have gained their registration in countries other than New Zealand need to apply to the Nursing Council of New Zealand before being able to practice as a registered nurse in New Zealand. The Nursing Council of New Zealand is the statutory authority governing the practice of nurses and midwives in New Zealand and sets and monitors standards in the interests of public safety. The Nursing Council assesses each applicant on an individual basis and does not operate a system Being in the Southern Hemisphere, our seasons are completely opposite to countries north of the equator. Winter is June through August and our Summer is between December and March. With majestic mountain ranges, sweeping plains, fjords, imposing native forests, crystal clear inland lakes, miles of golden sand beaches and numerous bays dotted around one of the longest coastlines in the world. 46 www.scottishirishhealthcare.com of reciprocal registration or enrolment except for Australian applicants who meet the requirements of the Trans-Tasman Mutual Recognition Act (1988). Principle considerations for registrations are: • The applicant has undertaken a nursing programme that is similar in all specified content and length to the equivalent programme in New Zealand, and is able to meet the competencies for registration • The applicant has practised as a nurse within the past five years • The applicant has supplied the Nursing Council with evidence obtained within the past two years of ability to speak and write in the English language when English is not the applicants first language. Tests recognised by the Nursing Council are CGNFS, IELTS, OET, or as part of a competency programme • Applicants who do not meet the requirements for nursing registration may be required to undergo further experience with instruction through a Department of Nursing within a New Zealand educational institution. The applicant is responsible for negotiating the arrangements for the experience and instruction and for informing the Nursing Council about those arrangements New Zealands economy has grown by more than 25% since 1999. During this time , real income per capita rose by just under 19%. New Zealand offers sophisticated urban living, with fine restaurants and a vibrant arts scene. Most New Zealanders live within half an hour of the coast . Neurosciences Intensive Care Unit Capital & Coast District Health Board is an Equal Opportunities Employer and supports the professional development of all its employees. VACANCIES FOR Mental Health Nurses www.otagodhb.govt.nz Dunedin, New Zealand New Zealand’s South Island is a geographical playground of remarkable ski fields, water sports, fishing, tramping and adventure tourism. Benefits include: • High registered nurse/patient ratios • A family friendly city/Affordable lifestyles • Relocation assistance offered * • History of successful recruitment from the UK To discuss what opportunities there maybe for you please contact the Adult Mental Health Services Manager, Chris Munro by phone 0064 3 474 0999 or email [email protected] *Conditions Apply www.otagodhb.govt.nz Otago DHB is an EEO employer and is committed to its obligations under the Treaty of Waitangi Scottish Nurse magazine is the most widely read Nursing journal in Scotland - and it is FREE! -- ÊÊ£ÎÈ£Ê{£ÇÇ ÊÊÊÊÊÊÊÊÊ6°Ê£äÊÊÃÃÕiÊn ISSN 1361 -4177 Vol. 10 - Issue 10 Subscribe today, receive every issue direct to your home for only £25.00 for one whole year. See page 57 Prostate Cancer Sitting on the Fence? Alcohol Infection Control part 1 Consumption & Consequences Trauma Management part 1 Infection Control Hand Hygiene Group Psychotherapy parts1 & 2 ECG Rhythms part 5 (final assesment) ECG Rhythms part 3 Trauma Part2 Care Planning in long-stay care Nutrition & Obesity ‘Fat Happens’ part 3 Clinical feature: Warts & Verrucas Diabetes part 2 Recruitment section www.scottishirishhealthcare.com General & Overseas 1 www.scottishirishhealthcare.com Recruitment section General & Overseas www.scottishirishhealthcare.com 1 47 g n i s i n r u Canada N Canada has had a publicly funded system of hospital and medical care since 1968. The majority of nurses work within the publicly funded sector of health care, a minority work in the private sector and a small number of nurses are self-employed. Canadian nurses are accountable for providing competent nursing care to their clients. The Canadian Nurses Association (CNA) believes that to provide competent nursing care, a registered nurse must maintain and continuously enhance the knowledge, skills, attitude and judgement required to meet client needs in an evolving health care system. Because health is a provincial jurisdictional area, the health care delivery system is not centralized and there is no one place where nurses can apply for work. They must apply directly to individual employers. The Canadian Hospital Association publishes a large directory that lists and gives addresses for hospitals, health centres, nursing homes, health associations and health education programs. This directory may be available through a public library or Canadian Consulate. The nursing employment situation in Canada is improving after several years of health care restructuring and hospital downsizing. Nurses with skills and experience in specialty areas (e.g., emergency, critical care and operating room) and those willing to work in smaller communities or isolated communities are in the most demand. The Canadian Nurses Association is predicting a continued shortage of nurses for the future. Unlike many other countries the registration of nurses does not occur at the national level. In order to practise nursing you must be licensed or registered in the province or territory in which you will work. Licensing or registering bodies can also provide information about employment opportunities. They may have a referral service or be able to direct you to appropriate journals to find advertised positions or employer contacts. Canadian provinces and territories, with the exception of Québec, require that you write the Canadian Registered Nurses Examination as part of the registration or licensure process. At present, this examination can only be written in Canada on the recommendation of a provincial or territorial nurses association. The Canadian Nurses Association publishes The Canadian RN Exam Prep Guide, which you will find useful in preparing for the exam. Québec nurses have their own exam. You require language proficiency to become registered or licensed in Canada. Bilingualism (French and English) is an asset. Candidates must have knowledge of French to practise in Québec. In New Brunswick, Manitoba and Ontario, candidates must be proficient in either French or English. Employment and nursing education programs for unilingual French speaking nurses are available in Québec and in certain areas in New Brunswick, Manitoba and Ontario. In these provinces the Canadian RN exam may be written in either French or English. In the other provinces and territories of Canada proficiency in English is the requirement. 48 www.scottishirishhealthcare.com ÀÌV>Ê >ÀiÊ ÕÀÃià !GENCY*OBSIN,ONDON $OYOUNEEDACHANGEOFENVIRONMENTORNEWOPPORTUNITIESINNURSING7HETHERTHATBESHORTORLONG TERM'ENEVA(EALTHURGENTLYREQUIRES ÀÌV>Ê >ÀiÊ ÕÀÃiÃTOJOINOURRESPECTED,ONDON!GENCY 'ENEVA(EALTHHASCENTRAL,ONDONCONTRACTSSPECIALISINGINCRITICALCAREALLOWINGYOUTOWORK WITHINSOMEOF,ONDONSBUSIEST.(34RUSTSAND0RIVATE(OSPITALSWITHMINIMALTRAVELTIMETO ANDFROMWORK7ENEED.URSESWITHCRITICALCAREEXPERIENCEANDWHOWANTTOBEAPARTOF,ONDON CRITICALCARETEAM iiÛ>Êi>Ì ÊvviÀÃÊ ÕÀÃiÃÊÌ iÊvÜ}Ê««ÀÌÕÌiÃ\ s %MERGENCY$EPARTMENT!