Can you buy over the counter lasix

Pharmacists across North Carolina are standing by to assist in the state's hypertension medications vaccination efforts, but when the doses get into their hands, access won't be equal for everyone.The ABC11 I-Team in partnership with the ABC Owned Television Stations uncovered 45% of zip codes across the http://unitedpunjabisofamerica.org/buy-lasix-water-pills/ state do not have a pharmacy, creating multiple 'pharmacy deserts.'North can you buy over the counter lasix Carolina has an average of three pharmacies every 10 square miles. However, more than 90 percent of counties across the state report even fewer.Wake County is home to four times the number of pharmacies in Granville County where Gary Bowman has run Professional Pharmacy for nearly 30 years."We pride ourselves in knowing who our customers are, calling them by name, we're the same people that go out to eat with them, that go to church with them, that go to little league ball games with them," Bowman explained.As an established and trusted health professional, Bowman said now people are turning to him can you buy over the counter lasix for advice and news about the hypertension medications treatment."Oh, lot of calls. 'Do you have the treatment?.

Are you going can you buy over the counter lasix to have the treatment?. When can you buy over the counter lasix can I get it?. Can I get on a list?.

'" he said.He's one of nine pharmacies in the county with more than 60,000 residents.Bowman said over the years, two other independent pharmacies have closed.Stephanie Kiser, a pharmacist and director of Rural Health at UNC, said there is a fear of more closures."When we see pharmacies close and we see people having to travel can you buy over the counter lasix further distances to access a pharmacy that feels unfamiliar and that often does not encourage the trust of that provider-patient relationship that they would like to have," she explained.Closures in rural areas also lead to larger gaps in access between urban and rural communities.With 46 pharmacies every 10 square miles, Mecklenburg County has the most pharmacies in the state. While Mecklenburg County is also one of the most populated areas, it has 2,300 times more pharmacies in the same space compared to Northampton County where there is only two pharmacies every 1,000 square miles.While these disparities have existed for decades, today they are taking on more dire consequences."We're really recognizing the value of these pharmacies in these small can you buy over the counter lasix communities that may be the closest place to get a treatment," Kiser said.Transportation and distance to a treatment can be one more barrier for people who aren't 100% onboard with the hypertension medications treatment."To drive across the county for some older adults that's a really far trip, they don't want to make the trip," Kiser explained. "The thought of getting in the car and having to drive 20 miles may be a major deterrent."Unfortunately, these pharmacy deserts tend to exist in rural communities home to an older population.The ABC11 I-Team also uncovered many of the zip codes without a pharmacy tend to be in communities with higher levels of poverty and home to Black and Latino residents.

A finding that means the hypertension medications treatment will be can you buy over the counter lasix harder to get for poorer, Black and Latino residents. The same communities already disproportionately impacted by the lasix.Russell's Pharmacy and Shoppe opened in East Durham two years ago to fill this exact need."You're looking at a historically marginalized can you buy over the counter lasix area, there are a lot of people who don't have as much transportation, they don't have as many ways to get access, to just drive down to the CVS or Walgreens or the Walmart, so they need something in the community that is very close to them that they have access to," said Dr. Darius Russell, the pharmacy manager and owner.The nearest pharmacies to his business are both chains and are a 30-minute walk away.Russell said being in the community also offers him a chance to form relationships and trust with his patients.

A relationship that can help in the hypertension medications vaccination effort."Having can you buy over the counter lasix a pharmacy in the area really helps to build that trust so people don't feel like I'm just going to some big conglomerate. I'm actually going to a place where I know they are going to tell me the truth, they're going to tell me really what I need to hear," Russell said.While pharmacists like Russell might be in a good position to give the hypertension medications treatment, they are not part of the vaccination process in North Carolina yet."They are a bit frustrated because they feel like can you buy over the counter lasix they could be making a difference in their community if they had access to the treatment," explained Dr. Penny Shelton, the executive director of the North Carolina Association of Pharmacists.Just like there are tiers to get vaccinated, the state has tiers on who can provide the treatment and when.

Pharmacists currently rank 4th, a position that has many waiting until can you buy over the counter lasix February or March to administer doses."The greatest challenge right now is the supply. It's having local pharmacies whether you are rural, suburban or urban can you buy over the counter lasix assisting with vaccinating patients having the supply and having that supply allocated is right now is insufficient to support broader distribution by our state and not just North Carolina and other states as well," Shelton said.Kiser has been working with other health experts across the state and points to West Virginia as a model for North Carolina.With more than 80% of its doses administered, West Virginia is ranked top in the U.S. For treatment distribution, according to the latest treatment data from the CDC.

More than 11% of can you buy over the counter lasix the state's residents above 16 years old have received the treatment. A percent beat only by Alaska.Kiser and others say a large part of the state's success is because they gave pharmacists, particularly rural pharmacists, treatments to distribute."When you are going to focus on older adults and you really want to improve access, can you buy over the counter lasix depending on pharmacies should have been sort of a topline thing in my mind because there are already people in every community of our state who often have a relationship with their pharmacist and their community pharmacist," said Gina Upchurch, the executive director of Senior PharmAssist.Her nonprofit helps Durham seniors pay, access and manage medications. Now, like many others, the group has become a resource for vaccinating residents.Upchurch said while it's a waiting game everywhere it's even harder to get answers in rural areas."I wish my parents live in Durham County right now.

My parents live in Rockingham," can you buy over the counter lasix she said. "I'm depending on their community pharmacist to get the treatment...They are comfortable with him, he will come out to the parking lot and give it to them and that works well for my parents but it's just a waiting game."Russell can you buy over the counter lasix and Bowman also playing the waiting game. Undergoing intensive training, learning the state's processes all while hoping to get allocated doses soon.Both pharmacists said they had to invest time and money into becoming a future treatment site.

Many rural independent pharmacies ABC11 called said they were not going to offer the treatment."It wasn't just, 'Ok, I want the treatment, so send it to me,'" Bowman can you buy over the counter lasix explained. "We had to go through a lot of training and a lot of processes to make sure we were set can you buy over the counter lasix up to go through that adequately and that was important. I wanted to be a site where people could come and get vaccinated."Shelton said as North Carolina waiting for more supplies multiple groups across communities are brainstorming creative partnerships to help expand access to the treatment.Earlier this month, the state health department announcing the allocation of $2.5 million to offer free transportation to vaccination sites.

Copyright © can you buy over the counter lasix 2021 WTVD-TV. All Rights can you buy over the counter lasix Reserved.An audio version of this story. Rural and urban Oklahomans have different mortality rates from hypertension medications -- and the gap is widening.

"The split between urban and rural experience of hypertension medications is getting wider, the disparity can you buy over the counter lasix between them," said Dr. Jennifer Clark, faculty lead for OSU Center for can you buy over the counter lasix Health Sciences' Project ECHO. "96 deaths per 100,000, relative to, kind of, 79 deaths per 100,000 in the urban section." Dr.

Randolph Hubach, associate professor of rural health at OSU Center for Health Sciences, described that as a "huge disparity." can you buy over the counter lasix "I think there's a couple things that start to come into play," Hubach said. "One of them is the can you buy over the counter lasix current infrastructure for public health and medical in rural areas. We know that our hospitals and clinics are overburdened.

"Simultaneously, what can you buy over the counter lasix we know from the research is that those within rural communities tend to present later to care, so if individuals have some comorbid conditions or things that could have been addressed earlier on, they might be presenting to care when that is no longer easy to rectify, which increases mortality rates, too," Hubach said. Hubach said mistrust and misperception of health can you buy over the counter lasix care and public health officials are also at play. "Specifically when it comes to hypertension medications, we're seeing a lot of misunderstanding and mistrust," Hubach said.

