General

BBQ safety!

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Plan ahead for barbecue weather!

The summer break has arrived for most students, and while the weather might not be as sunny and warm as we’d all hoped, there has been the odd day of great weather.

Barbecues are one of the most popular social activities over the summer but before you dust off your old barbecue and start heating up the coals, here is some essential fire and barbecue safety advice from fire safety specialists Firemart (www.firemart.co.uk).

Take care when deciding where to position your barbecue
Barbecues should only be used on flat surfaces, outdoors, and you should ensure they are not placed near any shrubs, trees or any furniture which could catch fire.

It’s also worth thinking about your use of the outdoor area – any games or activities taking place should be kept well away from the barbecue area, as well as away from any children or pets.

Safe Barbecue usage
If you’re in charge of cooking on the barbecue we advise that you avoid drinking alcohol until your cooking duties have finished.

For coal barbecues, only use approved barbecue lighter fluid, and make sure you use the minimum amount necessary. You should never use petrol or other fuels which were not meant for barbecues as these can ignite ferociously…and there could be the added side effect of your food tasting strange!
Choose barbecue utensils like tongs and forks which have long handles.

Food preparation

Aside from the fire safety elements, there are also some considerations when it comes to preparing your food for the barbecue. If you’re cooking meat from the freezer, ensure it is properly thawed before you cook it.

Remember that raw meat needs to be kept separately from cooked food – use different containers and utensils for each.

To avoid upset tummies the next day, ensure your meat is cooked on the barbecue throughout by turning it regularly.

After your Barbecue

Wait until your barbecue has cooled down completely before you attempt to move it or clean it, and never place hot barbecue coals into your bin. If your barbecue has a lid, you can speed up the cooling down process by placing the lid on – this removes the oxygen.

Some final tips
If the sun is out, don’t forget to wear sun screen, and if you’re feeling too hot then spend some time in the shade. Keep yourself hydrated throughout the day by drinking plenty of water.

 

If you keep the above guidance in mind, and plan in advance for the next day of good weather, your next barbecue should be a success!

‘Safeguarding adults’; what does that mean?

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Every adult has a right to respect dignity, privacy, equity and a life free from abuse. That is the firmly held belief of all those who work here at Students’ Health Service, and we see our role partly as being here to protect ‘vulnerable adults’. Many of us hear that phrase and think of adults with learning disabilities, say, but it also encompasses any adult who, because of mental ill health, emotional disturbance, physical disability, cultural or social isolation, may lack the resources to protect themselves against significant harm or exploitation. So it can, unfortunately, describe some of the students we look after, and even someone you might know, though you may not have considered them ‘vulnerable’ before.

If you are worried about someone, that they may be being abused or exploited, or if you are worried about yourself, then we are here to help you. The whole team receives training in supporting adults with safeguarding issues, and we can engage other services to help us if we need to. Examples of abuse include physical violence in a relationship, sexual abuse, including where someone is pressurised to consent, not just where consent was withheld, psychological abuse through intimidation or hostility, and financial abuse such as theft, and misuse of benefits. We are also aware of occasional cases of racial and discriminatory abuse, and are able to offer support in these situations too.

Abusers can be someone the vulnerable adult knows well, or a person in a position of authority above them. Whatever the situation we can ensure confidentiality and sharing of information on a need to know basis, and we will not disclose personal information inappropriately.

If you suspect abuse, please report it. If you would like our support then please talk to any one of our clinical team, and we will ensure you are cared for with the respect and dignity that everyone deserves.

 

Other support;

 

Hate crime unit; http://www.avonandsomerset.police.uk/community_safety/hate_crime/help-and-support.aspx

Domestic abuse; http://www.avonandsomerset.police.uk/community_safety/crime_reduction/violent_crime/domestic_violence/index.aspx

http://www.wellaware.org.uk/organisations/12984-bristol-freedom-programme

http://www.nextlinkhousing.co.uk/

 

 Honour based violence; http://www.karmanirvana.org.uk/

Feeling Pale and Pasty?!

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Feeling pale and pasty? Feel like a quick visit to the tanning salon to use the sun bed? Think again….

Recent research published in the British Medical Journal has shown evidence that the increase in use of artificial sources of ultraviolet radiation such as indoor tanning devices like sun beds is associated with an increase in risk  of the 3 main skin cancers including malignant melanoma, an aggressive form. This risk is increased if the first exposure to artificial UV radiation is before the age of 35 yrs.

