Chronic care Health Dictionary

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  2. Chronic Care

Chronic Care: From 1 Different Sources

The ongoing provision of medical, functional, psychological, social, environmental and spiritual care services that enable people with serious and persistent health and/or mental conditions to optimize their functional independence and well-being, from the time of condition onset until problem resolution or death. Chronic care conditions are multidimensional, interdependent, complex and ongoing.
Health Source: Community Health
Author: Health Dictionary

Chronic

A disease or imbalance of long, slow duration, showing little overall change and characterized by periods of remission interspersed with acute episodes. The opposite of acute.... chronic

Chronic Fatigue Syndrome

(CFS) is a recently designated semi-disease, often attributed to EBV (the Epstein-Barr virus) or CMV (Cytomegalovirus) infections, characterized by FUOs (Fevers of Unknown Origin) and resulting in the patient suffering FLS (Feels Like Shit). In most of us, the microorganisms involved in CFS usually provoke nothing more than a head cold; in some individuals, however, they induce a long, grinding, and debilitating disorder, characterized by exhaustion, depression, periodic fevers...a crazy-quilt of symptoms that frustrates both the sufferer and the sometimes skeptical physician. MCS (Multiple Chemical Sensitivities) are another syndrome that is often lumped with CFS, and they may often be two faces of the same condition. I am not using all these acronyms to mock the conditions, but as an irony. There is too much (Acronym Safety Syndrome) in medicine, reducing complex and frustrating conditions to insider’s techno-babble, somehow therein trivializing otherwise complex, painful and crazy-making problems. The widest use of acronyms (AIDS, HIV, CFS, MCS, MS etc.) seems to be for diseases hardest to treat, least responsive to procedural medicine, and most depressing to discuss with patients or survivors.... chronic fatigue syndrome

Intermediate Care

A short period of intensive rehabilitation and treatment to enable people to return home following hospitalization or to prevent admission to hospital or residential care.... intermediate care

Primary Care

Basic or general health care focused on the point at which a patient ideally first seeks assistance from the medical care system. It is the basis for referrals to secondary and tertiary level care.... primary care

Continuity Of Care

The provision of barrier-free access to the necessary range of health care services over any given period of time, with the level of care varying according to individual needs.... continuity of care

Secondary Care

Specialist care provided on an ambulatory or inpatient basis, usually following a referral from primary care.... secondary care

Tertiary Care

The provision of highly specialized services in ambulatory and hospital settings.... tertiary care

Antenatal Care

The protocol which doctors and midwives follow to ensure that the pregnant mother and her FETUS are kept in good health, and that the pregnancy and birth have a satisfactory outcome. The pregnant mother is seen regularly at a clinic where, for example, her blood pressure is checked, the growth and development of her child-to-be are carefully assessed, and any problem or potential problems dealt with. Most antenatal care deals with normal pregnancies and is supervised by general practitioners and midwives in primary-care clinics. If any serious problems are identi?ed, the mother can be referred to specialists’ clinics in hospitals. (See PREGNANCY AND LABOUR.)... antenatal care

Community Care

Services and support to help people with care needs to live as independently as possible in their communities.... community care

End-of-life Care

Care of older persons who are dying.... end-of-life care

Health Care

Services provided to individuals or communities by health service providers for the purpose of promoting, maintaining, monitoring or restoring health.... health care

Intensive Care

Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in a specially equipped unit of a health care facility. It can also be administered at home under certain circumstances (dialysis, respirators, etc.).... intensive care

Managed Care

A health care delivery system which entails interventions to control the price, volume, delivery site and intensity of health services provided, the goal of which is to maximize the value of health benefits and the coordination of health care management for a covered population.... managed care

Palliative Care

The active total care offered to a person and that person’s family when it is recognized that the illness is no longer curable, in order to concentrate on the person’s quality of life and the alleviation of distressing symptoms. The focus of palliative care is neither to hasten nor postpone death. It provides relief from pain and other distressing symptoms and integrates the psychological and spiritual aspects of care. It offers a support system to help relatives and friends cope during an individual’s illness and with their bereavement.... palliative care

Primary Care Trust

See GENERAL PRACTITIONER (GP)... primary care trust

Terminal Care

Medical and nursing care of persons in the terminal stage of an illness. See also “palliative care”.... terminal care

Bronchitis, Chronic

The ‘English Disease’. The result of repeated attacks of the acute condition. Menace to the elderly when bronchi becomes thickened and narrowed. Inelastic walls secrete a thick purulent mucus of fetid odour which plugs tubes and arrests oxygen intake. Aggravated by cold and damp, hence the need of a warm house with warm bedroom. Causes are many: smoking, industrial pollution irritants, soot, fog, etc. Breathlessness and audible breathing sounds may present an alarming spectacle.

A steady herbal regime is required including agents which may coax sluggish liver or kidneys into action (Dandelion, Barberry). Sheer physical exhaustion may require Ginseng. For purulent sputum – Boneset, Elecampane, Pleurisy root. To increase resistance – Echinacea. Where due to tuberculosis – Iceland Moss. For blood-streaked mucus – Blood root. For fever – Elderflowers, Yarrow. To conserve cardiac energies – Hawthorn, Motherwort. A profuse sweat affords relief – Elderflowers.

Alternatives. Capsicum, Ephedra, Fenugreek, Garlic, Grindelia, Holy Thistle, Iceland Moss, Lobelia, Mullein, Pleurisy Root, Wild Cherry.

Tea. Formula. Iceland Moss 2; Mullein 1; Wild Cherry bark 1. 1 heaped teaspoon to each cup water gently simmered 10 minutes. Dose: 1 cup 2-3 times daily.

Powders. Pleurisy root 2; Echinacea 1; Holy Thistle 1. Pinch Ginger. Mix. Dose: 500mg (two 00 capsules or one-third teaspoon) 2-3 times daily.

Tinctures. Formula. Iceland Moss 2; Lobelia 2; Grindelia quarter; Capsicum quarter. Dose: 1-2 teaspoons two or more times daily.

Practitioner. Liquid Extract Ephedra BHP (1983), dose 1-3ml. Or: Tincture Ephedra BHP (1983), dose 6-8ml.

Topical. Same as for acute bronchitis.

Note: In a test at Trafford General Hospital, Manchester, blowing-up balloons proved of benefit to those with chronic bronchitis. Fourteen patients were asked to inflate balloons and 14 refrained from doing so. After 8 weeks, the balloon-blowers showed considerable improvement in walking and a sense of well- being. Breathlessness was reduced. Condition of the others was either unchanged or worse. ... bronchitis, chronic

Chronic Obstructive Pulmonary Disease

See pulmonary disease, chronic obstructive.... chronic obstructive pulmonary disease

Coronary Care Unit

A specialist ward for the care of acutely ill patients who may be suffering, or who have suffered, a myocardial infarction (heart attack) or another serious cardiovascular disorder.... coronary care unit

Acute Care / Acute Health Care

Care that is generally provided for a short period of time to treat a new illness or a flare-up of an existing condition. This type of care may include treatment at home, short-term hospital stays, professional care, surgery, X-rays and scans, as well as emergency medical services.... acute care / acute health care

Adult Care Home / Residential Facility

A residence which offers housing and personal care services to a number of residents. Services (such as meals, supervision and transportation) are usually provided by the owner or manager. Usually 24-hour professional health care is not provided on site. See also “assisted living facility”.... adult care home / residential facility

Adult Day Care

See “day care centre”.... adult day care

Advance Care Planning

Planning in advance for decisions that may have to be made prior to incapability or at the end of life. People may choose to do this planning formally, by means of advance directives, or informally, through discussions with family members, friends and health care and social service providers, or a combination of both methods.... advance care planning

After-care

Care provided to individuals after their release from institutional care.... after-care

Aged Care

Services provided to people deemed to be aged or elderly.... aged care

Aged Care Assessment Team

Multidisciplinary team of health professionals that is responsible for comprehensive assessments of the needs of older persons, including their suitability for hospital, home or institutional care.... aged care assessment team

Alternative And Complementary Health Care / Medicine / Therapies

Health care practices that are not currently an integral part of conventional medicine. The list of these practices changes over time as the practices and therapies are proven safe and effective and become accepted as mainstream health care practices. These unorthodox approaches to health care are not based on biomedical explanations for their effectiveness. Examples include homeopathy, herbal formulas, and use of other natural products as preventive and treatment agents.... alternative and complementary health care / medicine / therapies

Ambulatory Care

Health services provided on an outpatient basis in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies the patient travels to a location to receive services and no overnight stay in hospital is required. Many surgeries and treatments are now provided on an outpatient basis, while previously they were considered reason for inpatient hospitalization.... ambulatory care

Assisted Living Facility / Assisted Care Living Facility

Establishment which provides accommodation and care for older or disabled persons who cannot live independently but do not need nursing care. Residents are also provided with domestic assistance (meals, laundry, personal care).... assisted living facility / assisted care living facility

Attendant Care

Personal care for people with disabilities in non-institutionalized settings generally by paid, non-family carers.... attendant care

