Vorige pagina Drie vragen over mantelzorgondersteuning artikel - 4 november 2014 Drie vragen over mantelzorgondersteuning
Zoveel mensen, zoveel wensen. Dat principe gaat absoluut op voor de ondersteuningsbehoeften van mantelzorgers. De gemeentelijke taak hierin wordt vanaf 2015 een stuk groter door de nieuwe Wmo. Aan de slag dus! Maar hoe? Twee adviseurs van Movisie beantwoorden drie vragen.
1. Hoe kunt u als gemeente mantelzorgers waardering geven?
Michelle Emmen: 'Mantelzorgers voelen zich het meest gewaardeerd door een combinatie van waardering én een tegemoetkoming in de kosten van mantelzorg. Dat laatste is niet zo vreemd: gemiddeld betalen mantelzorgers per jaar 1.100 euro extra kosten. Met een tegemoetkoming kunt u creatief omgaan. Denk aan een gemeentelijke kortingspas voor diensten als de bioscoop, restaurants of sportieve activiteiten. Dit gebeurt bijvoorbeeld in Den Haag. Extra voordeel: doordat mantelzorgers de pas aanvragen, heeft u meteen een beter beeld van het aantal mantelzorgers in uw gemeente.' 2. Hoe betrekt u mantelzorgers bij het keukentafelgesprek?
Ilse de Bruijn: 'Vraag meteen bij de melding of aanvraag voor een Wmo-voorziening of er iemand in de omgeving is die zorg en ondersteuning voor zijn of haar rekening neemt. Nodig diegene expliciet uit voor het keukentafelgesprek. Idealiter vinden deze gesprekken ook ‘s avonds plaats zodat ook de werkende mantelzorger erbij kan zijn. Het is belangrijk dat de professional over de juiste vaardigheden beschikt om een evenwichtig gesprek te voeren met zorgvrager én mantelzorger. Om professionals hiervoor te scholen, is in Amsterdam een E-module ontwikkeld. Aan bod komen: het erkennen van mantelzorgers, het bespreekbaar maken van hun situatie, het herkennen van mogelijke overbelasting en het bespreken van ondersteuningsmogelijkheden.'
Het deurknopeffect: een mantelzorger vertelt vaak pas na afloop bij de deur hoe het écht gaat
Michelle Emmen: 'Een gesprek met zorgvrager én mantelzorger biedt de kans om ondersteuningsbehoeften en -mogelijkheden expliciet te maken. Als gemeente zult u de afweging maken om met de mantelzorger een apart gesprek te hebben, los van de zorgvrager. Vaak hoor je namelijk van het deurknopeffect: als de mantelzorger je na afloop van het gesprek naar de deur brengt, vertelt diegene pas hoe het écht met hem of haar gaat.' 3. Welke ondersteuning mag niet ontbreken in een gemeente?
Michelle Emmen: 'Bij deze vraag denk ik in eerste instantie aan respijtzorg en aan het faciliteren van mantelzorgers. Respijtzorg ontlast de mantelzorger tijdelijk van zijn mantelzorgtaak en is één van de taken die vanuit de AWBZ naar de Wmo gaat. Goed om te weten: mantelzorgers doen minder een beroep op respijtzorg dan ze eigenlijk willen.' Ilse de Bruijn: 'Dit komt onder meer door onbekendheid met alle ondersteuning en de moeite om het mantelzorgen los te laten. Professionals die met de zorgvrager en mantelzorger spreken, kunnen het ondersteuningsaanbod actief uitdragen en mogelijke drempels om er gebruik van te maken wegnemen. Op deze manier benut je de natuurlijke vindplaatsen.' Ilse de Bruijn: 'Materiële hulp die in eerste instantie bedoeld is voor zorgvragers kan voor mantelzorgers groot verschil maken. U kunt dus ook een woningaanpassing, mantelzorgwoning, huishoudelijke hulp, parkeerkaart of aangepast vervoer toewijzen als ondersteuning voor de mantelzorger.' Wat zegt de Wmo 2015 over ondersteuning van mantelzorgers? - De gemeenteraad moet in het beleidsplan opnemen hoe mantelzorgers worden ondersteund. - Gemeenten bepalen per verordening hoe mantelzorgers jaarlijks een blijk van waardering ontvangen; de opvolger van het huidige mantelzorgcompliment. - Om mantelzorgers te ondersteunen zodat zij het mantelzorgen kunnen volhouden, wordt de mantelzorger betrokken bij het keukentafelgesprek. - De eigen mogelijkheden van de cliënt én de mantelzorger zijn het uitgangspunt in de Wmo. In het gesprek 'aan de keukentafel' wordt niet alleen gekeken wat de zorgvrager nodig heeft, maar óók wat de mantelzorger nodig heeft aan ondersteuning om die rol te kunnen vervullen. - Mantelzorgers die zelf onvoldoende zelfredzaam zijn, kunnen ondersteuning (een maatwerkvoorziening) van de gemeente krijgen. - In de nieuwe Wmo staat dat gemeenten aandacht moeten besteden aan de manier waarop mantelzorgers en vrijwilligers ondersteund worden. Gemeenten zijn verplicht om in ieder geval algemene voorzieningen te treffen die mantelzorgers ondersteunen.
