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From time to time, some of us might receive a needlestick injury or be spat at by a patient that is known to have an illness such as HIV, no matter how or what has happened you are likely to be suffering mentally from the event itself, let alone the fact the worry of what or if you have caught something life changing. what we all need to understand right now is, no matter what common sense and the facts say, you will be feeling awful and will be worried to death no matter what anyone says.

In the UK there are two drugs that are given as what are refer to as PEP. Post Exposure Prophylaxis medications. these are a series of powerful drugs that stop HIV taking hold in the body but need to be started within 72 hours.

Two common drugs given as PEP in the UK is Truvada and Raltegravir

Side effects (Common) from receiving Truvada can be :

  • nausea,
  • vomiting,
  • stomach pain,
  • diarrhea,
  • headache,
  • dizziness,
  • depression,
  • joint pain,
  • trouble sleeping,
  • strange dreams,
  • back pain,
  • itching or skin rash,
  • changes in the color of skin on your palms or soles of your feet, or
  • changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

And common side effects of Raltegravir 

  • nausea,
  • vomiting,
  • diarrhea,
  • stomach pain,
  • headache,
  • tired feeling,
  • dizziness,
  • sleep problems (insomnia), or
  • changes in the shape or location of body fat (especially in arms, legs, face, neck, breasts, and trunk).

 

Are you having problems with any of the above side effects and also fighting as an NHS worker to retain your Un Social Hours payments then Contact your Union Rep to discuss

 

Some Facts about HIV : from https://www.nhs.uk/conditions/hiv-and-aids/causes/

Causes

In the UK, most cases of HIV are caused by having sex with a person who has HIV without using a condom.

A person with HIV can pass the virus on to others even if they don't have any symptoms. People with HIV can pass the virus on more easily in the weeks following infection.

HIV treatment significantly reduces the risk of someone with HIV passing it on.

 

Sexual contact

Most people diagnosed with HIV in the UK acquire the virus through unprotected vaginal or anal sex.

It may also be possible to catch HIV through unprotected oral sex, but the risk is much lower.

The risk is higher if:

  • the person giving oral sex has mouth ulcers, sores or bleeding gums
  • the person receiving oral sex has recently been infected with HIV and has a lot of the virus in their body, or another sexually transmitted infection

 

Other risk behaviours

Other ways of getting HIV include:

  • sharing needles, syringes and other injecting equipment 
  • from mother to baby before or during birth or by breastfeeding
  • sharing sex toys with someone infected with HIV
  • healthcare workers accidentally pricking themselves with an infected needle, but this risk is extremely low
  • blood transfusion – now very rare in the UK, but still a problem in developing countries

 

Who's most at risk?

People who are at higher risk of becoming infected with HIV include:

  • men who have unprotected sex with men
  • people who engage in chemsex (using drugs to help or enhance sex) – chemsex among men who have sex with men is an increasing concern as it can be associated with risky sexual behaviours, such as having lots of different sexual partners and not using condoms
  • women who have unprotected sex with men who have sex with men
  • people who have unprotected sex with a person who has lived or travelled in Africa
  • people who inject drugs and share equipment
  • people who have unprotected sex with somebody who has injected drugs and shared equipment
  • people with another sexually transmitted infection
  • people who have received a blood transfusion while in Africa, eastern Europe, the countries of the former Soviet Union, Asia or central and southern America

 

How HIV is transmitted

HIV isn't passed on easily from one person to another. The virus doesn't spread through the air like cold and flu viruses.

HIV lives in the blood and in some body fluids. To get HIV, one of these fluids from someone with HIV has to get into your blood.

The body fluids that contain enough HIV to infect someone are:

  • semen
  • vaginal fluids, including menstrual blood
  • breast milk
  • blood
  • lining inside the anus

 

Other body fluids, like saliva, sweat or urine, don't contain enough of the virus to infect another person.