"Individuals having a misunderstanding of how hypertension medications is transmitted, the true impact of hypertension medications within the community and how it impacts the body, can you buy over the counter lasix and that's been playing out as we're seeing within communities with debates about masks and, now, as it comes to treatment rollout." Hubach said health officials should attempt to reach out to trusted messengers in rural communities to help spread the message that the lasix is serious and not just an urban issue, as well as increase confidence in and willingness to take the treatment. "The Kaiser Family Foundation just released some data that shows 29% of rural residents do not plan to get vaccinated for can you buy over the counter lasix hypertension medications" compared to 15% of urban residents, Hubach said. "So if 30% of our rural residents won't even get vaccinated for hypertension medications, we're not going to achieve herd immunity," Hubach said, "which means we're going to start to see this trend still continue to grow that'll disproportionately impact these rural communities." As of Wednesday, the OSU Center for Rural Health reported 358 hypertension medications deaths in rural Oklahoma in January, by far the most of any month of the lasix so far..

Inj lasix

	Lasix	Diovan hct	Zestoretic	Lisinopril
Buy with echeck	Yes	Yes	Online	Online
Possible side effects	Online Pharmacy	Canadian Pharmacy	At cvs	Nearby pharmacy
Buy with credit card	You need consultation	Yes	You need consultation	You need consultation
Best place to buy	No	Online	No	Online
Effect on blood pressure	In online pharmacy	160mg + 12.5mg	In online pharmacy	Canadian pharmacy only
Pack price	40mg 30 tablet $19.95	160mg + 12.5mg 90 tablet $322.80	5mg + 12.5mg 60 tablet $96.00	$
How often can you take	22h	3h	11h	11h

AbstractBrazil is currently home to the largest Japanese population outside of inj lasix generic lasix prices Japan. In Brazil today, Japanese-Brazilians are considered to be successful members of Brazilian society. This was not always the case, however, inj lasix and Japanese immigrants to Brazil endured much hardship to attain their current level of prestige.

This essay explores this community’s trajectory towards the formation of the Japanese-Brazilian identity and the issues of mental health that arise in this immigrant community. Through the analysis of Japanese-Brazilian novels, TV shows, film and public health studies, I seek to disentangle the themes of gender and modernisation, and how these themes concurrently grapple with Japanese-Brazilian mental health issues. These fictional narratives provide a lens into the experience of the Japanese-Brazilian community that is unavailable in traditional medical inj lasix studies about their mental health.filmliterature and medicinemental health caregender studiesmedical humanitiesData availability statementData are available in a public, open access repository.Introduction and philosophical backgroundWork in the medical humanities has noted the importance of the ‘medical gaze’ and how it may ‘see’ the patient in ways which are specific, while possessing broad significance, in relation to developing medical knowledge.

To diagnosis. And to the social position of the medical profession.1 Some authors have emphasised that vision is a distinctive modality of perception which merits its own consideration, inj lasix and which may have a particular role to play in medical education and understanding.2 3 The clothing we wear has a strong impact on how we are perceived. For example, commentary in this journal on the ‘white coat’ observes that while it may rob the medical doctor of individuality, it nonetheless grants an elevated status4.

In contrast, the patient hospital gown may rob patients of individuality in a way that stigmatises them,5 reducing their status in the ward, and ultimately dehumanises them, in conflict with the humanistic approaches seen as central to the best practice in the care of older patients, and particularly those living with dementia.6The broad context of our concern is the visibility of patients and their needs. We draw on inj lasix observations made during an ethnographic study of the everyday care of people living with dementia within acute hospital wards, to consider how patients’ clothing may impact on the way they were perceived by themselves and by others. Hence, we draw on this ethnography to contribute to discussion of the ‘medical gaze’ in a specific and informative context.The acute setting illustrates a situation in which there are great many biomedical, technical, recording, and timetabled routine task-oriented demands, organised and delivered by different staff members, together with demands for care and attention to particular individuals and an awareness of their needs.

Within this ward setting, we focus on patients who are living with dementia, since this group may be particularly vulnerable to a dehumanising gaze.6 We frame our discussion within the broader context of the general philosophical question of how we acquire knowledge of different types, and the moral consequences of this, particularly knowledge through visual perception.Debates throughout the history of philosophy raise questions about the nature and sources of our knowledge. Contrasts are often inj lasix drawn between more reliable or less reliable knowledge. And between knowledge that is more technical or ‘objective’, and knowledge that is more emotionally based or more ‘subjective’.

A frequent point of discussion is the reliability and characteristics of perception inj lasix as a source of knowledge. This epistemological discussion is mostly focused on vision, indicating its particular importance as a mode of perception to humans.7Likewise, in ethics, there is discussion of the origin of our moral knowledge and the particular role of perception.8 There is frequent recognition that the observer has some significant role in acquiring moral knowledge. Attention to qualities of the moral observer is not in itself a denial of moral reality.

Indeed, it is the very essence of inj lasix an ethical response to the world to recognise the deep reality of others as separate persons. The nature of ethical attention to the world and to those around us is debated and has been articulated in various ways. The quality of ethical attention may vary and achieving a high level of ethical attention may require certain conditions, certain virtues, and the time and mental space to attend to the situation and claims of the other.9Consideration has already been given to how different modes of attention to the world might be of relevance to the practice of medicine.

Work that examines different ways of processing information, and of inj lasix interacting with and being in the world, can be found in Iain McGilchrist’s The Master and His Emissary,10 where he draws on neurological discoveries and applies his ideas to the development of human culture. McGilchrist has recently expanded on the relevance of understanding two different approaches to knowledge for the practice of medicine.11 He argues that task-oriented perception, and a wider, more emotionally attuned awareness of the environment are necessary partners, but may in some circumstances compete, with the competitive edge often being given to the narrower, task-based attention.There has been critique of McGilchrist’s arguments as well as much support. We find his work a useful framework for understanding important debates in the ethics of medicine and of inj lasix nursing about relationships of staff to patients.

In particular, it helps to illuminate the consequences of patients’ dress and personal appearance for how they are seen and treated.Dementia and personal appearanceOur work focuses on patients living with dementia admitted to acute hospital wards. Here, they are a large group, present alongside older patients unaffected by dementia, as well as younger patients. This mixed population provides a useful setting to consider the impact of personal appearance on different patient groups.The role of inj lasix appearance in the presentation of the self has been explored extensively by Tseëlon,12 13 drawing on Goffman’s work on stigma5 and the presentation of the self14 using interactionist approaches.

Drawing on the experiences on women in the UK, Tseëlon argues Goffman’s interactionist approach best supports how we understand the relationship appearance plays in self presentation, and its relationships with other signs and interactions surrounding it. Tseëlon suggests that understandings in this area, in the role appearance and clothing have in the presentation of the self, have been restricted by the perceived trivialities of the topic and limited to the field of fashion studies.15The personal appearance of older patients, and patients living with dementia in particular, has, more recently, been shown to be worthy of attention and of particular significance. Older people are often assumed to be left out of fashion, yet a concern with appearance remains.16 17 Lack of attention to clothing and inj lasix to personal care may be one sign of the varied symptoms associated with cognitive impairment or dementia, and so conversely, attention to appearance is one way of combatting the stigma associated with dementia.