The report – SANS Health Care Cyber Threat Report (email registration here) – was sponsored by Norse (a threat intelligence vendor) who provided the data to SANS Institute for analysis. As described on their website (here):
SANS is the most trusted and by far the largest source for information security training and certification in the world. It also develops, maintains, and makes available at no cost, the largest collection of research documents about various aspects of information security, and it operates the Internet’s early warning system – the Internet Storm Center.(www.sans.org)
Senior SANS Analyst and Healthcare Specialist Barbara Filkins authored the report which included some startling analysis.
The data analyzed was alarming. It not only confirmed how vulnerable the industry had become, it also revealed how far behind industry-related cybersecurity strategies and controls have fallen.
During the sample period [09/2012 to 10/2013], the Norse threat intelligence infrastructure – a global network of sensors and honeypots that process and analyze over 100 terabytes of data daily – gathered data. The intelligence data collected for this sample included:
49,917 Unique Malicious Events 723 Unique Malicious Source IP addresses 375 U.S.-based health-care related organizations were compromised
A SANS examination of cyberthreat intelligence provided by Norse supports these statistics and conclusions, revealing exploited medical devices, conferencing systems, web servers, printers and edge security technologies all sending out malicious traffic from medical organizations. Some of these devices and applications were openly exploitable (such as default admin passwords) for many months before the breached organization recognized or repaired the breach. Barbara Filkins – SANS Analyst and Healthcare Specialist
One reason for the alarm – this was all just a sample data set. The report identified all categories in healthcare as having been compromised and in some instances – still open and vulnerable.
Health care providers – 72.0% of malicious traffic Health care business associates – 9.9% of malicious traffic Health plans – 6.1% of malicious traffic Health care clearinghouses – 0.5% of malicious traffic Pharmaceutical – 2.9% of malicious traffic Other related health care entities – 8.5% of malicious traffic
Even though the largest single category of malicious traffic was identified as health care providers, the report highlighted one medical device company in Florida (Site One) as having a significant number of events (over 12,000) during the reporting period.
The list of exploited devices included medical devices, conferencing systems, web servers, printers and edge security technologies that were all sending out malicious traffic from medical organizations. Surprisingly, the two biggest categories of risk were security devices themselves and then devices that fall more broadly into the Internet-of-Things (IoT). Newer versions of devices like dialysis and MRI machines are often “network” attached.
Connected medical devices, applications and software used by health care organizations providing everything from online health monitoring to radiology devices to video-oriented services are fast becoming targets of choice for nefarious hackers taking advantage of the IoT to carry out all manner of illicit transactions, data theft and attacks. This is especially true because securing common devices, such as network-attached printers, faxes and surveillance cameras, is often overlooked. The devices themselves are not thought of as being available attack surfaces by health care organizations that are focused on their more prominent information systems. SANS-Norse Report
The example of an IP connected device (in this case a video surveillance camera with default security settings) was highlighted as an easy entry point where access could then be extended to other devices on what the organization would likely consider their secure and private network.
Perhaps the most chilling aspect of the report (aside from the enormous financial liability for healthcare entities) was the potential consumer liability associated with Medical Identity Theft (largely around electronic medical record software and “personal health information”).
In the e-commerce world, consumers have some protection from theft and fraud. In the healthcare world, consumers are directly responsible for costs related to compromised medical insurance records. A survey last year by the Ponemon Institute estimated the cost of Medical Identity Theft to consumers at $12 billion for 2013 (here).
