TCM practitioners are expected to have a sense of responsibility for their patients and to provide medical care only after an adequate assessment of patients’ conditions, through good history taking and appropriate TCM clinical examinations.

If treatments are suggested or offered to a patient without such personal evaluation, the TCM practitioners must satisfy themselves that they have sufficient information available and that the patients’ best interests are always being served.

We need to move on and not solely depending on old diagnostic methods. For example, using of dipstick to do the urine analysis, stethoscope, blood pressure set, blood sugar monitoring device, pregnancy test kits, etc. Although blood taking is prohibited by TCM practitioners for any laboratory tests, they can always refer their patients to Polyclinics or General Practitioners to perform the tests.

However, having said that, some of the traditional Chinese medicine methods are still valuable for the TCM practitioners to do a more accurate diagnosis. After all TCM diagnosis methodologies have withstood the test of time and have its diagnostic values. In my opinion, practitioners should make the best of both Eastern and Western techniques to help them in performing clinical diagnosis.

The clinical evaluation of patients could be transmitted by voice, electronic or other means by a referring TCM practitioner or a registered medical practitioner. Only in exceptional or emergency circumstances should a diagnosis or treatment be offered without personal contact and without the intermediation of a referring TCM practitioner or a registered medical practitioner (MOH, 2006).

Reference

Traditional Chinese Medicine Practitioners Board. (2006)  ETHICAL CODE AND ETHICAL GUIDELINES FOR TCM PRACTITIONERS. Retrieved from http://www.tcmpb.gov.sg/tcm/ on June 07, 2009

Order Lexapro

Falls are not only the most common cause of injury among older adult population, but are also the leading cause of leading cause of accidental death in the United States and Singapore as well. Older adults who fall, sustain a hip fracture and are hospitalized, die within a year of the fall

Even if the fall does not result in hospitalization, fear of falling has become a major factor. In some cases, fear may lead to inactivity and loss of confidence. This can produce a cycle of fear, loss of self-confidence, and inactivity, thereby decreasing the quality of life and increasing the risk of falls.

Patient and family education are important and the following guides will advise you on how best to safeguard your health. Some of the tips here are good common sense measures for people of any age, which you can also do to lower risk for falls. This is not intended to be exhaustive instructions and in case you may receive different/additional instructions from your doctor. You are advised to follow any specific written or oral instructions given to you by your doctor or healthcare worker. Do seek clarification when in doubt.

Activity / Rehabilitation
• Continue with the exercise regime as taught by the therapists.
• You may increase your activities of daily living gradually as tolerated.
• Rest in between activities. Try not to do activities for more than one hour without a break so that you do not tire yourself.

Nutrition / Diet
• Maintain daily calcium by eating foods rich in calcium e.g. milk, cheese, yogurt, anchovies, sardine, green leafy vegetables, beans, soya bean milk, tofu and dhal. Make sure there is no contraindicated with the medicine or special diet that you are taking.
• Remember to avoid alcohol intake as it can impair your balance and slow your reflexes.

Safe and effective use of medication
• Discuss with your doctor or pharmacist:
 o If your medications will increase your risk for falls
 o If the combinations or timings can be adjusted to reduce the side effects.

Lifestyle Changes
• Take your time when standing up from lying or sitting position. A sudden change of position may cause dizziness.
• Wear well fitted rubber-soled / non-slip shoes.
• Keep a look out for wet floors and clutters when walking indoors and outdoors.
• Reduce the needs of going to toilet at night by:
 o Reduce fluid intake after dinner
 o Empty bladder before sleeping
 o Seek medical advice regarding the management of incontinence.
 o Avoid rushing
 o Use walking aids when necessary.

Home Modifications
Toilet
• Use non-skid mats on the bathroom floor, as well as apply non-skid strips inside your bathtub / shower.
• Install grab bars or handrails around the bathtub and attach tem through the tile and to the structural supports of the wall.
• Use a non-skid shower chair and hand held showerhead

Bedroom
• Ensure bedroom is free of clutter with a clear walking path.
• Always keep a night light and phone beside the bed.
• Use night-lights next to your bed and between your beds to toilet.
• Have a bedside table to hold glasses, water and other items.
• Ensure that your bed is not too high. Your feet should touch the floor when you sit on the bed.