The authors of the study estimated that 3438 cases of malignant melanoma could be prevented each year in Western Europe by avoiding exposure to indoor tanning. The World Health Organisation has now classified tanning beds as a group 1 carcinogen alongside tobacco smoking and asbestos.

Still feeling pale and pasty? Feel like planning a holiday somewhere hot and sunny? Think again…..

It has long been recognised that excessive exposure of the skin to the direct UVA and UVB rays of direct sunlight increases the risk of developing skin cancers of all types. Episodes of sunburn greatly increase this risk as skin cells that are damaged are at greater risk of becoming abnormal and cancerous.

Take measures to be ‘sun safe’

Avoid the sun when the sun is strongest in the middle of the day.

Cover up when you are out in direct sunshine for a prolonged time.

Use high factor sunscreen with UVA and UVB protection and reapply it regularly.

Still feeling pale and pasty? There is an answer……

Opt for a spray tan and take a walk, quite literally, on the sunny side of the street. Exposure to a moderate amount of direct sunlight is actually beneficial.

Vitamin D is vital for good health, growth and strong bones and is made in the skin with the help of sunlight. We also get a small amount from the foods we eat (oily fish, egg yolk and fortified foods eg. some breakfast cereals).

To prevent deficiency of Vitamin D it is estimated that we need 2 to 3 sun exposures per week in the summer months (April to September), lasting 20-30 mins, to bare arms and face. This needs to be in direct sunlight and not through a window. This is not the same as suntanning and sunburn should be avoided at all costs.

How can we help?

If you have any new or changing skin lesions, and particularly if you have been a heavy user of indoor tanning and sun beds, or have a history of multiple episodes of sunburn, the doctors at the Students’ Health Service

would be very keen to take a look at them. The earlier any skin cancer is caught, the better the outcome of treatment.

Further information:

Sunsmart- www.cancerresearchuk.org/sunsmart

Sun Awareness Fact sheet- www.bad.org.uk/site/734/default.aspx

Sun and Health- www.patient.co.uk/health/sun-and-health

Reference:

BMJ 6 October 2012 Volume 345.

Editorial p7, Research p14/15, Personal View p31

Online resources for medical matters

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For someone who never went to medical school Dr Google seems to be an incredibly popular and sought after ‘specialist’.  A significant number of people will turn to the internet for information and advice before seeking professional help, and this is a good idea in the right context. There are some fantastic resources out there, and so I thought it might be helpful to list a few of them, to improve the quality of the results our patients are getting when they go online, and to save time for those who get drawn into elaborate and complex searches featuring more and more worrying symptoms and diagnoses!

First off, a safe and reliable place to start for all medical queries;

www.patient.co.uk

Next up, for info on local services, how the NHS can help, conditions, and health costs;

www.nhs.uk

And for travel advice

www.fitfortravel.nhs.uk

Lastly for mental health advice and support;

www.mind.org.uk  or

 www.bigwhitewall.com

which is an award-winning online mental wellbeing service. It offers the first online pathway for mental health and wellbeing, placing people at the centre of their own care.  It enables people to access well governed, safe therapeutic services through self-referral from the comfort of their own homes.

Apps;

The NHS has also realised the need for a reliable single source of credible and safe online resources and has recently launched its Health Apps Library, at last month’s NHS Healthcare Innovation Expo in London.

Here at SHS we are particularly interested in the ‘Patient Access’ App, as we already have the online facility allowing our patients to book appointments and re order repeat prescriptions via the internet, but it would be brilliant to have a phone app too, making it potentially even simpler. We will be looking into how to adopt this app, but it is something that the local health community may need to fund, so watch this space.

The Sound Doctor App; An Audio app which enables patients to listen to information about their long term conditions and therefore help them look after themselves more easily and get the best out of life.Leading doctors, nurses, patients and other relevant health professionals have been interviewed to provide a really comprehensive look at a number of long term conditions.All the information is presented in short chapters of between 3 and 5 minutes each with several interviewees in each chapter.

ActiveMe App; Developed by NHS experts in CFS/ME, activity record charts are widely used to help patients and
practitioners work together to develop a daily baseline of energy use before increasing it in regular steps
to enable you to achieve your goals.Fast, easy, portable and discreet, ActiveME can help you balance your activities.

Type 1 Diabetes (Alcohol guide) App; Having type 1 diabetes means that it is important to know how to keep safe when having alcohol. This guide aims to help you find out what to do to keep safe and how alcohol can affect your body.This App has been designed based on ideas and suggestions provided during the qualitative interviewing of young people with type 1 diabetes aged between 18 and 21. It has been developed in collaboration with the Poole Hospital Diabetes Centre in the UK for use by their patients.