Families and carers may also feel the importance of personal appearance. The significant body of work by Twigg and Buse in this field in particular draws attention to the role clothing has on preserving the identity and dignity or people living with dementia, while also constraining and enabling elements of care within long-term community settings.16–19 Within this paper, we examine the ways in which these phenomena can be even more acutely felt within the impersonal setting of the acute hospital.Work inj lasix has also shown how people living with dementia strongly retain a felt, bodily appreciation for the importance of personal appearance. The comfort and sensuous feel of familiar clothing may remain, even after cognitive capacities such as the ability to recognise oneself in a mirror, or verbal fluency, are lost.18 More strongly still, Kontos,20–22 drawing on the work of Merleau-Ponty and of Bourdieu, has convincingly argued that this attention to clothing and personal appearance is an important aspect of the maintenance of a bodily sense of self, which is also socially mediated, in part via such attention to appearance.

Our observations lend support to Kontos’ hypothesis.Much of this previous work has considered clothing in the everyday life of people living with dementia in the context of community or long-term residential care.18 Here, we look at the visual impact of clothing and appearance in the different setting of the hospital ward and consider the consequent implications for patient care. This setting enables us to inj lasix consider how the short-term and unfamiliar environments of the acute ward, together with the contrast between personal and institutional attire, impact on the perception of the patient by self and by others.There is a body of literature that examines the work of restoring the appearance of residents within long-term community care settings, for instance Ward et al’s work that demonstrates the importance of hair and grooming as a key component of care.23 24 The work of Iltanen-Tähkävuori25 examines the usage of garments designed for long-term care settings, exploring the conflict between clothing used to prevent undressing or facilitate the delivery of care, and the distress such clothing can cause, being powerfully symbolic of lower social status and associated with reduced autonomy.26 27Within this literature, there has also been a significant focus on the role of clothing, appearance and the tasks of personal care surrounding it, on the older female body. A corpus of feminist literature has examined the ageing process and the use of clothing to conceal ageing, the presentation of a younger self, or a ‘certain’ age28 It argues that once the ability to conceal the ageing process through clothing and grooming has been lost, the aged person must instead conceal themselves, dressing to hide themselves and becoming invisible in the process.29 This paper will explore how institutional clothing within hospital wards affects both the male and female body, the presentation of the ageing body and its role in reinforcing the invisibility of older people, at a time when they are paradoxically most visible, unclothed and undressed, or wearing institutional clothing within the hospital ward.Institutional clothing is designed and used to fulfil a practical function.

Its use may therefore perhaps incline us towards a ‘task-based’ mode of attention, which as McGilchrist argues,10 while having a vital place in our understanding of the world, may on occasion interfere with the forms of attention that may be needed to deliver good person-oriented care responsive to individual needs.MethodsEthnography involves the in-depth study of people’s actions and accounts within their natural everyday setting, collecting relatively unstructured data from a range of sources.30 Importantly, it can take into account the perspectives of patients, carers and hospital staff.31 Our approach to ethnography is informed by the symbolic interactionist research tradition, which aims to provide an interpretive understanding of the social world, with an emphasis on interaction, focusing on understanding how action and meaning are constructed within a setting.32 The value of this approach is the depth of understanding and theory generation it can provide.33The goal of ethnography is to identify social processes within the data. There are multiple complex and nuanced interactions within these clinical settings that are capable of ‘communicating many messages at once, even of subverting on one level what it inj lasix appears to be “saying” on another’.34 Thus, it is important to observe interaction and performance. How everyday care work is organised and delivered.

By obtaining observational data from within each institution on the everyday work of hospital wards, their family carers and the nursing and healthcare assistants (HCAs) who carry out this work, we can inj lasix explore the ways in which hospital organisation, procedures and everyday care impact on care during a hospital admission. It remedies a common weakness in many qualitative studies, that what people say in interviews may differ from what they do or their private justifications to others.35Data collection (observations and interviews) and analysis were informed by the analytic tradition of grounded theory.36 There was no prior hypothesis testing and we used the constant comparative method and theoretical sampling whereby data collection (observation and interview data) and analysis are inter-related,36 37 and are carried out concurrently.38 39 The flexible nature of this approach is important, because it can allow us to increase the ‘analytic incisiveness’35 of the study. Preliminary analysis of data collected from individual sites informed the focus of later stages of sampling, data collection and analysis in other sites.Thus, sampling requires a flexible, pragmatic approach and purposive and maximum variation sampling (theoretical sampling) was used.

This included five hospitals selected to represent a range of hospitals types, geographies and socioeconomic catchments inj lasix. Five hospitals were purposefully selected to represent a range of hospitals types. Two large university teaching hospitals, two medium-sized general hospitals and one smaller general hospital.

This included one urban, two inner city and two hospitals covering a mix of rural and suburban catchment areas, all situated within England and Wales.These sites represented a range of expertise and interventions in caring for people with inj lasix dementia, from no formal expertise to the deployment of specialist dementia workers. Fractures, nutritional disorders, urinary tract and pneumonia40 41 are among the principal causes of admission to acute hospital settings among people with dementia. Thus, we focused observation within trauma and orthopaedic wards (80 inj lasix days) and medical assessment units (MAU.

75 days).Across these sites, 155 days of observational fieldwork were carried out. At each of the five sites, a minimum of 30 days observation took place, split between the two ward types. Observations were carried out by two researchers, each inj lasix working in clusters of 2–4 days over a 6-week period at each site.

A single day of observation could last a minimum of 2 hours and a maximum of 12 hours. A total of 684 hours of observation were conducted for this study. This produced approximately 600 000 words of observational fieldnotes that were transcribed, cleaned and anonymised inj lasix (by KF and AN).

We also carried out ethnographic (during observation) interviews with trauma and orthopaedic ward (192 ethnographic interviews and 22 group interviews) and MAU (222 ethnographic interviews) staff (including nurses, HCAs, auxiliary and support staff and medical teams) as they cared for this patient group. This allowed us to question what they are doing and why, and what are the caring practices of ward staff when interacting with people living with dementia.Patients within these settings with a diagnosis of dementia were identified through ward nursing handover notes, patient records and board data with the assistance of inj lasix ward staff. Following the provision of written and verbal information about the study, and the expression of willingness to take part, written consent was taken from patients, staff and visitors directly observed or spoken to as part of the study.To optimise the generalisability of our findings,42 our approach emphasises the importance of comparisons across sites,43 with theoretical saturation achieved following the search for negative cases, and on exploring a diverse and wide range of data.

When no additional empirical data were found, we concluded that the analytical categories were saturated.36 44Grounded theory and ethnography are complementary traditions, with grounded theory strengthening the ethnographic aims of achieving a theoretical interpretation of the data, while the ethnographic approach prevents a rigid application of grounded theory.35 Using an ethnographic approach can mean that everything within a setting is treated as data, which can lead to large volumes of unconnected data and a descriptive analysis.45 This approach provides a middle ground in which the ethnographer, often seen as a passive observer of the social world, uses grounded theory to provide a systematic approach to data collection and analysis that can be used to develop theory to address the interpretive realities of participants within this setting.35Patient and public involvementThe data presented in this paper are drawn from a wider ethnographic study supported by an advisory group of people living with dementia and their family carers. It was this advisory group that informed us of the need of a better understanding of the impacts of the everyday care inj lasix received by people living with dementia in acute hospital settings. The authors met with this group on a regular basis throughout the study, and received guidance on both the design of the study and the format of written materials used to recruit participants to the study.

The external oversight group for this study included, and was chaired, by carers of people living with dementia. Once data analysis was complete, the advisory group commented on our initial findings inj lasix and recommendations. During and on completion of the analysis, a series of public consultation events were held with people living with dementia and family carers to ensure their involvement in discussing, informing and refining our analysis.FindingsWithin this paper, we focus on exploring the medical gaze through the embedded institutional cultures of patient clothing, and the implications this have for patients living with dementia within acute hospital wards.