Living Room
• Rearrange living room furniture to allow for a clear walking path.
• Leave extra space if you are using a walker.
• Rugs, runners and floor mats should be secured or removed.
• Secure and keep electrical cords and telephone cables out of the walkway. The telephone should be at a safe and convenient position for the user.
• Use chairs and couch that are easy to get in and out. It is recommended that chairs should have armrests and is of appropriate height.
• Lighting should be adequate and easily accessible.

Kitchen
• Place commonly used utensils within easy reach.
• Avoid standing on chairs and stools to reach for objects. Get someone to assist.
• Long handle utensils should be turned to the side so as not to obstruct your path
• Clean up spills immediately.

Stairs
• If you have stairs in your house ensure that there is ample lighting to guide your steps.
• Install handrails on both sides of the stairway.
• Place coloured strips at the edge of each step and at the top and bottom step to make it easier to see.

When and how to seek further treatment
• Inform your doctor if you have fallen and describe the circumstances of the fall.
• Inform your doctor if you have trouble balancing or walking.
• Inform your doctor if you experience blurring of vision and any other medical problem.
• Inform your doctor if you experience any weakness or other problems with your legs.

Others
• A fall may not result in a serious injury, it still need to be evaluated in the elderly due to:
 o Loss of confidence
 o Fear of further falling may restrict their subsequent mobility.
 o It may be a sign of serious illness.
• Speak to your therapist or nurse if you need more advice.

As in any education, there must be some response from the patient or the family when the above are shared with them. It is an important that they understood what were being taught to them so that fall can be prevented. Therefore, useful guides on the type of learning outcomes can be:
• Patient / Family are Not Competent – not interested or not able to comprehend?
• Patient / Family are Not Receptive to Teaching – not interested at all!
• Patient / Family Verbalizing Understanding – theoretically know what to do but not going to demonstrate how to do them.
• Patient / Family are Able to return demonstration with Assistance – not able to grasp the concept but able to demonstrate with proper guidance given.
• Patient / Family are Able to return demonstration Independently – good to Go!

It is crucial for nurses to understand the concepts so that they can be better prepared with all the necessary paper works to handle the administrative work involved. It also help us to understand our rights to report a Sentinel event or to prevent such event to happen, when someone is not doing the right thing.

In Singapore, under the Criminal Procedure Code Cap 68, all cases meeting the following criteria should be referred to the Coroner and the police must be notified.

Criteria for Coroner’s Case

Death due to known, or likely, to have been due to, of the consequence of, any violent or unnatural event of cases, such as:

• Homicide or suicide
• Any accidents, including drowning
• Asphyxia and choking, including aspiration pneumonia
• Electrocution and lighting strike
• Burns and scalds
• Drug overdose and poisoning
• Infection following injury/unnatural event
• Any occupational diseases
• Want, neglect or exposure

Death that occurred during, or at any time after, which may be deemed in any way, to have been caused, or contributed by:

• Any operation or invasive procedure
• Use of therapeutic substances (Western drugs, TCM, alternative cures)
• Medical devices
• Blood or blood products
• Any medical intervention

Death occurring whilst in statutory care:

• Death of persons in police custody, prisoners, or destitute persons detained involuntarily
• Brought in dead when cause of death is unknown
• Unidentified person
• Death under suspicious circumstances

A sentinel event has to be reported to the Clinical Services Department immediately, as it has to be notified to Ministry Of Health (MOH) within 7 calendar days. Any medical, nursing and paramedical staff can report a sentinel event. All deaths that are sentinel events should be made a Coroner’s Case.

Criteria for Sentinel Event

An unexpected occurrence involving death OR major permanent loss of function / major injury, AND that is associated with the treatment, lack of treatment, or delay in treatment of the patient’s illness and underlying condition :

• An occurrence shall be categorized as follows:
• Blood transfusion
• Childbirth / Pregnancy
• Inpatient suicide
• Medication usage
• Surgical / procedure complications:
  1. Ward based (e.g. chest tube insertion, pleural biopsy and Haemodialysis, etc.)
  2. Non-ward based (e.g. surgery done in operating theatre, angiography and CT-guided biopsy, etc.)

