Onlinepharmanews. Health News

CHOOSING NURSING HOME FOR OLDER PEOPLE: DRG SYSTEM AND MORE

admin — Tue, 01 Jun 2010 14:31:35 +0000

Ideally you will have the luxury of making a fully informed choice. In reality your options are likely to be more limited. If your relative is arriving from the community, the best homes tend to have long waiting lists. Priority is given to patients coming from hospitals. Even if your ideal choice has a wait years long, get on the list. Beds do open up.
If your relative is in the hospital, you may not have time to choose at all. Hospitals used to be paid by the day. According to a new reimbursement method called the DRG system, the hospital is now paid a fixed sum before admission according to the person’s “diagnostic related group” -the cost of an estimated “average length of stay” for that condition. This system was devised as an incentive to discourage unnecessarily long hospitalizations. Instead of benefiting economically by keeping patients longer, hospitals now benefit by discharging them sooner, because they collect the same fee regardless of how many days a person stays.
Critics of this system argue that it discriminates against the elderly because, being more frail, they tend to require more time than “average” to recuperate from illness or surgery. Apart from whether this argument has merit, the practical effect of the DRG system is this bottom line: your relative will be pressured to leave the hospital as soon as possible, pushed to accept the first available bed in any area nursing home. But you can forestall this by knowing in advance which homes are acceptable and telling the hospital social worker to call only them. So start your inquiries the minute you think institutional care may be needed -for instance, when your relative enters the hospital.

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GENERAL HEALTH

TAKING CARE OF OLDER PEOPLE: SELECTING NURSING HOME WITH CHECKLIST

admin — Tue, 01 Jun 2010 14:31:04 +0000

The physical plant. Is the home clean, well lit, relatively odor-free, laid out with a disabled person’s needs in mind? Do residents’ rooms contain personal belongings? What is the policy on bringing in such belongings? Is there enough room for privacy and an attractive place to sit outside?
You want a place that looks cheerful and is appropriate for people who have problems in walking or seeing or hearing well, where the environment minimizes excess disabilities. You also want an administration that is sensitive to a crucial human need – not to be parted from all the treasured possessions that are so essential to maintaining our sense of self.
The residents. Are they clean and well groomed? Are they kept occupied, or are most lying in bed or sitting and staring at the wall? Do not expect a camp atmosphere, but expect some residents to be happy and engaged. Approach some of these people, tell them who you are, and ask how they feel about the home. Expect complaints, but also expect to learn a good deal about whether this is a humane place.
The staff. Are they neatly dressed and well groomed? Are they on the floor helping residents? Do they appear to be caring, respectful, and conscientious, answering calls for help without delay? Linger with your eyes and ears open.
The meals and activities. Both are important events in the lives of nursing-home residents. Visit when a meal is being served. Does the food look appetizing, and are there substitutes for the main dish? Do residents who need it get prompt help with eating? Do most eat in the dining room? Visit the activities room. Is it well equipped and staffed? Is a list of activities posted? Do they seem varied, and does the selection include things your loved one would enjoy? Is an effort made to get residents out into the community and bring outsiders in? Is there a volunteer program?
The nursing home should be open to the community, and it should offer residents who are able regular opportunities to leave the grounds. As much as possible, it should also let residents exercise choice, in what they eat, in what they do. The ability to make choices enhances not only our psychological well-being but our physical health too.
The medical care. Are there physicians on the staff? Can residents select among them, or are they assigned a doctor? What hospitals are used if your loved one becomes ill? Is this home equipped to provide any needed specialized medical and rehabilitative care?
Health inspection information. Nursing homes are required by law to post the results of the most recent health inspection. However, since inspections occur infrequently and tend to focus on safety violations and the adequacy of the home’s physical plant, knowing an institution has passed will not tell much about the quality of care it provides. But information about violations and whether they are being corrected should be used along with your observations as a sign the home is good.
Admissions and cost. If the home seems acceptable, visit the admissions office. Is there a waiting list, and if so, how long? What forms are needed to apply, and how long are applications kept on file? If you are paying privately, what services are included in the basic rate, and what costs are extra? What is the refund policy for leaving prematurely? What is the procedure for applying for Medicaid?