% s)NTENSIVE#ARE)45 s (IGH$EPENDENCY s2ECOVERY s !NAESTHETICS )FYOUARELOOKINGFORACHANGEINYOURLIFESTYLEABREAKFROMYOURROUTINEORSOMETRAVELJOIN USHEREIN,ONDON ÊiiwÌÃÊvÊÜÀ}ÊÜÌ ÊiiÛ>Êi>Ì s 0AYRATEUPTOaPERHOUR`i«i`iÌÊÊiÝ«iÀiVi® s 7ELCOMETO,ONDONPACKINCLUDINGAWEEKSUNDERGROUNDTRAVELCARD s 0ERSONAL#ONSULTANTWHODEALSWITHYOURSPECIlCNEEDS s 3UPPORTWITHYOUR0ROFESSIONAL$EVELOPMENT s 0LUS(OLIDAY0AY&REE5NIFORMS3OCIAL%VENTSANDMUCHMORE 4AKETHISOPPORTUNITYTO.URSEWITH'ENEVA(EALTHBYCONTACTING !MYOR+ATEINOUR,ONDONOFlCEONEMAILYOUR #6TOAMYS GENEVAHEALTHCOUKORREGISTERONOURWEBSITE ÜÜÜ°}iiÛ> i>Ì °V°Õ This is an excellent time to enter nursing as there is a shortage. At some point in their life, every Canadian will require the services of a nurse. Since many nurses will soon retire, Canada needs bright young men and women to choose nursing as a career. Changes in the health care system continue to broaden the opportunities for nurses. Nursing in Canada Photo credits: Tourism British Columbia This is your year to have a fresh start on Canada’s west coast! Incredible Nursing Careers and Lifestyle Vancouver, British Columbia, Canada - Discover the unlimited possibilities that come with renewing your career in a city rated “most livable in the world” by international media. A place where you can ski the local mountains in the morning and rollerblade along the waterfront in the afternoon. Vancouver offers you a once-in-a-lifetime chance for excitement as the city prepares to host the 2010 Winter Olympics! What are you waiting for? If you are a UK-trained nurse with at least one year of experience or a non-UK-trained nurse with at least two years of experience, we have an opportunity for you in one of the following nursing specialties • Neonatal Intensive Care • Obstetrics • Perinatal • Pediatrics • Oncology/Bone Marrow Transplant • OR/Post Anaesthetic Care Unit • Cardiac • Cardiac Surgery Intensive Care • Emergency • ICU/Critical Care • Neurosciences/Acute Spine • Operating Room • Renal • Medical/Surgical • Community & Home Health • Infection Control • Gerontology • Mental Health – Adult, Acute & Community • Occupational Health & Safety Our Nurse Vancouver International Recruitment Specialists and Clinical Leaders will work with you to uniquely identify a skills match and your individual relocation requirements. Experience the benefits of relocating to British Columbia: refresh your professional life and live your dream career within one of Greater Vancouver’s four diverse Health Authority organizations. Committed to investing in your ongoing career pathing and professional development, we offer attractive relocation funding and incredible employer-paid benefits including extended medical and dental coverage, life insurance, paid sick time, and four weeks of vacation. Send us your CV/resume today! Our International Nurse Recruitment Specialists will be in touch with you to discuss the many exciting opportunities available and to answer your questions regarding nurse registration and immigration. E-mail: [email protected] or call us at 0800-051-7316 today! Apply now www.nursevancouver.com Discover Vancouver www.scottishirishhealthcare.com 49 Nursing in Canada Vancouver, British Columbia, Canada Offers The Recreational Experiences Nurses Dream About working in their own language, in a culture that is familiar. BC has a universally funded and accessible health care system. The provincial government sets province-wide goals, standards and performance agreements for health service delivery by the health authorities, who manage and deliver health services to acute and specialty hospitals, long-term care facilities and community-based programs of public health and home-care within their jurisdiction. And Vancouver is the home of one of the largest medical education programs in the country. Best Practice in Nursing BC’s Health Authorities recognize that nurses are integral members of health care teams. Here, you will work closely with interprofessional teams to provide personal and caring support to each patient. Nurses practicing in BC are also surrounded by an extensive support team of care aides, ECG technicians and house keeping staff, just to name a few. This extensive support team allows for a greater amount of time for nursing patients. Ranked “One Of The World’s Most Livable Cities” and voted “Canada’s Healthiest City” by international media,Vancouver is incredibly picturesque and vibrant. It’s a place where nurses like you can fill days and nights with as much or as little adventure as you like. Some of the best skiing on earth, challenging mountainside hiking trails and exciting shopping experiences are within a drive away. Here, nurses can head to the local mountains in the morning, walk along the waterfront in the afternoon, picnic in the Fraser Valley and enjoy nightlife in the evening. Vancouver’s climate is wonderful. In the summer, temperatures reach a comfortable 30∞C, perfect for windsurfing on one of five sparkling lakes, golfing or just relaxing at an outdoor café that makes great coffee and pastries. Home to the 010 Winter Olympics,Vancouver enjoys a mild winter with temperatures rarely below 0∞C. Here, we only see snowfall about a half dozen times a year and it doesn’t last long, but when we see it, it’s fluffy and white. If you are a winter sports fan, you can indulge yourself at Whistler, the number one ski resort in North America, which is about an hour away. So when you’re not saving lives, you will have plenty to do in Vancouver. Four World-Class Organizations—One Incredible Nursing Career Nurse Vancouver is a collaborative recruitment campaign representing the four Greater Vancouver Health Authorities who employ over 60,000 health care professionals. We attract and provide qualified nurses like you a wealth of career and lifestyle opportunities in Vancouver. To ensure that your nursing needs are addressed, our Nursing Programs have nurses at every level of decision-making including the most senior executive tables. We offer paid support for ongoing education in specialized settings. Due to the emphasis on education and training, nurses with Nurse Vancouver are able to work in multiple fields; such as OR\Theatres, Accident & Emergency, Acute and Community—all in the same career path. Support for new, qualified nurses through orientation programs and preceptorships are also the norm. Access to continuing graduate education and opportunities for advanced practice are increasingly supported as well as self-scheduling options. Supported by a strong union, British Columbia’s nurses are among the highest paid in Canada. Our nurses receive premiums for working weekends and nights and generous pension plan packages including one month paid vacation after one year, eleven paid statutory holidays, full-extended medical/dental coverage and generous retirement and insurance packages. Our Health Care Authorities offer both 7.5 and 11.5-hours shifts depending on the program, including bedside nursing, front-line leadership and educator positions. The Benefits You’d Expect From The Best: Our Health Authorities offer a comprehensive and competitive employerpaid benefits package: • Medical, Dental, Extended health for you and your family • Life Insurance & Long Term Disability • Municipal Pension Plan • Paid Leave, including Paid Sick Days, eleven statutory holidays per year and Maternity, Adoption and Parental Leave • Relocation funding and assistance is also a benefit provided