·        Others, for example

1.      fall

2.      choking

3.      use of restraints

4.      medical equipment, etc

The MOH has defined that the following specific cases are also to be categorized under sentinel event when:

• Retained instrument or material after procedure
• Wrong type of procedure or surgery
• Wrong site procedure or surgery
• Wrong patient procedure or surgery

I sincerely hope that the above information will be useful for the nurses, especially the newbies in the wards. With better understanding of the concepts will give them an upper hand advantage to when handling such cases confidently. I also encourage them to continue to learn and excel.

Communication is something we do everyday. It is the means by which we express our desires, needs and feelings. It is especially important for health care professionals, who must continually assess and care for patients, to be able to communicate well, to understand others and to make oneself understood. Good communication is an essential skill, one that takes much practice to master,

There are 2 main types of communication – verbal and non-verbal. The former is self-explanatory, and includes all forms in which speaking is involved. Non-verbal communication is defined as “all aspects of communication other than words themselves. It includes not only gestures and body language, but also how we utter words (Wood, 1999, p.148)”.

One of the aspects is self-disclosure. This “is the process of making intentional revelations about oneself that others would be unlikely to know… it allows you to establish more meaningful relationships with others (Pearson & Nelson, 2000, p. 158-159)”.

Communicating with my father

My family is a traditional one when it comes to communication. We do not show affection openly, and my parents maintain an air of authority towards my siblings and I. Conversations tend to be about whether we had eaten rather than about sharing our feelings. I also felt that my father was somewhat disappointed in me that I had not lived up to his expectations.

As I am trained in Chinese massage (tuina), I am often called upon whenever my family members suffer sprained ankles or stiff shoulders. On many occasions, I had rubbed out their knotted muscles and swollen joints. Most of them do not have trouble asking me for that favour, and they know that I will do so willingly. My father, however, is the exception. He suffered from a bad back. Which would be aggravated whenever he lifted heavy objects incorrectly. At that time, I was unaware of his pain, although I noticed that he observed me keenly when I was treating someone else, as if he wished I were treating him instead. However, he remained adamantly silent about his needs.

After weeks of suffering in silence, my father finally told my mother that he wanted me to massage his painful back. I am happy to say that not only was his pain lessened by my treatment, but we had become closer as a result. He speaks to me more as an equal now, and not so much as a father to a son. Through this simple encounter, he realized that I had capabilities that he was not aware of , and I think he feels proud of me now.

Conclusion

Communication is an ongoing process. Whenever 2 or more persons are together, they are communicating, consciously or unconsciously. If used effectively, it enables us to adapt to all kinds of situations, achieve our goals, and improve relationships with others. A breakdown in communication, however, may cause misunderstanding, result in mistakes made, and destroy relationhips.

Reference:

Pearson, Judy C. & nelson, Paul E. (2000). An Introduction to Human Communication (8th ed.). United States of America: McGraw-Hill Higher Education.

Wood, Julia T. (1999). Interpersonal Communication Everyday Encounters (2nd ed.). California: Wadsworth Publishing Company.
 

Although the use of opioids (remember not to crush the pills) is well tolerated and can significantly improve the the quality of life for those cancer patients, the incorporating of massage can be a complimentary therapy that focusing on the emotional elements of pain (Portenoy and Lesage 1999). SAGA (2007) has reported that massage is one of the most commonly used complementary therapies for cancer pain relief in the UK. In the US hospitals, such therapy is also prevalent (Calenda 2006).

However, patients will have mixed feeling when receiving the massage therapy. Firstly, the benefit is debatable as there are few rigorous, randomised controlled trials on the efficacy of massage in cancer pain relief (Post-White et. al. 2003). Next, there is a common misunderstanding that massage can cause cancer to spread. To debate the later misunderstanding, Joske et al (2006) had concluded that there is no evidence showing that therapy can promote the spread of cancer, after a review was done.

There are contraindications to massage. Patients with DVT (Deep Vein Thrombosis) should be handled carefully because Pulmonary Emboli may develop as a result of the massage therapy (Stephenson et al 2000). Ernst et al (2006) had come up with a list of contraindications to massage therapy; that include those patients with advanced osteoporosis, bone fractures, burns, DVT, eczema, open wounds, phlebitis and skin infections. Ernst (2003) reported that no treatment is absolutely free of risk but serious adverse events are rare. It definitely has no significant side-effects like nausea and constipation.

