scholarly journals Diamorphine for pain and distress in young patients: case examples and discussion of mechanisms

2021 ◽  
pp. bmjspcare-2021-003295
Author(s):  
Caradoc Morris
Keyword(s):  
Psychological Distress ◽  
Palliative Medicine ◽  
Clinical Effect ◽  
Young Patients ◽  
Subjective Improvement ◽  
Active Metabolites ◽  
Supply Disruption ◽  
Case Examples ◽  
High Doses ◽  
The Uk

Diamorphine is a strong opioid licensed in the UK for many uses, including moderate and severe pain. In the early 2000s, its use in palliative medicine was widespread before a supply disruption led to preferential use of alternative, cheaper opioids. Though these supply issues were resolved, the use of diamorphine in palliative medicine has remained reduced, particularly with another UK supply disruption in 2021. Following anecdotal reports of good results from diamorphine use in younger patients, this piece discusses two cases of young patients with metastatic cancers suffering significant pain and psychological distress. Both patients were approaching end of life and required high doses of opioids, benzodiazepines and co-analgesics, all given to limited benefit. Both patients were rotated to diamorphine giving objective and subjective improvement in symptoms. These cases are presented in the context of newer information and description of the biochemical actions of diamorphine and its metabolites, which exert their own clinical effect before themselves generating active metabolites. Various trials on, and discussion about, diamorphine’s unique metabolism and subsequent central nervous system effects help argue for its use in situations where extreme pain and psychological distress overlap.

scholarly journals ‘Should I Stay, or Should I Go?’ Psychological Distress Predicts Career Change Ideation among Intensive Care Staff in Lithuania and the UK Amid COVID-19 Pandemic

2021 ◽  
Vol 18 (5) ◽  
pp. 2660
Author(s):  
Ieva Norkiene ◽  
Lina Jovarauskaite ◽  
Monika Kvedaraite ◽  
Encarl Uppal ◽  
Mandeep Kaur Phull ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Healthcare Professionals ◽  
Psychosocial Support ◽  
Career Change ◽  
Well Being ◽  
Self Report ◽  
Care Staff ◽  
Psychological Well Being ◽  
The United Kingdom ◽  
The Uk

The COVID-19 pandemic had a significant effect on healthcare globally. Additional pressure created by coronavirus adversely affected the mental health and psychological well-being of healthcare workers, leading many to question their desire and willingness to continue working in healthcare. This study aimed to identify predictors for career change ideation among healthcare professionals in two countries; Lithuania and the United Kingdom amid the coronavirus pandemic. In total, 610 healthcare professionals from Lithuania and the UK (285 and 325, respectively) participated in a survey from May to August 2020. Psychological distress and psychological well-being were measured using the self-report scales “DASS-21” and “WHO-5”. Almost half of the sample (49.2%), 59.6% and 40.0% in Lithuanian and the UK, respectively, exhibited career change ideation, the country effect was significant (AOR = 2.21, p < 0.001). Stronger ideation to leave healthcare was predicted by higher levels of depression (AOR = 1.10, p = 0.005), stress (AOR = 1.10, p = 0.007), anxiety surrounding inadequate personal protective equipment (AOR = 2.27, p = 0.009), and lower psychological well-being scores (AOR = 1.10, p = 0.007). We conclude that psychosocial support must be provided for healthcare professionals to prevent burnout and loss of staff amid the pandemic.

scholarly journals New technical advances in swivel walkers

2003 ◽  
Vol 27 (2) ◽  
pp. 132-138 ◽  
Author(s):  
J. Stallard ◽  
B. Lomas ◽  
P. Woollam ◽  
I. R. Farmer ◽  
N. Jones ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Muscular Atrophy ◽  
Young Patients ◽  
Suitable Alternative ◽  
Detail Design ◽  
Increased Risk ◽  
Technical Advances ◽  
Disabled Patients ◽  
Manual Handling ◽  
The Uk

