Thursday, 12 December 2024
Sleep habits
Remember bed is only for sleep (and sex)
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Friday, 25 October 2024
How to Reset Your Vagus Nerve...This Will Change Your Life! Dr. Mandell
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Friday, 20 September 2024
To improve my consultation skills
Preparing for the consultation : Establishing initial rapport, Establishing the reason for the consultation
Gathering information: Questioning & Listening
Explanation and planning: Providing evidence based advice and information, Discussing options and potential outcomes of
Closing the session: Offering a safety net, Verifying and agreeing a plan
Building the relationship: Demonstrating empathy, Building rapport throughout, Increasing a person's involvement in consultation, Using open body language.
Additional Skills for Person-centred approach: Understanding the person's perspective of their medicines and/or health. Analysing own behaviours during the consultation and identifying areas for change (body language and attitudes towards people). Engaging the person in shared decision making. Working in partnership with the person. Taking a holistic view of the person
Consultations Models:
Calgary-Cambridge: Preparing for the encounter, establishing rapport with the patient, and identifying the reason for the consultation.
Pendleton: a set of guidelines designed to structure the feedback process in a way that encourages learning and improvement.
Neighbour: Five checkpoints of connecting, summarising, handing over, safety netting and housekeeping alongside an awareness of 'minimal cues' (verbal and non-verbal) to help discover the unspoken agenda.
BARD: Using an open question to start the consultation Listening carefully to the patient Using verbal cues like "mmm" and "ok" Using non-verbal cues like a smile or nod the totality of the relationship between the doctor and patient.
Health Coaching Models:
GROW: Goal (what do you want to achieve), Reality (tell me about the current situation), Option ( What could you do differently, what might get you on the way), Way forward (how committed are you? SMART action plan).
4Es: Explore, Empower, Educate, Enable
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Thursday, 5 September 2024
Tuesday, 13 August 2024
Shingles
Paracetamol is the first-line pain management option for shingles, as it is well-tolerated and effective for mild to moderate pain. NSAIDs, like ibuprofen, can be used if paracetamol is insufficient. Opioids and Gabapentinoids are reserved for more severe, refractory pain.
Aciclovir is the first-line antiviral treatment for shingles in immunocompetent individuals aged over 50 years when started within 72 hours of rash onset.
The presence of shingles in the ophthalmic dermatome, even without any symptoms affecting vision, warrants referral for urgent assessment to prevent potential eye complications.
Immunocompromised patients with widespread, disseminated shingles and systemic symptoms require immediate referral to emergency services for intravenous antiviral therapy and close monitoring.
Valaciclovir is the preferred antiviral for immunocompromised patients and can be managed under the NHS Pharmacy First Clinical Pathway, providing the patient is not severely immunosuppressed. The NHS Pharmacy First service PGD for the supply of Valaciclovir in shingles indicates that a person is classed as being ‘severely immunosuppressed’ when taking a dose of Methotrexate of 20mg or above, or where lower doses are taken in combination with other immunosuppressive therapies.
Valaciclovir is the preferred antiviral for patients with adherence concerns, because it has a simpler dosing regimen (three times daily) than aciclovir (five times daily).
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Saturday, 25 May 2024
GLP-1 agonists
GLP-1 agonists are medicines used to treat type 2 diabetes and weight loss. Usually patient stays on a dose for 4 weeks.
Patient Consultation:
Have they taken it before
What dose they are expecting
If they are increasing their dose with the new prescription
It shouldn't be more that 2 weeks lapsed since their last dose, Speak to the prescribing team to ensure patient is managed correctly.
Sunday, 28 April 2024
Diagnostic Tools
https://dermnetnz.org/dermdiag
The DermDiag Tool is designed to help you understand your skin condition.
https://www.pcds.org.uk/
Sunday, 17 March 2024
About inhaler use
https://cpe.org.uk/quality-and-regulations/pharmacy-quality-scheme/
"Inhalers still account for approximately 3% of the NHS’ carbon footprint, mostly due to the propellants used to deliver the medications.
press and breathe pressurised metered-dose inhalers (pMDIs) currently use hydrofluorocarbon gases (HFCs or ‘F-gases’) as propellants. • When released from the inhaler, HFCs remain in the atmosphere for approximately 270 years and they are potent greenhouse gases between 1,300 and 3,350 times greater than CO2.
Used inhalers typically have 30% of the original propellant remaining in the canister.
While residual propellant gases in inhalers can be extracted, cleaned and reused in industrial equipment, such as air conditioning systems, they are being phased out of use in most applications because of their environmental impacts. • Inhalers returned to pharmacies for safe disposal will be incinerated at high temperature by NHS England and NHS Improvement’s waste contractor. This process destroys the propellant gases, so they don’t escape into the atmosphere. Steel and aluminium from inhaler canisters may be recovered and recycled at some incinerators."
For patients using inhaler:
Checked that all children aged 5 to 15 (inclusive) dispensed an inhaled press and breathe pMDI for asthma have a spacer device where appropriate, in line with NICE TA38.
Referred children aged 5 to 15 (inclusive) with asthma to an appropriate healthcare professional where this is not the case.
Personalised asthma action plan (PAAP) can help identify worsening asthma, support corrective action and advise patients and carers of how and when to seek help.
Referrals for patients using 3 or more bronchodilators in 6 months
patients with asthma, for whom three or more short-acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a six-month period have, since the last review point, been referred to an appropriate healthcare professional for an asthma review.
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Tuesday, 12 March 2024
Carbapenems
Carbapenems are powerful broad-spectrum antibiotics that are often the last line of effective treatment for patients with multidrug-resistant infections, including those caused by ESBL-producing bacteria (extended spectrum beta-lactamases).
Cases of carbapenem resistance in E. coli and Klebsiella in the UK started to increase during 2008 and 2009.
Antimicrobial resistance (AMR) is resistance of a micro-organism to an antimicrobial medicine to which it was previously sensitive. Resistant organisms (they include bacteria and viruses) are able to withstand attack by antimicrobial medicines, such as antibiotics and antivirals, so that standard treatments become ineffective and infections are prolonged, with longer periods of infectivity, and may spread to others. Inappropriate and irrational use of antimicrobial medicines provides favourable conditions for resistant micro-organisms to emerge, spread and persist.
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Friday, 1 March 2024
How to wear Tynor Medical Compression Stockings
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10 Exercises for Leg Lymphedema (Swelling or Edema of the Lower Extremit...
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Self Lymphatic drainage (SLD) for the leg for lymphoedema lymphedema
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Monday, 26 February 2024
Parkinson's disease
"Before starting antiparkinsonian treatment, the patient's individual circumstances, including symptoms, comorbidities and preferences, should be discussed together with the potential benefits and harms from the different drugs available.
Patients and their carers should be informed about the risk of adverse reactions from antiparkinsonian drugs, including psychotic symptoms, excessive sleepiness and sudden onset of sleep with dopamine-receptor agonists, and impulse control disorders with all dopaminergic therapy (especially dopamine-receptor agonists). For further information see Impulse control disorders."
"To avoid the potential for acute akinesia or neuroleptic malignant syndrome, antiparkinsonian drug concentrations should not be allowed to fall suddenly due to poor absorption or abrupt withdrawal."
https://www.medicinescomplete.com/#/content/bnf/_661075101
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Tuesday, 20 February 2024
Will you be an Antibiotic Guardian?
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