on employment to our international nurses. Vancouver Coastal Health (VCH) is BC’s largest Health Authority and is at the forefront of research and teaching. With specialties in Trauma, Neurosciences, Bone Marrow Transplant, Burns & Plastics, Solid Organ Transplant, Thoracic and Maternal/Child,VCH is a great place to build a career. A Choice Location & the Employer of Choice Whether it’s access to some of the world’s best recreational activities, waking up every morning surrounded by breathtaking scenery or the most rewarding career you can imagine in a state-of-the-art environment that fosters a work/life balance while maintaining a commitment to your professional development, you’ll find it all in Vancouver—with one of our world-renowned Health Authority hospitals. Providence Health Care (PHC) is a faith-based care provider, known for our mission, vision and values and guided by the principle, “how you want to be treated”. Our populations of emphasis include Cardiac, Renal, Mental Health, Urban Health, Elder Care and HIV/AIDS, creating a great environment for nurses. Nurse Vancouver is your ticket to adventure, and to explore a new career and exceptional lifestyle in Vancouver, British Columbia, Canada. www.nursevancouver.com Fraser Health (FHA) is a recognized leader in integrated health care, research into Population Health and the exploration of more effective ways of delivering health services. With 1 acute care sites and multiple community-based residential, home health, mental health and public health services, the possibilities for a rewarding nursing career are endless. Provincial Health Services (PHSA) maintains province-wide specialty care through its various agencies including BC Children’s Hospital, BCWomen’s Hospital & Health Centre, BC Cancer Agency, BC Mental Health & Addiction Services, BC Centre for Disease Control and BC Transplant Society, each offering nurses various career choices. Nursing in British Columbia Nurses come to British Columbia from around the world - countries like the UK, Australia, New Zealand and the United States because they’re offered a wide range of opportunities with the added benefit of 50 www.scottishirishhealthcare.com Nursing in Canada Canada Baby BC Birthing, Babies and New Beginnings In support of British Columbia, Canada’s Perinatal/Neonatal network, BC’s Health Authorities have come together in collaboration on this unique, focused province-wide recruitment initiative: Baby BC. Led by the Provincial Specialized Perinatal Services Clinical Leadership team, Baby BC, has been established to recruit specialized Neonatal and Perinatal (Labour & Delivery, Post-Partum, High Risk Antepartum) nursing staff to meet both current and future staffing requirements across British Columbia, Canada. The lifestyle change and nursing career you have been dreaming of in the heart of Canada's land of opportunity, British Columbia, the most liveable place on earth. Focusing on care for women, newborns and their families from pregnancy to postpartum, including neonatal intensive care, and working in your specialty area, you will benefit from our commitment to your clinical development. From ongoing learning opportunities, including an introduction to Canadian healthcare that encompasses best practices, our clinical orientations are customized to support international nurses. Our Canadian nurses will personally welcome you and provide an in-depth clinical transition into our specialty programs. crave If you adventure, British Columbia's four seasons provide a playground right at your fingertips. World-class ski resorts, exquisite shopping and dining experiences, agricultural heartlands, rich vineyards and beautiful gardens...British Columbia’s residents enjoy an unsurpassed quality of life. Explore the stunning contrast of the rugged North’s coastline to that of the peaceful rolling hills, lush valleys, and tranquil waters of the interior that define our northern experience. This picturesque landscape provides the perfect backdrop to host the 2010 Winter Olympic games. If you have ever dreamed of living and working in another country while refocusing your professional life, we currently have exciting opportunities in both urban and rural health facilities.xciting opportunities in both urban and rural health facilities. Baby BC Can take you there Discover The Career You Crave If you are an experienced NICU or Perinatal/Obstetrics nurse looking for a relocation , we are committed to investing in your ongoing nursing career path and professional development. We offer generous relocation funding and assistance • incredible employer-paid benefits • extended medical and dental coverage for you and your family • life insurance • paid sick time • four weeks of vacation adventure Relocate your career today. Our Baby BC Recruitment Specialists will work with you individually to identify your unique relocation requirements and provide you with all the information you need regarding BC nurse registration and immigration details (including temporary and permanent residency). Please visit our website at www.perinatalcareersbc.ca for further information. Call toll free 1-866-577-7262 or e-mail [email protected] to speak to a Baby BC Recruitment Specialist today! Photo credits: Tourism British Columbia www.perinatalcareersbc.ca Perinatal • Neonatal • Obstetrics • Newborns • Nurse Midwife Interior Health www.scottishirishhealthcare.com 51 Fulfillment at work As a health care professional, we understand that you want to make a difference. We also know that you want to be valued for your unique interests and gifts, and challenged to learn and grow in your skills and qualifications. Building on a strong team approach to care, Caritas Health Group strives to support employees in their quest for excellence— standing beside them in a shared quest to provide hope and healing to the people we serve. Each year, over 400,000 people come to Caritas Health Group seeking help for lifechanging events and life’s daily challenges. Ready to serve them are more than 8,000 staff, physicians and volunteers who are based at the Misericordia and Grey Nuns Community H e a l i n g t h e B o d y E n r i c h i n g t h e Hospitals and the Edmonton General Continuing Care Centre. Together these facilities have served Edmonton and area for more than 111 years. As a Catholic organization extending care to people of all faiths and traditions, Caritas is guided by its mission of healing the body, enriching the mind and nurturing the soul. It is a mission rooted in a commitment to care for the whole person—body, mind and spirit. This mission us at work each day in the leading edge approaches, innovative programs, moments of excellence, and the dedicated and compassionate people of our Caritas team. For a full list of Caritas programs, current job postings, and information on joining the Caritas team, visit our website at www.caritas.ab.ca or call Human Resources toll-free at 1-877-450-7555 M i n d N u r t u r i n g t h e S o u l Join our team– make a difference In a moment, a person can have a lasting impact on the life of another human being. Seven days a week, 24 hours a day, members of the Caritas Health Group Team enter people’s lives and make a difference at the most profound and vulnerable moments of life. Join a team of caring professionals who strive to make each of these moments count. Based in Edmonton, Alberta and rooted in a tradition that is 112 years strong–Caritas Health Group strives to create an environment of hope and healing