Board And Care Home

See “adult care home”.... board and care home

Care

The application of knowledge to the benefit of a community or individual. There are various levels of care:... care

Care Chain / Chain Of Care

1 A well planned entity of inter- and intra-organizational care processes to solve the complexity of problems of an individual, and accompanied by systematic follow-up actions. Care chains are integrated to the extent that there are no gaps, barriers or breaks in the process leaving the older person without proper care. 2 A description of the different parts of care.... care chain / chain of care

Care Home

A residential facility that provides accommodation and offers a range of care and support services. Care homes may provide a limited number of services to support low dependency or may provide a wide range of services to cater for the continuum from low to high dependency care. See “assisted living facility”; “high dependency care facility”.... care home

Care In Community

See COMMUNITY CARE.... care in community

Care Management

See “case management”.... care management

Care Need

Some state of deficiency decreasing quality of life and affecting a demand for certain goods and services. For the older population, lowered functional and mental abilities are decisive factors that lead to the need for external help.... care need

Care Package

A combination of services designed to meet a person’s assessed needs.... care package

Care Pathway

An agreed and explicit route an individual takes through health and social care services. Agreements between the various providers involved will typically cover the type of care and treatment, which professional will be involved and their level of skills, and where treatment or care will take place. See also “care plan”; “care programme”.... care pathway

Care Plan

A dynamic document based on an assessment which outlines the types and frequency of care services that a client receives. It may include strategies, interventions, continued evaluation and actions intended to help an older person to achieve or maintain goals.... care plan

Care Programme

A documented arrangement of integrated care, based on the analysed needs of a specific group of people, from intake to supply of care and services, as well as the intended outcomes, and including a description of the way the arrangement should be applied in order to match the needs of individual persons.... care programme

Care Standards Act

Legislation (approved by the UK parliament in 2001) that sets up a new, independent regulatory body for social care and private and voluntary health-care services. The new body is called the National Care Standards Commission and covers England and Wales, but in the latter the National Assembly is the regulatory body. Independent councils register social-care workers, set social-care work standards and regulate the education and training of social workers in England and Wales. The Act also gives the Secretary of State for Health the authority to keep a list of individuals considered unsuitable to work with vulnerable adults. In addition, the legislation reforms the regulation of childminders and day-care provision for young children, responsibility for overseeing these services having been transferred from local authorities to the Chief Inspector of Schools. Services covered by the Act range from residential care homes and nursing homes, children’s homes, domiciliary-care agencies, fostering agencies and voluntary adoption agencies through to private and voluntary health-care services. This includes private hospitals and clinics and private primary-care premises. For the ?rst time, local authorities will have to meet the same standards as independent-sector providers.... care standards act

Care Supply

The types and volumes of services available.... care supply

Care-dependent

Persons with chronic illnesses and/or impairments which lead to long-lasting disabilities in functioning and reliance on care (personal care, domestic life, mobility, self direction).... care-dependent

Caregiver

A person who provides support and assistance, formal or informal, with various activities to persons with disabilities or long-term conditions, or persons who are elderly. This person may provide emotional or financial support, as well as hands-on help with different tasks. Caregiving may also be done from long distance. See also “formal assistance”; “informal assistance”.... caregiver

Caregiver Burden

The emotional, physical and financial demands and responsibilities of an individual’s illness that are placed on family members, friends or other individuals involved with the individual outside the health care system.... caregiver burden

Caregiver Burnout

A severe reaction to the caregiving burden, requiring intervention to enable care to continue.... caregiver burnout

Carer

See “caregiver”; “formal assistance”; “informal assistance”.... carer

Caresse

(French) A woman with a tender touch

Caress, Caressa, Carressa... caresse

Carew

(Latin) One who rides a chariot Carewe, Crewe, Crew... carew

Careya Arborea

Roxb.

Family: Barringtoniaceae.

Habitat: Sub-Himalayan tract, from Jammu eastwards to West Bengal, Madhya Pradesh and Tamil Nadu.

English: Kumbi, Slow-Match tree.

Ayurvedic: Katabhi, Kumbhi- ka, Kumbhi, Kumbi, Kaitrya, Kumudikaa.

Siddha/Tamil: Kumbi, Ayma.

Action: Bark—demulcent (in coughs and colds), antipyretic and antipruritic (in eruptive fevers), anthelmintic, antidiarrhoeal. An infusion of flowers is given after child birth.

Seeds contain triterpenoid sapo- genols, sterols; leaves contain a tri- terpene ester, beta-amyrin, hexaco- sanol, taraxerol, beta-sitosterol, quer- cetin and taraxeryl acetate.

Careya herbacea Roxb., a related species, is known as Kumbhaadu-lataa in Bengal.

Dosage: Bark—50-100 ml decoction. (CCRAS.)... careya arborea

Chronic Condition / Disease

A disease which has one or more of the following characteristics: is permanent; leaves residual disability; is caused by non­reversible pathological alternation; requires special training of the patient for rehabilitation; or may be expected to require a long period of supervision, observation or care.... chronic condition / disease

Chronic Diarrhoea

Refers to diarrhoeal episodes of presumed infectious aetiology that begin acutely but have an unusually long duration, usually more than 14 days (see also WHO Classification).... chronic diarrhoea

Chronic Hospital

A facility that serves patients who do not need acute care or care in another kind of specialty hospital and whose needs for frequency of monitoring by a medical practitioner and for frequency and duration of nursing care exceed the requirements for care in a comprehensive care or extended care facility.... chronic hospital

Chronic Sick And Disabled Act 1970

UK legislation that provides for the identi?cation and care of individuals who have an incurable chronic or degenerative disorder. The patients are usually distinguished from elderly people with chronic disorders. Local authorities identify relevant individuals and arrange for appropriate services. The legislation does not, however, compel doctors and nurses in the community to inform local authorities of potential bene?ciaries. This may be because the individuals concerned dislike being on a register of disabled, or because questions of con?dentiality prevent health sta? from reporting the person’s condition.... chronic sick and disabled act 1970

Chronic Disorder

A persistent or recurring condition or group of symptoms. Chronic disorders are customarily contrasted with acute diseases which start suddenly and last a short time. The symptoms of acute disease often include breathlessness, fever, severe pain and malaise, with the patient’s condition changing from day to day or even hour to hour. Those suffering from chronic conditions – for example, severe arthritis, protracted lung disease, ASTHMA or SILICOSIS – should be distinguished from those with a ‘static disability’ following a stroke or injury. Chronic disorders steadily deteriorate, often despite treatment and the patient is increasingly unable to carry out his or her daily activities.... chronic disorder

Chronic Fatigue Syndrome (cfs)

See also MYALGIC ENCEPHALOMYELITIS (ME). A condition characterised by severe, disabling mental and physical fatigue brought on by mental or physical activity and associated with a range of symptoms including muscle pain, headaches, poor sleep, disturbed moods and impaired concentration. The prevalence of the condition is between 0.2 and 2.6 per cent of the population (depending on how investigators de?ne CFS/ME). Despite the stereotype of ‘yuppie ?u’, epidemiological research has shown that the condition occurs in all socioeconomic and ethnic groups. It is commoner in women and can also occur in children.

In the 19th century CFS was called neurasthenia. In the UK, myalgic encephalomyelitis (ME) is often used, a term originally introduced to describe a speci?c outbreak such as the one at the Royal Free Hospital, London in 1955. The term is inaccurate as there is no evidence of in?ammation of the brain and spinal cord (the meaning of encephalomyelitis). Doctors prefer the term CFS, but many patients see this as derogatory, perceiving it to imply that they are merely ‘tired all the time’ rather than having a disabling illness.

The cause (or causes) are unknown, so the condition is classi?ed alongside other ‘medically unexplained syndromes’ such as IRRITABLE BOWEL SYNDROME (IBS) and multiple chemical sensitivity – all of which overlap with CFS. In many patients the illness seems to start immediately after a documented infection, such as that caused by EPSTEIN BARR VIRUS, or after viral MENINGITIS, Q FEVER and TOXOPLASMOSIS. These infections seem to be a trigger rather than a cause: mild immune activation is found in patients, but it is not known if this is cause or e?ect. The body’s endocrine system is disturbed, particularly the hypothalamopituitary-adrenal axis, and levels of cortisol are often a little lower than normal – the opposite of what is found in severe depression. Psychiatric disorder, usually depression and/or anxiety, is associated with CFS, with rates too high to be explained solely as a reaction to the disability experienced.

