Confidential enquiries Health Dictionary

Confidential Enquiries: From 1 Different Sources


special enquiries that seek to improve health and health care by collecting evidence on aspects of care and disseminating recommendations based on these findings. MBRRACE-UK (Mothers and Babies; Reducing Risks through Audits and Confidential Enquiries in the UK) investigates maternal deaths, stillbirths, late fetal losses and terminations, and neonatal deaths (see infant mortality rate; maternal death; maternal mortality rate; perinatal mortality rate). It replaced the Centre for Maternal and Child Enquiries (CMACE), which carried out this work until 2012. The National Confidential Enquiry into Patient Outcome and Death investigates general medical and surgical care, and the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness covers the care of people with mental illness. *NHS England manages the contracts with the confidential enquiries.
Health Source: Oxford | Concise Colour Medical Dictionary
Author: Jonathan Law, Elizabeth Martin

Confidentiality

The ethical principle that a doctor does not disclose information given in confidence by a patient.

The patient’s consent is needed before a doctor supplies confidential information to an insurance company, employer, or lawyer. However, doctors must disclose information when required to by law or when faced with injuries or disorders that indicate a serious crime. Doctors are also required to notify specified infectious diseases. Treatment of young children is usually discussed with the parents, but an older child’s request for confidentiality is generally respected if the doctor feels that he or she is competent enough to understand the issues involved.... confidentiality

Privacy

The state of being free from unsanctioned intrusion. For example, personal privacy in daily living activities (e.g. for clients in residential facilities) or confidential health records.... privacy

Aids

Acquired Immune Deficiency Syndrome. Infection by HIV virus may lead to AIDS, but is believed to be not the sole cause of the disease. It strikes by ravaging the body’s defence system, destroying natural immunity by invading the white blood cells and producing an excess of ‘suppressant’ cells. It savages the very cells that under normal circumstances would defend the body against the virus. Notifiable disease. Hospitalisation. AIDS does not kill. By lacking an effective body defence system a person usually dies from another infection such as a rare kind of pneumonia. There are long-term patients, more than ten years after infection with HIV who have not developed AIDS. There are some people on whom the virus appears to be ineffective. The HIV virus is transmitted by infected body fluids, e.g. semen, blood or by transfusion.

A number of co-factors are necessary for AIDS to develop: diet, environment, immoral lifestyle, drugs, etc also dispose to the disease which, when eliminated, suggest that AIDS needs not be fatal. However, there is no known cure. Smoking hastens onset. Causes include needle-sharing and sexual contacts. Also known as the ‘Gay Plague’ it can be transmitted from one member of the family to another non-sexual contact.

The virus kills off cells in the brain by inflammation, thus disposing to dementia.

Symptoms. Onset: brief fever with swollen glands. “Feeling mildly unwell”. This may pass off without incident until recurrence with persistent diarrhoea, night sweats, tender swollen lymph nodes, cough and shortness of breath. There follows weight loss, oral candida. Diagnosis is confirmed by appearance of ugly skin lesions known as Kaposi’s sarcoma – a malignant disease. First indication is the appearance of dark purple spots on the body followed by fungoid growths on mouth and throat.

While some cases of STDs have been effectively treated with phytotherapy, there is evidence to suggest it may be beneficial for a number of reasons. Whatever the treatment, frequent blood counts to monitor T-4 cells (an important part of the immune system) are necessary. While a phytotherapeutic regime may not cure, it is possible for patients to report feeling better emotionally and physically and to avoid some accompanying infections (candida etc).

Treatment. Without a blood test many HIV positives may remain ignorant of their condition for many years. STD clinics offer free testing and confidential counselling.

Modern phytotherapeutic treatment:–

1. Anti-virals. See entry.

2. Enhance immune function.

3. Nutrition: diet, food supplements.

4. Psychological counselling.

To strengthen body defences: Garlic, Echinacea, Lapacho, Sage, Chlorella, Reisha Mushroom, Shiitake Mushroom. Of primary importance is Liquorice: 2-4 grams daily.

Upper respiratory infection: Pleurisy root, Elecampane.

Liver breakdown: Blue Flag root, Milk Thistle, Goldenseal.

Diarrhoea: Bayberry, Mountain Grape, American Cranesbill, Slippery Elm, lactobacillus acidophilus.

Prostatitis: Saw Palmetto, Goldenrod, Echinacea.

Skin lesions: External:– Comfrey, Calendula or Aloe Vera cream.