The larger consumer risk isn’t financial – it’s the life-threatening inaccuracies in the medical records themselves (often used for committing the financial fraud). According to the Ponemon survey (sponsored by the Medical Identity Fraud Alliance) victims reported these medical risks:
15% of respondents experienced a misdiagnosis 13% of respondents experienced a mistreatment 14% of respondents experienced a delay in treatment 11% of respondents were prescribed the wrong pharmaceutical 50% of respondents have done nothing to resolve the incident
The largest single takeaway from the report for the HIPAA-obsessed healthcare industry could well be this one.
Press of Atlantic City Everyone Has a Story: Home-care nurse honored after forming friendship with ... Press of Atlantic City Regina Derby, holding flowers at her awards ceremony in Charlotte, N.C., in May.
Polly Toynbee: The right to die in peace will be hard fought because of unfounded fears of a 'slippery slope', but we need to change the law
Jan Bergmans's insight:
For the generation that won on abortion, contraception and gay liberation, the principle was always the right to do what you like with your own body – and that includes a right to die in peace. All these freedoms were won in the face of ferocious opposition from the same hell-in-a-handcart brigade. I had thought all minds were made up, ideological battle lines uncrossable, so Lord Carey, former evangelical archbishop, is a most unlikely and thus especially welcome convert to the assisted dying cause. Archbishop Tutu's eloquent abhorrence at Nelson Mandela's last days offers a perfect example of why dignity in death is an essential part of a good life.
The arrival of these Christian leaders, both well experienced in death-bed scenes, breaks the notion that life is sacred and only God can dispose of us in his own good time. But that still guides the current archbishop of Canterbury, as well as the Catholics and other faiths that pack the Lords in greater numbers than among the public. How odd that many Catholics pray to St Joseph for a good death, and yet deny it to themselves. Scrape below the surface and you will see during Friday's debate that almost all speaking against this freedom are religious, but they will shroud faith reasons behind other arguments.
Those, like me, who have watched a parent die too slowly and painfully, yearning for a quicker end, would want to escape that fate ourselves, making our choice, in our own good time. Switzerland's Dignitas clinic is a grim way to go, yet one Briton each fortnight takes that lonely route for fear of an agonising death here. The myth of the good death on morphine needs to be exposed: there is no dreamy drifting away. Hallucinations can be terrifying and months of extreme and humiliating constipation bring a death not focused on eternities, but on the bowels. Nor do opioids necessarily relieve, let alone remove severe pain. None of us knows until the time comes what pain we can withstand, what value we will place on our last days of life or if we want to end it sooner. But 80% of people wisely say they want that choice, according to polls over many years.
Of all the bad arguments, the most common is the infamous "slippery slope", warning this will lead to extermination of all imperfect or inconvenient human beings. Let the dying depart a few months before the end and gas chambers for the feeble minded will follow. Greedy relatives will press the potion on their parents, eager for the inheritance or just to be rid of the muddles and puddles of the decrepit. The "slippery slope" imbues all moral panic arguments – do this, and other direst consequences follow, as night does day. Slippery slopes have the left accusing any act on the right as the path to fascism or the right claiming anything social democratic leads down the road to Stalinism. We all stand on slippery slopes, if the alternative is to stand at an extreme at either end. But law exists as perpetual arbitrator of slippery slopes – thus far and no further – in every aspect of life, defining, refining, grading degrees of acceptability in a world of shifting greys.
This bill slips down no slopes, as Lord Falconer's safeguards are solid. Two doctors, acting independently, must confirm a patient is likely to die within six months, is of sound mind, has decided without pressure, is told of palliative options and is able to take the medication themselves, after a cooling-off period of reflection. A sunset clause means the law is repealed in 10 years, requiring parliament to vote it in again. How often will it be used? After 17 years of Oregon's Death with Dignity Act 80 people out of 30,000 deaths used it last year. Peace of mind is knowing you can.
If ever parliament wanted to extend the right to die to those such as quadriplegic Tony Nicklinson, then that debate will be had. I would favour it, others wouldn't, but it's a new discussion on another law, not a slippery slide. Eventually, my guess is that law would be passed too, because again it has overwhelming public support. But that's no reason to refuse the Falconer bill.
Another bad argument is that the frail will be intimidated into hastening the end of their lives so as not to be a burden on their children. Well, why not? I would not choose to put unbearable caring duties on my four children. I hope not to leave them with a miserable memory of a wretched prolonged and agonising end. That's not a bad reason.
Finally, opponents say the right to die is a dangerous substitute for good care, but that's disingenuous. I've worked in an old people's home and visited dementia wards where no one wants to be. Blame the lack of money or care, do better – but in truth, what saddens most is the wretched condition of the people themselves, often openly asking for death.
