1. Wheatley, Amie RN

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A Day in the Life of ... a District Nurse

Lichfield, Staffordshire, is a vibrant city in central England, noted for its three-spired medieval cathedral. This is where I work as a District Nurse, seeing "housebound" patients who have a wide variety of nursing needs. A district nurse's day is unpredictable. It's 08:15 a.m. and I am holding the Team's mobile phone. I receive handover from the night staff as the phone rings; a nurse reports she is unwell and is self-isolating pending COVID-19 results. I reassure her and reschedule her patients, prioritizing the care of the most vulnerable.

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On the way to my first patient, I answer my phone and hear the tearful voice of a patient's wife. Her husband is vomiting. I'm nearby so I quickly make a call to handover my planned patient and arrive at the elderly couple's house and don PPE. I administer a prescribed antiemetic injection and sit with the couple, reassuring them we are a phone call away and will visit, no matter when they need us. The wife is upset and lonely during the lockdown. I leave but update the hospice nurses and request a prescriber review later today.


A voicemail from the hospice team informs me one of my palliative patients had passed away in the night. The family have requested we visit this afternoon. I check in at the office and prioritize urgent messages and allocate extra calls to the team. I also quickly check my emails; too many to read in any detail.


I arrive at my next patient. Betty greets me at the door, her smile beaming. It's the highlight of her week seeing the district nursing team. She is concerned her leg wound is not improving. I discuss the Doppler assessment booked for next week and explain this may aid the healing process. I note Betty has lost weight; her daughter cannot visit to deliver her home-cooked meals as she is shielding. Betty is having microwave meals, which she isn't enjoying. I call Betty's daughter and learn she has planned to cook her Mum some tasty food and have it delivered. As Betty's District Nurse, I'm looking at the bigger picture of contributory factors in Betty's health, focusing on the whole person.


At my next visit, the next-door neighbor informs me the gentleman was taken into hospital overnight following a fall. I make a note to close this referral and await a hospital discharge referral once he returns home. The "on-call" phone rings; it's the hospice nurse requesting I begin subcutaneous drugs for pain relief and sedation for the gentleman I saw this morning. She has sent the prescription to the pharmacy and the drugs will be ready in an hour. The pharmacy agrees to deliver the medication, so his wife doesn't have to leave him. I make a quick stop for a toilet break and collect the syringe box. I arrive at the next patient just in time for his lunchtime insulin; they are pleased to see me and it's so rewarding to see their health improving.


I call to see the bereaved family, as requested earlier. I offer my deepest condolences; they wanted to pass something onto the team. A "thank you" card and beautiful flower arrangement for the team. I express my thanks on behalf of the team.


I arrive to begin the subcutaneous drugs for the gentleman approaching the end of his life. His wife sobs, confiding that in their 70 years married life they had never been apart. The patient was comfortable and settled but his breathing had altered; I could see death was imminent. I suggested his wife sit with him and I gave them some privacy as he passed away. I stay a little longer to support the wife; they have no children, only close friends who are unable to visit due to COVID-19 restrictions. Before I leave, I help make the necessary arrangements with the funeral directors. I was sad not to be able to comfort her with a hug.


The phone rings again; a staff member needs advice regarding palliative medication. I support them to make their clinical decisions. The phone rings again, it's the family of a palliative patient who are requesting a review for pain and nausea. I visit and assess; I administer medication that resolves the pain and nausea quickly and increase the frequency of palliative visits.


There is still one more patient to see, I glance at the time; there are simply not enough hours in the day. I dash back to deliver "handover" at the office base; this is via a digital call. Digital technology has changed the way we work in the community; it creates opportunities for communication, but it never beats "face-to-face" contact.


It's been a busy day and, already, it's time to allocate tomorrow's work. As the caseload holder, I allocate work for the next day using my professional judgment, ensuring the skill mix of staff is safe for the care required. As I do this, the phone rings; it's a staff member calling in sick. I now have no staff to cover the shift and tomorrow is my day off. I offer to work to ensure that the shift is covered. I check my email, return the missed phone calls, and update the allocation system from my "to-do" list. Tomorrow's work is allocated, and the shift is covered safely.


Back on the road for the final patient to administer insulin. As I arrive, they are hypoglycemic. I administer a sugary product. Half an hour passes before I can safely administer insulin. The care agency calls are delayed by 30 minutes; I prepare the evening meal to ensure insulin and meal are given in a timely manner.


5.30 p.m. another rewarding day and time for home! District nurses are the hidden heroes of the NHS


App may help identify children with autism spectrum disorder

NIH: The brain is wired to pay attention to social information like facial expressions, speech, and gestures. Infants learn about the world through these social interactions. Autism spectrum disorder (ASD), is a developmental disorder that affects communication and behavior. People with ASD can have a hard time engaging in and interpreting social behavior. Symptoms generally appear in the first two years of life. Studies have shown that children with the disorder have distinct patterns of eye movement when viewing social scenes that can help with early detection. A child with ASD may spend more time looking at an object off to the side than a person smiling at them in a video.


Researchers investigated whether smartphones and tablets could be used to detect symptoms of ASD. They tested the eye-tracking app with nearly 1,000 toddlers at well-child visits with their pediatricians. The children, ages 16 to 38 months, viewed video clips on a tablet or smart phone while sitting in a caregiver's lap. The videos were all 60 seconds or less and included people on one side of the screen: a man blowing bubbles, a woman spinning a top or a pinwheel, or two women talking to each other about a trip to the park. Objects like toys or a clock appeared on the opposite side of the screen. The children were also shown two control movies without people or language. A front-facing camera recorded each child's eye gaze while viewing the videos. They were also screened for autism at the visit using a standard questionnaire. Among the toddlers, 40 were diagnosed with autism after further evaluation.


Children with ASD were much less likely than typically developing children to focus on social stimuli in the videos. The research team also observed problems with the children's ability to visually track conversations, which hadn't been previously documented.