To help prevent dementia: a common destructive symptom of the disease: agents rich in minerals – Alfalfa, Irish Moss, Ginkgo, St John’s Wort, Calcium supplements.

Nervous collapse: Gotu Kola, Siberian Ginseng, Oats, Damiana.

Ear Inflammation: Echinacea. External – Mullein ear drops.

With candida: Lapacho tea. Garlic inhibits candida.

Anal fissure: Comfrey cream or Aloe Vera gel (external).

Practitioner: Formula. Liquid extract Echinacea 30ml (viral infection) . . . Liquid extract Poke root 10ml (lymphatic system) . . . Liquid extract Blue Flag root 10ml (liver stimulant) . . . Tincture Goldenseal 2ml (inflamed mucous membranes) . . . Liquid extract Guaiacum 1ml (blood enricher) . . . Decoction of Sarsaparilla to 100ml. Sig: 5ml (3i) aq cal pc.

Gargle for sore throat: 5-10 drops Liquid extract or Tincture Echinacea to glass water, as freely as desired.

Abdominal Castor oil packs: claimed to enhance immune system.

Chinese medicine: Huang Qi (astragalus root).

Urethral and vaginal irrigation: 2 drops Tea Tree oil in strong decoction Marshmallow root: 2oz to 2 pints water. Inject warm.

Diet. Vitamin C-rich foods, Lecithin, Egg Yolk, Slippery Elm gruel, Red Beet root, Artichokes. Garlic is particularly indicated as an anti-infective.

Nutrition. Vitamin A is known to increase resistance by strengthening the cell membrane; preferably taken as beta carotene 300,000iu daily as massive doses of Vitamin A can be toxic. Amino acid – Glutathione: Garlic’s L-cysteine relates.

Vitamin C. “The virus is inactivated by this vitamin. Saturating cells infected with the HIV virus with the vitamin results in 99 per cent inactivation of the virus. The vitamin is an anti-viral and immune system modulator without unwanted side-effects. The ascorbate, when added to HIV cells, substantially reduced the virus’s activity without harming the cells at specific concentrations. Patients taking large doses report marked improvement in their condition. Minimum daily oral dose: 10 grams.” (Linus Pauling Institute, Science and Medicine, Palo Alto, California, USA)

Periwinkle. An anti-AIDS compound has been detected in the Madagascan Periwinkle (Catharanthus roseus), at the Chelsea Physic Garden.

Mulberry. The black Mulberry appears to inhibit the AIDS virus.

Hyssop. An AIDS patient improved to a point where ulcers were healed, blood infection eliminated, and Kaposi’s sarcoma started to clear when her mother gave her a traditional Jamaican tea made from Hyssop, Blessed Thistle and Senna. From test-tube research doctors found that Hyssopus officinalis could be effective in treatment of HIV/AIDS. (Medical Journal Antiviral Research, 1990, 14, 323-37) Circumcision. Studies have shown that uncircumcised African men were more than five to eight times more likely to contract AIDS than were circumcised men; life of the virus being short-lived in a dry environment. (Epidemiologist Thomas Quinn, in Science Magazine)

Study. A group of 13 HIV and AIDS patients received 200mg capsules daily of a combination of Chelidonium (Greater Celandine) 175mg; Sanguinaria (Blood root) 5mg; and Slippery Elm (Ulmus fulva) 20mg. More than half the patients enjoyed increased energy and improved immune function with reduction in both size and tenderness of lymph nodes. (D’Adamo P. ‘Chelidonium and Sanguinaria alkaloids as anti-HIV therapy. Journal of Naturopathic Medicine (USA) 3.31-34 1992)

Bastyr College of Naturopathy, Seattle, MA, USA. During 1991 the College carried out a study which claimed that a combination of natural therapies including nutrition, supplements, herbal medicine, hydrotherapy and counselling had successfully inhibited HIV and other viral activity in all patients in controlled trials lasting a year.

Patients chosen for the trial were HIV positive, not on anti-viral drugs and showing symptoms of a compromised immune system, but without frank AIDS (generally taken to be indicated by Karposi’s sarcoma and/or PCP-pneumocystitis carinii pneumonia).

Symptoms included: Lymphadenopathy in at least two sites, oral thrush, chronic diarrhoea, chronic sinusitis, leukoplakia, herpes, night sweats and fatigue.

Assessment was subjective and objective (including T-cell ratio tests). The patients did better than comparable groups in published trials using AZT.