Because we do not know the cause, the underlying problem cannot be dealt with e?ectively and treatments are directed at the factors leading to symptoms persisting. For example, a slow increase in physical activity can help many, as can COGNITIVE BEHAVIOUR THERAPY. Too much rest can be harmful, as muscles are rapidly weakened, but aggressive attempts at coercing patients into exercising can be counter-productive as their symptoms may worsen. Outcome is in?uenced by the presence of any pre-existing psychiatric disorder and the sufferer’s beliefs about its causes and treatment. Research continues.... chronic fatigue syndrome (cfs)

Clinical Care

Professional specialized or therapeutic care that requires ongoing assessment, planning, intervention and evaluation by health care professionals.... clinical care

Communal Care

Assistance provided free of charge or at reduced rates to members of a group or society. Other members of the group or society generally provide care on a voluntary basis.... communal care

Community Health Care

Includes health services and integrates social care. It promotes self care, independence and family support networks.... community health care

Community-based Care / Community-based Services / Programmes

The blend of health and social services provided to an individual or family in his/her place of residence for the purpose of promoting, maintaining or restoring health or minimizing the effects of illness and disability. These services are usually designed to help older people remain independent and in their own homes. They can include senior centres, transportation, delivered meals or congregate meals sites, visiting nurses or home health aides, adult day care and homemaker services.... community-based care / community-based services / programmes

Comprehensive Health Care

Provision of a complete range of health services, from diagnosis to rehabilitation.... comprehensive health care

Continuing Care

The provision of one or more elements of care (nursing, medical, health-related services, protection or supervision, or assistance with personal daily living activities) to an older person for the rest of his or her life.... continuing care

Continuing Care Facility

A facility which provides continuing care.... continuing care facility

Chronic Obstructive Pulmonary Disease (copd)

This is a term encompassing chronic BRONCHITIS, EMPHYSEMA, and chronic ASTHMA where the air?ow into the lungs is obstructed.

Chronic bronchitis is typi?ed by chronic productive cough for at least three months in two successive years (provided other causes such as TUBERCULOSIS, lung cancer and chronic heart failure have been excluded). The characteristics of emphysema are abnormal and permanent enlargement of the airspaces (alveoli) at the furthermost parts of the lung tissue. Rupture of alveoli occurs, resulting in the creation of air spaces with a gradual breakdown in the lung’s ability to oxygenate the blood and remove carbon dioxide from it (see LUNGS). Asthma results in in?ammation of the airways with the lining of the BRONCHIOLES becoming hypersensitive, causing them to constrict. The obstruction may spontaneously improve or do so in response to bronchodilator drugs. If an asthmatic patient’s airway-obstruction is characterised by incomplete reversibility, he or she is deemed to have a form of COPD called asthmatic bronchitis; sufferers from this disorder cannot always be readily distinguished from those people who have chronic bronchitis and/ or emphysema. Symptoms and signs of emphysema, chronic bronchitis and asthmatic bronchitis overlap, making it di?cult sometimes to make a precise diagnosis. Patients with completely reversible air?ow obstruction without the features of chronic bronchitis or emphysema, however, are considered to be suffering from asthma but not from COPD.

The incidence of COPD has been increasing, as has the death rate. In the UK around 30,000 people with COPD die annually and the disorder makes up 10 per cent of all admissions to hospital medical wards, making it a serious cause of illness and disability. The prevalence, incidence and mortality rates increase with age, and more men than women have the disorder, which is also more common in those who are socially disadvantaged.

Causes The most important cause of COPD is cigarette smoking, though only 15 per cent of smokers are likely to develop clinically signi?cant symptoms of the disorder. Smoking is believed to cause persistent airway in?ammation and upset the normal metabolic activity in the lung. Exposure to chemical impurities and dust in the atmosphere may also cause COPD.

Signs and symptoms Most patients develop in?ammation of the airways, excessive growth of mucus-secreting glands in the airways, and changes to other cells in the airways. The result is that mucus is transported less e?ectively along the airways to eventual evacuation as sputum. Small airways become obstructed and the alveoli lose their elasticity. COPD usually starts with repeated attacks of productive cough, commonly following winter colds; these attacks progressively worsen and eventually the patient develops a permanent cough. Recurrent respiratory infections, breathlessness on exertion, wheezing and tightness of the chest follow. Bloodstained and/or infected sputum are also indicative of established disease. Among the symptoms and signs of patients with advanced obstruction of air?ow in the lungs are:

RHONCHI (abnormal musical sounds heard through a STETHOSCOPE when the patient breathes out).

marked indrawing of the muscles between the ribs and development of a barrel-shaped chest.

loss of weight.

CYANOSIS in which the skin develops a blue tinge because of reduced oxygenation of blood in the blood vessels in the skin.

bounding pulse with changes in heart rhythm.

OEDEMA of the legs and arms.

decreasing mobility.

Some patients with COPD have increased ventilation of the alveoli in their lungs, but the levels of oxygen and carbon dioxide are normal so their skin colour is normal. They are, however, breathless so are dubbed ‘pink pu?ers’. Other patients have reduced alveolar ventilation which lowers their oxygen levels causing cyanosis; they also develop COR PULMONALE, a form of heart failure, and become oedematous, so are called ‘blue bloaters’.

Investigations include various tests of lung function, including the patient’s response to bronchodilator drugs. Exercise tests may help, but radiological assessment is not usually of great diagnostic value in the early stages of the disorder.

Treatment depends on how far COPD has progressed. Smoking must be stopped – also an essential preventive step in healthy individuals. Early stages are treated with bronchodilator drugs to relieve breathing symptoms. The next stage is to introduce steroids (given by inhalation). If symptoms worsen, physiotherapy – breathing exercises and postural drainage – is valuable and annual vaccination against INFLUENZA is strongly advised. If the patient develops breathlessness on mild exertion, has cyanosis, wheezing and permanent cough and tends to HYPERVENTILATION, then oxygen therapy should be considered. Antibiotic treatment is necessary if overt infection of the lungs develops.

Complications Sometimes rupture of the pulmonary bullae (thin-walled airspaces produced by the breakdown of the walls of the alveoli) may cause PNEUMOTHORAX and also exert pressure on functioning lung tissue. Respiratory failure and failure of the right side of the heart (which controls blood supply to the lungs), known as cor pulmonale, are late complications in patients whose primary problem is emphysema.

Prognosis This is related to age and to the extent of the patient’s response to bronchodilator drugs. Patients with COPD who develop raised pressure in the heart/lung circulation and subsequent heart failure (cor pulmonale) have a bad prognosis.... chronic obstructive pulmonary disease (copd)

Continuing Care Retirement Community

A community which provides several levels of housing and services for older people, ranging from independent living units to nursing homes, on one site but generally in separate buildings.... continuing care retirement community

Continuum Of Care

The entire spectrum of specialized health, rehabilitative and residential services available to the frail and chronically ill. The services focus on the social, residential, rehabilitative and supportive needs of individuals, as well as needs that are essentially medical in nature.... continuum of care

Coordinated Care

A collaborative process that promotes quality care, continuity of care and cost-effective outcomes which enhance the physical, psychosocial and vocational health of individuals. It includes assessing, planning, implementing, coordinating, monitoring and evaluating health-related service options. It may also include advocating for the older person.... coordinated care

Coronary Care Unit (ccu)

A specialised hospital unit equipped and sta?ed to provide intensive care (see INTENSIVE THERAPY UNIT (ITU)) for patients who have had severe heart attacks or undergone surgery on the heart.... coronary care unit (ccu)

Curative Care

Medical treatment and care that cures a disease or relieves pain and promotes recovery.... curative care

Custodial Care

Board, room and other personal assistance services generally provided on a long-term basis. It excludes regular medical care.... custodial care

Day Care Centre

A facility, operated by a local authority, voluntary organization, geriatric centre or acute hospital, providing activities for older people. These activities, usually during the day for a determined period, are intended to promote independence and enhance living skills, and can include the provision of personal care and preparation of meals.... day care centre

Direct Patient Care

Any activities by a health professional involving direct interaction, treatment, administration of medications or other therapy or involvement with a patient.... direct patient care

Domiciliary Care

Care provided in an individual’s own home.... domiciliary care

Duty Of Care

A legal requirement that a person act towards others and the public with the watchfulness, attention, caution and prudence that a reasonable person would use in the circumstance. If a person’s actions do not meet this standard of care, then the acts are considered negligent, and any damages resulting may be claimed in a lawsuit for negligence.... duty of care

Economy Of Care

Costs are the measure of the economic function of care. Total costs and unit costs are the basic indicators.... economy of care

Elder Care

See “aged care”.... elder care

Episode Of Care

The description and measurement of the various health care services and encounters rendered in connection with an identified injury or period of illness.... episode of care

Equity Of Care

Fair treatment of needs, regarding both the distribution of services and allocation of resources.... equity of care

Ethics (of Care)

The basic evaluative principles which (should) guide “good” care. Principles typically refer to respect for, and the dignity of, human beings. Basic dimensions are “autonomy” (respect for self determination), “well-being” (respect for happiness, health and mental integrity) and “social justice” (justifiable distribution of scarce goods and services). More specifically, ethics of care refer to ethical standards developed for the care professions which are designed to implement ethical principles in the practice of care provision.... ethics (of care)

Evidence-based Care

The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individuals. This approach must balance the best external evidence with the desires of the individual and the clinical expertise of health care providers.... evidence-based care

Extended Care Facility (ecf)

A facility that offers sub-acute care, providing treatment services for people requiring inpatient care who do not currently require continuous acute care services, and admitting people who require convalescent or restorative services or rehabilitative services or people with terminal disease requiring maximal nursing care.... extended care facility (ecf)