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GENERAL HEALTH

BIOLOGICAL REASONS WHY YOU BINGE: SEROTONIN – WHAT DO YOU HAVE ON BREAKFAST?

admin — Wed, 28 Apr 2010 08:38:34 +0000

I am sure you have noticed that sweets have a calming, relaxing effect on you. They also make you drowsy and less alert. Have you also noticed that when you eat breakfast (which most overweight people do not eat) you feel drowsy and hungry by late morning? That’s not because you ate breakfast but because of what you had for breakfast.

Let’s suppose you had French toast or pancakes versus yogurt or cereal and milk. A carbohydrate breakfast of French toast or pancakes would raise your serotonin, causing you to feel tranquil but not very alert. If you had a business meeting at 10:30 A.M. you might have trouble staying awake and concentrating. A little more protein for breakfast might be better.

Too much protein and not enough carbohydrates would make it more likely that you will binge. High-protein, low-carbohydrate diets help to cause binge eating because they lead to lowered serotonin levels. Your body will crave carbohydrate foods on these diets in an attempt to increase serotonin.

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SLEEP PROBLEMS AT DIFFERENT AGES: TODDLERS

admin — Thu, 21 May 2009 06:59:30 +0000

Parents have a variety of complaints about their toddlers. Many toddlers refuse to go to bed at night. They will invent an extraordinary variety of reasons why they should stay up a little longer, and some parents dread the approach of bedtime as they know that they will inevitably get involved in a drawn-out struggle with the child.

Some toddlers are happy enough to go to bed but then refuse to sleep. Again, reasons, all of which, of course, are designed to involve the parents. They may be hungry, thirsty, need to go to the toilet (having just been), are afraid of the dark, or the dog, or something else, or just want to say one last thing to mummy or daddy, or are just not tired, and so on. All parents will be able to add to this list. The one thing that all of these excuses have in common is that they all are intended to involve the parents in giving a response. Indeed, as we shall discuss shortly, it is precisely because the parents respond that these behaviours continue. They are dependent on a response from the parents — once this is not forthcoming, they very quickly stop.

Other toddlers wake during the night, and either call out to their parents or else come out of bed to be with the parents wherever they are, including the parents’ bed. Again the continuation of this behaviour depends on the parents reinforcing it.

Some children have got so used to having a parent present when they go off to sleep that it may be impossible for them to go to sleep alone. The usual scenario is for the child to go to sleep in the parent’s arms, or at the breast, or with the parent lying alongside the child until he falls asleep. While in some families this is the norm, and without saying necessarily that it is wrong or leads to any long-term harm, it does mean that the parents should be resigned to having to be involved with the child falling asleep for a long, long time.

During the toddler period other sleep problems begin to emerge, such as nightmares, night terrors, sleepwalking and sleeptalking, as well as fears and phobias that may affect a child’s sleep patterns.

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CONSTIPATION – DESCRIPTION

admin — Mon, 18 May 2009 06:51:16 +0000

You are constipated if your motions are hard and you have difficulty opening your bowels. It doesn’t really matter if you don’t open your bowels very often, as long as your motions are soft and easy to pass when you do.

I’m sure you know some of the simple things that can cause constipation—not eating enough (especially not enough fibre), not drinking enough fluids, and lack of exercise. Certain drugs can make the bowel work sluggishly, including most painkillers, the chemotherapy drugs vinblastine and vincristine and some antacids. The barium that is given by mouth for X-rays of the stomach and intestines or in enema form for X-rays of the lower bowel is also very constipating. Constipation is one of the symptoms caused by excessive calcium in the blood.