PillManager App; helps you manage your medications, never forget them, and also helps with re ordering them too.

These are just a few to get you thinking.

See our website for loads more Useful Links

http://www.bristol.ac.uk/students-health/links/

 

Running Late AGAIN?!

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“OMG! She’s running late AGAIN! I’ve got a lecture in half an hour… what shall I do…? I’ll just wait for a bit and see… how can she always run late? What’s the point of booking an appointment time if I am never seen on time?! Grrrr…”

Meanwhile, in a room down the corridor…

“OMG I’m running late again! Why does this always happen to me? I hate keeping people waiting, but it’s so difficult to balance the lists of ailments that some people bring, and the complex mental health issues of others. All in 10 minutes. Now the phone’s ringing…

Yes, ok I’ll speak to that mum later, send me an email and I’ll call her back once we have consent from the student.

Now who’s at the door, grrr, an urgent prescription, ok just this once, but please leave it in my basket next time.

Right, where was I? Write myself a note to check if those results are back this afternoon.

Ok, next person, ‘buzzzz’.

Now the minutes are ticking by as they gather their things together in the waiting room… then strolling down to my door, and here we are…

Hi, come in have a seat. How can I help today? Three things to discuss? OK, let’s see what we can do…

Sorry the phone’s ringing, let me just see what that is, the on-call biochemist? Ok yes, put them through. Sorry, I just need to ask about a result…

Now where were we?

Panic attacks, and depressed you say, ok, tell me all about it…”

 

At the Students’ Health Service we are very aware of time keeping issues, and that quite often our patients have to wait to see us. We would, of course, rather that this was kept to a minimum, but we hope that you will understand that there are some things that can’t be rushed, and that we try to give each person the time they need, when they need it.  Everyone’s time is precious, we really do understand that.

We have all taken part in extra communications skills training in the last year, to try to identify more efficiently ways of working, but there will always be difficult situations, and therefore we hope that you will understand the challenging line we tread when trying to run to time.

 

Thank you for being patient.

 

Art and Wellbeing

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Art and Wellbeing by Dr Emma Webb

Appreciation of beauty is a part of maintaining happiness whether you find it in the arts, the natural world, human connections or other experiences. It has a positive effect on our sense of well being. Appreciation of art can enrich us through its message whether that is political, sociological or psychological or more simply via its direct emotional effect.

There is a broad spectrum of evidence to show how the arts achieve positive outcomes for patients, for staff, for the patient-staff relationship, for hospitals, mental health services and in the health of the general population.

In healthcare environments the experiences of patients and staff can be improved by artwork. Participation in the arts can be a valuable tool for improving one’s own physical, social and emotional wellbeing. Arts are now used in medical training to gain insight into patient health and to explore ethical issues as well as being used as a psychotherapeutic treatment for mental health problems.

Visiting Bristol Museum and ArtGallery recently, I was particularly drawn to the sculpture ‘A Ton of Tea’ by the Chinese contemporary artist Ai Weiwei. It is unexpected and as well as its political symbolism, also has an amazing texture and fragrance when you get close to it.

The ‘Sands of Time’ by David Maitland is a beautifully colourful photographic depiction of the skeletal remains of sea invertebrates found in a sample of sand – fascinating, microscopic beauty.

Back at Students’ Health Service we are looking forward to enhancing our own surroundings with the addition of some artwork to our walls. I hope that it will be engaging, interesting and enjoyable for all our visitors.

 

You can visit;

BristolMuseum and ArtGallery – ‘No Borders’ contemporary art in a globalised world. Free exhibition until June 2013

BristolMuseum and ArtGallery – Wildlife Photographer of the Year

 

Powdered willow bark for your headache?!

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On a daily basis I am amazed by the number of students who have seemingly no idea what to take for their pain or fever. The same issue has been noticed by our colleagues at the local Emergency Department, who are somewhat frustrated with having to deal with people who haven’t yet tried a simple painkiller for their sore throat, headache, or sprained ankle.

So I thought it might be useful to write a short blog about painkillers (or analgesia, to use the technical term!), for future reference next time you have a pain somewhere, or a raised temperature.

Salicin, from powdered willow bark, is a method of pain control dating back to Hippocrates in the 4th century BC. Over the centuries it was modified, and since 1897 we have known it as aspirin.

Paracetamol is much newer, coming from France originally, then modified in Germany in 1899, to a form very similar to the one still manufactured in huge quantities today.

Indomethacin was the first Non Steroidal Anti Inflammatory Drug (NSAID) in the 1960s. The commonest NSAID we recommend is ibuprofen.