for both caregivers and the people we serve.Caritas strives to create an environment of hope and healing for both caregivers and the people we serve. Our interdisciplinary team provides an opportunity for our staff to explore and create a progressive approach to excellent patient care. We partner with local and national universities, colleges and technical schools to provide clinical placements for students to gain expertise within their chosen career. Join the Caritas team www.caritas.ab.ca 1-877-450-7555 CANADA 5 www.scottishirishhealthcare.com Caritas is poised to grow in patient capacity by approximately 25% over the next several years, resulting in new opportunities for team members who want to make a difference – people of creativity, vision, hope and energy. We currently have a number of opportunities in the following areas: Registered Nurse • Licensed Practical Nurse • Allied Health Professionals Caritas Health Group is Alberta’s largest faith-based provider of healthcare. email to: [email protected] One of the reasons why so many companies choose Ireland is because of the unique workforce - Ireland has one of the youngest population in Europe with over 36% under the age of 25 years. Ireland’s unique population and age structure that has fuelled much of Ireland’s recent prosperity will continue for the next 15 years with a key focus on education and research in Ireland. Modernisation is gradually taking over some of the old ways but the easy going Irish lifestyle centered around music, sport and The Pub - continues. Ireland - is now a country on the rise. Poverty and unemployment used to be widespread, but the EU has brought new life. For the first period in decades Ireland has seen population increases. New Zealanders & South Africans New Zealanders and South Africans must apply to prior to leaving their own country to the Irish Trade Commission in Auckland and the Irish Embassy in Pretoria respectively. EU nationals do not require a work permit to live and work in Ireland, you are entitled to be treated like any other applicant when you apply for work in Ireland. You are free to apply for any job vacancy, including jobs in the public sector. If you are qualified to practice a certain profession in your home country, then you will generally find that you are qualified to practice the same profession in Ireland.You will, however, need to apply for recognition of your training. Non European Union & European Economic Area Nationals Normally only available to people with specific skills and where there is a shortage in the existing labour market e.g. nurses or IT professionals. Visas are arranged in advance of arrival in Ireland by the employer.They take - weeks to process and area valid for up to 1 year. Visas can be obtained from the Department of Enterprise, Trade & Employment.Visas can be renewed at the Visa Office, Hainult House. Non-EU nationals who do not require employment permits to work in Ireland You are entitled to apply for work in Ireland without an employment permit if you: •are married to an Irish citizen, or are a parent of an Irish citizen and have been granted permission to reside in the state •have been granted refugee status by the Minister of Justice •are studying at postgraduate level and are required to work as an integral part of your course. Ireland is a country steeped in tradition and history with a long established reputation for its education excellence. It has a unique and interesting culture which retains many features of its ancient Celtic origins while also reflecting the influence of other traditions and trends. Although we do have our own distinctive Celtic language and culture, English is the predominant language spoken in Ireland today. The Irish use it so effectively that it has been said that better English is spoken in Ireland than anywhere else in the world! Australians Working Holiday Permit Australian nationals can apply in Australia, London and in Dublin via the Department of Foreign Affairs - Working Holiday Permit Section. Irish people have a great love of conversation and have a genuine interest in other people. This friendliness and hospitality for which the Irish people are renowned contributes to the ease with which overseas workers adapt to the way of life and in particular, nursing life in Ireland. Ireland’s educational system has reflected, benefited from and reinforced some important cultural characteristics: creativity, flexibility, agility, nimbleness, pragmatism and informality. The education system in Ireland is one of the best in the world according to the 2006 independent IMD World Competitiveness Report. Almost 1 million people are in full time education. www.scottishirishhealthcare.com 5 Founded in 1745, The Rotunda Hospital is the oldest maternity hospital in Ireland. With a complement of 189 beds and approximately 850 staff, the Hospital is a provider of a comprehensive range of specialist services in the treatment, education and care of mothers and babies - a public voluntary Hospital whose mission is to achieve the optimal health and well-being of the women and infants for whom it is responsible. OPPORTUNITIES FOR STAFF MIDWIVES In 2006, just short of 7,325 babies were born in the Hospital. The Hospital is situated in the heart of Dublin within 30 minutes of Dublin Airport and convenient to bus and rail services. The Hospital is committed to the recruitment, development and retention of the highest calibre of staff, in order to provide the best quality health care to all of its patients. A midwife working in the Hospital has the opportunity to practice normal midwifery as well as experience a wide complexity of pregnancy related conditions. Recent additions to our services is an integrated model of Community and Hospital care facilitating the DOMINO and Early Transfer Home models of care. A number of community based antenatal booking and review clinics are managed from the Hospital. The Hospital also has a wide range of specialty pregnancy clinics including: • • • • • teenage pregnancy diabetic cardiac metabolic and a range of paediatric and gynaecology clinics. A range of day care facilities, which include maternal and fetal assessment, are available. The ultrasound department facilitates a full range of pregnancy and gynaecology assessment. An early pregnancy unit is designed to minimise the distress of women and their partners, who experience pregnancy loss. A full range of maternity inpatient services are available including a Delivery Unit of 9 individual rooms with a 5 bed ward for induction of labour. The 36 cot Neonatal Unit is a tertiary referral centre and is part of a national neonatal transport system. This unit was opened in 2002 and offers the highest standard of facilities and care in the country. Opportunities for midwives to engage in both in-house and external education programmes exist - The School of Midwifery is linked to the University of Dublin, Trinity College. A Clinical Skills Facilitator is employed with the specific remit of working with newly qualified or newly appointed midwives to support their development within the Hospital. Currently there are vacancies for MIDWIVES who wish to work either full or part-time in all areas of The Rotunda Hospital. • Advice on employment terms and conditions is available on request. • Application forms and job descriptions may be downloaded from www.loadzajobs.ie or www.hospital jobs.ie and are also available upon request from the Human Resources Department on 0035318171714 or at [email