Research at Brunel

I am enjoying attending Brunel University as part of the Brunel Older Persons Reference Group. This week we were invited to a research presentation on the use of Risperidone in treatment of agitation in dementia. We were invited as lay persons to help with the study of identifying risk factors. The group of OAPs were in fact a group of resourceful retirees with good career, science and clinical backgrounds. We feel we are still of use with all our life experience, knowledge and skills. It is very stimulating to share together and a wonderful ray of hope that we have clinical scientists & psychologists that are looking into the problems of ageing and conditions that can arise. We all wish to preserve our faculties and independence in our old age, a time of great vulnerability in our later years,  

Useful article link for background reading in the use of Risperidone in Dementia in the Frontiers of Pharmacology. Risperidone & Dementia in this article you will come up with term EPS and so this is what is means ExtraPyrimidal Symptoms that is the drugs can induced involuntary movements. 

The research team at Brunel University have teamed up with Sheffield University to look at risk factors in the use of Risperidone in Dementia. The prime worry is that it can cause stroke. So there is a need to look at those that are already at risk of stroke before adding to this risk factor. If you look at the active link to a useful article I have put in this post you will read how this drug has been a drug of choice to help calm patients that have become agitated & may also have some aggressive behaviour. You will read how this can be a problem in dementia but there are also non pharmaceutical ways to care plan as we know perception and interpretation of the environment and situation can change. 

Here is a link to look at recognition of Dementia & Alzhiemer's Disease I remember a talk at our local library on Alzhiemer's and the library itself was a good analogy used.  Look at the shelves of books and see these as memories, learning and experiences filed away in your brain. Now imagine someone knocking those shelves and some books fall away and some stay. Some memories are still stored and some lost. Some known perceptions of surroundings changed as the information lost. So a dark round circle of pattern on a rug may be seen as a deep pool of water and so the patient holds back and is fearful of stepping forward. The nurse or carer will be seeing no danger but the patients is seeing danger. This may lead to agitation but an agitation understood if you see this analogy. So developing surroundings to minimise such extreme misinterpretations is needed. 

In our sharing at the meeting we also identified that agitation may in fact be due to physiological conditions such as constipation and ureamia from lack of fluids or reduced intake. Hence why in a nursing care plan we need to be sure we monitor daily physiological needs and actions. Basic health care nutrition is vital to reduce the incidence of agitation. We also identified that staffing levels in nursing homes, residential homes and care of elderly wards need to be such as to spend time with patients to understand individual needs and preferences. As I write this I am thinking back to a dear Indian friend that was hospitalised in ITU it was so upsetting seeing her in her hospital open back gown and it felt therapeutic for me and I feel for her to drape a dupattia around her .. the loose scarf worn with sarwaar chemise. I too think of what I would like in my vulnerability to have something of my identity to feel a link to the "ME!" that I may be losing. In fact this BORG is brilliant now for me to link to me and my experience as a nurse and midwife.

So now to think on this side effect worry of stroke when using Risperidone. We has a group wished to know why is there this increased risk. If raises BP to cause a stroke then what is there in the patients past medical history that is an alert. I keep bringing to the researchers the need to identify if there is a history of Sleep apnoeas and the need for CPAP. But this is problematic as there are unknown diagnosis in the population that have sleep apnoeas and thus do not have CPAP treatment. There is a further thought in me as if this is so, could prolonged incidences of low oxygen sats have led to the dementia? I tied in with last weeks look at long covid and incidence of dementia. Do we have the data on the low oxygen sats and was this the causative factor?

One group member was putting forward that if the drug causes high BP can we not counter this with an anti hypertensive?   Another asked well what effect does it have on the dementia does it improve the condition to warrant the use of this drug or is it solely to calm agitation? 

I am trying to read round why the drug causes high blood pressure does it affect the angiotension renal regulation or is it that it vasa constricts. We have a duality here as if to calm agitation then surely it would lower blood pressure with the sedative effect. There is some lay literature discussing high blood pressure effect in first days of administration but also standing drop in blood pressure to incur risk of falls.. So I am looking forward to learning more on the exact mechanism of the drug.