So what does it mean to healthcare professionals, espeically nurses? Well, we shall advocates that massage therapy is considered to be safe with fewer side effects than some conventional treatments. On the other hand, we need to educate the patients that with the paucity of rigorous studies and with the limit robust evidence available, a certain degree of precautions need to be exercised when receiving such therapy.

Reference

Calenda E (2006). Massage therapy for cancer pain. Current Pain and Headache Reports. 10, 4, 270-274.

Caraceni A, Brunelli C, Martini C, Zecca E, De Conno F (2005). Cancer pain assessment in clinical trials. A review of the literature (1999-2002). Journal of Pain and Symptom Management. 29, 5, 507-519

Ernst E (2003). The safety of massage. Rheumatology. 42, 9, 1101-1106.

Gescedi R, Decker G (2001). Incorporating alternative therapies into pain management: more patients are considering complementary approaches. American Journal of Nursing. 101, Suppl 4, 35-39.

Gray RA (2000). The use of massage in palliative care. Complementry Therapies in Nursing and Midwifery. 6, 2, 77-82.

Joske DJL, Rao A, Kristjanson L (2006). Critical review of complementary therapies in haemato-oncology. Internal Medicine Journal. 26, 9, 579-586.

Portenoy RK, Lesage P (1999). Management of cancer pain. The Lancet. 353, 9165, 1695-1700.

Post-White J, Kinney ME, Savik K, Gau JB, Wilcox C, Lerner I (2003). Therapeutic massage and healing touch improve symptoms in cancer. Integrative Cancer Therapies. 2, 4, 332-344.

SAGA (2007). Healthy Living: Complementary Therapies. Therapies Most Likely to Make it into Mainstream Treatment. Www.saga.co.uk/health/healthyliving/complementary therapies/TherapiesMostLikelyToMakeItIntoMainstreamTreatment.asp (Last accessed: January 2 2008).

Stephenson NL, Weinrich SP, Tavakoli AS (2000). The effects of foot reflexology on anxiety and pain in patients with breast and lung cancer.Oncology Nursing Forum. 27, 1, 67-72.

Individuals should take responsibility for their health. Therefore, an effective disease management programmes must be introduced to empower trained healthcare professionals to do more for patients with chronic diseases. In Singapore, at the polyclinic level, we could see contact time between the patients and healthcare professionals extended in order to help to facilitate the promotion of self responsibility, disease education and disease management skills.

Teaching patients with the necessary skills are essential for them to participate in the management of their own conditions. In all public hospitals and polyclinics, nurse educators have been teaching patients about the diseases and skills to cope with and manage their medical conditions. Private care providers such as General Practitioners, should also be encouraged to participate in the education of the patients on how to manage their medical conditions too. Unfortunately, this will not be feasible as there is always opportunity cost involved in spending more time with the patients and hiring of extra staff to take up the patient education roles. Hence, Ministry of Health (MOH) may want to consider to work out a compensation package for the lost of income.

In my opinion, it is essential for MOH to continue their subsidies so that patients with chronic diseases can continue to seek consultation at the polyclinics for their medical conditions. This should also be extended to those who needed treatments even when they are admitted to the step down care or nursing homes. In additional, the Ministry can also provide holistic and improved healthcare services to help patients who are interested to improve their own health conditions or to reach treatment goals. Having said that, financial assistance schemes must first be put in place to ensure that patients are able to receive treatments even if though they are financially disadvantaged.

The public should continue to be educated on how to reduce the risk of developing chronic diseases, early detection of the diseases and treatments that are required to prevent further complications. MOH should also work with relevant institutions, such Traditional Chinese Medicine Associations, by enhancing the skills of the care providers and caregivers. Besides the dissemination of relevant information and training that will help the caregivers in the rendering of care for their dependants, the Ministry must be also provides emotional support to the caregivers too. 

It is not a simple task taking care of the sick. Caregivers are humans too and they require emotional supports from whatever sources. The Ministry can form a focus group to look into on how to help to address the emotional and psychological needs of these caregivers. Without given the caregivers the necessary supports, one will see that the patients under their care will keep coming back to the hospitals for treatments. That will cost more money and stress to the families.