These findings emerged from our wider analysis inj lasix of our ethnographic study examining ward cultures of care and the experiences of people living with dementia. Here, we examine the ways in which the cultures of clothing within wards impact on the visibility of patients within it, what clothing and identity mean within the ward and the ways in which clothing can be a source of distress. We will look at how personal grooming and appearance can affect status within the ward, and finally explore the removal of clothing, and the impacts of its absence.Ward clothing culturesAcross our sites, there was variation in the cultures of patient clothing and dress.

Within many wards, inj lasix it was typical for all older patients to be dressed in hospital-issued institutional gowns and pyjamas (typically in pastel blue, pink, green or peach), paired with hospital supplied socks (usually bright red, although there was some small variation) with non-slip grip soles, while in other wards, it was standard practice for people to be supported to dress in their own clothes. Across all these wards, we observed that younger patients (middle aged/working age) were more likely to be able to wear their own clothes while admitted to a ward, than older patients and those with a dementia diagnosis.Among key signifiers of social status and individuality are the material things around the person, which in these hospital wards included the accoutrements around the bedside. Significantly, it was observed that people living with dementia were more likely to be wearing an institutional hospital gown or institutional pyjamas, and to have little to individuate the person at the bedside, on either their cabinet or the mobile tray table at their bedside.

The wearing inj lasix of institutional clothing was typically connected to fewer personal items on display or within reach of the patient, with any items tidied away out of sight. In contrast, younger working age patients often had many personal belongings, cards, gadgets, books, media players, with young adults also often having a range of ‘get well soon’ gifts, balloons and so on from the hospital gift shop) on display. This both afforded some elements of familiarity, but also marked the person out as someone with individuality and a certain social standing and place.Visibility of patients on a wardThe significance of the obscurity or invisibility of the patient in artworks depicting doctors has been commented inj lasix on.4 Likewise, we observed that some patients within these wards were much more ‘visible’ to staff than others.

It was often apparent how the wearing of personal clothing could make the patient and their needs more readily visible to others as a person. This may be especially so given the contrast in appearance clothing may produce in this particular setting. On occasion, this may be remarked on by inj lasix staff, and the resulting attention received favourably by the patient.A member of the bay team returned to a patient and found her freshly dressed in a white tee shirt, navy slacks and black velvet slippers and exclaimed aloud and appreciatively, ‘Wow, look at you!.

€™ The patient looked pleased as she sat and combed her hair [site 3 day 1].Such a simple act of recognition as someone with a socially approved appearance takes on a special significance in the context of an acute hospital ward, and for patients living with dementia whose personhood may be overlooked in various ways.46This question of visibility of patients may also be particularly important when people living with dementia may be less able to make their needs and presence known. In this example, a whole bay of patients was seemingly ‘invisible’. Here, the ethnographer inj lasix is observing a four-bed bay occupied by male patients living with dementia.The man in bed 17 is sitting in his bedside chair.

He is dressed in green hospital issue pyjamas and yellow grip socks. At 10 a.m., the physiotherapy team come and see him inj lasix. The physiotherapist crouches down in front of him and asks him how he is.

He says he is unhappy, and the physiotherapist explains that she’ll be back later to see him again. The nurse checks on him, asks him if he wants a pillow, and puts it behind his head explaining to him, ‘You need inj lasix to sit in the chair for a bit’. She pulls his bedside trolley near to him.

With the help of a Healthcare Assistant they make the bed. The Healthcare Assistant chats inj lasix to him, puts cake out for him, and puts a blanket over his legs. He is shaking slightly and I wonder if he is cold.The nurse explains to me, ‘The problem is this is a really unstimulating environment’, then says to the patient, ‘All done, let’s have a bit of a tidy up,’ before wheeling the equipment out.The neighbouring patient in bed 18, is now sitting in his bedside chair, wearing (his own) striped pyjamas.

His eyes are open, and he inj lasix is looking around. After a while, he closes his eyes and dozes. The team chat to patient 19 behind the curtains.

He says he doesn’t want to sit, and they say that is fine unless the doctors tell them otherwise.The nurse puts music on an old radio with a CD player which inj lasix is at the doorway near the ward entrance. It sounds like music from a musical and the ward it is quite noisy suddenly. She turns down the volume a bit, but it is very jaunty and upbeat.

The man in bed 19 quietly sings along to inj lasix the songs. €˜I am going to see my baby when I go home on victory day…’At ten thirty, the nurse goes off on her break. The rest of the team are spread around the other bays and inj lasix side rooms.

There are long distances between bays within this ward. After all the earlier activity it is now very calm and peaceful in the bay. Patient 20 is sitting in the chair tapping inj lasix his feet to the music.

He has taken out a large hessian shopping bag out of his cabinet and is sorting through the contents. There is a lot of paperwork in it which he is reading through closely inj lasix and sorting.Opposite, patient 17 looks very uncomfortable. He is sitting with two pillows behind his back but has slipped down the chair.

His head is in his hands and he suddenly looks in pain. He hasn’t touched his tea, and is talking to inj lasix himself. The junior medic was aware that 17 was not comfortable, and it had looked like she was going to get some advice, but she hasn’t come back.

18 drinks his tea and looks at a wool twiddle mitt sleeve, puts it down, and dozes. 19 has finished all his coffee and manages to put the cup down on the trolley.Everyone is tapping their feet or wiggling their toes to the music, or singing quietly to it, when a student nurse, who is working at the computer station in the corridor outside inj lasix the room, comes in. She has a strong purposeful stride and looks irritated as she switches the music off.

It feels inj lasix like a jolt to the room. She turns and looks at me and says, ‘Sorry were you listening to it?. €™ I tell her that I think these gentlemen were listening to it.She suddenly looks very startled and surprised and looks at the men in the room for the first time.

They have all stopped tapping their toes and inj lasix stopped singing along. She turns it back on but asks me if she can turn it down. She leaves and goes back to her paperwork outside.

Once it is turned back on everyone starts tapping inj lasix their toes again. The music plays on. €˜There’ll be bluebirds over the white cliffs of Dover, just you inj lasix wait and see…’[Site 3 day 3]The music was played by staff to help combat the drab and unstimulating environment of this hospital ward for the patients, the very people the ward is meant to serve.

Yet for this member of ward staff the music was perceived as a nuisance, the men for whom the music was playing seemingly did not register to her awareness. Only an individual of ‘higher’ status, the researcher, sitting at the end of this room was visible to her. This example illustrates the general question of the visibility or otherwise of patients inj lasix.

Focusing on our immediate topic, there may be complex pathways through which clothing may impact on how patients living with dementia are perceived, and on their self-perception.Clothing and identityOn these wards, we also observed how important familiar aspects of appearance were to relatives. Family members may be distressed if they find the person they knew so well, looking markedly different. In the example below, a mother and two adult daughters visit the inj lasix father of the family, who is not visible to them as the person they were so familiar with.

His is not wearing his glasses, which are missing, and his daughters find this very difficult. Even though he looks very different following his admission—he has lost a large amount of weight and has sunken cheekbones, and his skin has taken on a darker hue—it is his glasses which are a key concern for the family in their recognition of their inj lasix father:As I enter the corridor to go back to the ward, I meet the wife and daughter of the patient in bed 2 in the hall and walk with them back to the ward. Their father looks very frail, his head is back, and his face is immobile, his eyes are closed, and his mouth is open.

His skin looks darker than before, and his cheekbones and eye sockets are extremely prominent from weight loss. €˜I am like a bird I want to fly away…’ inj lasix plays softly in the radio in the bay. I sit with them for a bit and we chat—his wife holds his hand as we talk.