Swivel walkers were commonly prescribed for children with complete thoracic lesion myelomeningocele in the 1970s and 80s, when the incidence of spina bifida in the UK was of the order of 3 per 100,000 live births. The advent of reciprocal walking orthoses provided a more suitable alternative for those with good upper limb and trunk function, and swivel walkers were then used primarily for very young or more severely disabled patients. Prenatal screening has dramatically reduced the incidence of spina bifida in the UK and subsequently swivel walkers have been used in a wider range of pathology, including spinal muscular atrophy, multiple sclerosis, muscular dystrophy and other neurological conditions that lead to lower limb dysfunction. The detail design of these devices has been adapted to accommodate the specific problems encountered in these conditions. In particular the designs have been updated to: enable very young patients to be more readily fitted at the age of 1 year; allow the walking mechanisms to be conveniently adjusted for easier ambulation when weakness or lack of confidence inhibits performance; permit simple adjustment to a standing frame mode to enhance stability in situations of increased risk; promote manual handling practice that is compatible with the National Health Service (NHS) policy of compliance with relevant regulations. To underpin appropriate prescription and safe supply the NHS Procurement Agency have encouraged the development of a common course for all types of swivel walker.

scholarly journals The role of the internet in testimony: the case of the ‘Forgotten Australians’

2014 ◽  
Vol 36 (8) ◽  
pp. 1151-1167 ◽  
Author(s):  
Barbara Adkins ◽  
Donna Hancox
Keyword(s):  
Web 2.0 ◽  
Social Inclusion ◽  
Church And State ◽  
The Internet ◽  
Case Examples ◽  
Abuse And Neglect ◽  
The Uk ◽  
Past Experiences ◽  
National Museum Of Australia

This article examines the case of the Forgotten Australians as an opportunity to examine the role of the internet in the presentation of testimony. ‘Forgotten Australians’ are a group who suffered abuse and neglect after being removed from their parents – either in Australia or in the UK – and placed in Church- and State-run institutions in Australia between 1930 and 1970. The campaign by this profoundly marginalized group coincided with the decade in which the opportunities of Web 2.0 were seen to be diffusing throughout different social groups, and were considered a tool for social inclusion. We outline a conceptual framework that positions the role of the internet as an environment in which the difficult relationships between painful past experiences and contemporary injunctions to remember them, are negotiated. We then apply this framework to the analysis of case examples of posts and interaction on websites with web 2.0 functionality: YouTube and the National Museum of Australia. The analysis points to commonalities and differences in the agency of the internet in these two contexts, arguing that in both cases the websites provided support for the development of a testimony-like narrative and the claiming, sharing and acknowledgement of loss.

scholarly journals Psychological distress associated with the second COVID-19 wave: Prospective evidence from the UK Household Longitudinal Study

2021 ◽  
Author(s):  
Michael Daly ◽  
Eric Robinson
Keyword(s):  
Psychological Distress ◽  
Longitudinal Study ◽  
Fixed Effects ◽  
General Health Questionnaire ◽  
School Age Children ◽  
Clinically Significant ◽  
Fixed Effects Regression ◽  
The Uk ◽  
Second Wave ◽  
Pandemic Wave

BackgroundIn late 2020 a second wave of COVID-19 infections occurred in many countries and resulted in a national lockdown in the UK including stay at home orders and school closures. This study aimed to compare the prevalence of psychological distress before and during the second COVID-19 wave in the UK. MethodsThis study drew on data from 10,657 participants from the nationally representative probability-based UK Household Longitudinal Study (UKHLS). The 12-item General Health Questionnaire (GHQ-12) assessment measure was used to detect the proportion of UK adults experiencing clinically significant psychological distress. Changes in distress levels associated with the second pandemic wave were examined between September 2020 and January 2021 using logistic regression and linear fixed-effects regression models. ResultsLongitudinal analyses showed that the prevalence of clinically significant distress rose by 5.8% (95% CI:4.4-7.2) from 21.3% in September 2020 to 27.1% in January 2021, compared with a 2019 pre-pandemic estimate of 21% in this cohort. Fixed effects analyses confirmed that the second COVID-19 wave was associated with a significant within-person increase in distress (d =0.15, p&lt;.001). Increases were particularly pronounced among those with school-age children in the home. LimitationsA non-specific measure of mental health symptoms was utilized and it was not possible to separate the potential impact of the pandemic from other changes occurring in tandem within the study period. ConclusionClinically significant distress rose during the second wave of the COVID-19 pandemic and reached levels similar to those observed in the immediate aftermath of the first pandemic wave.