High cholesterol is not dangerous by itself, but may reflect an unhealthy condition, or it may be innocent totally. Thus, what people should be worried about is keeping our body inflammation free, or in simple terms, to stay healthy. Although it is true that drugs aimed at lowering cholesterol have proven to be effective, but the drawback is that these drugs do nothing more but to lower cholesterol. They do not improve your heart or total mortality and in some cases, the side effects due to consumption of such drugs can actually shorten your life instead.

There are no visible signs or symptoms that can inform us whether our cholesterol levels have been hitting the roof. Most of the time, people only find out about their high cholesterol problems when they go for their routine medical check ups yearly and often shocked to discover about their condition. Unfortunately, the only way we can determine whether we are having high cholesterol is when we do a blood test in a clinic or hospital.

Mental stress, physical activity and change of body weight may influence the level of blood cholesterol. In the ever-increasingly competitive society we live in, we face huge amounts of pressure each day and our stress level indicators are always in the danger zone. As a result, scientists have faith to believe that more and more youths will suffer from high cholesterol in the future and eventually develop heart conditions. Thus, it is always to be better to have your cholesterol levels checked regularly.

So, is there a need to maintain a healthy blood cholesterol level? The fact is that balance is the key to good health, just as we do not want to have very low levels of cholesterol, we have to make sure our cholesterol levels do not go off the roof as well. No doubt, a healthy cholesterol level is always an added advantage to a person’s life as he or she would have no worry over heart diseases and would be able to lead a healthy and happy lifestyle. When do we know what is balanced? There is no accurate answer, but a rough gauge of below 200 would be a healthy range of cholesterol level.

In our modern society, it is increasingly hard for a person to lead a healthy lifestyle and maintain a healthy cholesterol level. We have frequently caught up with our work and always have insufficient time for leisure, let alone exercise or having the spare time to cook up a healthy dish for our families.

Nevertheless, is having a healthy lifestyle that leads to a healthy cholesterol level not for us? I believe for now. our safest bet for a healthy body is to have a good nutritious diet together with regular exercise and abstinence from vices such as drugs and cigarettes. This way, we can look forward to a healthy lifestyle, be it with high or low cholesterol.

Lets discuss about one of the coronary heart diseases – Angina. Chest pain, or medically known as Angina, is the primary symptom associated with coronary heart disease in which a patient may suffer due to high cholesterol. Angina is felt by the person suffering from it. It could be described like a pressing on the chest, or a tight squeeze around the chest. It is as if another person is sitting on your chest, causing it to be pressurized. Although initially and most common part of the body that would be affected is the pressure feeling on the chest, these symptoms can actually spread to other parts of the body; the jaw, neck and even your arms. In certain cases, patients feel pressure in some other parts of their body but not their chest.

Besides feeling pain in the chest, people suffering from coronary heart disease may also exhibit signs of shortness of breath, feeling nausea, experience huge amount of sweating and lightheadedness. Any chest pains felt should be taken seriously, as it is most likely to be directly related to coronary heart disease. Victims to coronary heart disease should avoid having a large meal or be too overly excited as they can turn out to become fatal. Rather, when you are experiencing chest pains, you should stop whatever you are doing and have a short rest. If these symptoms persist continuously, it would be best to pay your doctor a visit.

Smoking builds up the plaque in one’s arteries causes by high cholesterol much faster. As a result, a smoker’s heart has to work much harder to pump blood through those clogged up arteries to provide oxygen for the whole body. This extra work forced onto the heart can actually cause heart failure, or when the arteries are completely blocked, there is a high chance a stroke or heart attack would occur. My strong advice – Please STOP smoking!

Through exercise, running, cycling, swimming, basketball, one can improve their cardiovascular health and strengthen their heart and circulatory system. Although exercise may not directly reduce one’s cholesterol; but the strengthening of the circulatory system can help reduce the chances of stroke or heart attacks. Moreover, exercise can help one reduce their weight of which also helps reduce the cholesterol levels in a person’s body.

However, contrary to the belief of many, the astonishing discovery made by researchers is that, plague that builds up in arteries which eventually leads to heart disease has nothing to do with cholesterol levels. It is reaction to inflammation within one’s body. Such inflammation can be caused by viruses, smoking, having an imbalance of omega-6 polyunsaturated fat to omega-3 polyunsaturated fat in our diets and even factors like stress!