 

The main ways the virus enters the bloodstream are: 

  • by injecting into the bloodstream with needles or injecting equipment that's been shared with other people
  • through the thin lining on or inside the anus, vagina and genitals
  • through the thin lining of the mouth and eyes
  • through cuts and sores in the skin

HIV isn't passed on through:

  • spitting
  • kissing
  • being bitten
  • contact with unbroken, healthy skin
  • being sneezed on
  • sharing baths, towels or cutlery
  • using the same toilets or swimming pools
  • mouth-to-mouth resuscitation
  • contact with animals or insects like mosquitoes

 

How HIV infects the body

HIV infects the immune system, causing progressive damage and eventually making it unable to fight off infections.

The virus attaches itself to immune system cells called CD4 lymphocyte cells, which protect the body against various bacteria, viruses and other germs.

Once attached, it enters the CD4 cells and uses it to make thousands of copies of itself. These copies then leave the CD4 cells, killing them in the process.

This process continues until eventually the number of CD4 cells, also called your CD4 count, drops so low that your immune system stops working.

This process may take up to 10 years, during which time you'll feel and appear well. 

Well, it’s all now official: the Mental Health Act 1983 will be amended by the provisions in the Policing and Crime Act 2017 with effect from midnight on 11th December 2017. The regulations were laid in Parliament today for a) commencement of the change; and b) the use of Police Stations as a Place of Safety and we can now stare straight down the barrel of what we know has been coming for around three years.
 
The big surprise in these developments has been the extent to which it will become very difficult to use police custody as a Place of Safety, at all. We knew the amendments would ban such use for children, but we always understood that police stations could continue to be used for adults in exceptional circumstances. Whilst there were various hints in the consultation document from 2014 and various other clues during the informal discussions which occurred between the Home Office and the NPCC / College of Policing, we obviously couldn’t be certain of anything until such time as the Regulations were published – and that happened today.
 
We now know it will be a strict requirement whilst police stations are being used for this purpose that detainees’ health is checked by a healthcare professional ..........


This is an extract from the highly acclaimed blog known as the Mental health cop.   to finish this follow this link
 The Resuscitationist
 

Sharing some raw data and thoughts on the LUCAS, ITD, CPR and Epi from my lab

I don’t know of too many researchers that share raw data directly from their lab. Dr. Jeffrey Kline however seems to be setting a pretty good example of a leading researcher in a field interacting directly with the masses, which I think is an excellent thing. Now I have no delusions that I am anywhere near the stature of Dr. Kline, in fact part of the reason I’d like to share some of my data through my blog is that as a full time med student and part time researcher, it feels like it’s going to take me forever to get all this stuff collected and into a publishable quality. Even though we are not done collecting data, and the differences seen now may eventually fade into statistical obscurity, there are still things I get to see first hand doing my research that are flat out amazing to me. And I’d like to share some of those with you here.

First I’m going to share one of my carotid blood flow strips with some notations on it so you can see some data yourself. Study this for a minute and then I’ll go over some of my thoughts on it and the lab in general below.

peak CBF_black notated

  1. The LUCAS doesn’t take very long to place. Sure it takes longer to put on than it does to start manual CPR. It also takes a little longer to place on my pigs since they have a larger anterior-posterior diameter than humans it requires placing them in the LUCAS rig along with a V-shaped wedge and some towels so they don’t roll onto their side (which is why vets do CPR on the animals side). Also I’m not rushing when I place it, I don’t measure this as one of my data points in this study, so 53 seconds is me at my leisure! I’m literally coming off the chest, walking across the room, unplugging the LUCAS from the wall charger, walking back to the pig and placing it. When using it on humans, after some practice, I felt the time to place was quite short and someone was always doing manual CPR while getting the machine ready so I don’t personally feel this is that big of an issue. Especially since…

This extract is from 'The Resuscitationist' to read the entire article click here

    Making a good first impression is essential to establishing positive rapport with your patient. Within the first few seconds of that encounter, most patients will make a value judgment about whether they like you and whether they think you're competent to care for them.
    You don't get a second chance to make a great first impression!

    Studies show that people, including patients, are most likely to remember the beginning and the end of an encounter. This is called the "serial positioning effect."

    That's why, in addition to a positive first impression, a positive ending encounter with the patient is also very important. Taking a moment or two to say goodbye to the patient and thank them for the opportunity to be of service leaves them with a positive impression of you.