Extra Care Sheltered Housing

Housing where there is additional support (such as the provision of meals and extra communal facilities) to that usually found in sheltered housing. Sometimes called ‘very sheltered housing’.... extra care sheltered housing

Formal Care

See “formal assistance”.... formal care

Foster Care

A form of assisted housing, usually provided in private homes owned and occupied by individuals or families, offering a place of residence, meals, housekeeping services, minimum supervision, and personal care for a fee to non-family members who do not require supervision by skilled medical personnel.... foster care

Geriatric Care

Care of older persons that encompasses a wide range of treatments from intensive care to palliative care.... geriatric care

Health Care Delivery System

See “health system”.... health care delivery system

Health Care Institution / Facility

Any establishment that is engaged in direct patient care on site.... health care institution / facility

Health Care Team

A group comprising a variety of professionals (medical practitioners, nurses, physical and occupational therapists, social workers, pharmacists, spiritual counsellors), as well as family members, who are involved in providing coordinated and comprehensive care. There are three types of health care team, defined by the degree of interaction among members and the sharing of responsibility for care:... health care team

Health Care Technology Assessment (hcta)

The systematic evaluation of properties, effects and/or impacts of health care technology. It may address the direct, intended consequences of technologies as well as their indirect, unintended consequences.... health care technology assessment (hcta)

High Dependency Care Facility

An establishment primarily engaged in providing inpatient nursing and rehabilitative services to individuals requiring nursing care.... high dependency care facility

Health-care Priorities

As the needs and demands of patients, and the costs of health care of populations, have risen sharply in recent years, governments and health-care providers – whether tax-funded, insurance-based, employer-provided or a mix of these – have had increasingly to face the dilemma of what services a country or a community can a?ord to provide. As a result, various techniques for deciding priorities of care and treatment are evolving. In the United Kingdom, priorities were for many years based on the decisions of individual clinicians who had wide freedom to prescribe the most appropriate care. Increasingly, this clinical freedom is being circumscribed by managerial, community and political decisions driven in part by the availability of resources and by what people want. Rationing services, however, is not popular and as yet no broadly agreed consensus has emerged, either in western Europe or in North America, as to how priorities can be decided that have broad community support and which can be a?orded. (See CLINICAL GOVERNANCE; EVIDENCE-BASED MEDICINE.)... health-care priorities

Home And Community-based Services; Home And Community Care Programme

See “community-based care”.... home and community-based services; home and community care programme

Home Health Agency (hha) / Home Health Care Agency

A public or private organization that provides home health services supervised by a licensed health professional in a person’s home, either directly or through arrangements with other organizations.... home health agency (hha) / home health care agency

Home Health Care / Home Care

See “domiciliary care”.... home health care / home care

Home-from-hospital / Hospital After-care Schemes

Schemes providing nursing care, personal care or practical help for older people who have returned home after a stay in hospital.... home-from-hospital / hospital after-care schemes

Hospice Care

A cluster of comprehensive services that address the needs of dying persons and their families, including medical, spiritual, legal, financial and family support services.... hospice care

Housing With Care

A range of housing schemes providing high levels of care.... housing with care

Informal Care

See “informal assistance”.... informal care

Institutional (care) Health Services

Health services delivered on an inpatient basis in hospitals, nursing homes or other inpatient institutions. The term may also refer to services delivered on an outpatient basis by departments or other organizational units of such institutions, or sponsored by them.... institutional (care) health services

Integrated Care

The methods and strategies for linking and coordinating the various aspects of care delivered by different care systems, such as the work of general practitioners, primary and specialty care, preventive and curative services, and acute and long-term care, as well as physical and mental health services and social care, to meet the multiple needs/problems of an individual client or category of persons with similar needs/problems.... integrated care

Intensive Care Medicine

The origin of this important branch of medicine lies in the e?ective use of positive-pressure VENTILATION of the lungs to treat respiratory breathing failure in patients affected by POLIOMYELITIS in an outbreak of this potentially fatal disease in Denmark in 1952. Doctors reduced to 40 per cent, the 90 per cent mortality in patients receiving respiratory support with the traditional cuirass ventilator by using the new technique. They achieved this with a combination of manual positive-pressure ventilation provided through a TRACHEOSTOMY by medical students, and by looking after the patients in a speci?c area of the hospital, allowing the necessary sta?ng and equipment resources to be concentrated in one place.

The principle of one-to-one, 24-hours-a-day care for seriously ill patients has been widely adopted and developed for the initial treatment of many patients with life-threatening conditions. Thus, severely injured patients – those with serious medical conditions such as coronary thrombosis or who have undergone major surgery, and individuals suffering from potentially lethal toxic affects of poisons – are treated in an INTENSIVE THERAPY UNIT (ITU). Patients whose respiratory or circulatory systems have failed bene?t especially by being intensively treated. Most patients, especially post-operative ones, leave intensive care when their condition has been stabilised, usually after 24 or 48 hours. Some, however, need support for several weeks or even months. Since 1952, intensive medicine has become a valued specialty and a demanding one because of the range of skills needed by the doctors and nurses manning the ITUs.... intensive care medicine

Interim Nursing Home Care

Care provided in geriatric centres and acute hospitals to older persons who are in need of limited medical care and who are awaiting nursing home placement.... interim nursing home care

Intermediate Care Facility (icf)

An institution which is licensed to provide, on a regular basis, health-related care and services to individuals who do not require the degree of care or treatment which a hospital or skilled nursing facility is designed to provide.... intermediate care facility (icf)

International Classification Of Health Problems In Primary Care (ichppc)

A classification of diseases, conditions and other reasons for attendance for primary care. This classification is an adaptation of the ICD but makes allowance for the diagnostic uncertainty that prevails in primary care.... international classification of health problems in primary care (ichppc)

International Classification Of Primary Care (icpc)

The official classification of the World Organisation of Family Doctors. It includes three elements of the doctor-patient encounter: the reason for the encounter; the diagnosis; and the treatment or other action or intervention.... international classification of primary care (icpc)

Long-term Care (ltc) / Long-term Aged Care

A range of health care, personal care and social services provided to individuals who, due to frailty or level of physical or intellectual disability, are no longer able to live independently. Services may be for varying periods of time and may be provided in a person’s home, in the community or in residential facilities (e.g. nursing homes or assisted living facilities). These people have relatively stable medical conditions and are unlikely to greatly improve their level of functioning through medical intervention.... long-term care (ltc) / long-term aged care

Long-term Care Facility

See “high dependency care facility”.... long-term care facility

Long-term Care Insurance

Insurance policies which pay for long-term care services (such as nursing home and home care) that are generally not covered by other health insurance.... long-term care insurance

Managed Care Plan

A health plan that uses managed care arrangements and has a defined system of selected providers who contract with the plan. Those enrolled have a financial incentive to use participating providers who agree to furnish a broad range of services to them. Providers may be paid on a pre-negotiated basis.... managed care plan

Managed Health Care

This process aims to reduce the costs of health care while maintaining its quality. The concept originated in the United States but has attracted interest in the United Kingdom and Europe, where the spiralling costs of health care have been causing widespread concern. Managed care works through changing clinical practice, but it is not a discrete entity: the American I. J. Iglehart has de?ned it as ‘a variety of methods of ?nancing and organising the delivery of comprehensive health care in which an attempt is made to control costs by controlling the provision of services’. Managed care has three facets: health policy; how that policy is managed; and how individuals needing health care are dealt with. The process and its applications are still evolving and it is likely that di?erent health-care systems will adapt it to suit their own particular circumstances.... managed health care

National Care Standards Commission

This was set up under the CARE STANDARDS ACT 2000 as an independent regulator in respect of homes for the elderly, the disabled and children in the state and private sectors in the UK.... national care standards commission

Neonatal Intensive Care

The provision of a dedicated unit with special facilities, including one-to-one nursing and appropriate technology, for caring for premature and seriously ill newborn babies. Paediatricians and neonatologists are involved in the running of such units. Not every maternity unit can provide intensive care: for example, the provision of arti?cial ventilation, other than as a holding procedure until a baby can be transferred to a better-equipped and better-serviced unit. Such hospitals tend to have special-care baby units, which are capable of looking after the needs of most, but not all, premature or ill babies.... neonatal intensive care

Patient Care Planning

See “care plan”.... patient care planning

Patient-centred Care

An approach to care that consciously adopts a patient’s perspective. This perspective can be characterized around dimensions such as respect for patients’ values, preferences and expressed needs; coordination and integration of care; information, communication and education; physical comfort, emotional support and alleviation of fear and anxiety; involvement of family and friends; or transition and continuity.... patient-centred care

Persistent Chronic Diarrhoea

Diarrhoea that begins acutely but lasts more than 21 days. The usual enteropathogens are Shigella spp., Salmonella spp., Campylobacter jejuni, Yersinia enterocolitica, Capillaria philippinensis, Cryptosporidium. Giardia can also be a cause.... persistent chronic diarrhoea

Personal Care

Assistance with those functions and activities normally associated with body hygiene, nutrition, elimination, rest and ambulation, which enables an individual to live at home or in the community.... personal care

Personal Care Plan

See “care plan”.... personal care plan

Plan Of Care

See “care plan”.... plan of care

Post-acute Care

See “transitional care”.... post-acute care

Preventive Care

Care that has the aim of preventing disease or its consequences. It includes health care programmes aimed at warding off illnesses, early detection of disease, and inhibiting further deterioration of the body.... preventive care

Primary Health Care

Sometimes called primary medical care, this is the care provided by a GENERAL PRACTITIONER (GP) – traditionally entitled the family doctor – or other health professionals who have ?rst contact with a patient needing or wanting medical attention. In the NHS, the primary health-care services include those provided by the general, dental, ophthalmic and pharmaceutical services as well as the family doctor service. Community health services provided outside the hospitals also o?er some primary health care.... primary health care

Private Health Care

The provision of medical and dental care to patients who pay for the care either directly, through private medical insurance, or through employer-funded private insurance. In the UK, most patients are treated and cared for by the community- or hospital-based NHS. Although not forbidden to do so, few NHS general practitioners see private patients. NHS consultants are – within certain prescribed circumstances – allowed to treat private patients and many, especially surgeons, do so; but consultations and treatment are usually done on private-health premises. Some NHS hospitals have private facilities attached, but most private care is carried out in separate, privately run clinics and hospitals.