 

Thoughts & Prayers for Peace in art

Poweful read The Figurine by Victoria Hislop

Victoria Hislop

Victoria! Victoria! You are amazing ... just closed the book just now finished reading this wonderfully crafted story.. You have totally pulled me in on its journey as if there with the characters, felt emotion and reaction to the characters. Got quite protective of Helena in parts.. I love what you have done, you researched and we learn much in the story. Even the clever way you use Greek words and phrases then in the craft of the story we learn the meaning. Quite moved as reminds me of my times in Athens but for different reasons  to help Syrian refugees in Eleonas. But not visited islands.. .. now I have finished the book must catch up on cleaning lol as I could not put the book down a real absorbing page turner! Strong advice to those yet to read.. clean up in advance!.. and make sure lots of snacks in house as you will not wish to stop reading this thrilling book. THANK YOU 💞 Victoria I needed this escape into the adventure. 😘

 

Open Lab

On Thursday was another Brunel afternoon for Brunel Older People Reference Group there was an Open lab afternoon in Mary Seacole department. One of my spritely and youthful looking 80yrs old neighbour from the next street to me asked to come along. We had a brilliant time together with the team of researchers and other members of BORG. We retired folk have a lot of life and career experiences in us and it is a wonderful feeling for young and old to learn and share with one another.  There is some important work going on to understand ageing looking visual and cognitive behaviour and mobility. It is good that there is a look at how falls occur and how to prevent them. We worry as we get older of the fall that leads to fractured neck of femur and hospital admission. We all wish to keep our independence and age healthy as possible. 

Long covid symposium

Last Wednesday 15th November we members of Brunel Older People Reference Group got invited to an afternoon symposium on Long Covid research. There were attendees in person and others on a linked zoom.It was a very stimulating presentation. Prof. Veena Kumar opened the symposium with her work on loss of smell and taste a widely reported symptom of Covid. You will have a great informative time googling the meaning of words such as Anosmia- no smell, Hyposomia, Parosmia this I saw in oncology with altered smell from chemotherapy & radiation, ageusia -no taste, hypogenusia, dysgeusia- this is fascinating and we may at some time of our lives experienced distorted taste. Often associated with strange taste from medication and infections. I am sure many will have had the experience with some paint odours how you can get a metallic taste in your mouth. I would experience this with IV antiboitics as a patient and could get a transient metallic taste in the early moment of IV bolus injection.  I good sign my IV line was patent!

So you begin to see in my posting of this that I am hooked on the stimulation of this presentation and it generated lots of thoughts, ideas and speculations in me. The biological importance of smell is one of detecting danger if a foul odour of something wrong or alert on odour such as fire and toxic gases to get us to react out of danger. It may be linked to a memory of something that was either a repugnant situation or a sweet situation. The memory can be triggered to affect us in a way to either induce nausea or to relax in the safety of a memory. I popular one is the smell of lavender it can often we associated with grand and great grandmothers it may evoke a peaceful relaxing safe memory... or a memory of pain and loss. So you will get varying reports on the smell of lavender. 

But there is another important role that it is the start of our digestive process. We all know the feeling of hunger and anticipation of a good meal when we smell cooking or baking. Our saliva secretion starts and we can sometimes drool at the thought of the food to come. So our digestive tract is awakened in readiness to start receiving the tasty food to come. Given that smell and taste are linked then no smell and no taste or distorted taste can hinder this process. It made me think of in the case of long covid was some of the tiredness linked to inefficient absorption of vitamins (particularly Vitamin B complex important in our Krebs cycle in the mitochondria for max energy production. Given the covid virus was an hijacker of our mitochondria for its own energy production it has some bearing), the absorption of  minerals, carbohydrates and proteins important for our overall health .. A thought I raised with Prof Veena in our time of comments and questions. 

Professors work had looked a challenging smell and taste to regain and looked at mood affects over a period of time. So given my past study on Aromatherapy and that in many clinical settings it is used from Midwifery, Cardiology to Oncology I wondered if a study had been made on this to assess smell and reawakening smell. The aromatherapy induces mood changes too with the high and low notes of aroma. Can be used to relax or to uplift.  But I also need to think the active components can be absorbed through the skin in therapeutic massage. This leads to also the effects of therapeutic touch to help healing. 

See how fascinating this subject is.. Also in break time we were discussing the very elite job role of "Le Nez the Nose" in the perfumery industry to develop new perfumes for the market. It is well known we desensitise to smells over a long exposure.  So in that role of "Le Nez" the hours are limited lol but well paid!

Some other areas of discussion looked at Low Mood and Anxiety, Unhealthy Eating Patterns, Reduced Quality of Life, Early Dementia, Brain Fog. One of the Long Covid patients in the Zoom put forward how as in her 80s she had hot flushes something she had finished with long before in menopause. So this made us think of hormonal disturbances caused by long Covid given that women can experience brain fog in the menstrual cycle, post partum and peri menopause. So that was an interesting symptom to pursue. The resumption of those hot flushes was a key point brought to the table.

Trying to help the lack of taste there was a presentation on breathing exercises to improve olfactory response. But a subnote! does it depend on the environment we are in at the time.. There is a difference to breathing exercises say by the sea or in a forest to being in a busy city.. 