    With the serial positioning effect, the things that happen in the middle of an encounter tend to be a "blur," and details are often forgotten.

    From a risk management standpoint, that can be very good. It means that if you're nice to the patient when arriving on scene and nice to them when you leave, the patient is likely to forget about the bumps (i.e., mistakes) that may have occurred in the middle-like that IV you missed! Typically, patients won't sue you if they like you-even if you do
    make mistakes.

    Here are nine tips for making a good first impression that will set the stage for a positive interaction with the patient-and reduce the risk of a lawsuit:

    1. Recharge yourself. Take a deep breath before you enter the situation to clear your mind and to be ready to focus on the patient. Tell yourself you're going to make the patient feel better about the situation they're in.

    2. Check your breath. As obvious as this is, bad breath can turn people off and sets up a barrier to communication. Always carry gum and mints and use them.

    3. Have a confident physical approach. Move with purpose; look like you want to get to where you're going. Stand up straight with a confident gait as you approach the room. Start looking at faces to assess the situation and use a positive, clear tone of voice when speaking.

    4. Look them in the eye. Focus on the patient. It helps you assess their emotions. It will also allow you to detect subtle changes in emotion, pain levels and distress.

    5. Make an immediate introduction. Make sure you introduce yourself; explain who you are and why you're there. Avoid using clichés like "honey," "sweetie," or "buddy" when
    speaking to the patient. Ask the patient if it's okay to call them by their first name. Acknowledge family members, too; they may have valuable information about the patient's past and present medical history that can help you.



    READ THE FULL ARTICLE AT JEMS

    By Matthew House, DHC, MSc, LL.B (hons) , Michael Jackson, MBA, MSc, DipIMC(Ed), FCPara , Joanne Dinning, MSc , Peter McMeekin, PhD

    Transport of cardiac arrest patients entails substantial costs and involves risk due to emergency blue-light transportation. Photos courtesy North West Ambulance Service NHS Trust
    In the United Kingdom, sudden cardiac arrest accounts for close to 100,000 deaths annually.1 Despite improvements in resuscitation practices,2 outcomes from OHCA remain poor, regardless of interventions utilized.3
    In a one-year period during 2014-2015, approximately 30,406 out-of-hospital cardiac arrests (OHCAs) in England were transported to hospitals by ambulance, with a survival rate of 8.6%.4
    Transporting patients with nearly certain poor outcomes represents an ineffective use of ambulance resources.5,6 Termination of resuscitation (TOR) clinical decision rules (CDRs) for OHCA exist and have been validated.5,7,8
    These TOR CDRs reduce the burden on both the ambulance and wider healthcare system, and improve public safety by reducing blue light transports, which present an inherent risk.
    The guideline proposed after reviewing the study data compared 
    favorably with pre-existing termination of resuscitation guidelines.
    Several studies have identified predictors of unsuccessful prehospital resuscitation, allowing for the development of evidence-based and validated TOR CDRs.9,10
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    The BLS guideline predicts that the patient will not survive to hospital discharge if the arrest isn't witnessed by the ambulance clinician, there's no return of spontaneous circulation (ROSC) before transport and no shocks have been administered.
    The ALS guideline adds that the cardiac arrest must not have been witnessed by a bystander and there must have been no bystander CPR. Although these rules have been independently validated, it's been shown that they're not universal for all patient groups.11
    Moreover, these studies involved systems with no pre-existing TOR guidelines. In systems where clinicians already terminate efforts on scene, the ALS guidelines have been shown potentially to increase the numbers of futile transportations.12
    U.K. ambulance services are able to terminate attempts that have resulted in asystole following ALS.13 Therefore, the majority of patients transported to a hospital in the U.K. will be those who persist with pulseless electrical activity (PEA) on scene. (See Figure 1.)

    .................................