Certain specialties – for example, orthopaedic and reconstructive/cosmetic surgery and mental health – attract more private patients than others, such as paediatrics or medicine for the elderly. The standards of clinical care are generally the same in the two systems, but private patients can see the specialist of their choice at a time convenient to them. Waiting times for consultations and treatment are short and, when in hospital, private patients usually have their own room, telephone, TV, open visiting hours, etc.

A substantial proportion of private medical-care services are those provided for elderly people requiring regular nursing care and some medical supervision. The distinction between residential care and nursing care for the elderly is often blurred, but the government policy of providing means-tested state funding only for people genuinely needing regular nursing care – a system operated by local-authority social-service departments in England and Wales – has necessitated clearer de?nitions of the facilities provided for the elderly by private organisations. The strict criteria for state support (especially in England), the budget-conscious approach of local authorities when negotiating fees with private nursing homes, and the fact that NHS hospital trusts also have to pay for some patients discharged to such homes (to free-up hospital beds for new admissions) have led to intense ?nancial pressures on private facilities for the elderly. This has caused the closure of many homes, which, in turn, is worsening the level of BED-BLOCKING by elderly patients who do not require hospital-intensity nursing but who lack family support in the community and cannot a?ord private care.... private health care

Quality Of Care

The degree to which delivered health services meet established professional standards and are judged to be of value to the consumer. Quality may also be seen as the degree to which actions taken or not taken maximize the probability of beneficial health outcomes and minimize risk and other outcomes, given the existing state of medical science and art.... quality of care

Residential Aged Care Facility

See “residential care”; “assisted living facility”.... residential aged care facility

Residential Care

Provides accommodation and other care, such as domestic services (laundry, cleaning), help with performing daily tasks (moving around, dressing, personal hygiene, eating) and medical care (various levels of nursing care and therapy services). Residential care is for older people with physical, medical, psychological or social care needs which cannot be met in the community.... residential care

Residential Care Services

Accommodation and support for people who can no longer live at home.... residential care services

Respite Care

Services provided in the home, at a day care centre or by temporary placement in a nursing home or residential home to functionally disabled or frail individuals to provide occasional or systematic relief to informal caregivers.... respite care

Restorative Care

Services provided to older people on a short-term basis to restore their physical condition to a level which would allow them to return home with appropriate support. See “rehabilitation”.... restorative care

Self Care

Health activities, including promotion, maintenance, treatment, care and health related decision-making, carried out by individuals and families.... self care

Short-term Aged Care

Involves care designed to improve the physical wellbeing and restore the health of older people to an optimum level following a serious illness.... short-term aged care

Skilled Care

“Higher level” of care (such as injections, catheterization and dressing changes) provided by trained health professionals, including nurses, doctors and therapists.... skilled care

Skilled Nursing Care

Daily nursing and rehabilitative care that can only be performed by, or under the supervision of, skilled nursing personnel.... skilled nursing care

Social Care Service

Assistance with the activities of daily life (personal care, domestic maintenance, self-direction) delivered by a personal care helper, home helper or social worker and aimed at supporting older people who experience disabilities in functioning.... social care service

Social Network Care

See “informal care”.... social network care

Special Care Unit

A long-term care facility unit with services specifically for persons with particular diseases, disorders or injuries.... special care unit

Specialized Nursing Care Needs

Nursing care needs that require the advanced and specialized clinical skills and knowledge of a registered nurse.... specialized nursing care needs

Stakeholders (in Aged Care)

People or groups who have an involvement or interest in the aged care system, including beneficiaries, providers and funders.... stakeholders (in aged care)

State Medicine (health Care Systems)

Major government schemes to ensure adequate health services to substantial sectors of the community through direct provision of services.... state medicine (health care systems)

Sub-acute Care

Sub-acute care is a bridge between acute care and home care. It is medical and skilled nursing services provided to persons who are not in the acute phase of an illness but who require a level of care higher than that provided in a long-term care setting.... sub-acute care

Transitional Care

A type of short-term care provided by some long-term care facilities and hospitals, which may include rehabilitation services, specialized care for certain conditions (such as stroke and diabetes) and/or post-surgical care and other services associated with the transition between hospital and home.... transitional care

Arthritis, Juvenile, Chronic

A group of rheumatoid conditions of unknown causation with onset before 16 years. Girls more than boys. Still’s disease being the form presenting with enlargement of spleen and lymph nodes, high temperature with macular rash comes and goes. Children usually ‘grow out of it’ although stiffness may continue. Deformities possible. Tardy bone growth of the mandibles giving the face a birdlike look. May progress to rheumatoid arthritis (girls) or ankylosing spondylitis (boys). So strong is psychosomatic evidence that sociologists believe it to be a sequel to broken families, divorce or bereavement. Few patients appear to come from a balanced environment or happy home.

Treatment. BHP (1983) recommends: Meadowsweet, Balm of Gilead, Poke root, Bogbean, Hart’s Tongue fern, Mountain Grape.

Teas: Singly or in combination (equal parts): Chamomile, Bogbean, Nettles, Yarrow. 1-2 teaspoons to each cup boiling water; infuse 5-10 minutes. 1 cup thrice daily before meals.

Tablets/capsules. Blue Flag root, Dandelion root, Poke root, Prickly Ash bark.

Formula. White Poplar bark 2; Black Cohosh half; Poke root quarter; Valerian quarter; Liquorice quarter. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon) (children 5-12 years: 250mg – one 00 capsule or one-sixth teaspoon). Liquid extracts: 1 teaspoon: (children 5-12: 3-10 drops). Tinctures: 2 teaspoons: (children 5-12: 5-20 drops).

Evening Primrose oil. Immune enhancer.

Topical. Hot poultice: Slippery Elm, Mullein or Lobelia.

Diet: Lacto vegetarian. Kelp. Comfrey tea. Molasses. Low fat.

General. Adequate rest, good nursing, gentle manipulation but no massage to inflamed joints. Natural lifestyle. Parental emotional support.

Oily fish. See entry. ... arthritis, juvenile, chronic

Leukaemia, Chronic Lymphocytic

A type of leukaemia caused by proliferation of mature lymphocytes. Although it is incurable, the disease is not always fatal. The cause is unknown.

Symptoms develop slowly, often over many years. As well as symptoms and signs common to acute forms of leukaemia (see leukaemia, acute), there may be enlargement of the liver and spleen, persistent raised temperature, and night sweats. Diagnosis is by blood tests and a bone marrow biopsy. In many mild cases, no treatment is needed. To treat severe cases, anticancer drugs are given, sometimes with radiotherapy.... leukaemia, chronic lymphocytic

Bright’s Disease (chronic)

Chronic glomerulonephritis. The final stage. May follow the sub- acute stage or repeated attacks of the acute stage. Kidneys small and white due to scar tissue. Amount of urine passed is considerably increased, pale and low specific gravity. Kidneys ‘leak’ protein in large quantities of water passed, their efficiency as filters greatly impaired. Tissues of eyelids and ankles waterlogged. Symptoms include loin pain, anaemia, loss of weight, progressive kidney damage.

A constant fear is the onset of uraemia caused by accumulation in the blood of waste by-products of protein digestion, therefore the patient should reject meat in favour of fish. Eggs and dairy products taken in strict moderation.

Where urea accumulates in the circulation ‘sustaining’ diuretics are indicated; these favour excretion of solids without forcing the discharge of more urine: including Shepherd’s Purse, Gravel root, or Uva Ursi when an astringent diuretic is needed for a show of blood in the urine. According to the case, other agents in common practice: Dandelion root, Yarrow, Hawthorn, Marigold, Stone root, Hydrangea. Parsley Piert, Buchu, Hawthorn, Golden Rod.