Opioids have been around since as early as 3400BC and have caused problems alongside bringing benefits, ever since! Methadone came along in the 1930s.

There is a reason that these medications have been around for a long time, and that is because they work. I regularly encounter a strange reluctance to take anything at all, despite seeing patients with raging sore throats or disabling headaches because ‘it will mask the symptoms for you, doctor’, or it’s seen as a form of ‘personal failure’ to need a medicine.

I have to admit that I am baffled by both approaches, as any significant clinical signs will not be ‘masked’ (other than fever, and we ask about history of fever, not just current fever), and how can it be a ‘failing’ to use the wonders of science to treat illness. We wouldn’t deny another pain relief, so why do we deny ourselves?

So please, if you are suffering with pain or fever, and are not allergic to these medications, try the following from the pharmacy or supermarket (no prescription required);

 Paracetamol;               1 gram (2 tablets) up to 4 times a day (adult dose)

 Ibuprofen;                    400-600mg 3 times a day with food (total 1800mg)

 Cocodamol;                 8/500 tablets, 2 to be taken 4 times a day (instead of paracetamol)

Paracetamol and ibuprofen are synergistic and therefore taking both will give you even greater benefit.

Read the packets for dosage and side effect information, and if unsure ask the pharmacist for advice.

 Don’t suffer, take something and take comfort in the fact that our ancestors were onto a good and painfree thing!

Sit less, Move more!

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Ignoring your parents, and other ways to save your life

by John Wilford

 

“Don’t do that”

“Put that down”

“Don’t talk with your mouth full”

 Familiar ‘instructions’ heard by kids, of all ages.  Now the truly disgusting ones…

 “Sit down!”

“Sit still!”

 Mum, you got it so wrong.

 If you are reading this sitting down, please, get up. Standing comfortably? Then we’ll begin…

 Sitting is killing us.  It has become a ‘goto’ topic for the BBC on slow news days, and a recent article on the Harvard Business Review blog condemns sitting as our generation’s smoking.  There is an increasing body of evidence, generated by clever academic types on both sides of the Atlantic, showing just how bad sitting is for us.

Research in the USA shows people spending more time sitting (9.3 hours per day) than asleep (7.7 hours).  Like it or not, the UK is in the same ballpark.

Add up the time spent sat at your desk, in the library, in lectures, seminars, meetings and tutorials.  Time spent sat in the car or on the bus. Then there’s ‘leisure sitting’ – watching TV, at the computer or games console.  Sitting, just sitting. Oh, sit.

Further research suggests that if you sit for more than 6 hours a day, you are 40% more likely to die within the next 15 years than someone sitting for just 3 hours.  The bombshell is that this is true even if you exercise. Sedentary behaviour (sitting/lying whilst awake) is not just a lack of physical activity; it’s bad in its own right. As soon as you sit down, your leg muscles switch off, calorie burn drops to 1 per minute and after 2 hours your ‘good cholesterol’ has dropped 20%.  Whether you are an exerciser or not.  Higher rates of sedentary behaviour correlate with greater risk of mortality, independent of levels of physical activity. 

Sitting is a habit – and a bad one.  Like smoking, or biting your nails (Sorry Mum…).  It’s automatic and easy.  But it is a habit that can be broken. 

Look at what makes you sit, and where and when you could do without it.  On the phone? Stand up.  Having a short meeting? Ignore the chairs. On the laptop? Raise it up and stand (use window sills, cabinets, even the ironing board). This is before we even get to walking more – park your car further away from destination, take the stairs not the lift, etc etc…..

Yes, there are times that you will need to sit.  But limit it.  Get up and move around frequently. Swap standing and moving for sitting wherever possible.

 

Take a stand against sitting – sit less, move more.