We had a very engaging presentation from Prof. Costa Karageorghis His opening demonstrated how in the lockdown the work of university research departments took on a different shape. From an urgent knock on the office door to go home to then finding new work was needed on the now emerging effects of the pandemic on all aspects of life! A key shift was one from outgoing to work to working from home and the effects on work production and health. Reduced exercise and mobility and changes in mental performance were affected. Brain fog came along again in the discussion as a result of changing world upskittled routines and having to adapt to new situation.  There was a need to look at pre and post covid changes in performance. But in among the loss of socialising out and about we also found a portal call Zoom and Teams Meetings. Some felt this a connecting experience some missed the in person interaction in office and social environment. So mentally we could see a rise in depression and low moods. 

I felt as we listened to this we needed to know if the people had been hospitalised or not. To be hospitalised and the need for induced coma and ventilation in ITU, that may have needed temporary tracheotomy, could have brought on PTSD on regaining consciousness and the healing journey. There was gratefulness to staff and survival but the journey had been life threatening and involved a degree of Scifi scariness in the type of clothing the care givers had to wear. Staff recognised this and would come up with ingenious ways to show their name, job role and personality on attached artwork to their gowns. 

I also felt that we needed medical data on the Oxygen sats in the disease process was it prolonged low to cause contribution to low mood, changed cognitive behaviour and mobility.  My point of concern in the present NHS format is the loss of convalescent beds and rehab wards, I know as a past patient myself from pneumonia that yes one wished to get home but there is a need for some nursing support even if you are trying to be independent. On my discharge I needed to devise a rehab plan for myself with realistic set goals for the day and weeks as I regained my energy levels and reduction in breathlessness on exertion. I needed time on inhalers to aid my breathing... So when we look at post covid effects can we see a multi disciplinary care plan to aid the journey to wellbeing.  

Professors work can be found on the link above and he introduced me to stats presentations of Stackdot plotting and Raincloud. So a thoroughly stimulating and informative afternoon.

 Some additional useful references found:

Retraining Smell post Covid

Loss of Smell & Taste NHS Scotland

Hospital Ships

the horror the word WAR generates results in enormous need to care for patients with complex injuries. Internal damage can lead to multiple sites of haemorrhage. Organs damaged means loss of function. Skeletal fractures and smashed bones can result in systemic problems of infection and fat embolisms. Fractures need internal fixation and may also need amputation of limb affected. War trauma will involve severed limbs, open abdominal cavity and large area skin burns.. blast damage of lungs can lead to need to support cardio pulmonary system to ensure oxygenation and circulation to vital organs. A/E doctors, surgeons, orthopaedic surgeons, plastic surgeons will have to deal with all age groups suffering from cruel injuries from cruel designed weapons. The anaesthetists not only supporting pain management in surgery but needed as vital team members in ITU and HDU care. Nurses, pharmacists paramedics ODAs all necessary. The very obvious need for power to drive life support machinery, IV pumps, lighting and heating and filter air systems in OT.& to sterilise instruments. The supplies need water, dressings, drugs, food for patients & staff . In war.. hospitals  medics to international law must be respected and protected. Care givers are driven by a duty of care from a duty of compassion to whoever needs help. That help to which ever side presents with injuries. Of course there are medical patients with pre existing disease to care for and pregnant & birthing mothers to help. 

But we have seen hospitals bombed and medics lives lost giving care or at home with their families. So I joined a vigil outside Downing Street on Friday evening 10th Nov to remember those that had died.  It was very moving and painful to hear how such amazingly skilled caring people now lost. We had doctors that have worked in Gaza remembering the friendships that developed. Organisation such as Medicin sans Frontiere,  Medical Aid for Palestinians and Medact with media attended the vigil. Which was calm dignified and very very emotional.

I am campaigning for Hospital ships not war ships. IF the UN could negiotate not only ceasefire but break the sea blockade, then hospital ships could dock in the sea port. Their facilities with theatres and ITU beds could greatly help in csre of the sick and injured. So got my campaign placard in front of cameras in the vigil.. On Saturday circulated in the peace march in front of the US embassy and media cameras. Twittering the photos to key world leaders. 

Remembering

yesterday 11th November had a quiet time in London at St Thomas's hospital (where I used to be a midwife) and on the embankment..the covid Memorial wall was my first time seeing ..it really hits home how much the pandemic had hurt families. Lost loved ones fallen to the quite vicious critter of a virus. A virus that demanded serious attention to get under control in the nation and globally.. 

On site at St Thomas's had time by the Mary Secole statue and remembrance wreaths had been laid .. Mary worked in the war tending injured ..and then went on to the Florence Nightingale museum.. Florence a nursing hero caring for war injured and building our nursing careers with her dedication to ensure good team management. Both these women amazing nurses that taught us much on dedication to others healing and wellbeing.  So a salute to their brave dedication to care.

Then had quiet time in the hospital chapel and found a beautiful and very moving corner to remember babies and children that have been lost to illness. Very a tear filling time given the wars in the world where children also being lost to adults war tantrum destruction . We need Global peace where our love care and compassion for one another unites us... life is very precious..