Treatment was naturopathic and herbal. Patients receiving homoeopathy and acupuncture did not do as well as those receiving herbs.

Best results with herbs were: Liquorice (1g powder thrice daily); St John’s Wort (Yerba prima tablets, 3, on two days a week only). Patients reported a great increase in the sense of well-being on St John’s Wort. An equivalent dose of fresh plant tincture would be 10ml. The tincture should be of a good red colour. The College did not use Echinacea, which would stimulate the central immune system and which would therefore be contra-indicated.

Supplements given daily. Calcium ascorbate 3g+ (to bowel tolerance). Beta-carotene 300,000iu. Thymus gland extract tablets 6. Zinc 60mg (with some Copper). B-vitamins and EFAs.

To control specific symptoms: most useful herbs were: Tea Tree oil for fungal infections; Goldenseal and Gentian as bitters. Ephedra and Eyebright for sinusitis. Carob drinks for non-specific enteritis. Vitamin B12 and topical Liquorice for shingles.

Counselling and regular massage were used to maintain a positive spirit. Studies show all long term HIV positive survivors have a positive attitude and constantly work at empowering themselves.

Results showed significant improvements in symptoms suffered by HIV patients despite a slow deterioration in blood status. Methods used in the study had dramatically reduced mortality and morbidity. A conclusion was reached that AIDS may not be curable but it could be manageable. (Reported by Christopher Hedley MNIMH, London NW1 8JD, in Greenfiles Herbal Journal) ... aids

Aromatherapy

The external use of essential oils from seeds, resins, herbs, barks and spices for relaxant purposes.

Plant essences give plants their scent and were known to the ancient civilisations of Egypt and Greece as the ‘vital force’ or spirit of the plant. They were used for inhalation, rubbing on the skin or as a healthful addition to baths and foot-baths. The art is complementary to phytotherapy, acupuncture and other systems of alternative medicine.

The aromatherapist uses oils individually or in blends of different oils. The natural concentrated oil is usually diluted by adding a vegetable oil before direct application to the skin. A massage oil usually comprises 6 drops essential oil to 10ml (2 teaspoons) carrier oil – Almond, Peanut or other vegetable oil.

The skin is known to be an integral part of the immune system. T-cells are scattered throughout, primarily in the epidermis or outer layer. It has been demonstrated that oils rubbed on the skin are readily absorbed and borne to distant organs in the body via the bloodstream to soothe, relax and heal. Some oils should not be used during pregnancy or lactation.

An oil may be used as a natural perfume. As a bath oil, 5-6 drops of a favourite oil may be added to bathwater. Oils freshen a room; stimulate or relax as desired when added to water on a warm radiator. Oils are never used on the skin undiluted.

The aromatherapist never uses essential oils internally. Other carrier oils may be used: Sesame seed, Sunflower seed, Apricot kernel and Wheatgerm. Usual methods of applying essential oils: massage, inhalation and baths. When adding oils to baths water should not be too hot which causes oils to evaporate.

Remedies absorbed into the body via the skin avoid metabolism by the liver as when taken by mouth.

When the therapy was used in a geriatric ward in Oxford drug expenditure on laxatives and night sedatives fell. It was reported to have given profoundly deaf patients, many of whom had multiple sensory deficits, tranquillity. The results of a randomised trial in patients on an intensive care unit showed significantly greater psychological improvement (as demonstrated with anxiety and mood rating scales) in those given aromatherapy (1 per cent Lavender and Grapeseed oil) over those massaged with Grapeseed oil only or those prescribed rest alone. (The Lancet 1990 336 (8723) 1120)

The governing body of the therapy in the UK is the Aromatherapy Organisations Council (AOC) which represents the majority of professional practitioners. Enquiries: AOC, 3 Latymer Close, Braybrooke, Market Harborough. Leicester LE16 8LN. Tel/Fax 01858 434242. ... aromatherapy

British Journal Of Phytotherapy

Published six-monthly by the School of Phytotherapy (Herbal Medicine), edited by Hein Zeylstra. Scientific journal for the professional. Enquiries: School of Phytotherapy, Bucksteep Manor, Bodle Street Green, near Hailsham, East Sussex BN27 4RJ, UK. ... british journal of phytotherapy

Consent

The legal term describing a patient’s agreement to a doctor performing an operation, arranging drug treatment, or carrying out diagnostic tests.

Strictly, consent is valid only if the patient has been fully informed about the purpose of the procedure, the likely outcome, and any complications and side effects.