A high proportion of NHS costs are spent on the last six months of life – and badly spent. Aversion to facing the inevitability of death is expensive and rarely conducive to ensuring people die well. I think I am not overly afraid of dying, but I won't know until I get there. What I do know is that I greatly fear departing through the torture chamber.
Today yet more distinguished doctors write to members of the House of Lords in support of the bill: polls find more doctors want the right to die for themselves than don't. On this bill more peers have requested to speak than on any bill ever. If opponents think they have the numbers, they'll push for a vote on a wrecking amendment, a delay with an imaginary royal commission. If not, it will pass the Lords by December, when it is for the government to find time in the Commons – of which snowballs have a better chance in hell. MPs are afraid of the religious in their constituencies before the election – even though no seat was ever won or lost on these moral issues. Falconer's hope is that parties will at least put a promise of a Commons vote in their manifestos, but parliament has always trailed far behind the public on moral matters. This craven cowardice is one reason politicians are so despised.
Dodelijke blikken Thuis kijk ik in zijn portemonnaie. Nog even hoop ik dat daar die nieuwe pas in zit. Maar dat is niet zo. Wél die van die andere rekening. Maar... die pas wordt nooit gebruikt. Ik weet de pincode niet en vraag me af of Wim hem wel weet. Ik rijd terug naar de bank, waar Wim me hoopvol aankijkt. "Weet jij de pincode van deze pas?", vraag ik hem. En wat ik al vreesde, hij weet het ook niet. Ondertussen worden zijn blikken naar mij weer dodelijk. En de mevrouw van de bureaucratische veiligheidshandelingen mag er ook van mee genieten. Ik ga gewoon verder met de mevrouw: "Hoe lossen we dit op?". Ze kan voor de ene rekening een melding doen dat de pas nooit is ontvangen en een nieuwe pas aanvragen, en voor de andere een nieuwe pincode. Allebei duurt het vier dagen. Wim laat zijn ongenoegen hoorbaar blijken. Ik negeer het. "Oke, laten we dat doen", zeg ik. "Dat aanvragen van die pincode moet telefonisch, ik zal nu meteen voor u bellen", zegt de mevrouw. Ze belt. Blijkbaar vraagt degene aan de andere kant van de lijn waarom de eigenaar van de pas dan niet zelf belt. "Ja, dat kan niet", zegt de mevrouw. Daar neemt die ander blijkbaar geen genoegen mee. "Meneer staat hier met zijn vrouw voor me bij het loket, en ik bel voor hem...... nee, meneer kan zelf niet bellen.... nee, dat is technisch onmogelijk zeg maar." Ze loopt rood aan in haar hals en lijkt boos op degene aan de andere kant van de lijn. "Nee.... technisch onmogelijk..". Ze voelt zich duidelijk ongemakkelijk en wil blijkbaar waar wij bij zijn niet benoemen dat Wim door de telefoon zeer moeilijk te verstaan is. Ik moet er wel om lachen en besluit haar een handje te helpen. "Zeg maar dat meneer een spraakprobleem heeft". Ze zuchtte van opluchting. "Ik bel omdat meneer een spraakprobleem heeft" zei ze toen. En ja, toen was het geregeld. Nu gewoon even vier dagen wachten en dan gaan we nog een keer. Om de pincode op te halen en om het telefoonnummer door te geven voor het ontvangen van de TAN codes. Dat kan dan ook met de nieuwe pas, die dan weer wel gewoon per post toegestuurd wordt. Allemaal voor onze eigen veiligheid.....
Onmacht Als we buiten zijn zegt Wim tegen me: "Jij hebt vast vorig jaar die nieuwe pas doorgeknipt in plaats van de oude". Ja, dat zou goed kunnen. Zo'n kluns ben ik soms. Hij lacht naar me: "Wat een stel zijn wij toch he?" Ik lach terug en vergeet ogenblikkelijk mijn frustratie over zijn dodende blikken en verwijtende opmerkingen. Het is allemaal onmacht.
We may be changing, but we’re not dead yet. I think people who are younger than us—like our adult children—are often confused about how to react to our diminishing abilities.
Jan Bergmans's insight:
To read the entire article click here. If you know someone who might find my material useful, please ask them to visit stangoldbergwriter.com and become a subscriber. There is a free ebook on change waiting for them. Thanks for your help.
