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An easy and reliable method of distinguishing bipolar disorder from major depressive disorder could save tens of thousands of lives, and transform millions more. Now researchers at Chongqing Medical University, China, claim to have found just that in a study based on biomarkers in urine.
The popular image of someone with bipolar disorder is epitomized by prominent figures such as Robin Williams – bouts of severe depression punctuated by off-the-wall mania. In reality, it is often not so easy to recognize; even Williams said he was never officially diagnosed. Moreover, as a new paper in The Journal Proteome research notes, “Multiple depressive episodes usually occur prior to the first manic episode in many bipolar patients.”
In these cases, the symptoms of bipolar can be very difficult to distinguish from those of major depressive disorder (MDD). Since MDD is the more common condition, clinicians often jump to an MDD diagnosis; indeed, many don’t even think to investigate the possibility of bipolar. Studies have found that as many as 39% of patients diagnosed with MDD have unrecognized bipolar.
The paper adds: “A large percentage of BD subjects are incorrectly treated with antidepressants in clinical practice.” The consequences can be lethal. Selective seratonin reuptake inhibitors (SSRIs) such as Prozac and Celexa probably don’t help people with bipolar. SSRIs are alleged to increase suicide risk among bipolar patients, a major concern since bipolar sufferers have suicide rates around 20 times the population as a whole.
While efforts have been made to alert doctors to the dangers of this sort of misdiagnosis, as long as we continue to rely only on multiple subtle signs, the problem will remain.
The Chongquing team think they have found a way out of this problem, having identified biomarkers whose concentrations are different for people with bipolar or MDD.
The authors note that some of these biomarkers have been investigated before, but individually did not provide a sufficiently reliable method for diagnosis. However, senior author Dr. Peng Xie proposed that multiple markers in combination might succeed where each had failed.
For the study, experienced psychiatrists recruited 71 people with bipolar disorder, 126 whose diagnosis of MDD was considered reliable, and 126 "healthy controls." Each group was divided into a training set and a test set. For the training set, the researchers knew the subject’s condition ahead of time and used this to identify relevant markers, while in the other set it was a blinded test to confirm the predictive capacity of these markers. The researchers examined the urine of those in the training set to identify 20 metabolites associated with either MDD or bipolar.
An initial trial on the test set identified 76% of those with MDD and 79% of those with bipolar, falling short of what would be required clinically. However, when the results were reanalyzed, six metabolites stood out.
We want to alleviate the emotional and psychological pain of the person for whom we are caring. The mistake is believing “doing more” is the solution. In caregiving, as in writing, sometimes less is more.
Jan Bergmans's insight:
For forty years what he did for her was always out of love.
His wife also did many things for her husband. But with progressive muscular degeneration, her ability to take care of everyday chores decreased.
He now handled everything in their lives requiring mobility from shopping for food to helping his wife with toileting. As her needs increased and with little help available, what was done out of love before she became ill, was done because of necessity. He still loved his wife, but he daily skated on the verge of burnout.
Many strategies can make caregiving easier. The one most often written about is the reduction of stress. The problem with focusing on stress reduction is the strategies are for AFTER events get out of control. For example, one often reads, “Take a break for yourself at least once a day.”
While taking breaks is important for reducing stress, the well-meaning statement doesn’t address what created the stress. Stress is what happens BECAUSE of prior events. Focusing on the resultant condition is similar to closing the gate of a barn after the animals have left.
Instead of focusing on stress reduction, concentrate on stress prevention. Caregiving is stressful, but we can do various things to reduce its impact. Below are three I and other caregivers found reduce the occurrence of stress.
One of the hardest things caregivers face is prioritizing what’s important. Many people, such as the husband, assume they can best serve their loved one by doing everything they did prior to the illness. While laudable, their efforts often are unrealistic, regardless of the love someone has for the person receiving care.
Equating the pre-caring situation with the caring situation is a formula for disaster. Even if the amount of effort appears identical, you need to factor in the new emotional weight of the activities.
Think about using simple criteria to prioritize needs. For the husband, developing criteria was simple. “Most important” was anything that could affect the physical health of his wife (e.g., creating a barrier-free home environment). Second most important were things that “buoyed her spirits” (e.g. going to the symphony). Least important were “everything else” (e.g., keeping the kitchen spotless).
“Complications” are a part of caregiving. A complication may involve increasing the number of required activities. At other times, the complication may involve consequences (e.g., scheduled ingestion of medicines moves from important to critical with some conditions).
Simplicity can be introduced into caregiving. The easiest way is to rank order the importance of everything you’re doing, as suggested in the “Prioritize” strategy. But often, even reducing the number of necessary activities doesn’t result in the prevention of stress.
An alternative is to reduce the importance of an outcome. In our example, the husband and wife always took pride in the spotlessness of their house. While a “clean house” was still important, an “immaculately clean” one no longer was. “Acceptably clean” simplified their lives.