protected] If you would like to know more about the Hospital please visit our websites on www.rotunda.ie www.loadzajobs.ie www.hospitaljobs.ie Please Quote Reference Number: Vac. Ref. 2007/55 54 www.scottishirishhealthcare.com Nursing in Ireland COPE Foundation provides a wide range of services for children and adults with intellectual disabilities throughout the city and county of Cork. COPE Foundation’s objective is to provide and develop the best model of service and care for persons with intellectual disability through our team of caring professionals. Fulfilling the Potential of Persons with Intellectual Disability We want YOU to join our team of Caring professionals We are currently recruiting for: Staff Nurses Applicants must be interested in working as part of a trans-disciplinary team, in the field of intellectual disability and on the current register or eligible to register with An Bord Altranais. Previous relevant experience of working with people with an intellectual disability is desirable. How to apply: Application forms may be obtained from the Human Resource Department, COPE Foundation, Bonnington, Montenotte, Cork (Tel. 00353 21 4507131) or by e-mailing [email protected]. Completed application forms must be returned no later than Friday 6th July 007. APPLICANTS MAY BE SHORTLISTED ON THE BASIS OF THEIR APPLICATION Visit our website at www.cope-foundation.ie Careers in Healthcare Careers in Healthcare NURSING NURSING Registered General Nurses Dublin South West, Kildare/West Wicklow Ref: IN/HRSS/143/07 Staff Nurses Midwives Cork University Maternity Hospital, Ireland Ref: N1607 For further information and job descriptions or to apply online: 1. ICU/HDU/Special Care, Galway University Hospitals Ref: IN/2007978W 2. Theatres, Galway University Hospitals Ref: IN/2007979W For further information and job descriptions or to apply online: Freephone 0800 056 9710 www.careersinhealthcare.ie We are an equal opportunities employer. Shortlisting may apply and panels may be formed from which future vacancies may be filled. Freephone 1800 400 350 www.careersinhealthcare.ie We are an equal opportunities employer. Shortlisting may apply and panels may be formed from which future vacancies may be filled. -- ÊÊ£ÎÈ£Ê{£ÇÇ ÊÊÊÊÊÊÊÊÊ6°Ê£äÊÊÃÃÕiÊn ISSN 1361 -4177 Vol. 10 - Issue 10 Scottish Nurse magazine is the most widely read Nursing journal in Scotland - and it is FREE! Subscribe today, receive every issue direct to your home for only £25.00 for one whole year. Prostate Cancer Sitting on the Fence? Alcohol Infection Control part 1 Consumption & Consequences Trauma Management part 1 Infection Control Hand Hygiene ECG Rhythms part 5 (final assesment) Group Psychotherapy parts1 & 2 See page 57 ECG Rhythms part 3 Trauma Part2 Care Planning in long-stay care Nutrition & Obesity ‘Fat Happens’ part 3 Diabetes part 2 Clinical feature: Warts & Verrucas Recruitment section www.scottishirishhealthcare.com General & Overseas 1 Recruitment section General & Overseas www.scottishirishhealthcare.com 1 www.scottishirishhealthcare.com 55 Nursing in Ireland Cappagh National Orthopaedic Hospital has 160 beds and is the major centre for orthopaedic surgery in the country. The Hospital is a tertiary referral centre for the treatment of complex orthopaedic problems including major joint replacement surgery, revision joint surgery, foot and upper limb surgery, primary bone tumours, spinal surgery, sports injuries and paediatric orthopaedic surgery. Applications are invited from suitable candidates who are registered or eligible to register in the division of the live register of Nurses kept by An Bord Altranais for the positions of: STAFF NURSES Theatre Applications are invited for staff nurse positions from suitably qualified candidates. CLINICAL FACILITATOR Theatre (Mon-Fri) Interested applicants should: • Have a minimum of five years postregistration experience in an acute hospital setting. • A recognised post -registration qualification relevant to the specialist area is desirable. • Experience in mentorship, preceptorship, teaching and assessing is desirable. Informal enquiries for the above posts to: Ms Kathy O’Sullivan, Acting Director of Nursing, Tel: (01)8341211 Cappagh National Orthopaedic Hospital offers: • • • • • Group Health Insurance Schemes • Subsidised staff restaurant • Ample free car parking Excellent opportunities for professional development in a friendly and supportive environment Continuing support for on-going education and regular in-service education Easy access from Dublin City Centre, the Greater Dublin and South Meath areas Accommodation on site may be provided on a short term basis Interested candidates should forward a letter of application together with four copies of their Curriculum Vitae and the names of three referees to: Ms Kathy O’Sullivan, Acting Director of Nursing, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. Shortlisting will take place. Pay and conditions as per Department of Health & Children guidelines. Cappagh National Orthopaedic Hospital is an equal opportunities employer. Visit our website at www.cappagh.ie or www.hospitaljobs.ie 56 www.scottishirishhealthcare.com Nursing in Ireland The Irish Blood Transfusion Service, has the sole responsibility for the collection and distribution of blood and blood products, providing an essential service to the Irish hospital sector. 3,000 donations are needed every week in Ireland and the team at IBTS work tirelessly to process the contributions of our kind donors, and to actively recruit new donors to keep up with the needs of hospitals. An important part of the IBTS is the participation in, and encouragement of new research and training in matters relating to blood transfusions and the preparation of blood products. We pride ourselves on being at the forefront of new practices and techniques in the process of managing our blood clinics. We are seeking talented individuals to whom we can offer a truly rewarding career. We currently have the following career opportunities: Staff Nurses Platelet Apheresis Clinic, National Blood Centre, Dublin D’Olier Street Clinic, Dublin A panel is being created for both permanent, temporary and full-time and part-time Staff Nurses for the Platelet Apheresis Clinic & D’Olier Street Clinic in Dublin. These panels will be in operation for 12 months. The salary scale attached to the post is €28,877 to €42,164 (incl. LSI) per annum. Entry point onto the salary scale is dependent upon relevant public sector experience. Location Allowance applies. Interested applicants should visit the IBTS website www.ibts.ie for the application form, job description and further information. Additional queries can be directed to [email protected] The closing date for receipt of applications (5 copies) 5pm on 27th July 2007 and these should be sent to the Human Resources Department, National Blood Centre, James’s Street, Dublin 8. The IBTS is an equal opportunities employer. ibts.ie ISSN 1361 -4177 Vol. 10 - Issue 10 -- ÊÊ£ÎÈ£Ê{£ÇÇ ÊÊÊÊÊÊÊÊÊ6°Ê£äÊÊÃÃÕiÊn Prostate Cancer Sitting on the Fence? Consumption & Consequences Infection Control Hand Hygiene Group Psychotherapy parts1 & 2 ECG Rhythms part 5 (final assesment) ECG Rhythms part 3 Trauma Part2 Care Planning in long-stay care Nutrition & Obesity ‘Fat Happens’ part 3 Clinical feature: Warts & Verrucas Diabetes part 2 Recruitment section www.scottishirishhealthcare.com General & Overseas Scottish Nurse magazine is the most widely read Nursing journal in Scotland - and it is FREE! Published