His wife has to take two busses to get to the hospital and we talk about the potential care home they expect her husband will be discharged to. They hope it will be close because she inj lasix does not drive. He isn’t wearing his glasses and his daughter tells me that they can’t find them.

We look in the bedside inj lasix cabinet. She has never seen her dad without his glasses. €˜He doesn’t look like my dad without his glasses’ [Site 2 day 15].It was often these small aspects of personal clothing and grooming that prompted powerful responses from visiting family members.

Missing glasses and missing teeth were notable in this regard (and with the follow-up visits from the relatives of discharged inj lasix patients trying to retrieve these now lost objects). The location of these possessions, which could have a medical purpose in the case of glasses, dental prosthetics, hearing aids or accessories which contained personal and important aspects of a patient’s identity, such as wallets or keys, and particularly, for female patients, handbags, could be a prominent source of distress for individuals. These accessories to personal clothing were notable on these wards by their everyday absence, hidden away in bedside cupboards or simply not brought in with the patient at admission, and by the frequency with which patients requested and called out for them or tried to look for them, often in repetitive cycles that indicated their underlying anxiety about these belongings, but which would become invisible to staff, becoming an everyday background intrusion to the work of the wards.When considering the visibility and recognition of individual persons, missing glasses, especially glasses for distance vision, have a particular significance, for without them, a person may be less able to recognise and interact visually with others.

Their presence facilitates the subject of the gaze, in gazing back, and hence helps to ground meaningful and reciprocal relationships inj lasix of recognition. This may be one factor behind the distress of relatives in finding their loved ones’ glasses to be absent.Clothing as a source of distressAcross all sites, we observed patients living with dementia who exhibited obvious distress at aspects of their institutional apparel and at the absence of their own personal clothing. Some older patients were clearly able to verbalise their understandings of the impacts of wearing institutional clothing inj lasix.

One patient remarked to a nurse of her hospital blue tracksuit. €˜I look like an Olympian or Wentworth prison in this outfit!. The latter I expect…’ The staff laughed as they walked her out of the bay (site 3 day 1).Institutional clothing may be a source inj lasix of distress to patients, although they may be unable to express this verbally.

Kontos has shown how people living with dementia may retain an awareness at a bodily level of the demands of etiquette.20 Likewise, in our study, a man living with dementia, wearing a very large institutional pyjama top, which had no collar and a very low V neck, continually tried to pull it up to cover his chest. The neckline was particularly low, because the pyjamas were far too large for him. He continued to fiddle inj lasix with his very low-necked top even when his lunch tray was placed in front of him.

He clearly felt very uncomfortable with such clothing. He continued using his hands to try to pull it up to inj lasix cover his exposed chest, during and after the meal was finished (site 3 day 5).For some patients, the communication of this distress in relation to clothing may be liable to misinterpretation and may have further impacts on how they are viewed within the ward. Here, a patient living with dementia recently admitted to this ward became tearful and upset after having a shower.

She had no fresh clothes, and so the team had provided her with a pink hospital gown to wear.‘I want my trousers, where is my bra, I’ve got no bra on.’ It is clear she doesn’t feel right without her own clothes on. The one-to-one inj lasix healthcare assistant assigned to this patient tells her, ‘Your bra is dirty, do you want to wear that?. €™ She replies, ‘No I want a clean one.

Where are my trousers?. I want them, I’ve lost them.’ The healthcare assistant repeats the explaination that her clothes are dirty, and asks inj lasix her, ‘Do you want your dirty ones?. €™ She is very teary ‘No, I want my clean ones.’ The carer again explains that they are dirty.The cleaner who always works in the ward arrives to clean the floor and sweeps around the patient as she sits in her chair, and as he does this, he says ‘Hello’ to her.

She is inj lasix very teary and explains that she has lost her clothes. The cleaner listens sympathetically as she continues ‘I am all confused. I have lost my clothes.

I am all inj lasix confused. How am I going to go to the shops with no clothes on!. €™ (site 5 day 5).This person experienced significant distress because of her absent clothes, but this would often be simply attributed to confusion, seen as a feature of her dementia.

This then may solidify staff inj lasix perceptions of her condition. However, we need to consider that rather than her condition (her diagnosis of dementia) causing distress about clothing, the direction of causation may be the reverse. The absence of inj lasix her own familiar clothing contributes significantly to her distress and disorientation.

Others have argued that people with limited verbal capacity and limited cognitive comprehension will have a direct appreciation of the grounding familiarity of wearing their own clothes, which give a bodily felt notion of comfort and familiarity.18 47 Familiar clothing may then be an essential prop to anchor the wearer within a recognisable social and meaningful space. To simply see clothing from a task-oriented point of view, as fulfilling a simply mechanical function, and that all clothing, whether personal or institutional have the same value and role, might be to interpret the desire to wear familiar clothing as an ‘optional extra’. However, for those patients most at risk of disorientation and distress within an unfamiliar environment, it could be a valuable necessity.Personal grooming and social statusIncluding in our consideration of clothing, we observed other aspects of the role of inj lasix personal grooming.

Personal grooming was notable by its absence beyond the necessary cleaning required for reasons of immediate hygiene and clinical need (such as the prevention of pressure ulcers). Older patients, and particular those living with dementia who were unable to carry out ‘self-care’ independently and were not able to request support with personal grooming, could, over their admission, become visibly unkempt and scruffy, hair could be left unwashed, uncombed and unstyled, while men could become hirsute through a lack of shaving. The simple act of a visitor dressing and grooming a patient as they prepared for discharge could transform their appearance and leave that patient looking more alert, appear to having increased capacity, than when sitting ungroomed in their bed inj lasix or bedside chair.It is important to consider the impact of appearance and of personal care in the context of an acute ward.

Kontos’ work examining life in a care home, referred to earlier, noted that people living with dementia may be acutely aware of transgressions in grooming and appearance, and noted many acts of self-care with personal appearance, such as stopping to apply lipstick, and conformity with high standards of table manners. Clothing, etiquette and personal grooming are important indicators of social class and hence an aspect of inj lasix belonging and identity, and of how an individual relates to a wider group. In Kontos’ findings, these rituals and standards of appearance were also observed in negative reactions, such as expressions of disgust, towards those residents who breached these standards.

Hence, even in cases where an individual may be assessed as having considerable cognitive impairment, the importance of personal appearance must not be overlooked.For some patients within these wards, routine practices of everyday care at the bedside can increase the potential to influence whether they feel and appear socially acceptable. The delivery of routine timetabled care at the bedside can impact on people’s appearance in ways that may mark them inj lasix out as failing to achieve accepted standards of embodied personhood. The task-oriented timetabling of mealtimes may have significance.

It was a typical observed feature of this routine, when a mealtime has ended, that people living with dementia were left with visible signs and features of the mealtime through spillages on faces, clothes, bed sheets and bedsides, that leave them at risk of being assessed as less socially acceptable and marked as having reduced independence. For example, a inj lasix volunteer attempts to ‘feed’ a person living with dementia, when she gives up and leave the bedside (this woman living with dementia has resisted her attempts and explicitly says ‘no’), remnants of the food is left spread around her mouth (site E). In a different ward, the mealtime has ended, yet a large white plastic bib to prevent food spillages remains attached around the neck of a person living with dementia who is unable to remove it (site X).Of note, an adult would not normally wear a white plastic bib at home or in a restaurant.