scholarly journals Heterogeneous Mental Health Development During the COVID-19 Pandemic in the United Kingdom

2021 ◽  
Author(s):  
Lea Ellwardt ◽  
Patrick Praeg
Keyword(s):  
United Kingdom ◽  
Psychological Distress ◽  
Latent Class ◽  
Mitigation Measures ◽  
Social Lives ◽  
The United Kingdom ◽  
Policy Measures ◽  
Nationally Representative ◽  
The Uk

Aim. The COVID-19 pandemic and the mitigation measures by governments have upended the economic and social lives of many, leading to widespread psychological distress. However, how distress developed during the pandemic and who was most affected is poorly understood. We explore heterogeneity in trajectories of psychological distress during the first six months of the pandemic in the United Kingdom and relate this heterogeneity to socio-demographic and health factors. Subjects and Methods. We analyze six waves of longitudinal, nationally representative survey data from the UK Household Longitudinal Study (N = 15,218), covering the first lockdown in 2020. First, latent class mixture modelling (LCCM) is used to identify trajectories of psychological distress. Second, associations of the trajectories with covariates are tested with multinomial logistic regressions. Results. We find four different trajectories of distress: continuously low, continuously moderate, temporarily elevated, and continuously elevated distress. One-fifth of the population experienced severely elevated risks of distress. Long-term exposure was highest among younger people, women, those who lost income, and those with previous health conditions or COVID-19 symptoms. Conclusion. Given the threat of persistent stress on health, policy measures should be sensitized to the unintended yet far-reaching consequences of non-pharmaceutical interventions.

scholarly journals Social justice, diversity and leadership

2018 ◽  
Vol 6 (1) ◽  
pp. 111-125
Author(s):  
Rachel Tribe ◽  
Deanne Bell
Keyword(s):  
Social Justice ◽  
Psychological Distress ◽  
Social Inequalities ◽  
Leadership Role ◽  
Service Users ◽  
Inclusive Practice ◽  
The Uk ◽  
Discriminatory Practice ◽  
Counselling Psychology

This paper will discuss what is meant by social justice in relation to counselling psychology specifically and psychology generally within the UK, as well as briefly considering social justice in the wider context. It will discuss if there is a role for counselling psychologists and psychology in promoting social justice through challenging social inequalities and promoting anti-discriminatory practice. It will review the role of counselling psychology in potentially foregrounding inclusive practice which celebrates diversity and provides leadership on this issue. It will then discuss the possible skills and theories psychologists have at their disposal to undertake work which promotes social justice and equality and takes into consideration human rights. It will provide a range of examples of where psychologists have undertaken social justice work using their training and skills and provided leadership in a range of contexts outside the consulting room. The paper will argue that taking an active leadership role to encourage the promotion of social justice is at the centre of our work as a profession, a division and as individual counselling psychologists. Counselling psychology has traditionally put individual therapeutic work at the centre of training and whilst this work is important, this paper will argue that there are numerous other roles and tasks which psychologists could usefully be involved with. These would help ensure that the requirements of service users/experts by experience (EBE) are met and that the context of their lives are foregrounded at the micro (individual) as well as the macro (contextual) level. This may require counselling psychologists to take a wider holistic or systemic perspective and understanding, advocating or intervening in relation to the structural and contextual issues which may give rise to psychological distress, and thereby promote social justice.