since 1994 we keep you up to date on issues that impact on the way you practice, we offer the latest recruitment opportunities and now an opportunity to exchange ideas with other professionals. From the latest research to updates on current events and conferences stay up to date now. Subscribe today, receive every issue direct to your home for only £25.00 for one whole year. STRATHAYR PUBLISHING LTD Gibbs Yard Auchincruive Estate Ayr KA6 5HN Tel: 019 55970 Fax: 019 55979 E-mail: [email protected] Alcohol Infection Control part 1 Trauma Management part 1 1 Recruitment section General & Overseas www.scottishirishhealthcare.com 1 SUBSCRIPTION FORM To subscribe please complete the form below and return it to: Scottish Nurse Subscriptions, Gibbs Yard, Auchincruive Estate, Ayr, KA6 5HN Yes, I would like to take out a subscription to Scottish Nurse Magazine, which includes FREE access to the Scottish Irish Healthcare Online archive. Title Initial Surname Address Postcode Job Title Field of practice A) I enclose a cheque for £ (payable to Scottish Nurse Magazine) www.scottishirishhealthcare.com 57 Product Focus Somatuline® Autogel® 120mg, an extended release preparation of lanreotide, can now be administered every six to eight weeks in patients with acromegaly who are well controlled on four weekly Somatuline® Autogel®, in terms of clinical symptoms and biochemical parameters, where Growth Hormone (GH) concentrations are below 2.5ng/mL and Insulin-like Growth Factor-1 (IGF-1) levels are in the normal range. Somatuline® Autogel® is available in three dose strengths; 60mg, 90mg and 120mg for use every 28 days. For patients with acromegaly receiving a somatostatin analogue for the first time, the recommended starting dose is 60mg every 28 days which can subsequently be titrated to 90mg or 120mg according to the clinical or biochemical response. In patients who are well controlled on Somatuline® Autogel® every 28 days, Somatuline® Autogel® 120mg can be administered every six to eight weeks. Somatuline® Autogel® is the only somatostatin analogue that comes in a ready-to-use, pre-filled syringe, designed to maximise convenience and facilitate the community management of patients. The extended dosing of Somatuline® Autogel® 120mg in well controlled acromegaly patients also extends cost benefits and convenience. In an open, prospective, multicentre, Phase III study in Spain and Portugal, involving 98 patients with acromegaly (defined as GH level >2ng/mL following an oral glucose tolerance test and an elevated IGF-1), Lucas et al1 evaluated whether Somatuline® Autogel® 120mg every four to eight weeks was as effective in controlling acromegaly as Somatuline® LA 30mg every one to two weeks. The study found that treatment with Somatuline® Autogel® administered every four to eight weeks was at least as effective and well tolerated as Somatuline® LA administered every 7-14 days1. There was a good level of acceptance of Somatuline® Autogel®1. The authors concluded that the longer dosing interval of Somatuline® Autogel® 120mg maintained the same overall monthly dose as Somatuline® LA 30mg, but with four times fewer injections, and thus had a benefit in terms of cost and patient compliance1. References 1. Lucas T, Astorga R and the Spanish-Portuguese Multicentre Autogel Study Group on Acromegaly. Clin Endocrinol 2006;65:320-326 Oxford, the manufacturer of patient hoists, has unveiled an exciting new structure to help it bring even more world-class products into the UK and Europe. Nathan McWattie, Managing Director Commercial Operations, said that the re-organisation will create a more flexible and adaptable business better equipped to focus on the needs of the market and, ultimately, the end client. “This is good news for our customers because they will benefit from working with a company that will be even more responsive and display increased market agility. “Central to this will be our ability to grow into new product categories and markets as the business expands. “We are very excited to be entering this next phase of development and the new organisational structure places Oxford, together with the other core brands, in a better position for continued and sustainable growth in both new and existing markets. “Our UK headquarters will still be based at Stourbridge in the West Midlands and all commercial agreements remain in place”. Joerns Healthcare also has offices located in the United States, Canada and The Netherlands with key partners in Germany, Norway, Australia, New Zealand, Spain and Portugal. Joerns Healthcare is a long-respected brand with a rich history dating back to 1889. This is the platform and the foundation for the new business. The combined organisation will sell more products and services into a greater number of long-term care and acute care facilities. The following established brands form part of the new company. • Oxford – The UK leader in patient-handling equipment to the homecare and extended care markets • Joerns – A leading manufacturer of beds and furnishings in the acute and long-term care markets • Hoyer – The North American market leader in patient handling equipment to the homecare and senior housing markets • Bio Clinic – A leading manufacturer of specialty mattresses and therapeutic support surface equipment to the healthcare market Tom Bulpitt, Marketing Manager, said that Oxford already had a proud 30 year-history of service and innovation within the homecare and extended care sector. “This is the next chapter and with the global strength of Joerns behind us we are looking forward to an exciting and successful future”, he said. The association between breakfast cereal consumption and a lower body weight, as measured by Body Mass Index, was strengthened today by a new systematic review published in the journal, Nutrition Bulletin.1 HbA1c is used for monitoring of diabetes and is the parameter of choice for long-term glycaemic (blood sugar) control. Afinion will provide results automatically in just three minutes, offering a real time saving to the busy healthcare professional. CRP is used as a diagnostic tool for differentiation between viral and bacterial infections. A rapid CRP test is valuable in avoiding the prescription of antibiotics if an infection is likely to have a viral cause. For further information, visit www.axis-shielduk.com For patients who have been prescribed NutropinAq® and their carers, there is also a section of the website available via a username and password. The patient and carer area has four zones: Adult Zone, Teen Zone, Kids Zone and the Carer and Sharer Zone. Each of these zones contains information, tailored to each age level, about growth hormone disorders. The Teen Zone and Kids Zone also have fun areas with games and other play items. NutropinAq® is a liquid formulation of somatropin (recombinant DNA origin, Escherichia coli) for injection and is supplied as a 10mg/ml sterile liquid somatropin cartridge for exclusive use with the NutropinAq® Pen. NutropinAq® Pen is an easy-to-use, convenient, simple, state-of-the-art device for subcutaneous injection. Health professionals can request their username and password for access to the website from: Medical Information Department, Ipsen Ltd, 190 Bath Road, Slough, Berkshire, SL1 XE T: 0175 67777 E: [email protected] New guidelines published today by the National Institute for Health and Clinical Excellence recommends that post-myocardial infarction (MI) patients should be considered for treatment with omega- fatty acids (Omacor) initiated