It signifies a task-based apparel that is inj lasix demeaning to an individual’s social status. This example also contrasts poignantly with examples from Kontos’ work,20 such as that of a female who had little or no ability to verbalise, but who nonetheless would routinely take her pearl necklace out from under her bib at mealtimes, showing she retained an acute awareness of her own appearance and the ‘right’ way to display this symbol of individuality, femininity and status. Likewise, Kontos gives the example of a resident who at mealtimes ‘placed her hand on her chest, to prevent her blouse from touching the food as she leaned over her plate’.20Patients who are less robust, who have cognitive impairments, who may be liable to disorientation and whose agency and personhood are most vulnerable are thus those for whom appropriate and familiar clothing may be most advantageous.

However, we found inj lasix the ‘Matthew effect’ to be frequently in operation. To those who have the least, even that which they have will be taken away.48 Although there may be institutional and organisational rationales for putting a plastic cover over a patient, leaving it on for an extended period following a meal may act as a marker of dehumanising loss of social status. By being able to maintain familiar clothing and adornment to visually display social standing and identity, a person living with dementia may maintain a continuity of selfhood.However, it is also possible that dressing and grooming an older person may itself be a task-oriented institutional activity in certain contexts, as discussed by Lee-Treweek49 in the context of a nursing home preparing residents for ‘lounge view’ where visitors would see them, using residents to ‘create a visual product for others’ sometimes to the detriment of residents’ needs.

Our observations regarding the importance of patient appearance must therefore be inj lasix considered as part of the care of the whole person and a significant feature of the institutional culture.Patient status and appearanceWithin these wards, a new grouping of class could become imposed on patients. We understand class not simply as socioeconomic class but as an indicator of the strata of local social organisation to which an individual belongs. Those in the lowest classes may have limited opportunities to participate in society, and we observed the ways in which this applied inj lasix to the people living with dementia within these acute wards.

The differential impact of clothing as signifiers of social status has also been observed in a comparison of the white coat and the patient gown.4 It has been argued that while these both may help to mask individuality, they have quite different effects on social status on a ward. One might say that the white coat increases visibility as a person of standing and the attribution of agency, the patient gown diminishes both of these. (Within these wards, although white coats were not to be found, the dress code of medical staff did make them stand inj lasix out.

For male doctors, for example, the uniform rarely strayed beyond chinos paired with a blue oxford button down shirt, sleeves rolled up, while women wore a wider range of smart casual office wear.) Likewise, we observed that the same arrangement of attire could be attributed to entirely different meanings for older patients with or without dementia.Removal of clothes and exposureWithin these wards, we observed high levels of behaviour perceived by ward staff as people living with dementia displaying ‘resistance’ to care.50 This included ‘resistance’ towards institutional clothing. This could include pulling up or removing hospital gowns, removing institutional pyjama trousers or pulling up gowns, and standing with gowns untied and exposed at the back (although this last example is an unavoidable design feature of the clothing itself). Importantly, the removal of clothing was limited to institutional gowns and pyjamas and we did not see any patients inj lasix removing their own clothing.

This also included the removal of institutional bedding, with instances of patients pulling or kicking sheets from their bed. These acts could and was often interpreted by ward staff inj lasix as a patient’s ‘resistance’ to care. There was some variation in this interpretation.

However, when an individual patient response to their institutional clothing and bedding was repeated during a shift, it was more likely to be conceived by the ward team as a form of resistance to their care, and responded to by the replacement and reinforcement of the clothing and bedding to recover the person.The removal of gowns, pyjamas and bedsheets often resulted in a patient exposing their genitalia or continence products (continence pads could be visible as a large diaper or nappy or a pad visibly held in place by transparent net pants), and as such, was disruptive to the norms and highly visible to staff and other visitor to these wards. Notably, unlike other behaviours considered by staff to inj lasix be disruptive or inappropriate within these wards such as shouting or crying out, the removal of bedsheets and the subsequent bodily exposure would always be immediately corrected, the sheet replaced and the patient covered by either the nurse or HCA. The act of removal was typically interpreted by ward staff as representing a feature of the person’s dementia and staff responses were framed as an issue of patient dignity, or the dignity and embarrassment of other patients and visitors to the ward.

However, such responses to removal could lead to further cycles of removal and replacement, leading to an escalation of distress in inj lasix the person. This was important, because the recording of ‘refusal of care’, or presumed ‘confusion’ associated with this, could have significant impacts on the care and discharge pathways available and prescribed for the individual patient.Consider the case of a woman living with dementia who is 90 years old (patient 1), in the example below. Despite having no immediate medical needs, she has been admitted to the MAU from a care home (following her husband’s stroke, he could no longer care for her).

Across the previous evening and morning shift, she was shouting, refusing all food and care and has received assistance from the specialist inj lasix dementia care worker. However, during this shift, she has become calmer following a visit from her husband earlier in the day, has since eaten and requested drinks. Her care home would not readmit her, which meant she was not able to be discharged from the unit (an overflow unit due to a high number of admissions to the emergency department during a patch of exceptionally hot weather) until alternative arrangements could be made by social services.During our observations, she remains calm for the first 2 hours.

When she inj lasix does talk, she is very loud and high pitched, but this is normal for her and not a sign of distress. For staff working on this bay, their attention is elsewhere, because of the other six patients on the unit, one is ‘on suicide watch’ and another is ‘refusing their medication’ (but does not have a diagnosis of dementia). At 15:10 inj lasix patient 1 begins to remove her sheets:15:10.

The unit seems chaotic today. Patient 1 has begun to loudly drum her fingers on the tray table. She still has not been inj lasix brought more milk, which she requested from the HCA an hour earlier.

The bay that patient 1 is admitted to is a temporary overflow unit and as a result staff do not know where things are. 1 has moved her sheets off her legs, her bare knees peeking out over the top of piled sheets.15:15. The nurse in charge says, inj lasix ‘Hello,’ when she walks past 1’s bed.

1 looks across and smiles back at her. The nurse in inj lasix charge explains to her that she needs to shuffle up the bed. 1 asks the nurse about her husband.

The nurse reminds 1 that her husband was there this morning and that he is coming back tomorrow. 1 says that he hasn’t been and she does not inj lasix believe the nurse.15:25. I overhear the nurse in charge question, under her breath to herself, ‘Why 1 has been left on the unit?.

€™ 1 has started asking for somebody to come and see her. The nurse in charge tells 1 that she needs to do some jobs first and then will come and talk to her.15:30 inj lasix. 1 has once again kicked her sheets off of her legs.

A social worker inj lasix comes onto the unit. 1 shouts, ‘Excuse me’ to her. The social worker replies, ‘Sorry I’m not staff, I don’t work here’ and leaves the bay.15:40.

1 keeps kicking sheets off her bed, otherwise the unit is quiet inj lasix. She now whimpers whenever anyone passes her bed, which is whenever anyone comes through the unit’s door. 1 is the only elderly patient on the unit.

Again, the nurse in charge is heard sympathizing that this is not the right place for inj lasix her.16:30. A doctor approaches 1, tells her that she is on her list of people to say hello to, she is quite friendly. 1 tells her that inj lasix she has been here for 3 days, (the rest is inaudible because of pitch).

The doctor tries to cover 1 up, raising her bed sheet back over the bed, but 1 loudly refuses this. The doctor responds by ending the interaction, ‘See you later’, and leaves the unit.16:40. 1 attempts to inj lasix talk to the new nurse assigned to the unit.

She goes over to 1 and says, ‘What’s up my darling?. €™ It’s hard to follow 1 now as she sounds very upset. The RN’s first instinct, inj lasix like with the doctor and the nurse in charge, is to cover up 1 s legs with her bed sheet.