Another possible cause for constipation is damage to the nerves which supply the muscle in the wall of the bowel. This can happen if you have a cancer growth pressing on the spinal cord or on the nerves as they pass through the pelvis. With constipation due to nerve damage, you may not be able to tell when you need to open your bowels. This is because the nerves which carry this message are often damaged along with the ones which supply the bowel muscle.

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RESUSCITATION – GENERAL INFORMATION

admin — Mon, 18 May 2009 06:28:08 +0000

You should learn how to do mouth-to-mouth resuscitation and teach it to your older children.

If breathing has stopped, place the patient on his back. Check to see whether his heart is beating. The pulse can be felt at the wrist or at the neck, or you can place your hand over his heart and feel his heart beat, or you can listen with your ear placed on his chest.

If the heart has stopped, the pupils of the eyes dilate and they do not respond to light. If the heart has stopped, you must begin external cardiac massage.

If the heart is still beating, but the breathing has stopped, the patient will show signs of cyanosis. This is the blue discoloration of the skin, more noticeable on the lips and other mucous membranes in a dark-skinned person. It is due to a build-up of carbon dioxide in the blood.

Check the mouth and remove any foreign body, such as seaweed, blood or vomit. In an adult you may have to remove false teeth. Do this quickly.

If possible place a small pillow or a folded towel or a coat under the shoulder blades. Kneel beside the head of the patient. Lift the lower jaw forward and keep this up all the time, otherwise the tongue will fall back and obstruct breathing.

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GLAUCOMA – DESCRIPTION

admin — Fri, 15 May 2009 09:07:09 +0000

The defect in vision usually affects the inner or nasal side and this loss is often not noticed because it falls into the binocular area covered by both eyes.

Later it may involve the outer area and so lead to “tunnel vision”, where it appears the vision is reduced to seeing straight ahead as if one were looking through a tunnel.

The visual loss may not involve the central area and so the person may still appear to have good vision with or without correcting glasses. Being unaware of the progressive loss, the sufferer may see no need to have his eyesight checked.

As in acute glaucoma, haloes may be seen on looking at bright lights. This phenomenon can occur in any condition which gives rise to oedema of the cornea. Once diagnosed, chronic glaucoma can usually be brought under control.

Pilocarpine has been the mainstay of treatment. It is instilled into the affected eye several times a day, constricts the pupil and so prevents the bunching up of the colored iris into the corner of the eye where the duct to drain away the fluid from the chamber behind the cornea is.

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HOME BIRTHS

admin — Fri, 15 May 2009 07:07:34 +0000

A generation has grown up not knowing that the large obstetric hospitals developed because of unsatisfactory results in home deliveries of babies.

Confinements are normal and mother and baby do well in 70 per cent of cases with no complications so for the majority it really doesn’t matter where the mother has the baby.

But what of the others?

Good obstetric care has meant a great drop in the maternal mortality. In NSW, in 1936, the maternal mortality was 6.3 per thousand live births and in 1977 0.13 per thousand live births. Babies have also benefited from this care.

Criticism of obstetric intervention is now com-monNand doctors are believed to resort too quickly to induction of births and caesarian section.

The Medical Journal of Australia, in talking about recent research in this area, says “… even if labor does not progress in a normal manner and manipulative interference is required, the outlook for the baby is not prejudiced.

“With the advent of ante-natal care, availability of blood transfusion and increased use of caesarian section, women began to expect a live baby from each pregnancy. As is shown from this research, modern obstetrics is ensuring the baby is not only alive, but well. We must avoid turning back the clock half a century because someone thinks that darkness is beneficial or the home environment is best for mother and baby.”

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TREATMENT OF SYMPTOMS – SYMPTOMS AND NERVOUS TENSION (PART 1)

admin — Fri, 15 May 2009 06:46:52 +0000

Everybody who has cancer is under some nervous strain some of the time. This shows itself in different ways in different people. Symptoms which can be due to nervous tension include difficulty sleeping, lack of energy, irritability, crying spells, loss of appetite, nausea, difficulty in swallowing, indigestion, stomach pains, diarrhoea, breathlessness, chest pains, palpitations, headache, neck pain and many others. Each of these symptoms can also have other causes. For example, nausea may be due to anxiety, but may also be due to cancer in the stomach, liver or brain, to chemotherapy, radiotherapy, stomach ulcers, a hangover, viruses, excessive calcium in the blood and so on.