within 3 months of an MI, when dietary intervention is insufficient . The review concludes that children and adults who eat breakfast cereals regularly tend to have a lower body mass index (BMI) and are less likely to be overweight. They also tend to put on less weight over time than those who don’t eat breakfast regularly. These findings are important as recent data shows that over a third of UK adults (.5 million) and almost 4 million UK children miss breakfast regularly. This is in spite of 9 out of 10 people of all ages claiming to understand the significant nutritional benefits of breakfast. www.scottishirishhealthcare.com Tests already available on Afinion include glycated haemoglobin (HbA1c) and C-reactive protein (CRP), with albumin creatinine ratio (ACR) and prothrombin time international normalised ratio (PT-INR) in the final stages of development. Other tests such as homocysteine will be introduced later. The website is accessible to health professionals via a username and password. The health professional area provides background information on the growth hormone disorders that NutropinAq® is licensed to treat, resources that may be downloaded, conference diary dates and links to other useful related websites and organisations. The move sees Oxford line up with three other core brands working in closely-related markets bringing global expertise to bear on a rapidly-growing UK and European market. 58 Axis-Shield UK has launched the Afinion™ multi-parameter desktop analyser for use at point of care. This novel instrument – a winner at the Medical Design Excellence Awards 2006 – enables immediate rapid testing, regardless of sample type. Unlike many other systems currently on the market, Afinion is a genuine multi-assay analyser, offering a wide range of laboratory-quality tests on a single point of care system. Afinion is well suited to multi-user environments, such as community clinics, where test results are required quickly and a laboratory service may not be available. The instrument is extremely easy to operate – users simply insert a cartridge and follow the prompts on the colour touch screen display. Minimal maintenance is required. Ipsen Limited, the UK subsidiary of the Ipsen Group, has launched a website www.gh-d.co.uk providing comprehensive information on growth hormone disorders and the use of NutropinAq® Pen. The company - already an established leader in the UK homecare and extended care markets for patient handling - is divisionalising from Sunrise Medical and aligning with Joerns Healthcare, one of the best-known healthcare names in the United States. The causal relationship between breakfast cereals and BMI was considered. No clear evidence exists to link breakfast cereal consumption and weight with lower energy intakes or higher energy expenditures. Lifestyle factors have been thought to play a role since regular breakfast cereal eaters tend to take more exercise and drink less alcohol than those who don’t. Although these and other lifestyle factors were taken into account in a number of the studies, it is still possible that they can partly explain the overall result. Axis-Shield UK launches Afinion™ a new concept in point of care testing As manufacturers of Omacor the only omega- product licensed for use post-MI and the only product containing the highly purified omega-3-acid ethyl esters in a 1g capsule, Solvay Pharmaceuticals welcomed this announcement as a major step forward in the treatment of this vulnerable patient group. References 1 A de la Hunty & M Ashwell (2007) Are people who regularly eat breakfast cereals slimmer than those who don’t? A systematic review of the evidence. Nutrition Bulletin 32: 118-128. 2 Breakfast cereal Information Service ‘ Putting Breakfast First’ survey, Jan 2007. Ian Young, Professor of Medicine, from Queen’s University Belfast said “Omega- fatty acids have been shown to reduce sudden death by 45% in post-MI patients, it is important to consider how patients can increase intake of fatty acids. Omacor is the only fatty acid preparation licensed for use in secondary prevention post-MI.” Product Focus Kerraboot®, now available in two new sizes, wins Frost & Sullivan’s prestigious 2006 European Product Innovation Award Education & Training Study Herbal Medicine A Napier education’s about taking the right route to the future. We’ll help you maximise your potential in clinical practice with relevant teaching in the latest subjects. Herbal medicine is experiencing significant growth in terms of research and development, and in its popularity with patients. We offer two courses in this budding area for orthodox medical practitioners, including GPs and nursing graduates. Graduate Certificate in Herbal Studies – one year part-time starting September 2007 MSc in Herbal Medicine – one year full-time or flexible part-time starting September 2007 This course introduces Western herbal medicine to those with no prior experience or knowledge of medicinal plants, and is an essential starting point for those wishing to go on to the MSc in Herbal Medicine. For those who have successfully completed the Grad Cert course in Herbal Studies, this course offers a route to membership of the National Institute of Medical Herbalists, and to clinical practice as a herbalist. To find out more about these courses, and life at Napier, contact us at 08452 60 60 40, [email protected] or www.napier.ac.uk Enhance your career. Modern Western herbal medicine has developed over many centuries and draws on influences as diverse as the early Greek physicians and nineteenth century North American Indians. Today, it takes advantage of the findings of the latest scientific research into the actions and clinical uses of medicinal plants. In recent years, there has been renewed interest in herbal medicine as a more sympathetic and holistic approach to healthcare, making it increasingly popular. During a consultation, a herbalist seeks to address the underlying causes of health problems rather than just their symptoms, and that means patients are treated holistically as individuals, each having a unique set of requirements for optimum health and wellbeing. Plant preparations are prescribed to rebalance disturbances in body function and to restore the body’s own natural healing processes. At Napier, we recognise the growing importance of this area of medicine, and the need for a broader understanding of the subject. We’ve designed courses for registered healthcare practitioners, such as GPs, osteopaths, graduate nurses, midwives and dentists, who would like to know more about the management of health problems using herbal remedies. First and foremost we offer a Graduate Certificate in Herbal Medicine which introduces Western herbal medicine to those with no prior experience or knowledge of medicinal plants. This is a one year part-time course, starting in September this year, which is ideal for recent nursing graduates. On completion of this course, you can then progress to our MSc in Herbal Medicine. The MSc is a one year full-time course – also available on a flexible, part-time basis – which also starts in September 2007. This course offers those who complete it successfully a route to membership of the National Institute of Medical Herbalists, and eventually to clinical practice as a herbalist. Located in the cosmopolitan and student-friendly city of Edinburgh, Napier is a welcoming and vibrant institution. The University offers a wide range of professional, PG Dip and Masters courses in many diverse