Consent cannot be given by children or by people with serious mental disorders, but a relative may give or withhold consent on their behalf.

The patient’s consent is also needed before a doctor supplies confidential information to an insurance company, employer, or lawyer.... consent

Sexually Transmitted Infections

(STIs) Infections transmitted primarily, but not exclusively, by sexual intercourse. Common STIs include chlamydial infections, genital herpes, pubic lice, genital warts, trichomoniasis, syphilis, gonorrhoea, and HIV infection. Antibiotics can be used to treat most bacterial STIs. Confidential tracing and treatment of an affected person’s partners is an essential part of the management of STIs (see contact tracing).

Practising safer sex can help prevent STIs.... sexually transmitted infections

Cepod

Confidential Enquiry into Peri-Operative Deaths: an influential enquiry by the Royal College of Surgeons of England that is used to monitor standards of surgical treatment. See also confidential enquiries.... cepod

Child Abuse

the maltreatment of children. It may take the form of sexual abuse, when a child is involved in sexual activity by an adult; physical abuse, when physical injury is caused by cruelty or undue punishment (see nonaccidental injury); neglect, when basic physical provision for needs is lacking; and emotional abuse, when lack of affection and/or hostility from caregivers damage a child’s emotional development (see attachment disorder).

ChildLine website: advice on physical, emotional, and sexual abuse from the NHS’s Child and Adolescent Mental Health Services, together with a confidential helpline... child abuse

Child Protection Register

(in Britain) a confidential list of children whose social circumstances render them at risk of neglect or abuse. Each local authority maintains a register of children who are subject to a child protection plan, who will receive extra support and surveillance from health and/or social services. See also safeguarding.... child protection register

Fiduciary Relationship

a relationship in which one person holds a position of trust with respect to the other and is expected to act solely in the *best interests of that person and to treat information shared as confidential. In medicine, the doctor–patient relationship is a fiduciary relationship.... fiduciary relationship

Maternal Mortality Rate

the number of deaths due to complications of pregnancy, childbirth, and the puerperium per 100,000 live births (see also stillbirth). In 1952 concern about maternal mortality resulted in Britain in the setting up of a triennial *confidential enquiry into every such death to identify any shortfall in resources or care. The first triennial report was published in 1985. Since 2014 reports have been produced annually by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries Across the UK). Levels of *maternal deaths are currently low: a report published in 2017 (covering 2013–15) counted 202 obstetric-related deaths (8.76 per 100,000 live births). Thromboembolism was the commonest direct cause of death (30 deaths, 1.13 per 100,000 live births), while heart disease was the commonest indirect cause of death (54 deaths, 2.34 per 100,000 live births).... maternal mortality rate

Mbrrace-uk

see confidential enquiries.... mbrrace-uk

Patient Advice And Liaison Service

(PALS) (in England) a confidential service provided by each NHS trust to support patients, their families, and carers by giving advice and information in response to questions and concerns about local NHS services. See also advocacy.... patient advice and liaison service

Perinatal Mortality Rate

(PNM) the total number of babies born dead after 24 weeks gestation (*stillbirths) and of live-born babies that die in the first week of life, regardless of gestational age at birth (early neonatal deaths), per 1000 live births and stillbirths. See infant mortality rate. See also confidential enquiries.... perinatal mortality rate

Samaritans

n. a British voluntary organization providing a telephone service for the suicidal and despairing. Started in 1953 by the Rev. Chad Varah in the cellars of a London church (St Stephen, Walbrook) with one telephone, it now has over 200 branches throughout the country manned by some 22,000 volunteers. It offers a free, nonprofessional, confidential, and (if required) anonymous service at all hours. Samaritans offer little advice, believing that their clients will be helped to make their own decisions by talking to someone who cares.... samaritans

Stillbirth

(intrauterine fetal death) n. birth of a fetus that shows no evidence of life (heartbeat, respiration, or independent movement) at any time later than 24 weeks after conception. Under the Stillbirth (Definition) Act 1992, there is a legal obligation to notify all stillbirths to the appropriate authority. The number of such births expressed per 1000 births (live and still) is known as the stillbirth rate. In legal terms, viability is deemed to start at the 24th week of pregnancy and a fetus born dead before this time is known as a *miscarriage or *abortion. However, some fetuses born alive before the 24th week may now survive as a result of improved perinatal care. See also confidential enquiries.... stillbirth



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