In 2009 I wrote, When the Ground Shakes, an article in which I described finding my mother coming out of a forested area holding a bunch of sticks and twigs. In response to my question of what she was doing, she replied, “straightening out the forest.” Now, twenty years after I was mystified by her …
Jan Bergmans's insight:
In 2009 I wrote, When the Ground Shakes, an article in which I described finding my mother coming out of a forested area holding a bunch of sticks and twigs. In response to my question of what she was doing, she replied, “straightening out the forest.” Now, twenty years after I was mystified by her behavior, I find myself doing the same thing.Click here to read the entire article.
If you know someone who might find my material useful, please ask them to visit stangoldbergwriter.com and become a subscriber. There is a free ebook on change waiting for them. Thanks for your help.
Unlike any other workshop in the world of healthcare information technology today!
Hacking Healthcare 2015 (HH2015) has been crafted from the ground up, to provide healthcare information technology professonals with the latest intelligence and best practices for safeguarding their complex environments.
Hacking Healthcare 2015 is a no-excuses, check the politically correctness at the door, keep your hands in the vehicle at all times, high energy, fast paced program. During our time together, you will be immersed in the most cutting edge cyber-security & privacy information. You will learn about and explore threats specific to healthcare, attack analysis methodologies from the inside out, dispel common myths and beliefs regarding the world of cyber-security and much more!
Hacking Heatlhcare 2015 will assure that you...
* Understand the top threats facing HIT organizations for 2015.
*Gain in-depth insight into threats associated with bio-medical devices.
*Develop a holistic set of cyber-security/privacy strategies for addressing core threats in 2015.
*Gain a clear understanding of your attack surface and potential attack pivot points.
*Ratify a strategy for dealing with business associates and reducing their threat to your systems.
*Go beyond the common and understand the world of malware and cyber-munitions.
...and that is by the end of the first day!
Your primary guide, coach and instructor during your journey will be John Gomez, CEO and Founder of Sensato. Sensato, and John, are unique as their entire DNA is focused on healthcare security and privacy. As you may know, John was the CTO/co-President of Allscripts and former CTO of Eclipsys. He is also the ex-CTO of WebMD and has over 14 years of experience in desigingg healthare information technology systems. John is one of the few technologists in the industry who has gone from designing and developing worldclass healthcare technology systems to breaking and hacking them; with the single goal of ultimately making healthcare technology safer and more secure.
Regardless if you represent a small or large physician practice, retail pharmacy, community healthcare organization, large scale delivery network, payer, pharma, or technology vendor this workshop is for you. Hacking Healthcare 2015 takes a holistic view of healthcare information technology and the content has been developed to be applicable across the healthcare ecosystem.
Given the sensitive nature of the information presented, workshop attendance requires that you are affiliated with a healthcare provider, payer or vendor. We are also limiting the attendance to assure there is ample opportunity for interaction with instructors and colleagues. Registration will be closed as soon as we reach our attendance limits - so please confirm your attendance as soon as possible.
Christmas won’t be spoiled for us for ever. A wise friend of Kate’s, who lost his own wife years ago, told us that because he remembered and thought about her every day the “big” days (anniversaries and Christmas) held no fears. I think he is right.
Kate once said, in relation to a mother’s love for her children, that “worry is love’s currency”. Well, for the first time in two years I don’t wake up worrying how she is. And two years of advance grieving has helped prepare us for today.
It has helped to have the love of family and friends, and the kindness of strangers, the thousands of messages we have received. Newspaper obituaries (I hadn’t realised until now quite how much it helps to have the life of someone you love rounded off in this way).
It helps that we can feel so proud of Kate’s work. She had always been high achieving. In her 20s she worked closely with two prime ministers; at 30 she was CEO of a charity that supported fragile democracies in Africa, hanging out with heads of state and wealthy American philanthropists. There are lots of babies who wouldn’t be alive now without Kate’s work, lots of children being educated, lots of parents able to find work and feed their families.
More than anything, it helps that we have Kate’s book, Late Fragments, written so that her sons may one day discover who she was and what she held dear. If anything good is to come from losing Kate, it will be that book and the effect it has on all who read it. Kate had, as her friend Katy Brand, the actress, said to her, the ability “to choose just the right word – to roll all the words around your head like ball bearings, until the perfect one drops into the hole”. But if not for the cancer, she probably wouldn’t have become a writer – like most high-flying working parents, she wouldn’t have had time.