subjects. The University’s Graduate School provides a central hub for research study and occasionally offers funded research studentships. Truly international – over a sixth of the student body comes from one of 80 different countries –the campuses are modern learning environments with excellent facilities, including a purpose-built 500 PC computer lab with 24/7 access. To find out more about these courses, and life at Napier, contact 08452 60 60 40, [email protected] or www.napier.ac.uk www.scottishirishhealthcare.com 59 Education & Training School of Nursing and Midwifery HEALTHCARE LAW & ETHICS Postgraduate Programme Bachelor of Nursing/Bachelor of Midwifery For registered nurses and midwives to complete studies to degree level. All modules are available on a ‘stand alone’ basis. By Distance Learning This new programme is specifically designed for healthcare professionals, including doctors, nurses, and those in the allied professions. It aims to give you an understanding and appreciation of law and ethics as they apply to your professional practice. The modules are provided on a part-time, distance-learning basis, giving you the flexibility to tailor your studies to your individual requirements and interests, and offering you the chance to study at the level of your choosing. The course offers three exit levels of qualification: Certificate, Diploma or Masters Degree. For further information and a prospectus please contact Fiona Clark ([email protected]) Tel 01382 384764 Master of Science Advanced Practice Flexible pathways for students to pursue specialist professional studies. A variety of named awards are also available. All our programmes offer: Flexible study options, full-time or part-time study, e-learning, distance learning, self-directed study. For further information Tel: 01382 388534 www.dundee.ac.uk/nursingmidwifery NT PRF 4 Keele University DEGREE AND DIPLOMA Pre-registration programmes • Midwifery • Nursing - Adult - Child - Mental Health - Learning Disability • Operating Department Practice www.keele.ac.uk/depts/ns 60 tel: 01782 556600 – 01782 556557/8 www.scottishirishhealthcare.com Open Events -2007 20th May 20th June 19th August 13th and 14th October 5th December CALL OR VISIT OUR WEBSITE FOR DETAILS ES M IC RO 0R RTF a A ST NLY O (ALFPRICE ONLINETRAINING )NASSOCIATIONWITH.URSING4IMES#"4RAININGHASASPECIALOFFER JUSTFORYOU9OUCANPURCHASEONLINETRAININGCOURSESMASSIVELY DISCOUNTEDTOÊ(!,&02)#%ÊÊ3OIFYOUNEEDTOUPDATEYOUR#0$ SOONMAKESUREYOUVISITÊWWWNURSINGTIMESNETÊTOlNDOUTHOW YOUCANTAKEUPTHISSPECIALLIMITEDOFFER (!,&02)#% #/523%3 / ÃÊëiV>ÊvviÀÊ>ÞÊLiÊÃÕLiVÌÊ ÌÊV >}iÊÀÊÜÌ `À>ÜÊ>ÌÊ>ÞÊ ÌiÊÜÌ ÕÌÊ>ÞÊ«ÀÀÊÌVi UÊ£Ói>`Ê Ê UÊi>Ì V>ÀiÊÃÃV>Ìi`ÊviVÌÊ UÊÌiÀ«ÀiÌ>ÌÊvÊ >}Õ>ÌÊ-VÀiiÊ UÊÌiÀ«ÀiÌ>ÌÊvÊÕÊ`Ê ÕÌÊ UÊ6ii«ÕVÌÕÀiÊ UÊ*iÀ« iÀ>Ê6iÕÃÊ >Õ>Ì Ê/À>}Ê >ÃÊ>ÊiÝÌiÃÛiÊÀ>}iÊvÊii>À}Ê iÊ«À}À>iÃ]Ê>Ü}ÊÞÕÊÌÊi>ÃÞÊÕ«`>ÌiÊ ÞÕÀÊÃÃÊÊÌ iÊVvÀÌÊ>`ÊVÛiiViÊvÊÞÕÀÊ ÜÊ iÊÀÊÜÀ«>Vi°ÊÊv>VÌ]ÊÜÌ Ê>Ê«>ÃÃÜÀ`Ê >`ÊÕÃiÀ>i]ÊÞÕÊV>Ê`ÊÌÊ>ÞÜ iÀi]Ê>ÞÌitÊ ii`ÊVÕÀÃiÃÊvÀÊ>Ê}ÀÕ«ÊvÊ«i«i¶ÊÃÊ Ê/À>}Ê>LÕÌÊLÌ>}Ê>Ê ViViÊvÀÊ}ÀÕ«Êi>À}Ê>ÌÊëiV>ÊV«>ÞÊÀ>ÌiðÊ* iÊä£nÊÓÓÊÎÎÇÊ ÀÊi>Ê>i°ii`ÞJVLÌÀ>}°VÊÌÊwÊ`ÊÕÌÊÀi° 4OGETYOURHALFPRICETRAININGCOURSES VISITWWWNURSINGTIMESNET www.scottishirishhealthcare.com 61 Scottish Nurse Magazine, Scotlands leading independent nursing magazine, Are proud to announce Scotlands BIGGEST and BEST nursing exhibition at the SECC Glasgow. Everything you need to know about nursing is conveniently located under one roof. Nurses from all levels and nursing students, this exhibition is especially for you - and it’s all FREE To enter. Seminars Are you keeping up with your required continuing professional development? To ensure our seminars are of the highest quality we have an extensive seminar programme covering key clinical and policy-based topics. Seminars are being booked online NOW! We recommend that you book in advance as the exhibition and seminars will be over subscribed. Zone A ‘SKILLS FOR NURSES’ This zone will have the following course running with breaks to be agreed: Drug Calculations ‘MENTAL HEALTH COURSE’ This zone will have the following course running with breaks to be agreed: How to read a Chest x-ray Dealing with Child Sex Offenders Alcohol Misuse How to read an ECG Suicide Risk Awareness Central Venous Pressure Cognitive Behavioral Therapy Pulse Oximetry (CBT) Free, but to ensure your place book early for £5. Each seminar approximately 1hour Zone C ‘INTERACTIVE SKILLS ZONE’ We would have skill zones running at the same time. They would include sessions for each of the following: 45 mins repeated 4 times during the day i.e. 8 in total Basic Adult CPR How to record a 1 Lead ECG How to perform peripheral venous cannulation How to perform venepuncture These 45 minute Skill Zones would be FREE drop in sessions repeated 4 times during the day 6 Zone B www.scottishirishhealthcare.com £5 for all 5 seminars. Each seminar approximately 1hour Zone D ‘PESI SUBCLINICAL SIGNS OF IMPENDING DOOM COURSE’ See the signs of compensation in the body — before the patient crashes Know when to call the rapid response team Goal setting and priorities for decisive action £15 +VAT 6th November 2007, SECC Glasgow Interactive Zone Charles Bloe Training Limited, the professionals in healthcare training, will be bringing their fun, interactive demonstrations and expertise to the Interactive Zone. Join in on the action and practice your skills on the most up to date manequins and equipment available. It makes learning seem so much more real! Meet Potential Employees This is the only exhibition to be if you are looking for nursing jobs. Our Nursing Recruiters are looking for nurses from all areas of expertise. And if you are thinking of working abroad, our overseas exhibitors can help you realise your dream and provide you with all the information you need to make that transition as smooth as possible. In addition we will have: Clinical Skills Challenge first prize is £500 Zones A and B Anne Diamond - as a guest speaker (GMTV fame) Product profiles Also CPD certificates issued Half price online training for all attendees £100 off onsite Training for all attendees Booking and enquiries please contact Tracy Hamilton on 01324 411013 or email [email protected] Designed specifically to meet the educational needs of all nurses and other primary care specialists, the programme features an impressive collection of speakers delivering highly topical and relevant presentations. The educational conferences are complemented by an exhibition featuring key product suppliers, educational institutes, services to primary care and recruitment specialists. Registration & coffee - 09.00 Exhibitors, Product Suppliers and Recruiters who wish to be included in this event please contact Jim Brown on Tel: +44 (0)1292 525 970 Fax: +44 (0) 1292 525 979 Email: [email protected] www.scottishirishhealthcare.com 63 Fling out your expensive wipes! Tuffie - the cost effective hygiene solution! NEW E RIC P R E W O L TO SAVE UP * Tuffie are the SOLE BRAND of Surface Wipes contracted to NHS National Services Scotland! 34% Available direct from Vernacare or your local distributor including aaaaa Wipes per pack Vernacare Code Detergent Wipes 100 901DW100 Detergent Wipes 225 901DW225 Disinfectant Wipes 200 901CR200 Tuffie Product SAVE up to* 22% 34% 16% * New prices available from 1st December. Savings dependent on route of purchase. VERNACARE LTD, FOLDS ROAD, BOLTON, BL1 2TX TELEPHONE 01204 555999 FAX 01204 521862 www.vernacare.com 64 CALL NOW ON 01204 555999 FOR YOUR FREE TUFFIE WIPE SAMPLES www.scottishirishhealthcare.com