    READ FULL STORY at  http://www.jems.com/articles/print/volume-42/issue-8/features/derivation-of-a-termination-of-resuscitation-clinical-decision-rule-in-the-uk.html

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    See bottom of the page for Video Review

    Superior NEWS Scoring tool designed for mobile use

    With World Sepsis Day approaching on 13th September, we are delighted to announce that the NHSScotland NEWS and Sepsis screening tool is now available for Android users as well as iPhone.


    app is a collaboration between NHS Education for Scotland (NES) and the Scottish Patient Safety Programme (SPSP). More information about the app as well as access options are available at http://www.knowledge.scot.nhs.uk/home/portals-and-topics/sepsis-app.aspx 

    iPhone users can also update this app to version 1.4. This now includes a short introductory video by Professor Kevin Rooney, NHS Scotland National Clinical Lead for the National Sepsis Collaborative. This video is also available to Android users.

    The app has been registered with the Medicines and Healthcare products Regulatory Agency (MHRA) as a medical device and was recently shortlisted for the British Computer Society Health Informatics Awards.

    We want to know whether this app is supporting improvement in the recognition and timely management of patients with sepsis.  We would therefore be very grateful if you could complete our evaluation at https://response.questback.com/nhseducationforscotland/sepsisevaluation/ based on your experience in using this app.

    For more information, contact:  knowledge@nes.scot.nhs.uk




     . The app is a collaboration between NHS Education for Scotland (NES) and the Scottish Patient Safety Programme (SPSP) - it provides:

    A National Early Warning Scoring System (NEWS) calculator to alert clinicians to the deteriorating patient and acute illness

    A Sepsis Screening tool for the prompt recognition and the timely initiation of treatment of patients with Sepsis.

    An outline of the Sepsis 6 care bundle for the treatment of Sepsis

    An algorithm to help identify Organ Dysfunction, Severe Sepsis, Septic Shock and when to escalate care for the individual patient.

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    Appearing in the three-part BBC primetime documentary series Ambulance, along with focused social media support, brought multiple benefits to the service, according to its evaluation of the project.

    Headline stats following broadcast showed that 70 per cent of viewers felt more positive towards the service, while two fifths would think twice about calling 999 if the situation wasn’t an emergency.

    Job applications for roles as emergency medical dispatchers and graduate paramedics, promoted during the series, also more than doubled.

    Internal comms impact

    Meanwhile, the internal comms gain was tangible, with more than 88 per cent of staff saying they felt proud working for LAS after the series was broadcast, compared with 54 per cent beforehand.

    "It is clear that the documentary - and the multimedia campaign that we ran alongside it - had a huge impact on the whole ambulance service, our stakeholders, the media and viewers," said Anna Macarthur, head of media and campaigns, London Ambulance Service.

    "It influenced how people will use the ambulance service in the future, made staff feel proud to work for the service and increased interest in working for us in the future."

    Initial discussions were held between the LAS comms team, the BBC and production company Dragonfly, before the service’s executive leadership team approved the project in January 2016.

    But at a time when LAS faced intense scrutiny, having been asked to improve by the Care Quality Commission, it was crucial the documentary would have a well-rounded impact.

    PR goals for the documentary

    LAS set out a number of goals for the PR activity, which included fostering a sense of pride in working for the service while boosting staff morale and retention, highlighting the skills of control room staff and clinical expertise of those on the front line, and showing how the service responds to increasing demand, while maintaining high levels of patient care. 

    It also wanted to encourage viewers to consider a career working for LAS, increase public understanding of what is an emergency, influence behaviour and help people understand that not everyone who dials 999 will get an emergency ambulance with flashing blue lights and that people with less serious illnesses and injuries will wait longer. 

    A casting period took place, when staff were chosen to appear in the show, before filming took place in April and May 2016.

    During a post-production editing phase through the summer, a media and social media campaign, including publicity photos and interviews, was created to maximise the impact of the documentary among staff, stakeholders and Londoners.

    Social media reach

    Ambulance was broadcast on BBC1 in September and October 2016, during which LAS ran a social media campaign to promote the correct use of 999, encourage people to consider working for the service and promote the expertise of staff. 

    A total of 18 Facebook posts had a combined reach of almost one million people, while 74 proactive tweets had 721,000 impressions, with an engagement rate of 3.8 per cent, more than double the usual average rate of 1.6 per cent.