The patient will feel the cold intensely and always be tired. Warm clothing and ample rest are essential. Heart symptoms require treatment with Lily of the Valley or Broom.

This condition should be treated by or in liaison with a qualified medical practitioner.

Treatment. As kidney damage would be established, treatment would be palliative; efforts being to relieve strain and obtain maximum efficiency. There may be days of total bed-rest, raw foods and quiet. Consumption of fluids may not be as abundant as formerly. Soothing herb teas promote well-being and facilitate elimination. Oil of Juniper is avoided.

Efforts should be made to promote a rapid absorption – to restore the balance between the circulation and the lymphatics. For this purpose Mullein is effective. A few grains of Cayenne or drops of Tincture Capsicum enhances action.

Indicated. Antimicrobials, urinary antiseptics, diuretics, anti-hypertensives. For septic conditions add Echinacea.

Of Therapeutic Value. Alfalfa, Broom, Buchu, Couchgrass, Cornsilk, Dandelion, Lime flowers, Marigold, Mullein, Marshmallow, Parsley Piert, Periwinkle (major), Wild Carrot, Water Melon seed tea. Tea. Combine equal parts: Couchgrass, Dandelion, Mullein. 2 teaspoons to each cup boiling water. Infuse 5-15 minutes. 1 cup freely.

Powders. Combine equal parts: Stone root, Hydrangea, Hawthorn. Dose: 500mg (two 00 capsules or one-third teaspoon) 3 or more times daily in water or cup Cornsilk tea. A few grains Cayenne enhances action. Formula. Buchu 2; Mullein 2; Echinacea 1; Senna leaves half. Mix. Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water or cup Cornsilk tea 3 or more times daily. 2-3 drops Tincture Capsicum to each dose enhances action.

Diffusive stimulant for the lymphatic vessels. Onion milk is an effective potassium-conserving diuretic and diaphoretic. Onions are simmered gently in milk for 2 hours and drunk when thirsty or as desired – a welcome alternative to water. May be eaten uncooked.

Diet. Salt-free, low fat, high protein. Spring water. Raw goat’s milk, potassium broth. Fish oils. Avoid eggs and dairy products. No alcohol.

Supplements. Vitamins A, B-complex, C plus bioflavonoids, B6, D, E, Magnesium, Lecithin. Herbal treatment offers a supportive role. ... bright’s disease (chronic)

Hair Care

Hair, like nails and skin, is a protein material built up on amino acids. It is rich in minerals, especially sulphur. A sebaceous gland at the base of the hair follicle secretes sebum, an oily substance, which acts as a lubricant. When vital minerals and vitamins are lacking in the blood the quality of fibre and sebum deteriorates resulting in lustreless hair and change of texture. Healthy hair depends upon good personal hygiene, brushing, and washing with gentle-acting materials instead of harsh detergent shampoos which remove natural oils from the scalp and spoils its condition.

An adequate daily intake of essential fatty acids is assured by the golden oils (Sunflower, Corn, etc) which can be well supported by Evening Primrose oil capsules.

Internal: Bamboo gum. Nettle tea, Alfalfa, Horsetail, Soya.

Topical. Shampoo. Soapwort or Yucca. Chop 2 tablespoons (dry) or 1 tablespoon (fresh) leaves or root. Place in cup of warm water. Stir until a froth is produced. Decant and massage liquor into scalp.

Aloe Vera gel is noted for its moisturising effect and to provide nutrients. It may be used as a shampoo, hair set and conditioner. Jojoba oil has been used for centuries by the Mexican Indians for a healthy scalp; today, it is combined with Evening Primrose and Vitamin E with good effect. Olive oil stimulates strong growth.

One of several herbs may be used as a rinse, including Nettles, Rosemary, Southernwood, Fennel, Chamomile, Yellow Dock and Quassia. Hair should be washed not more than once weekly with warm water and simple vegetable soap; rinse four times with warm rinse, finishing off with cold. Brunettes should add a little vinegar; blondes, lemon juice. Selenium once had a reputation as a hair conditioner; recent research confirms. Selenium shampoos are available.

Supplements: Vitamins B (complex), B6, Choline, C and E. Copper, Zinc, Selenium, Vitamin B12 (50mg thrice daily).

Aromatherapy. 2 drops each: Sage, Nettles, Thyme; to 2 teaspoons Gin or Vodka, and massage into the scalp daily. ... hair care

Lung Disease, Chronic Obstructive

See pulmonary disease, chronic obstructive.... lung disease, chronic obstructive

Postnatal Care

Care of the mother after childbirth until about 6 weeks later.... postnatal care

Teeth, Care Of

See oral hygiene.... teeth, care of

Affordable Care Act 2010

(ACA)... affordable care act 2010

Care Assistant

a person who helps with the general care of a patient, usually assisting a nurse or social worker with care of the vulnerable elderly in the community. Care assistants include home helps.... care assistant

Chronic Idiopathic Facial Pain

see persistent idiopathic facial pain.... chronic idiopathic facial pain

Chronic Pelvic Pain

(CPP) intermittent or constant pain in the lower abdomen or pelvis of at least six months’ duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy. It may be caused by an underlying gynaecological condition, such as *endometriosis or adhesions, but bowel or bladder disorders (e.g. irritable bowel syndrome, interstitial cystitis), visceral hypersensitivity, and psychological conditions may all contribute.... chronic pelvic pain

Laryngitis, Chronic

 The main symptom is hoarseness or loss of voice from malfunction of the vocal cords by disease, stroke, stress, or nerve disorder. Pain on speaking. “Raw throat.”

Constitutional disturbance: fever, malaise.

Many causes, including: drugs, drinking spirits. Gross mis-use of voice (singing or talking) may produce nodules (warts) on the cords. The smoker has inflammatory changes. Nerve paralysis in the elderly. Carcinoma of the larynx. Voice changes during menstruation are associated with hormonal changes (Agnus Castus). Professional singers, members of choirs benefit from Irish Moss, Iceland Moss, Slippery Elm or Poke root.

Alternatives. Cayenne, Caraway seed, Balm of Gilead, Lungwort, Queen’s Delight, Thyme, Wild Indigo, Marsh Cudweed, Mullein, Marshmallow.

For most infections: Equal parts, Tinctures Goldenseal and Myrrh: 3-5 drops in water 3-4 times daily; use also as a spray or gargle.

Tea. Formula. Equal parts: Mullein, Marshmallow root, Liquorice. 2 teaspoons to each cup water brought to boil; vessel removed on boiling. Drink freely.

Practitioner. Combine equal parts: Senega, Ipecacuanha and Squills (all BP). 5-10 drops thrice daily in water. Also gargle.

Poke root. Reliable standby. Decoction, tablets/capsules. Tincture: dose, 5-10 drops thrice daily in water or honey.

Topical. Aromatherapy. Steam inhalations. Oils: Bergamot, Eucalyptus, Niaouli, Geranium, Lavender, Sandalwood. Any one.

Diet. Slippery Elm gruel. Salt-free. Avoid fried foods.

Supplements. Daily. Vitamin A (7500iu). Vitamin C (1 gram thrice daily).

To prevent voice damage. The voice should not be strained by talking too much, shouting or singing – especially with a cold. Try not to cough or keep clearing the throat but instead, swallow firmly. Do not whisper – it will strain the voice.

A common cause of laryngitis is growth of a nodule, cyst or polyp on the vocal cords. They are visible on use of an endoscope. There are two vocal cords which, in speech, come together and vibrate like a reed in a musical instrument. In formation of a nodule they cannot meet, air escapes and the voice becomes hoarse. Relaxation technique.

Where the condition lasts for more than 4 weeks an ENT specialist should be consulted. ... laryngitis, chronic

Liver – Hepatitis, Chronic

Term referring to hepatitis where the condition is the result of acute attacks of more than six months duration.

Causes: alcohol excess, drugs (Paracetamol prescribed for those who cannot tolerate aspirin), autoimmune disease, toxaemia, environmental poisons. Clinically latent forms are common from carbon monoxide poisoning. May lead to cirrhosis.

Symptoms. Jaundice, nausea and vomiting, inertia.

Treatment. Bile must be kept moving.

Alternatives:– Decoction. Formula. Milk Thistle 2; Yellow Dock 1; Boldo 1. 1 heaped teaspoon to each cup water gently simmered 20 minutes. Half-1 cup thrice daily.

Formula. Barberry bark 1; German Chamomile 2. Dose: Liquid Extracts: 2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 750mg (three capsules or half a teaspoon) thrice daily.

Tablets/capsules. Blue Flag root. Goldenseal.

Astragalus. Popular liver tonic in Chinese medicine. A liver protective in chemotherapy.

Diet. Fat-free. Dandelion coffee. Artichokes. Lecithin.

Supplements. B-vitamins, B12, Zinc.

Treatment by or in liaison with a general medical practitioner. ... liver – hepatitis, chronic

Dying, Care Of The

Physical and psychological care with the aim of making the final period of a dying person’s life as free from pain, discomfort, and emotional distress as possible. Carers may include doctors, nurses, other medical professionals, counsellors, social workers, clergy, family, and friends.

