Asthma and chronic obstructive pulmonary disease are common respiratory disorders. Effective treatment and monitoring is necessary to avoid complications that can develop due to poor oxygen saturation or exacerbation of the disorder.
Asthma is a disorder in which the bronchial tubes tighten as a result of inflammation; this then creates difficulty breathing due to the narrowing of the lumen of the airway. This happens in recurrent episodes and can be caused by a number of triggers. These triggers can include: exercise, aerosols, cold air, dust, cigarette smoke and more.
The condition often develops in childhood and can have differing severity amongst patients. Some suffers can avoid the use of medication entirely, whereas others will need a variety of medication in a treatment plan to effectively manage their condition. This can have a profound impact on quality of life and can preclude suffers from activities or occupations that they might otherwise pursue. The lowest doses of medication that control symptoms should be used so as to avoid side-effects.
Chronic obstructive pulmonary disease (COPD) is the name of a collection of disorders where long term breathing problems and poor airflow are present. This is due to inflammation and damage within the lungs. It is typically caused by smoking, but some people that have never smoked can be affected. This can be due to a genetic cause of the disease. Asthma can lead to the development of COPD due to the narrowing of airways and inflammation that can be caused by asthma. Symptoms of COPD usually do not present until later in life and can include: increasing breathlessness, a persistent chesty cough, frequent chest infections and persistent wheezing.
COPD is a life limiting disorder as airflow obstruction is progressive. Exacerbations of the disorder are a frequent cause of hospitalisation. Due to the poor respiratory health of patients with COPD hospital acquired pneumonia can be a significant complication during hospitalisation which further worsens prognosis for these patients. An effective regimen with good patient compliance can reduce the risk of admission and therefore acquired infections.
Salbutamol is an intermittent therapy for asthma. One or two puffs of a metered dose inhaler containing this medication is used up to four times a day to help to relieve the symptoms of asthma when they are present. Patients should use this medication when they begin to notice symptoms such as wheezing, shortness of breath and tightness in the chest. It works by relaxing the muscles of the airways to the lungs.
Fluticasone is a regular preventer therapy which is taken twice daily. Doses of between 100 micrograms to 500 micrograms are given for adults. It works by reducing inflammation in the airways as well as reducing sensitivity to things that may trigger the symptoms of asthma. It is also used in the long term management of COPD to help provide relief from the symptoms of the disorder, as well as to try and reduce the number of exacerbations of COPD.
Montelukast is a leukotriene receptor antagonist. 10mg is taken once daily in the evening. It achieves its clinical effect by blocking the action of leukotriene on receptors contained within the lungs which results in decreased inflammation and relaxation of the muscle of the airways.
Long acting antimuscarinic receptor antagonists can be used in the treatment of asthma or COPD. Tiotropium is an example of a drug of this class. It is taken once daily and works by blocking the effect of a neurotransmitter on muscle. This relaxes the muscle and provides relief from constricted airways. It also provides a reduction in mucous secretion which can help patients with productive chesty coughs.
Common medicines for both these disorders are inhaled corticosteroids. These steroids share a large amount of side effects which can include: arrhythmias, dizziness, headache, hypokalaemia (with high enough doses), nausea, palpitations and tremor.
Antimuscarinic receptor antagonists cause many of the same side-effects: arrhythmias, dizziness, headache and nausea. However, due to their effect on muscarinic receptors they commonly cause dry mouth.
Proper inhaler technique is crucial to effective administration of medicines for these conditions. If a patient has poor technique then these local effect medications will not reach their intended area, or will do so in sub-optimal quantities to provide the intended clinical effect. With some inhaler devices a patient must have adequate lung function to deliver the drugs effectively to their lungs. This can be an issue, especially with patients with more advanced COPD. Some inhaler devices are able to deliver medications with greater velocity so that the patient themselves do not need to inhale with such force.
A patient should be assessed with spirometry to see which inhaler is suitable for them. Spirometry is a test that is used to monitor lung function and measures how much air a patient can inhale and exhale, and the force that they can generate as they perform these functions.