    Live Twitter events throughout the three episodes reached a combined total of 1.9 million impressions, with an engagement rate of 3.6 per cent. These included live tweeting while the shows were broadcast, as well as a Q&A with operational staff after one of the episodes.

    Traditional media

    On traditional channels, there were 39 pieces of regional and national media coverage, in newspapers including The Guardian, Radio Times, The Daily Telegraph and the Daily Mail, with a combined readership of around 28 million.

    Meanwhile, there was a strong focus on internal comms, with regular updates on the LAS intranet site, The Pulse, the Listening Into Action Facebook group, and daily comms email bulletins to staff.

    The London Ambulance Service’s evaluation of the project stated: "The documentary series boosted staff morale and recruitment and changed the perception of the service in a positive way."

    Read more at https://www.prweek.com/article/1447642/case-study-london-ambulance-service-documentary-boosts-morale-public-perception-recruitment#SshszPeYguXtGjXh.99

    The proportion of diabetics who go blind or suffer sight loss has almost halved since a new national retinopathy screening programme started in 2007.

    Swansea University research over eight years has now been published in the British Medical Journal.

    New certifications for severe sight impairment have fallen from 31.3 to 15.8 per 100,000 people.

    Diabetics aged over 12 are offered annual screening and health experts said the study shows a "clear benefit".

    Retinopathy is damage to the retina in the back of the eye and is a complication which can affect people with diabetes. Persistent high levels of glucose can lead to eye damage.




    The research shows:
    • There were 339 fewer new certifications for all levels of sight loss from any cause combined in 2014-15, compared with 2007-08
    • It is calculated that the sight of 22 people has been saved
    • The results are despite 52,229 (40%) more people being diagnosed with diabetes in Wales during the research period

    However, 20% of those offered the screening - which began in 2003 and was rolled out across Wales by 2007 - do not take it up.

    Dr Quentin Sandifer, medical director of Public Health Wales, said: "We would encourage people living with diabetes to take up the offer when they receive their invitation.

    "This is a great example of the NHS working together to improve outcomes for our population and is especially impressive as sight loss has reduced even through the number of people diagnosed with diabetes in Wales has increased over this time."


    WHAT IS DIABETES?

    People with type 1 diabetes cannot produce insulin. No-one knows exactly what causes it, but it is not to do with being overweight and it is not currently preventable. It usually affects children or young adults, starting suddenly and getting worse quickly. Type 1 diabetes is treated by daily insulin doses, a healthy diet and regular physical activity.

    People with type 2 diabetes do not produce enough insulin or the insulin they produce does not work properly (known as insulin resistance). They might get diabetes because of their family history, age and ethnic background. They are also more likely to get type 2 diabetes if they are overweight. Type 2 diabetes is treated with a healthy diet and increased physical activity.

    How many have diabetes? Diabetes Wales estimates there are 183,000 people in Wales living with diabetes, while at least another 70,000 people could have it but are unaware or undiagnosed.

    Diabetic retinopathy or "retinopathy" when it is spotted it can be treated and deterioration prevented, whether controlled through medication or laser treatment.



    Robert Lee, 65, from Cardiff, has been having screenings since 2004 and runs a patient support group.

    "I've seen people with serious eye problems and I've heard people say, if they'd known earlier it could have prevented these complications," he said.

    "If by screening we can make sure we don't progress to that level, it's very important and it's a great service."

    Prof David Owens, from the Diabetes Research Unit Cymru at Swansea University Medical School, said with the proportion of the population with diabetes expected to double in the next 25 years, the screening had already made a "major difference" and was the most dramatic seen anywhere in the UK.

    "If you have long-term diabetes - high blood sugar for a very long time - you will have damage to the small blood vessels at the back of the eye which supply all the blood and nutrition to the retina, which is essential," he said.

    "The essence of the screening is diagnosing it early before it has a huge impact on vision and it can be treated relatively simply and successfully."

    Public Health Minister Rebecca Evans said the research showed the significance of earlier diagnosis, alongside improved diabetes management, referral and newer treatments.

    source : http://www.bbc.co.uk/news/uk-wales-40715799

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