Pain can be relieved by regular low doses of analgesic drugs. Opioid analgesics, such as morphine, may be given if pain is severe. Other methods of pain relief include nerve blocks, cordotomy, and TENS. Nausea and vomiting may be controlled by drugs. Constipation can be treated with laxatives. Breathlessness is another common problem in the dying and may be relieved by morphine.

Towards the end, the dying person may be restless and may suffer from breathing difficulty due to heart failure or pneumonia. These symptoms can be relieved by drugs and by placing the patient in a more comfortable position.

Emotional care is as important as the relief of physical symptoms.

Many dying people feel angry or depressed and feelings of guilt or regret are common responses.

Loving, caring support from family, friends, and others is important.

Many terminally ill people prefer to die at home.

Few terminally ill patients require complicated nursing for a prolonged period.

Care in a hospice may be offered.

Hospices are small units that have been established specifically to care for the dying and their families.... dying, care of the

Chronic Total Occlusion

(CTO) a complete arterial blockage (usually coronary) that has been present for at least three months. Fibrosis and calcification at the site of occlusion are well established by this time, making *percutaneous coronary intervention to open the artery much more difficult.... chronic total occlusion

Health And Social Care Information Centre

(HSCIC) formerly, an executive nondepartmental public body set up in April 2013 to collect, analyse, and publish UK national health data and supply IT systems and services to health-care providers nationwide. It was rebranded as *NHS Digital in August 2016.... health and social care information centre

Health-care Commissioning

identifying services required to meet population health-care needs and obtaining such services from an appropriate service provider via allocation of resources and contracting arrangements. Commissioners monitor the quality of commissioned services, including adherence to any appropriate national standards. Most NHS commissioning is undertaken by *clinical commissioning groups or *NHS England.... health-care commissioning

Integrated Care Pathway

a multidisciplinary plan for delivering health and social care to patients with a specific condition or set of symptoms. Such plans are often used for the management of common conditions and are intended to improve patient care by reducing unnecessary deviation from best practice. See clinical governance.... integrated care pathway

Hepatitis, Chronic

Inflammation of the liver persisting for a prolonged period. Eventually, scar tissue forms and liver cirrhosis may develop.Chronic hepatitis may develop following an attack of acute hepatitis (see hepatitis, acute). It may also occur as the result of an autoimmune disorder, a viral infection (see hepatitis, viral), a reaction to certain types of drugs or, more rarely, to a metabolic disorder, such as haemochromatosis or Wilson’s disease.

Chronic hepatitis may cause slight tiredness or no symptoms at all.

It is diagnosed by liver biopsy.

Autoimmune hepatitis is treated with corticosteroid drugs and immunosuppressants.

Viral infections often respond to interferon.

In the drug-induced type, withdrawal of the medication can lead to recovery.

For metabolic disturbances, treatment depends on the underlying disorder.... hepatitis, chronic

Juvenile Chronic Arthritis

A rare form of arthritis affecting children. Juvenile chronic arthritis occurs more often in girls, and usually develops between 2 and 4 years of age or around puberty. There are 3 main types. Still’s disease (systemic onset juvenile arthritis) starts with fever, rash, enlarged lymph nodes, abdominal pain, and weight loss. These symptoms last for a period of several weeks. Joint pain, swelling, and stiffness may develop after several months. Polyarticular juvenile arthritis causes pain, swelling, and stiffness in many joints. Pauciarticular juvenile arthritis affects 4 joints or fewer.

Possible complications include short stature, anaemia, pleurisy, pericarditis, and enlargement of the liver and spleen. Uveitis may develop, which, if untreated, may damage vision. Rarely, amyloidosis may occur or kidney failure may develop. Diagnosis is based on the symptoms, together with the results of X-rays and blood tests, and is only made if the condition lasts for longer than 3 months.

Treatment may include antirheumatic drugs, corticosteroid drugs, nonsteroidal anti-inflammatory drugs, or aspirin. Splints may be worn to rest inflamed joints and to reduce the risk of deformities. Physiotherapy reduces the risk of muscle wasting and deformities.

The arthritis usually clears up after several years. However, in some children, the condition remains active into adult life.

– kala-azar A form of leishmaniasis that is spread by insects. Kala-azar occurs in parts of Africa, India, the Mediterranean, and South America.... juvenile chronic arthritis

Leukaemia, Chronic Myeloid

A type of leukaemia, also called chronic granulocytic leukaemia, which is caused by the overproduction of granulocytes, neutrophils, or polymorphonuclear leukocytes (see blood cells). The cause is unknown. This type of leukaemia usually has 2 phases: a chronic phase, which may last for several years, and a more cancerous phase, which is known as the blastic, accelerated, or acute phase.

During the chronic phase, symptoms may include fever, night sweats, and weight loss. Visual disturbances, abdominal pain, and priapism may also occur. The symptoms of the more cancerous phase are like those of the acute forms of leukaemia (see leukaemia, acute). The diagnosis is made from blood tests and a bone marrow biopsy. Treatment of the chronic phase includes anticancer drugs. When the disease transforms into the acute phase, treatment is similar to that given for acute leukaemia.... leukaemia, chronic myeloid

Pulmonary Disease, Chronic Obstructive

A combination of chronic bronchitis and emphysema, in which there is persistent disruption of air flow into or out of the lungs. Patients are sometimes described as either pink puffers or blue bloaters, depending on their condition. Pink puffers maintain adequate oxygen in their bloodstream through an increase in their breathing rate, and remain “pink” despite damage to the lungs. However, they suffer from almost constant shortness of breath. Blue bloaters are cyanotic (have a bluish discoloration of the skin and mucous membranes) because of obesity, and sometimes oedema, mainly due to heart failure resulting from the lung damage.... pulmonary disease, chronic obstructive

Care Quality Commission

(CQC) a publicly funded independent organization established in 2009 and responsible for regulation of health and social care in England; it replaced the Healthcare Commission, the Commission for Social Care Inspection, and the Mental Health Act Commission. The responsibilities of the commission include publication of national health-care standards; annual assessment of the performance of NHS and social-care organizations; reviewing other (i.e. private and voluntary) health- and social-care organizations; reviewing complaints about the services when it has not been possible to resolve them locally; and investigating serious service failures.... care quality commission

Inverse Care Law

an ironic ‘law’ stating that where good health care is most needed, it is usually least available. It was first stated by the Welsh GP Tudor Hart to underline the great difficulty in bringing areas of health-care poverty up to acceptable levels. See health inequalities; justice; need; rationing.... inverse care law

National Institute For Health And Care Excellence

see NICE.... national institute for health and care excellence

Patient Protection And Affordable Care Act

(PPACA) see Affordable Care Act 2010.... patient protection and affordable care act

Person-centred Care

an approach to health care that focuses on the needs of the individual care user, rather than providing a standardized response to their condition. The patient is encouraged to take an active role in discussing a health-care plan that reflects their own needs, circumstances, and values.... person-centred care

Postresuscitation Care

medical care given to an individual who has survived a *cardiac arrest. This will usually consist of a 12-lead electrocardiogram (see lead2), a chest X-ray, a number of venous and arterial blood tests, and transfer to a high-dependency or coronary care unit for further intensive monitoring and drug administration.... postresuscitation care

Chronic Sick And Disabled Persons Act 1970

(in Britain) an Act providing for the identification and care of those suffering from a chronic or degenerative disease for which there is no cure and which can be only partially alleviated by treatment. Such people are usually distinguished from the elderly who may also suffer from chronic diseases. It is the responsibility of local authorities to identify those with such problems and to ensure that services are available to meet their needs. Identification can be difficult because of the lack of a clear and agreed definition of what constitutes a disability of such severity as to warrant inclusion in such a register.... chronic sick and disabled persons act 1970

Dental Care Professional

any of several professionals supporting a dentist, formerly referred to as dental auxiliaries and professionals complementary to dentistry. A dental hygienist performs scaling and instruction in oral hygiene. A dental nurse helps the dentist at the chairside by preparing materials, passing instruments, and aspirating fluids from the patient’s mouth. A dental technician constructs dentures, crowns, and orthodontic appliances in the laboratory for the dentist. A clinical dental technician provides dentures directly to patients. A dental therapist performs non-complex treatment under the prescription of a dentist. In the UK dental care professionals are required to be statutorily registered with the General Dental Council (GDC).... dental care professional

Department Of Health And Social Care

(DHSC) (in Britain) a department of central government that supports the Secretary of State for Health and Social Care in meeting his or her obligations, which include the *National Health Service, the promotion and protection of the health of the nation, and social care, including some oversight of personal social services provided by local authorities. The department is staffed by civil servants, including some health professionals. Following the reforms of the Health and Social Care Act 2012, the Department no longer has direct control of the NHS, which has passed to *NHS England. The name of the department was expanded from ‘Department of Health’ in 2018. Equivalent departments support the ministers responsible for health services in Scotland, Wales, and Northern Ireland.