Caregiving is always in flux; either because the illness is progressive, or the effects of it continually require attitude adjustments by both the loved one and caregiver. Just when the caregiver and loved one adjust to the change, the situation shifts and a new period of adjustment begins which inevitably will change again.
“Acceptance” becomes the basis for developing future strategies. By planning for continual changes, you reduce the possibility of more disappointment when improvements don’t occur. If there is improvement, that’s icing on the cake.
Many people refuse to accept the permanence or progressiveness of a condition requiring care. They equate “acceptance” with “giving up”. However, acceptance of reality often leads to creative ways of adapting (e.g. trading in a sports car on a van equipped with a wheelchair ramp). Hope, on the other hand, can prevent adaptation and becomes a delusion leading to continued disappointment.
Will implementing all three strategies make caregiving a joy? Probably not. Caregiving involves making choices. Rarely are they between what’s “great” and what’s “terrible.” Most involve choosing between two or more alternatives, that are “less than great.” Using the three strategies will enable you to adapt to what is presently occurring and minimize the possibility of disabling stress.
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.
When a loved one dies unexpectedly, we not only mourn their loss, but also regret what we failed to tell her.
Jan Bergmans's insight:
I’ve counseled many people who never asked themselves the question. They assumed their loved one would outlast them. “I never thought she would die before me,” a caregiver said at a meeting two months after his wife died. “I’m the one with the heart condition.
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Companion CareAlzheimers Care HomeCaregivingElderly Care ServicesLong Term Care
Her cancer came on so unexpectedly, we didn’t have a chance to have the type of conversations you always wanted but were afraid to have.”
How to Plan for a Loved One’s Death
There is substantial information available that can enable you to financially and legally prepare for a loved one’s death whether or not it’s imminent.
Most of this information involves what I call “housekeeping chores,” important but fairly routine tasks. They are activities lawyers, accountants, and other professionals can assist with, such as setting up trusts, filing taxes, planning for internment, etc.
While there can be financial and legal problems if these activities aren’t done in advance of a person’s death, most are correctable, or their effects can be minimized. However, living with regrets because you neglected to do or say something when your loved one was alive, can create emotional pain that can remain forever.
How to Prevent Regrets
I’ve found regret torments many people following the death of a loved one. “Why didn’t I tell her how much she meant to me?” “I wish I could have taken that hurtful statement back.” “I never forgave her for having an affair, but I should have.”
Rein natürliches Präparat hilft bei Blasenentzündung, besonders wirksam
The solution to not living with regrets is to “clean your plate,” every day. Instead of allowing something to ferment—sometimes for years, take care of it on a daily basis. Steven Levine wrote a book in which he asked readers to imagine they had one year to live. How would you live it? In my counseling, I shorten the timeline to twenty-four hours.
If you knew you would be dead in one day, what would you say to your loved one?
Living Your Life As If It Will End Tomorrow
Since my cancer diagnosis thirteen years ago, I’ve tried to live my life as if it will end within twenty-four hours. When I shared this approach with some people, they thought it was a morbid and depressing exercise.
To the contrary, it has been fulfilling to me and soothing to friends and family. Difficulties in relationships don’t linger. If I do an unskillful act, I try to apologize as soon as possible. If I’m the recipient of an unskillful act, I try to forgive or at least understand what was behind it. If I’ve received a kindness from someone, I offer my gratitude to them.
I’m seventy, and my wife is sixty-eight. Will I be upset if she goes first? Of course. But it will be because I lost a loving companion of forty-five years, not because I regret having held back expressing gratitude, offering forgiveness, asking for forgiveness or expressing my love.
At the end of our lives, what do we most wish for? For many, it’s simply comfort, respect, love. BJ Miller is a palliative care physician at Zen Hospice Project who thinks deeply about how to create a dignified, graceful end of life for his patients. Take the time to savor this moving talk, which asks big questions about how we think on death and honor life.
Imagine you’re caring for someone as arrogant and unappreciative as Donald Trump. Worse, this person is your loved one.
Jan Bergmans's insight:
Leaning Into Sharp Points
My hospice assignment was to care for an elderly man with stage IV lung cancer. He was a white supremacist; I was an aging political radical from the 1960’s.
Each of us was the embodiment of what the other despised.
I could have refused the assignment, but I didn’t. My caring for him would be a test of my ability to be compassionate, and it would offer a unique learning experience. In hospice, I learned an important axiom: The more discomfort I sense, the more important the lesson. Caring for the man changed my life.
When We Can’t Withdraw
Sometimes there is the opportunity to withdraw from a caregiving situation, such as I could have done as a hospice volunteer. But for people with limited finances, there is no choice.
As a nation we undervalue the importance of caregiving. If we didn’t, government support for home care wouldn’t be controversial. Even when it’s possible to hire professional caregivers, the emotional draw of a loved one often pulls caregivers into disastrous situations.
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.
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