Safeguarding and Ethical Practice for People with Intellectual Disability

2020 ◽  
pp. 297-302
Author(s):  
Meera Roy ◽  
Ashok Roy ◽  
Priyanka Tharian ◽  
Ameeta Retzer
Keyword(s):  
Intellectual Disability ◽  
International Human Rights Law ◽  
Human Rights Law ◽  
Ethical Practice ◽  
Case Examples ◽  
History Of ◽  
Legal Foundations ◽  
The Uk ◽  
The Impact ◽  
Domestic Law

This chapter will outline the legal and practical principles that inform safeguarding and ethical practice for people with intellectual disability (ID) in the UK. The legal foundations for practice are discussed, drawing first on their foundations in international human rights law, the impact this has had on domestic law and the development of legislation to protect the rights of those with ID. Next, the current policy and principles that underpin ongoing practice are discussed, beginning with the particular history of people with ID and how understanding of ID has since evolved. Case examples are provided throughout to demonstrate these concepts in practice.

scholarly journals Treatment of Joint-Bleedings in Hemophiliacs with Antibodies to Factor VIII with High doses of Fraction Feiba.

1977 ◽  
Author(s):  
Kl. Schimpf ◽  
K. Zimmermann ◽  
P. Zeltsch
Keyword(s):  
Knee Joint ◽  
Factor Viii ◽  
Half Life ◽  
Clinical Effect ◽  
Single Injection ◽  
Life Time ◽  
Joint Effusion ◽  
The Third ◽  
Inhibitor Level ◽  
High Doses

Observations in 3 patients demonstrated, that joint-bleedings can be controlled with high doses of fraction FEIBA alone or in combination with factor (f) VIII on out-patient basis. First patient, inhibitor 5-10 units (u) per ml, suffered from 24 joint-bleedings within 392 days. 2o of them could be stopped by a single injection of 150-200 u of fraction FEIBA per kg bodyweight (bw). A combination of 90 u of FEIBA and 36 u of f VIII per kg bw had the same effect. But after 5 injections of this combination within 6 weeks, the inhibitor level had risen from 10 to 240 u per ml. During further treatment with 180 u of fraction FEIBA without addition of f VIII, the inhibitor fell down with a half life time of 50 days. The clinical effect of fraction FEIBA was not influenced by the elevated antibody level. Two further patients, inhibitors 2-4 and 32 u respectively, obtained combined injections of 50-100 u of FEIBA plus 36-42 u of f VIII. One patient was on a prophylaxis of 3 injections weekly for 193 days. After 57 injections the inhibitor had fallen from 2-4 u to unmeasurable values. The third patient obtained the above mentioned dosis twice a day for treatment of a knee joint effusion. After 1 week the inhibitor was diminished from 32 to 13 u.

scholarly journals Palliative Curriculum Re-imagined: A Critical Evaluation of the UK Palliative Medicine Syllabus

2018 ◽  
Vol 11 ◽  
pp. 117822421878037
Author(s):  
Julian Abel ◽  
Allan Kellehear
Keyword(s):  
Public Health ◽  
Social Support ◽  
Palliative Care ◽  
Palliative Medicine ◽  
Critical Evaluation ◽  
Well Being ◽  
Disease Models ◽  
Care Policy ◽  
The Uk ◽  
Illness And Disease

The UK Palliative Medicine Syllabus is critically evaluated to assess its relationship and relevance to contemporary palliative care policy and direction. Three criteria are employed for this review: (1) relevance to non-cancer dying, ageing, caregivers, and bereaved populations; (2) uptake and adoption of well-being models of public health alongside traditional illness and disease models of clinical understanding; and (3) uptake and integration of public health insights and methodologies for social support. We conclude that the current syllabus falls dramatically short on all 3 criteria. Suggestions are made for future consultation and revision.

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