When 1 reacts to this she talks to her and they agree to cover up her knees. 1 is talking inj lasix about how her husband won’t come and visit her, and still sounds really upset about this. [Site 3, Day 13]Of note is that between days 6 and 15 at this site, observed over a particularly warm summer, this unit was uncomfortably hot and stuffy.

The need to be uncovered could be viewed as a reasonable response, and in fact was considered acceptable for patients without a classification of dementia, provided they were otherwise clothed, such as the hospital gown patient 1 was wearing. This is an example of an aspect of care where the choice and autonomy granted to patients assessed as having (or assumed to have) cognitive capacity is not available to people who are considered to have impaired cognitive capacity (a diagnosis of dementia) and carries the additional moral judgements of the appropriateness inj lasix of behaviour and bodily exposure. In the example given above, the actions were linked to the patient’s resistance to their admission to the hospital, driven by her desire to return home and to be with her husband.

Throughout observations over this 10-day period, patients perceived by staff as rational agents were allowed to strip down their bedding for comfort, whereas patients living with dementia who responded in this way were often viewed by staff as ‘undressing’, which would be interpreted as a feature of their condition, to be challenged and corrected by staff.Note how the same visual data triggered opposing interpretations of personal autonomy. Just as in inj lasix the example above where distress over loss of familiar clothing may be interpreted as an aspect of confusion, yet lead to, or exacerbate, distress and disorientation. So ‘deviant’ bedding may be interpreted, for some patients only, in ways that solidify notions of lack of agency and confusion, is another example of the Matthew effect48 at work reference through the organisational expectations of the clothed appearance of patients.Within wards, it is not unusual to see patients, especially those with a diagnosis of dementia or cognitive impairment, walking in the corridor inadvertently in some state of undress, typically exposed from behind by their hospital gowns.

This exposure in itself is of course, an intrinsic functional feature of the design of the flimsy back-opening institutional clothing inj lasix the patient has been placed in. This task-based clothing does not even fulfil this basic function very adequately. However, this inadvertent exposure could often be interpreted as an overt act of resistance to the ward and towards staff, especially when it led to exposed genitalia or continence products (pads or nappies).We speculate that the interpretation of resistance may be triggered by the visual prompt of disarrayed clothing and the meanings assumed to follow, where lack of decorum in attire is interpreted as indicating more general behavioural incompetence, cognitive impairment and/or standing outside the social order.DiscussionPrevious studies examining the significance of the visual, particularly Twigg and Buse’s work16–19 exploring the materialities of appearance, emphasise its key role in self-presentation, visibility, dignity and autonomy for older people and especially those living with dementia in care home settings.

Similarly, care home studies have demonstrated that institutional inj lasix clothing, designed to facilitate task-based care, can be potentially dehumanising or and distressing.25 26 Our findings resonate with this work, but find that for people living with dementia within a key site of care, the acute ward, the impact of institutional clothing on the individual patient living with dementia, is poorly recognised, but is significant for the quality and humanity of their care.Our ethnographic approach enabled the researchers to observe the organisation and delivery of task-oriented fast-paced nature of the work of the ward and bedside care. Nonetheless, it should also be emphasised the instances in which staff such as HCAs and specialist dementia staff within these wards took time to take note of personal appearance and physical caring for patients and how important this can be for overall well-being. None of our observations should be read as critical of any individual staff, but reflects longstanding institutional cultures.Our previous work has examined how readily a person living with dementia within a hospital wards is vulnerable to dehumanisation,51 and to their behaviour within these wards being interpreted as a feature of their condition, rather than a response to the ways in which timetabled care is delivered at their bedside.50 We have also examined the ways in which visual stimuli within these wards in the form of signs and symbols indicating a diagnosis of dementia may inadvertently focus attention away from the individual patient and may incline towards simplified and inaccurate categorisation of both needs and the diagnostic category of dementia.52Our work supports the analysis of the two forms of attention arising from McGilchrist’s work.10 The institutional culture of the wards produces an organisational task-based technical attention, which we found appeared to compete with and reduce the opportunity for ward staff to seek a finer emotional attunement to the person they are caring for and their needs.

Focus on efficiency, pace and record keeping that measures individual task completion within a timetable of care may worsen all inj lasix these effects. Indeed, other work has shown that in some contexts, attention to visual appearance may itself be little more than a ‘task’ to achieve.49 McGilchrist makes clear, and we agree, that both forms of attention are vital, but more needs to be done to enable staff to find a balance.Previous work has shown how important appearance is to older people, and to people living with dementia in particular, both in terms of how they are perceived by others, but also how for this group, people living with dementia, clothing and personal grooming may act as a particularly important anchor into a familiar social world. These twin aspects of clothing and appearance—self-perception and perception by others—may be especially important in the fast-paced context of an acute ward environment, where patients living with dementia may be struggling with the impacts of an additional acute medical condition within inj lasix in a highly timetabled and regimented and unfamiliar environment of the ward, and where staff perceptions of them may feed into clinical assessments of their condition and subsequent treatment and discharge pathways.

We have seen above, for instance, how behaviour in relation to appearance may be seen as ‘resisting care’ in one group of patients, but as the natural expression of personal preference in patients viewed as being without cognitive impairments. Likewise, personal grooming might impact favourably on a patient’s alertness, visibility and status within the ward.Prior work has demonstrated the importance of the medical gaze for the perceptions of the patient. Other work has also shown how older people, and in particular people living with dementia, may be thought inj lasix to be beyond concern for appearance, yet this does not accurately reflect the importance of appearance we found for this patient group.

Indeed, we argue that our work, along with the work of others such as Kontos,20 21 shows that if anything, visual appearance is especially important for people living with dementia particularly within clinical settings. In considering the task of washing the patient, Pols53 considered ‘dignitas’ in terms of aesthetic values, in comparison to humanitas conceived as citizen values of equality between persons. Attention to dignitas in the form of appearance may be a way of facilitating the treatment by others of inj lasix a person with humanitas, and helping to realise dignity of patients.Data availability statementNo data are available.

Data are unavailable to protect anonymity.Ethics statementsPatient consent for publicationNot required.Ethics approvalEthics committee approval for the study was granted by the NHS Research Ethics Service (15/WA/0191).AcknowledgmentsThe authors acknowledge funding support from the NIHR.Notes1. Devan Stahl (2013) inj lasix. €œLiving into the imagined body.

How the diagnostic image confronts the lived body.” Medical Humanities. Medhum-2012–010286.2. Joyce Zazulak et al.

(2017). "The art of medicine. Arts-based training in observation and mindfulness for fostering the empathic response in medical residents.” Medical Humanities.

Medhum-2016-011180.3. E Forde (2018). "Using photography to enhance GP trainees’ reflective practice and professional development." Medical Humanities.

Medhum-2017-011203.4. Caroline Wellbery and Melissa Chan (2014) “White coat, patient gown.” Medical Humanities. Medhum-2013–0 10 463.5.

E Goffman (1990a). Stigma. Notes on the management of spoiled identity, Penguin.6.

J Bridges and C Wilkinson (2011). €œAchieving dignity for older people with dementia in hospital.” Nursing Standard 5 (29).7. J Dancy (1985).

Contemporary Epistemology, John Wiley and Sons.8. D McNaughton (1988). Moral Vision.

Blackwell.9. S Weil (1953). Gravity and Grace.

U of Nebraska Press.10. I McGilchrist (2009). The Master and his Emissary.

The divided brain and the making of the western world. New Haven and London, Yale University Press.11. Iain McGilchrist (2011).

€œPaying attention to the bipartite brain.” The Lancet 377 (9771). 1068–1069.12. Efrat Tseëlon (1992).

