Practitioner
Development UK
provides quality continuing professional development for advanced health practitioners. Our courses are designed for a variety of health care providers including nurse practitioners, GPs, practice nurses, health visitors, school nurses, paramedics and pharmacists. For further information visit our website on www.pduk.net
Latest in-house programmes
Our in-house courses are tailored to your requirements and are the cheapest way to keep staff up-to-date with current practice.
IH63 : Management of Traumatic Wounds for the Advanced Practitioner
AR43 : Auditing Your Telephone Triage Service
AR35 : Numeracy Skills & V300 Examination ‘Revision/Prep’ (NMP)
AR34 : Safe Prescribing for Non-Medical Prescribers
P16 : Sports Injuries in Young People
A44 : Quality Hospital Care for Dementia Sufferers
IH40 : 6-8 Week Baby Check
IH91 : Intravenous Therapy Core Skills
IH42 : ECG Essentials for Health Care Support Workers
P06 : Childhood Skin Conditions: The Basic
and more
Latest scheduled courses
Our scheduled courses will refresh, develop and improve your skills.
AR44 : Recognising Common Dermatological Conditions in People of Colour
A43 : Sexual Health and Family Planning
AR38 : Advanced X-ray Image Interpretation - The Central Skeleton
IH89 : The ABCs of ECGs
A40 : Common Presentations in Women’s Health
P14 : Paediatric Asthma Update
P17 : Minor Injuries in Children (1-18 years of age)
A39 : Primary Care Screening for Cardiac Disease
AR45 : Non Medical Prescribing - Preparing for OSCEs
AR40 : Immunisation Training for HCAs: Influenza & Pneumococcal Vaccinations
AR39 : The ABCs of Wound Care for Health Care Assistants
and more
Recommended products
We have a wide range of publications and resources to support and reinforce our workshops and courses. ALL publications purchased on line are discounted at 10%.
PDUK courses from February - June
5 Day Patient Assessment Skills Workshop
Telephone Triage
Minor Injury Essentials
Minor Surgical Procedures
X-ray Interpretation of Minor Injuries
Advanced X-ray Image Interpretation - the Central Skeleton
The ABCs of ECGs
Blood Results Made Easy
Primary Care Screening for Cardiac Disease
Non Medical Prescribing - Preparing for OSCEs
Recognising Common Dermatological Conditions in People of Colour
The ABCs of Dermatology
ENT “Top Ten”
Common Presentations in Women’s Health
Sexual Health and Family Planning
Paediatric Minor Illness
Minor Injuries in Children (1-18 years of age)
The ABCs of Wound Care for Health Care Assistants
Safe Prescribing for NMPs
Numeracy Skills & V300 NMP Examination Revision
Diabetes Drugs: Prescribing Update
Managing Pain & Bugs with Drugs
Paediatric Asthma Update
Immunisation Training for HCAs
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Under the microscope:
Researchers find early signs of Alzheimer's within the brain
The first signs of Alzheimer's disease can now be found in the brain years before symptoms of the illness appear in the patient.
Two studies by researchers at UCLA have used brain-imaging techniques to measure subtle changes in brain structure long before any outward signs develop. These initial changes can now be traced thus helping doctors predict the disease's progression and enabling them to start crucial treatment early on.
In the first study, published online in the journal Human Brain Mapping, scientists tracked 169 people who had been diagnosed with mild cognitive impairment (MCI) over three years. MCI causes memory problems greater than those expected for an individual's age but not the personality or cognitive changes that define Alzheimer's. They found those who went on to develop Alzheimer's had a 10 to 30 percent greater degeneration or atrophy in two specific locations in the hippocampus, an area of the brain critical for long-term memory.
The MCI patients were split into those who had no noticeable hippocampal atrophy, other then what is expected from normal aging, and those who had greater atrophy than expected. Three years later, the researchers found 10 to 30 percent greater atrophy in the patients with premature atrophy who were later diagnosed with Alzheimer's.
They looked at two areas within the hippocampus: the CA1 (cornu ammonis) and the subiculum. They tracked atrophy from the CA1 as it spread to the subiculum, which matched disease progression from the MCI state to a diagnosis of Alzheimer's.
In the second study, which appears in the online edition of the journal Neurobiology of Aging, the researchers looked at 10 cognitively normal elderly people and compared their brain scans with those of seven other elderly people who were later diagnosed with MCI and then Alzheimer's. Again, they found the Alzheimer's group showed the same pattern of degeneration in the same regions of the hippocampus.
Linda Apostolova, assistant clinical professor of neurology at UCLA, said the excess deterioration is present in cognitively normal people who are more likely to develop MCI. This deterioration then spreads across the rest of the hippocampus and leads to Alzheimer's.