I tried self hypnosis for my anxiety! You could too… a student writes…

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When I approached the Students’ Health Service to seek help with my study-related anxiety, night-time panic attacks and insomnia, I was really not sure what to expect. Although I knew they would have heard it all before, I did not anticipate such swift and effective support. Dr Grant, who I was able to see within a couple of hours of my panicked phone call, suggested a number of helpful options including referring me to a colleague in the Centre for Sports, Exercise and Health who introduced me to a range of approaches, including neuro-linguistic programming (NLP). In just an hour Matt Edwards had taught me a simple method of recalling a desired mental state: in my case, a state of calm and focused concentration on the task at hand. I had never attempted anything like this before, largely due to a deep suspicion of such techniques. I like to think of myself as a ‘rational’ person, not usually drawn to ‘alternative’ medicines or therapies. I felt nervous and a bit silly, but prepared to give it a try. In a private and comfortable office I explained that I was hoping address study-related anxiety and improve my concentration and focus. To my relief this was all the detail I had to give: this was not a counselling session! Matt outlined a range of approaches and we agreed to try a certain NLP technique. He told me to close my eyes and imagine a situation when I had felt calm, focused and in control: the mental state I wanted to be able to recall. He then talked me through a process of cementing in my mind what I could see, hear and feel in this situation. This took about ten minutes or so, but after imagining and magnifying that feeling in my mind’s eye, I felt that I really could return to it any time. Matt explained that in NLP this process is often accompanied by associating this mental state with a physical ‘anchor’: for me, this became a single word. Now, when I say that word to myself, I am able to recall that feeling of being calm and in control. I have used it several times since in class presentations and at home, particularly in the evenings, when my workload seems too much.

Apparently NLP is about being able to visualise what you want to achieve, and then re-create it for yourself by placing yourself mentally in that situation. I am being honest when I say I can’t believe it works, but it really does. I really would recommend anyone else at the end of their academic tether to give it a go – it can’t hurt, and if you believe in it even a little bit, it works wonders.

For a discussion about a referral to Matt Edwards book an appointment with a GP at Students’ Health Service.

The Change from Practice Nurse to Nurse Prescriber

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I have worked as a Practice Nurse since 2001 and at Students’ Health Service (SHS) since 2003, completing various courses over these years – minor illness/injury, contraception, sexual health and travel health. As a result of this experience and knowledge, I felt the next step was to be able to prescribe for certain conditions that I felt competent in; to complete episodes of care and to help reduce the number of doctors’ appointments within these specialities at SHS.

Therefore in 2011 I qualified as an Independent Nurse Prescriber, which involved undertaking a recognised Nursing and Midwifery Council (NMC) accredited prescribing course through a UK university.

Legislation to allow nurses to prescribe from an initially restricted list was introduced in 1986, and gradually nurses were given more autonomy, eventually culminating in Nurse Prescribers having full access to the British National Formulary (BNF) which has put nurses on a par with doctors in relation to prescribing capabilities. Although we have access to the BNF, this does not mean we can prescribe everything in there – we only prescribe within our own limitations and scope of competence. So, for example, I feel competent to prescribe antibiotics for certain conditions, and contraception methods, but I do not feel competent to prescribe anti depressants or diabetic medications.

Before the Change – Scenarios I would see in Practice…

“I feel REALLY terrible… I can hardly swallow as my throat is so sore, I can’t seem to get warm, but feeling freezing cold and sweating and I have painful swellings around my neck. I’ve come to Student Health and after waiting to see the nurse and having been assessed, I have been diagnosed with Tonsillitis. I’ve been given a leaflet with information about medicines I should take from the pharmacy to help with my symptoms, but I need to see the doctor for a prescription for antibiotics. I have to sit and wait now for my appointment. The waiting room is full, too much noise and I just want to go home and back to bed…”

“Oh… the nurse is running late… I’ve a lecture in 15 minutes. I just want to start the pill. My friends are all taking it and now I’m with Tom, I don’t want to repeat that episode with the split condom and having to take the emergency pill last month- how stressful was that… Hooray! I’ve been called in… after a few checks and lots of questions looks like I’m ok to take the pill- but the nurse cannot prescribe it and I now need to see a doctor… I’ll have to book an appointment on another day for my prescription as I need to go to my lecture…”

 

After the Change…

Advantages for me as a Practitioner

Being a Nurse Prescriber has increased my autonomy and independence at work leading to greater job satisfaction, especially in my specialised field of travel health medicine, which here at Students’ Health is now entirely nurse-led.This independence provides more streamlined care that is patient-focused.

Advantages for you as a Patient

Continuity of care, with particular reference to the scenarios as above – these are consultations I see fairly frequently and can complete independently in one appointment without the need for referral to a doctor for a prescription. This ensures timely access to medicines and treatments, increasing convenience for you.

Advantages for Students’ Health

Nurses being able to prescribe at SHS increases service efficiency by freeing up our doctors’ time to care for patients with more complex health care needs. We have three Nurse Prescribers at SHS.

Advantages for Secondary Care (Hospitals)

Evidence has shown that Nurse Prescribing helps to avoid unnecessary A&E and hospital admissions and improves access to treatment.

So please, when booking your appointments at SHS, check to see if a Nurse Prescriber can help you with your health care need – we are here to help you.