The last two years taught us the importance of time, of stepping off the treadmill. As Kate writes in her book: “Everything has changed and yet nothing has changed. In other words, the petty frustrations and stupid ambitions and general rushing around have melted away, but the good stuff remains. And it’s better than ever.”
Because of the Nuisance, we became a much closer family. We bridged the distances that grow between parents and their adult children and came to know and admire Kate and Jo, much more than we would have otherwise. We became part of Oscar and Isaac’s daily lives instead of occasional visitors. And we were – and still are – overwhelmed at the way Kate’s friends and our own have responded to her illness.
I’ve learned that there is more love in the world than I ever knew and that perhaps all we need to do is learn to ask for what we need.
• Kate Gross died peacefully at home from colon cancer on 25 December 2014. Kate finished writing her book in September and received finished copies a few weeks before her death. She leaves behind her devoted husband, Billy Boyle, and her five-year-old sons, Isaac and Oscar.
Late Fragments: Everything I Want to Tell You (About This Magnificent Life) by Kate Gross is published by William Collins, £14.99. To order a copy for £11.99, including free UK p&P, go to bookshop.theguardian.com or call 0330 333 6846
So, as the New Year hangovers finally, gently, fade away, why don't we consider what it is that we really do want in a healthcare system. And even, well, who manages to do this quite well?
Do not fear, we are not about to find that the answer is the US. That really is God's Own Clusterfuck of a system. All the problems of a market system and almost none of the benefits. Quite how any nation can manage that is beyond belief.
To start with, we should probably note that nobody really actually sat down and planned their healthcare systems. When economists discuss this sort of thing they peer over their glasses, mutter “path dependence” and then move on to simpler subjects.
The point they're trying to make is that sometimes shit just happens and which turd depends upon what has been eaten beforehand. With healthcare systems the general view is that they didn't actually do very much before about 1940. They might provide bed rest and hydration (hey, don't knock it, still the basic treatment for both flu and Ebola), and quarantine of certain infectious diseases, but not hugely more.
It was really only with the introduction of broad spectrum antibiotics that what we now regard as a proper healthcare system began to be possible. There had been huge increases in public health in the preceding century but this was public health: better diets, sewage, clean water, changes of clothes to beat lice and so on.
By nationalising all extant healthcare facilities and calling them "the NHS", the NHS performed healthcare in extant facilities
The path dependence bit here is that various countries cobbled together their systems from the ideas that they had to hand as that technological change came through. Over in the US, FDR had imposed (and managed by JK Galbraith) price and incomes controls to deter inflation during WWII. However, perks were not considered incomes to be controlled.
Thus American companies competed for labour by offering (tax free!) healthcare insurance. Thus when a proper healthcare system really became technologically possible, that's the system they went with: employer provided and tax free healthcare insurance. Over here in Blighty we had an almost Stalinist mindset about these things.
For example, George Orwell had TB and there was a new American drug (another of the new antibiotics) which was having some success in treating TB. He got some, was treated, was allergic to it (his fingernails fell out), stopped the treatment and died.
However, how he got the drug is informative. He had some US dollars, in the US, royalties from the US sales of one of his books (1984 I think? Or maybe Animal Farm, either is darkly humorous when connected to this story). Yes, sure, the UK was broke after WWII, foreign currency was at a significant premium but it was his money after all.
Yet when he applied for permission (Oh Yes! Permission to spend your own money in a foreign land was required) he was refused. So he asked again, having the odd contact, and a deal was agreed in which he could only spend his own money on his own drugs if he also bought more to treat other patients. Which he did – some were cured and he wasn't.
Maybe that's a fair enough reaction from the government and maybe it isn't but in a time when that was considered normal behaviour there's nothing really odd about the government of the day deciding to create the NHS as a centralised and monolithic state entity.
By nationalising all extant healthcare facilities and calling them 'the NHS' (please do note, they didn't “build” the NHS, the first NHS-built hospital didn't open until 1963), the NHS simply performed healthcare in extant facilities).
Other countries similarly built their healthcare systems with what was to hand in the form of resources and extant ideas. That's the theory at least and it explains some of the variance we've got over the different countries.
November 19, 2014 8:15 PM At least once in your life someone will say to you, “I have cancer,” and when those three words are spoken, you may struggle with a response. In my new ebook, “I HAVE CANCER” 48 THINGS TO DO WHEN YOU HEAR THOSE WORDS, I provide 48 specific suggestions that will support your loved one or friend on this unsettling journey you both will travel. The suggestions range from the simplicity of compassionate listening to the gut-wrenching preparation for death.