"We feel this is an important finding because it is in living humans," said Apostolova, senior author of both papers and a member of the UCLA Laboratory of Neuro Imaging. "Now we have a sensitive technique that shows the 'invisible', that is the progression of a disease before symptoms appear."
On the case:
Dealing with challenging behaviour in Alzheimer's patients
Arthur is an 82-year-old man who was diagnosed with Alzheimer’s disease three years ago. He has just taken up residence in a nursing home as his wife, his primary carer, is no longer able to cope with his aggressive and demanding behaviour. The nursing home staff have also found Arthur difficult to deal with. He has appeared to be very restless and agitated, he has been verbally aggressive to staff and once attempted to hit a carer who was taking him to the toilet.
The nursing home decided to give him some sedative medication and now Arthur will sit quietly in the lounge. However, his wife has complained he has become uncommunicative and unresponsive, and now requires more assistance to carry out basic tasks.
Questions:
- What do you think are the reasons for Arthur’s behaviour?
- How can we help him without sedative medication?
Answers:
- We need to recognise all behaviour, no matter how confused a person might be, has meaning and significance. As carers we must understand a person’s behaviour in the context of their experience. For example, a person can display aggressive or agitated behaviour for very valid and appropriate reasons. Arthur’s behaviour could be a response to factors such as pain or discomfort, feeling scared, helpless, frustrated, disempowered, useless, abandoned, isolated or stupid.
Finding the cause behind a person’s “challenging behaviour” can be difficult especially when their ability to communicate has become impaired. This is where we need to become more observant of visual clues (i.e. body language, posture, gestures, facial expressions) and vocal clues (i.e. tone of voice, pitch, volume). This can be done using resources such as pictures, cue cards or mimes. Techniques such as art and poetry are also useful as, in many types of dementia, sufferers are more able to express themselves creatively and this form of communication can be maintained for longer.
Validation therapy and dementia care mapping are two approaches that can help us understand the underlying causes of a person’s external behaviour. Validation therapy focuses upon the essential meaning behind a person’s communication. It helps practitioners to understand what the patient might be conveying even though the words used are incomprehensible. Dementia care mapping observes a person’s engagement with their environment and potential signs of well-being or ill-being.
Pain assessment should also be used. Guidelines from the American Geriatrics Association (2002) tell us to focus upon:
- Facial expressions
- Verbalisations/vocalisations
- Body movements
- Change in interpersonal interactions
- Changes in activity patterns or routines
- Changes in mental status
- Dealing with the causes of Arthur's behaviour will reduce the need to suppress it through medication. Taking away his ability to express himself may not take away the underlying feelings that are still present.
The problem for many people with dementia is the low expectations placed upon them. A lack of person-centred training means many practitioners assume “challenging" behaviour is the inevitable consequences of a person’s dementia and not the result of the environment and culture of care they find themselves in. Without recognising this we are failing the patient and perhaps subjecting them to unnecessary distress or potentially harmful treatment. Misuse of sedative medication has been linked with worsening symptoms and even increased fatality. The National Dementia Strategy (2009) has urged practitioners and policy makers to tackle such issues, offer more person-centred care and aim towards helping people to “live well with dementia”.
Gary Morris is a senior lecturer in mental health nursing and co-author of The Dementia Care Workbook.
In brief…
- PDUK's course Quality Hospital Care for Dementia Sufferers will help you offer person-centred care to your patients. For further details, click here
- Would you like further information on running an In House course in your area? For further details, click here.
- Still waiting for our latest brochure? Click here.
Ask PDUK
I was recently reviewing one of my patient’s notes and noticed a comment regarding pseudo dementia. Can you please explain what this means?
Major depression can masquerade as dementia, especially dementia of the subcortical type in elderly people. The characteristic psychomotor retardation may hinder the motivation to recall or learn, thereby mimicking memory impairment. The ability to concentrate and make decisions may be ineffective and a variety of tests of cognitive function may reveal inaccuracies.
Are there ways we as primary care providers can unknowingly contribute to making a patient’s dementia worse?
Yes. Only some of the problems a person experiences are attributable to the organic damage within their brain; their social environment and culture of care can have a detrimental impact. Lowered mood, anxiety states, disempowerment, increased dependency, lack of choice and losses can all exacerbate the patient’s condition.
Aging can also increase the sensitivity of the brain to pharmacologic agents and so polypharmacy has a compounding effect. Drugs that primarily affect the Central Nervous System (CNS) are an obvious source and should be eliminated if possible. A large number of other agents may also affect cognitive ability; these include antihistamines, nonsteroidals and a host of other medications.
What other conditions need to be ruled out before making a diagnosis of dementia?
There are a number of conditions that should be excluded. Physical problems such as acute infection and constipation can cause a confused state as can polypharmacy. Psychiatric disorders, many of which have overlapping symptoms relating to depression and anxiety, also need to be considered. Another condition is mild cognitive impairment (MCI).
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