Patients will need to have a discussion with their doctor about how well their condition is managed. Patients will initially be started on a short-acting beta-2 agonist, such as salbutamol, to offer some relief of symptoms.
If this does not adequately control their condition then they will be offered maintenance therapy of an inhaled corticosteroid, such as fluticasone. If their asthma is still uncontrolled then there should be the addition of a leukotriene receptor antagonist to their treatment plan. The patient’s response to this treatment should be reviewed after 4 to 8 weeks.
If this therapy does not offer control of asthma, then a long-acting beta-2 agonist should be used. Salmeterol and formoterol are examples of drugs in this class. They are often given in a combination inhaler such as seretide or fostair.
Patients should be cautioned about the use of their medicines if they suffer from some conditions. A patient with an existing arrhythmia may not be suitable for corticosteroids due to the potential for these medicines to cause arrhythmias. Patients with diabetes need to monitor their blood glucose levels carefully as some of these medications can influence these levels. Patients with hypertension or cardiovascular disease can face adverse effects due to the effect of drugs used in treatment of asthma and COPD.
So I was hitting a wall in terms of storage space on my server. I got a new one and put CentOS 7 on it with raid 5. Then it was time to set about putting everything back in its place. Obviously I never documented anything that I did to set things up the first time around.
One small step
A fairly big disclaimer if you wanted to emulate what I've done: it is by no means elegant and there are probably some redundant instructions in the following text.
First things, first; let's install some packages to get the ball rolling:
If I were starting afresh I wouldn't install older versions of the programs that are used to build my blog. I would recommend that you grab the newer versions so rework the following. However, the theme I use would require some tweaking to work on the newer versions so...
Deluge preferences:
Downloads
change download folder to /home/media/downloads
Network
Under network extras - turn off DHT
Encryption
Inbound: Forced
Outbound: Forced
Level: Full Stream
Check encrypt entire stream
Bandwidth
Maximum connections: 250
Maximum upload slots: 250
Interface
Turn on ssl and point to ssl/SERVER.key & ssl/SERVER.crt
Daemon
Allow remote connections
Queue
Total Active: 200
Downloading: 100
Seeding: 200
Stop seeding when ratio reaches 2
Plugins
turn on the label plugin
create a user with normal permissions by adding the following line to this file:
yum install openvpn
wget https://roy.marples.name/downloads/openresolv/openresolv-3.9.0.tar.xz
tar-xvf openresolv-3.9.0.tar.xz
cd openresolv-3.9.0
./configure
make
make install
Figured I'd compile some tips on how to get through the pre-registration trainee pharmacy technician application process.
First thing to consider is why you want to do the PTPT course. Before I applied I spoke with a lot of pharmacy technicians about their careers, and more than you'd think recommended doing something else. I'm very keen on aseptics so I'm likely to try climb the ladder in that. Alternatively, I can make use of my experience in genomic medicine and aseptics to pursue other options. Being a qualified pharmacy technician opens up the possibility of funding university study with locum work. It's good to have a goal in mind, but to keep your options open.
Selection criteria
Figuring this out is really important as you can filter through positions quickly when they start opening. For each hospital that meets your personal criteria you should look up the hospital's CQC rating, trust values and any particular reasons why doing the PTPT course there would be good.
My personal criteria was:
Ideally single hospital site but if not then travel between sites is very easy
Economically viable
Not in the middle of nowhere
Near a climbing gym
Has an aseptic unit
A lot of feedback that I got after interviews was that while I had done very well at interview they did not feel that I gave strong answers to why I wanted to work for their hospital in particular. Royal Salford mentioned their outstanding CQC rating when giving this sort of feedback to me, so in interviews I had after that one I would talk about CQC ratings, trust values and any larger news that was occurring with the hospital. Royal Liverpool, for example, was in the process of building a completely new hospital. I could then talk about working in a pre-fab unit while the aseptic unit I was meant to be working in was refurbished.