DHSC section of the website: provides information on a wide range of public health issues... department of health and social care

Psychiatric Intensive Care Unit

see PICU.... psychiatric intensive care unit

Severe Chronic Upper Airway Disease

(SCUAD) severe *rhinitis and *rhinosinusitis that has not been fully controlled by optimal pharmacological treatment.... severe chronic upper airway disease

Skin Care

Acne (M,S,F,B,I,N):

Bergamot, camphor (white), cananga, cedarwood (Atlas, Texas & Virginian), chamomile (German & Roman), clove bud, galbanum, geranium, grapefruit, immortelle, juniper, lavandin, lavender (spike & true), lemon, lemongrass, lime, linaloe, litsea cubeba, mandarin, mint (peppermint & spearmint), myrtle, niaouli, palmarosa, patchouli, petitgrain, rosemary, rosewood, sage (clary & Spanish), sandalwood, tea tree, thyme, vetiver, violet, yarrow, ylang ylang.

Allergies (M,S,F,B,I):

Melissa, chamomile (German & Roman), immortelle, true lavender, spikenard.

Athlete’s foot (S):

Clove bud, eucalyptus, lavender (true &spike), lemon, lemongrass, myrrh, patchouli, tea tree.

Baldness & hair care (S,H):

West Indian bay, white birch, cedarwood (Atlas, Texas & Virginian), chamomile (German & Roman), grapefruit, juniper, patchouli, rosemary, sage (clary & Spanish), yarrow, ylang ylang.

Boils, abscesses & blisters (S,C,B):

Bergamot, chamomile (German & Roman), eucalyptus blue gum, galbanum, immortelle, lavandin, lavender (spike & true), lemon, mastic, niaouli, clary sage, tea tree, thyme, turpentine.

Bruises (S,C):

Arnica (cream), borneol, clove bud, fennel, geranium, hyssop, sweet marjoram, lavender, thyme.

Burns (C,N):

Canadian balsam, chamomile (German & Roman), clove bud, eucalyptus blue gum, geranium, immortelle, lavandin, lavender (spike & true), marigold, niaouli, tea tree, yarrow.

Chapped & cracked skin (S,F,B):

Peru balsam, Tofu balsam, benzoin, myrrh, patchouli, sandalwood.

Chilblains (S,N):

Chamomile (German & Roman), lemon, lime, sweet marjoram, black pepper.

Cold sores/herpes (S):

Bergamot, eucalyptus blue gum, lemon, tea tree.

Congested & dull skin (M,S,F,B,I):

Angelica, white birch, sweet fennel, geranium, grapefruit, lavandin, lavender (spike & true), lemon, lime, mandarin, mint (peppermint & spearmint), myrtle, niaouli, orange (bitter & sweet), palmarosa, rose (cabbage & damask), rosemary, rosewood, ylang ylang.

Cuts/sores (S,C):

Canadian balsam, benzoin, borneol, cabreuva, cade, chamomile (German & Roman), clove bud, elemi, eucalyptus (blue gum, lemon & peppermint), galbanum, geranium, hyssop, immortelle, lavender (spike & true), lavandin, lemon, lime, linaloe, marigold, mastic, myrrh, niaouli, Scotch pine, Spanish sage, Levant styrax, tea tree, thyme, turpentine, vetiver, yarrow.

Dandruff (S,H):

West Indian bay, cade, cedarwood (Atlas, Texas & Virginian), eucalyptus, spike lavender, lemon, patchouli, rosemary, sage (clary & Spanish), tea tree.

Dermatitis (M,S,C,F,B):

White birch, cade, cananga, carrot seed, cedarwood (Atlas, Texas & Virginian), chamomile (German & Roman), geranium, immortelle, hops, hyssop, juniper, true lavender, linaloe, litsea cubeba, mint (peppermint & spearmint), palmarosa, patchouli, rosemary, sage (clary & Spanish), thyme.

Dry & sensitive skin (M,S,F,B):

Peru balsam, Tolu balsam, cassie, chamomile (German & Roman), frankincense, jasmine, lavandin, lavender (spike & true), rosewood, sandalwood, violet.

Eczema (M,S,F,B):

Melissa, Peru balsam, Tolu balsam, bergamot, white birch, cade, carrot seed, cedarwood (Atlas, Texas & Virginian), chamomile (German & Roman), geranium, immortelle, hyssop, juniper, lavandin, lavender (spike & true), marigold, myrrh, patchouli, rose (cabbage & damask), rosemary, Spanish sage, thyme, violet, yarrow.

Excessive perspiration (S,B):

Citronella, cypress, lemongrass, litsea cubeba, petitgrain, Scotch pine, Spanish sage.

Greasy or oily skin/scalp (M,S,H,F,B):

West Indian bay, bergamot, cajeput, camphor (white), cananga, carrot seed, citronella, cypress, sweet fennel, geranium, jasmine, juniper, lavender, lemon, lemongrass, !itsea cubeba, mandarin, marigold, mimosa, myrtle, niaouli, palmarosa, patchouli, petitgrain, rosemary, rosewood, sandalwood, clary sage, tea tree, thyme, vetiver, ylang ylang.

Haemorrhoids/piles (S,C,B):

Canadian balsam, Copaiba balsam, coriander, cubebs, cypress, geranium, juniper, myrrh, myrtle, parsley, yarrow.

Insect bites (S,N):

French basil, bergamot, cajeput, cananga, chamomile (German & Roman), cinnamon leaf, eucalyptus blue gum, lavandin, lavender (spike & true), lemon, marigold, melissa, niaouli, tea tree, thyme, ylang ylang.

Insect repellent (S,V):

French basil, bergamot, borneol, camphor (white), Virginian cedarwood, citronella, clove bud, cypress, eucalyptus (blue gum & lemon), geranium, lavender, lemongrass, litsea cubeba, mastic, melissa, patchouli, rosemary, turpentine.

Irritated & inflamed skin (S,C,F,B):

Angelica, benzoin, camphor (white), Atlas cedarwood, chamomile (German & Roman), elemi, immortelle, hyssop, jasmine, lavandin, true lavender, marigold, myrrh, patchouli, rose (cabbage & damask), clary sage, spikenard, tea tree, yarrow.

Lice (S,H):

Cinnamon leaf, eucalyptus blue gum, galbanum, geranium, lavandin, spike lavender, parsley, Scotch pine, rosemary, thyme, turpentine.

Mouth & gum infections/ulcers (S,C):

Bergamot, cinnamon leaf, cypress, sweet fennel, lemon, mastic, myrrh, orange (bitter & sweet), sage (clary & Spanish), thyme.

Psoriasis (M,S,F,B):

Angelica, bergamot, white birch, carrot seed, chamomile (German & Roman), true lavender.

Rashes (M,S,C,F,B):

Peru balsam, Tofu balsam, carrot seed, chamomile (German & Roman), hops, true lavender, marigold, sandalwood, spikenard, tea tree, yarrow.

Ringworm (S,H):

Geranium, spike lavender, mastic, mint (peppermint & spearmint), myrrh, Levant styrax, tea tree, turpentine.

Scabies (S):

Tolu balsam, bergamot, cinnamon leaf, lavandin, lavender (spike & true), lemongrass, mastic, mint (peppermint & spearmint), Scotch pine, rosemary, Levant styrax, thyme, turpentine.

Scars & stretch marks (M,S):

Cabreuva, elemi, frankincense, galbanum, true lavender, mandarin, neroli, palmarosa, patchouli, rosewood, sandalwood, spikenard, violet, arrow.

Slack tissue (M,S,B):

Geranium, grapefruit, juniper, lemongrass, lime, mandarin, sweet marjoram, orange blossom, black pepper, petitgrain, rosemary, yarrow.

Spots (S,N):

Bergamot, cade, cajeput, camphor (white), eucalyptus (lemon), immortelle, lavandin, lavender (spike & true), lemon, lime, litsea cubeba, mandarin, niaouli, tea tree.

Ticks (S,N):

Sweet marjoram.

Toothache & teething pain (S,C,N):

Chamomile (German & Roman), clove bud, mastic, mint (peppermint & spearmint), myrrh.

Varicose veins (S,C):

Cypress, lemon, lime, neroli, yarrow.

Verrucae (S,N):

Tagetes, tea tree.

Warts & corns (S,N):

Cinnamon leaf, lemon, lime, tagetes, tea tree.

Wounds (S,C,B):

Canadian balsam, Peru balsam, Tolu balsam, bergamot, cabreuva, chamomile (German & Roman), clove bud, cypress, elemi, eucalyptus (blue gum & lemon), frankincense, galbanum, geranium, immortelle, hyssop, juniper, lavandin, lavender (spike & true), linaloe, marigold, mastic, myrrh, niaouli, patchouli, rosewood, Levant styrax, tea tree, turpentine, vetiver, yarrow.

Wrinkles & mature skin (M,S,F,B):

Carrot seed, elemi, sweet fennel, frankincense, galbanum, geranium, jasmine, labdanum, true lavender, mandarin, mimosa, myrrh, neroli, palmarosa, patchouli, rose (cabbage & damask), rosewood, clary sage, sandalwood, spikenard, ylang ylang.... skin care


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