The reviews from the medical community, cancer researchers, people living with cancer, and those caring for loved ones with cancer have been humbling. You can read them and order the book at http://bit.ly/1xEqgjx.
Until November 30, it is available on Amazon as a pre-order for $.99. On December 1st it will be sold by all online booksellers for $3.99.
I’ve added a new section on my website “Thoughts for the Day”, a collection of daily observations ranging from 50 to 300 words. http://bit.ly/1uIT0YV Not enough for an article, but too much for a tweet. I’ll try to post Monday through Friday. Please let me know what you think.
And as always, if you don’t wish to receive these occasional announcements, please write “op out” on the message line and I’ll remove you from my connection list. Sorry for the intrusion.
Afgelopen weekend mijn 59e verjaardag gevierd in het prachtige Vielsalm in de Belgische Ardennen met alle kinderen en kleinkinderen. Ik had daar een 14-persoons huis gehuurd voorzien van alle gemakken met drie badkamers, een fitness-ruimte en een sauna. Geweldig om zo een paar dagen en nachten al het gebroed om me heen te hebben. Het weer was ook prima en daardoor hadden de kleinkinderen het geweldig naar hun zin in Plopsa Coo. Zondag was het wat miezerig en dat resulteerde in een bezoek aan het Abdijmuseum in Stavelot. De benedenverdieping was het voor mij helemaal. Daar staan alle herinneringen aan het circuit Francorchamps
The degree of Openness to Experiences reported by patients with bipolar disorder could be used to identify potential candidates requiring more comprehensive cognitive assessments, US researchers report.
Jan Bergmans's insight:
They found that Openness to Experiences, particularly Openness to Ideas, correlated significantly with measures of cognitive function in their study of 283 patients with bipolar disorder and 110 mentally healthy controls.
Therefore “low Openness to Ideas scores (e.g., below the 9th percentile) may serve as an additional indication to refer [bipolar disorder] patients for whom cognitive functioning is a clinical concern to a specialty cognitive evaluation”, write Deborah Stringer and colleagues, from the University of Michigan in Ann Arbor.
In addition to Openness, the researchers assessed Neuroticism, Extraversion, Conscientiousness and Agreeableness using the 240-item self-reported NEO Personality Inventory – Revised. They also measured cognitive variables such as attention, executive functioning, memory and fine motor skills.
Contrary to expectations, Neuroticism and Extraversion were not significant predictors of cognition in either the patients or controls, even though scores for both of these personality traits were significantly lower in the patients than in the controls.
In fact, Openness was the only personality trait that correlated significantly with any cognitive factor in both patients and controls.
Among the patients, Openness to Ideas correlated with seven of the eight measures of cognitive function – visual and verbal memory, emotion processing, verbal fluency/processing speed, conceptual reasoning/set shifting, processing speed/interference resolution and inhibitory control. There was no correlation with fine motor score.
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Openness to Values correlated significantly with five of the eight cognitive factor scores (all but visual memory, conceptual reasoning/set shifting and inhibitory control) while Openness to Fantasy, Feelings and Action each correlated with two to three cognitive factor scores. The final Openness facet, Openness to Aesthetics was not associated with any measure of cognitive function.
In the control group there was moderate, but still significant, correlation between emotion processing and Openness to both Ideas and Values and between fine motor score and Openness to Values.
In multivariate models, Openness to Ideas explained between 2.3% and 6.5% of variance in cognitive scores.
Writing in the Journal of Affective Disorders, Stringer and co-authors suggest that “[i]nterventions designed to encourage novel experiences and an intellectual approach to existing interests are rational treatments for bipolar individuals with modest disruptions in cognitive functioning.”
However they caution that although Openness “is a useful predictor of cognitive functioning, its use does not extend across all the cognitive constructs […] measured, nor does the amount of variance it explains provide enough incremental predictive power to completely solve the problem of whom to refer for complete cognitive assessment.”
LeBlanc: When dementia patients refuse to take medication Hernando Today If you get frustrated with or angry at them, they're going to feed off of that and you'll never get them to take their medication.