On the same note, cholesterol is a healing substance within the body, which can respond to inflammation in the arteries by being deposited in combination with other substances to form “plague” to heal the artery lining. However, just because the plague consists a portion of cholesterol, it does not mean cholesterol is the cause of the formation of the plague, but rather, it was only serving its purpose of being a healing agent in our body. Keeping it simple, plague deposits as a healing agent whenever our body suffers from any significant inflammation but will just continue to circulate in your blood if you do not have inflammation, regardless of you having high or low cholesterol. Thus, the real solution to heart problems is to keep your inflammation in your body low, rather than your cholesterol level.

Tell me what you think.

 Western medicine has been the main form of healthcare in Singapore for many years. However, recently we seen TCM enjoys considerable popularity as a complementary form of healthcare. According to Singapore’s media release in 2001, it has been estimated that about 45% of the population in Singapore had ever consulted a TCM practitioner in the past, and about 12% of daily outpatient attendances opt to see TCM practitioners here.

In t

What is foot reflexology?

Foot reflexology is a form of foot massage and sometimes accompanied by acupressure techniques that targets at points on the foot that are correspond to parts of the organ of the body.

As according to Byers (1983), the reflex areas or points in the feet are correspond to all of the glands, organs, and parts of the body.

Theories 

It has been known from studies that foot reflexology has a positive effect on anxiety reduction and pain reduction. It can also improve the blood supply, and promote homeostasis (Micozzi, 1996). As according to Nancy (2000), the effects were based on theories.

The energy theroy, which use electromagnetic field to direct engery to unblock the bloked pathways. The theroy of proprioceptive nervous receptors,  states that a connection exists between the area of the feet and the body organs and that reflexing the feet affects the organ.

Lastly, it is the lactic aci theory which explains that the lactic acid will deposite in the feet and flexology will crush the microcrystals and allows the free flow of energy.

Patients’ Privacy 

Lately, foot reflexolgy is more appealling to nurses, allied healthcare professionals because of its potential relaxation and pain relief effects. Besides, it is a form of avenue for human touch, it is non-invasive and just your pair of hands plus a little bit of skills.

When your are doing it professionally, it will not interfere with patients’ privacy in fact, it will show that you are showing care and concerns for your patients (Dobbs, 1985).

Head Related Illnesses

As documented in the ancient Traditional Chinese Medicine manual, Huang Di Nei Jin, the treatment for upper limbs illnesses can be effective addressed via lower extremeties. That is what is know as the “Shan Bin Xia Qiu”. This is a popular approach used by many Acupuncturist for treating head related illnesses including strokes.

The Acupuncturist will acupuncture the patients’ feet to help them to relief any discomforts. So, based on the same concept, foot reflexolgoy will be helpful to give refreshing feelings and experiences after that. If you have done foot reflexology before, you will know what I mean.

Increased Relaxations 

A research was done by Ferrell et al. (1991) on the use of foot reflexology to reduce pain for cancer patients. It was reported that patients with cancer experienced decreased pain specially after foot massage.

It was also observed that there was a decrease in patients’ heart rate and diastolic blood pressure and increase in skin temperature which were the results from their increased relaxation (Meek.1993).

Protect Yourself First 

Nurses who wish to incorporate reflexology in their practice can study it from accredited schools. Attaining a certification, although does not mean anything very much to nurses but it is a best way to ensure the use of technique on the patients will correct.

However, I would suggest that the practioners must be aware of your body constitutions as there could be lost of qi after performing the therapy. You must know when to stop when you are tired, and taking long breaks when necessary. I know that you are eager to help others but you must know how to protect yourself first.

Reference.

Byers, D.C. (1983). Beter health with foot reflexology. St. Pertersburg, FL: Ingham Publishing.

Dobbs, B.Z. (1985). Alternative health approaches. Nursing Mirror, 160(9), 41-42.

Ferrell, et. al. (1991). Pain as a metaphor for illness. Part II: Faily caregivers’ management of pain. Oncology Nursing Forum, 18, 1315-1321.

Meek, S.S. (1993). Effects of slow stroke back massage on relaxation in hospice clients. Image, 25 17-21

Micozzi, M.S. (Ed.) (1996). Fundamentals of complementary and alternative medicine. New York: Churchill Livingston.

Nancy et. al. (2000), The Effects of Foot Reflexology on Anxiety and Pain in Patients With Breast ad Lung Cancer. EBSCO Publishing, Vol 27 No 1.