Application
You want to try and write a lot in the supporting information section of any NHS job. Try and write to the person specification. I had a template that covered most bases and would rework this slightly for each hospital and the person specification they provided. My supporting information was 1372 words long, though from moving jobs fairly frequently I have a fair bit to write about - don't get too hung up about writing reams!
You get points for each of the criteria you meet in the person specification. Whoever is doing the interview will then invite the people with the most points to interview. Try and make their job easy by hitting all the things they are looking for in a clear and concise manner. It'll help your chances of getting invited to interview.
Interview
Interviews are a really mixed bag. Hospitals in the north west all use the BKSB functional skills test. If you are going for more than one hospital that uses the BKSB ask for a certificate proving the level you got and let other hospitals know you've done it so you don't end up sitting it repeatedly. Hospitals down south do their own tests which vary in difficulty. The level you get isn't the be all and end all - one of my coworkers got a lower level in maths and got the position over me.
One of the positions I didn't get was because I didn't speak enough about the details of the PTPT role. After that feedback I used to literally list out the main points. 2 year fixed term contract; band 4 annex U; have to pass first year to progress to the second; study for two qualifications, an NVQ level 3 and a BTEC level 3, day release at college to attend lectures for the BTEC portion; a brief overview of what I would study for the BTEC; what sort of rotations I would do in the hospital.
Sometimes you'll get a bit of a curve ball. At Countess of Chester they gave me three boxes of medication and asked me to give them information about them. We both acknowledged that working in aseptics I could only really read off the boxes so I did that and tried to give some basic information. Almost all the interview formats were the same. The panel usually consisted of 2 or 3 people. When you receive an invitation to interview it's worth making a note of which area the people on the panel are from so that you can talk about their areas. The only outlier was Western Sussex, they had 4 rooms with 2 people in each and each applicant went between the rooms and answered some questions. It's probably the worst format of interview I've encountered.
I ended up applying to the following trusts (sometimes more than once) before finding success at Royal Surrey: Greater Manchester Mental Health, Liverpool Womens, Countess of Chester, Wirral, Royal Liverpool, Western Sussex, Clatterbridge Cancer Centre, Manchester, Cambridge, Tameside and Glossop, Stockport, and Royal Salford. There were definitely points that I thought about giving up but persisting paid off. Try and not get discouraged if you aren't successful - the more interviews you do the better you will get at them.
It's worth checking your trust's leave policy. At Manchester Foundation Trust I was able to apply for special leave when attending interviews for NHS positions. Make sure to arrange this with your line manager so you don't end up using all your annual leave to go to interviews! Have a look on your trust's intranet for a special leave form or something similar to fill out.
Good luck! If you have any questions feel free to stick them in the comments below.
Section 7 of the Data Protection Act 1998 outlines the rights of an individual in regard to access to his or her personal data held by organisations. Unfortunately, few people are aware of this aspect of law.
One can make a subject access request to an organisation for personal information that the organisation holds. Exemptions can be made in the interest of the prevention and detection of crime, the apprehension and prosecution of offenders, and of matters of national security.
The National Pupil Database is a government dataset that contains information on all pupils in maintained schools and some more limited data on pupils in non-maintained schools. The private sector can apply for extracts of this dataset and the government would like to expand both the collection of data for this dataset and the access to it by third-party organisations. If this does not strike you as worrying you should evaluate what privacy means to you.
Organisations receive this data unanonymised [article] and are required to anonymise it if they produce any public works from it. The storage of this data is subject to the DPA 1998 but one only needs to look at the numerous huge data breaches of various large companies to see that their personal information is not safe in the hands of others.
I made a subject access request to the branch of the government that handles the NPD and gave them the relevant information so that they could comply with the subject access request. Interestingly this was only the school that I attended and my home address. Both pieces of information that a great number of people could know.
The man handling my case advised that given my age the volume of the material that they would be posting to me could be quite substantial and asked if there was anything specifically that I wanted to know. I dread to think the amount of information that is held on kids now given that the collection of this information was only just beginning when I was in school.