It can sometimes be quite difficult to work out which factors are playing a part in producing a certain symptom. Often it is more than one. It is not unusual for symptoms that begin for a physical reason to be aggravated by nervous tension. For instance, anxiety about nausea with chemotherapy can aggravate it and even result in it starting before you have your injection or tablets.

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THE G.I. FACTOR AND WEIGHT REDUCTION: PLANNING LOW G.I. MEALS

admin — Fri, 08 May 2009 13:53:04 +0000

Breakfast

1. Start with a bowl of low G.I. cereal served with skim or low-fat milk or yoghurt.

2. Try something like All-Bran™, rolled oats (raw or cooked) or Guardian™.

3. If you prefer muesli, keep to a small bowl of low-fat muesli—check that it doesn’t contain added fats.

4. Add a slice of toast made from a low G.I. bread (or 2 slices for a bigger person) with a dollop of jam, sliced banana, honey, Vegemite™, marmalade, or light cream cheese with sliced apple. Keep butter or margarine to a minimum, or use none at all.

5. If you like a hot breakfast, try baked beans, a boiled or poached egg, cooked tomatoes or mushrooms with your toast.

Lunch

1. Try a sandwich or roll, with only a smear of margarine. Choose a bread with lots of whole grains through it (not just sprinkled on top) if you can, for a low G.I. factor. Add plenty of salad fillings.

2. For the filling choose from a thin slice of leg ham, pastrami, lean roast beef or chicken or turkey smallgood, or a slice of low-fat cheese, salmon or tuna (in brine), or an egg. An extra container of salad or vegetable soup will help to fill you up.

3. Finish your lunch with a piece of fruit, or fruit salad with a low-fat yoghurt, or a low-fat flavoured or plain milk.

Dinner

1. The basis of dinner should be high carbohydrate grains and root vegetables.

2. Eat as many vegetables as you can, using a small amount of meat, chicken or fish as an accompaniment rather than the main ingredient.

3. Use lean meat like topside beef, veal, new-fashioned pork, trim lamb, chicken breast, fish fillets, turkey. Red meat is a valuable source of iron—just choose lean types. A piece of meat, chicken or fish that fits in the palm of your hand (no fingers) fulfils the daily protein requirements of an adult.

4. If you prefer not to eat meat, a cup of cooked dried peas, beans, lentils or chick peas can provide protein and iron without any fat. At the same time they supply low G.I. carbohydrate and fibre.

5. Sanitarium products such as Nutmeat™, Casserole Mince™ and tofu are based on high protein legumes like soya beans and peanuts and are good meat alternatives.

6. Boost your fruit intake and get into the habit of finishing your meal with fruit—fresh, stewed or baked—or try a fruit ice, such as Vitari™.

Snacks

1. It is important to include a couple of dairy food serves each day for your calcium needs. If you haven’t used yoghurt or cheese in any meals, you may choose to make a low-fat milkshake. One or two scoops of low-fat ice cream or custard can also contribute to daily calcium intake.

2. If you like grainy breads, an extra slice makes a very good choice for a snack. Other snacks can include toasted English-style muffin halves, a crumpet with a smear of margarine, bagels or fruit loaf.

3. Fruit is always a low kilojoule option for snacks. You should aim to consume at least 3 serves a day. It may be helpful to prepare fruit in advance to make it accessible and easy to eat.

4. Low-fat crackers (like water crackers) are a low kilojoule snack if you want something dry and crunchy, although they may not be as sustaining as a grainy bread. Popcorn (home prepared with a minimum of fat) is another good alternative.

5. Keep vegetables (like celery and carrot sticks, baby tomatoes, florets of blanched cauliflower or broccoli) ready prepared to snack on, too.

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