Definition of Primperan Reglan in the Medical Dictionary by The Free Dictionary
Jan Bergmans's insight:
[met′əklō′prəmīd]a GI motility agent.indications It is prescribed to stimulate motility of and increase the tone of gastric contractions of the upper GI tract and to prevent emesis.contraindications A history of seizures; concomitant use of drugs that cause extrapyramidal reactions; pheochromocytoma; GI hemorrhage, obstruction, or perforation; or known hypersensitivity to this drug prohibits its use.adverse effects Among the more serious adverse effects are extrapyramidal reactions, usually in children, and GI disturbances. Drowsiness and allergic reactions and rash also may occur.
There are a lot of myths about what it really means to love people. These simple guidelines may help you love without losing or compromising yourself.
Jan Bergmans's insight:
. Tell them about their brilliance. They likely can’t see it and they don’t know its immensity, but you can see it, and you can illuminate it for them.
2. Be authentic, and give others the gift of the real you and a real relationship. Ask your real questions. Share your real beliefs. Go for your real dreams. Tell your truth.
3. Don’t confuse “authenticity” with sharing every complaint, resentment, or petty reaction in the name of “being yourself.” Meditate, write, or do yoga to work through anxiety, resentment, and stress on your own so you don’t hand off those negative moods to everyone around you. Sure, share sadness, honest dilemmas, and fears, but be mindful: don’t pollute.
4. Listen, listen, listen. Don’t listen to determine if you agree or disagree. Listen to get to know what is true for the person in front of you. Get to know an inner landscape that is different from your own, and enjoy the journey. Remember that if, in any conversation, nothing piqued your curiosity and nothing surprised you, you weren’t really listening.
5. Don’t waste your time or energy thinking about how they need to be different. Really. Chuck that whole thing. Their habits are their habits. Their personalities are their personalities. Let them be, and work on what you want to change about you—not what you think would be good to change about them.
6. Remember that you don’t have to understand their choices to respect or accept them.
7. Don’t conflate accepting with being a doormat or betraying yourself. Let them be who they are, entirely. Then, you decide what you need, in light of who they are. Do you need to make a direct request that they change their behavior in some way? Do you need to take care of yourself better? Do you need to set a boundary or to change the relationship? Take care of yourself well, without holding anyone else in contempt.
8. Give of yourself, but never sacrifice or compromise yourself. Stop if resentment is building and retool. Don’t do the martyr thing. It helps no one and nothing.
9. Remember that everyone you encounter was created by divine intelligence and has an important role to play in the universe. Treat them as such.
10. If you want to keep growing emotionally and spiritually for the rest of your life, accept this as your mantra and try to live as if it were true: Everything that I experience from another human being is either love, or a call for love.
Sinds een maand roei ik weer. Het was vijftien jaar geleden dat ik voor het laatst in zo'n slanke roeiboot op het water zat en ik was benieuwd of ik het nog zou kunnen. Al jaren kriebelt het als ik roeiers op het water zie. "Ik wil dat ook weer gaan doen", zeg ik dan tegen Wim. "Waarom ga je dan niet?", is steeds zijn reactie. Jarenlang had ik allerlei (mantelzorg)excuses om maar niet te gaan. Ik vond het vervelend voor Wim, vond dat ik thuis moest zijn enzovoort. Maar dit voorjaar was de tijd er rijp voor en ik ging. En... ik heb me in vijftien jaar niet zo vitaal gevoeld. Hoe het zover kwam?
In zo'n slanke roeiboot...
Vijftien jaar geleden was ik 40 jaar. Alles zat tegen. Scheiding, ontslag, verhuizen maar toch net niet, vader overleden na kort ziekbed.... Ik zat in een echte midlifecrisis en had nergens puf voor. Samen met mijn twee kinderen zien te overleven, dat was het. Langzaamaan hervond ik mezelf. Ik kwam per ongeluk in Kenia terecht, waar mijn kijk op het leven 180 graden draaide. 'Druk, druk, druk", om te scoren in mijn werkomgeving, zou je mij daarna nooit meer horen zeggen. Ik volgde een opleiding tot hypnotherapeut, waarvan ik achteraf zeg dat het vooral twee jaren waren waarin ikzelf in therapie was. Ik leerde er te vertrouwen op mijn intuïtie. Na zeven jaar alleen, en mezelf enigszins te hebben hervonden, was er weer ruimte voor een man in mijn leven.
International researchers, who want to harness nuclear fusion to develop sustainable, clean energy, now have a much more powerful supercomputer to facilitate their work. The French Alternative Energies and Atomic Energy Commission (CEA) is increasing the power of the Helios supercomputer in Rokkasho, Japan, from 1.5 Petaflops to nearly 2 Petaflops by adding new Intel…
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