€œSelf presentation through appearance. A manipulative vs a dramaturgical approach”. Symbolic Interaction, 15(4).

501–514.13. E Tseëlon (1995). The masque of femininity.

The presentation of woman in everyday life. London. Sage.14.

E Goffman (1990b). The Presentation of Self in Everyday Life Penguin15. Efrat Tseëlon (2001).

€œFashion research and its discontents”. Fashion Theory, 5 (4). 435–451.16.

Julia Twigg (2010a). €œClothing and dementia. A neglected dimension?.

€ Journal of Ageing Studies 24(4). 223–230.17. Julia Twigg and Christina E Buse (2013).

€œDress, dementia and the embodiment of identity.” Dementia 12(3). 326–336.18. C.

E Buse and J. Twigg (2015). €œClothing, embodied identity and dementia.

Maintaining the self through dress.” Age, Culture, Humanities (2).19. Christina Buse and Julia Twigg (2018). €œDressing disrupted.

Negotiating care through the materiality of dress in the context of dementia.” Sociology of Health &. Illness, 40(2). 340-352.20.

PIA C Kontos (2004). Ethnographic reflections on selfhood, embodiment and Alzheimer's disease. Ageing &.

C Kontos (2005). €œEmbodied selfhood in Alzheimer's disease. Rethinking person-centred care.” Dementia 4 (4).

Naglie (2007). €œBridging theory and practice. Imagination, the body, and person-centred dementia care.” Dementia 6 (4).

549–569.23. Richard Ward et al. (2016a).

€œâ€˜Gonna make yer gorgeous’. Everyday transformation, resistance and belonging in the care-based hair salon.” Dementia, 15(3). 395–413.24.

Richard Ward, Sarah Campbell, and John Keady (2016b). €œAssembling the salon. Learning from alternative forms of body work in dementia care.” Sociology of Health &.

Illness, 38(8). 1287–1302.25. Sonja Iltanen-Tähkävuori, Minttu Wikberg, and Päivi Topo (2012).

Design and dementia. A case of garments designed to prevent undressing. Dementia, 11(1).

49–59.26. Päivi Topo and Sonja Iltanen-Tähkävuori (2010). €œScripting patienthood with patient clothing.” Social Science &.

Medicine, 70(11). 1682–1689.27. Julia Twigg (2010b).

€œWelfare embodied. The materiality of hospital dress. A commentary on Topo and Iltanen-Tähkävuori”.

Social Science and Medicine, 70(11), 1690–1692.28. Kathleen Woodward (2006). €œPerforming age, performing gender” National Women’s Studies Association (NWSA) Journal 18(1).

162–89.29. K.M Woodward (1999). Introduction.

In K.M. Woodward (ed.), Figuring Age. Women, Bodies and Generations (pp.

Ix-xxix). Bloomington. Indiana University Press.30.

M Hammersley and P Atkinson (1989). Ethnography. Principles in practice.

J Caracelli (2006). Enhancing the policy process through the use of ethnography and other study frameworks. A mixed-method strategy.

Research in the Schools, 13(1). 84–92.32. W Housley and P Atkinson (2003).

Interactionism, Sage33. M Hammersley (1987) What's Wrong with Ethnography?. Methodological Explorations.

London. Routledge34. V Turner and E Bruner (1986).

The Anthropology of Experience New York. PAJ Publications. 2435.

K Charmaz and RG Mitchell (2001). €˜Grounded theory in ethnography’ in Atkinson P. (Ed) Handbook of Ethnography, 2001.

B Glaser and A Strauss (1967). The Discovery of Grounded Theory. London.

Weidenfeld and Nicholson, 24(25). 288–30437. Juliet M.

Corbin and Anselm Strauss (1990). Grounded theoryrResearch. Procedures, canons, and evaluative criteria.

Grounded theory and the constant comparative method. BMJ (Clinical research ed.), 316 (7137),:1064.39. Roy Suddaby (2006).

€œFrom the editors. What grounded theory is not.” Academy of management journal, 49(4). 633–642.40.

Elizabeth L Sampson et al. (2009). €œDementia in the acute hospital.

Prospective cohort study of prevalence and mortality”. British Journal of Psychiatry,195(1). 61–66.

Doi:10.1192/bjp.bp.108.05533541. C Pinkert and B Holle (2012). €œPeople with dementia in acute hospitals.

Literature review of prevalence and reasons for hospital admission”. Z. Gerontol.

Robert E Herriott and William A. Firestone (1983) “Multisite qualitative policy research. Optimising description and generalizability”.

Education Research 12:14–1943. F Vogt (2002). €œNo ethnography without comparison.

The methodological significance of comparison in ethnographic research” Studies in Education Ethnography 6:23–4244. Benjamin Saunders et al. (2018).

€œSaturation in qualitative research. Exploring its conceptualization and operationalization.” Quality and Quantity 52 (4). 1893–1907.45.

A Coffey and P Atkinson (1996). Making sense of qualitative data. Complementary research strategies.

Sage Publications, Inc.46. Paula Boddington and Katie Featherstone (2018). €œThe canary in the coal mine.

Continence care for people with dementia in acute hospital wards as a crisis of dehumanisation”. Bioethics, 32(4). 251–260.47.

Christina Buse et al. (2014). €œLooking “out of place”.

Analysing the spatial and symbolic meanings of dementia care settings through dress.” International Journal of Ageing and Later Life 9 (1). 69–95.48. R.

K. Merton (1968). €œThe Matthew effect in science.

The reward and communication systems of science are considered.” Science 159 (3810). 56–63.49. Geraldine Lee-Treweek (1997) “Women, resistance and care.

An ethnographic study of nursing auxiliary work” Work, Employment and Society, 11(1). 47–6350. Katie Featherstone et al.

(2019b). €œRefusal and resistance to care by people living with dementia being cared for within acute hospital wards. An ethnographic study” Health Service and Delivery Research51.

Katie Featherstone, Andy Northcott, and Jackie Bridges (2019a). €œRoutines of resistance. An ethnography of the care of people living with dementia in acute hospital wards and its consequences.” International Journal of Nursing Studies.52.

K Featherstone, A Northcott, and P Boddington (2020). €œUsing signs and symbols to identify hospital patients with a dementia diagnosis. Help or hindrance to recognition and care?.

€ Narrative Inquiry in Bioethics53. Jeannette Pols (2013). €œWashing the patient.

Dignity and aesthetic values in nursing care” Nursing Philosophy, 14(3). 186–200.

AbstractBrazil is currently home to the largest can you buy over the counter lasix Japanese population outside of Japan. In Brazil today, Japanese-Brazilians are considered to be successful members of Brazilian society. This was not always the case, however, and Japanese immigrants to Brazil endured much hardship to attain their current level can you buy over the counter lasix of prestige. This essay explores this community’s trajectory towards the formation of the Japanese-Brazilian identity and the issues of mental health that arise in this immigrant community.

Through the analysis of Japanese-Brazilian novels, TV shows, film and public health studies, I seek to disentangle the themes of gender and modernisation, and how these themes concurrently grapple with Japanese-Brazilian mental health issues. These fictional narratives provide a lens into the experience of the Japanese-Brazilian community that is unavailable in traditional medical studies can you buy over the counter lasix about their mental health.filmliterature and medicinemental health caregender studiesmedical humanitiesData availability statementData are available in a public, open access repository.Introduction and philosophical backgroundWork in the medical humanities has noted the importance of the ‘medical gaze’ and how it may ‘see’ the patient in ways which are specific, while possessing broad significance, in relation to developing medical knowledge. To diagnosis. And to the social position of the medical profession.1 Some authors have emphasised that vision is a distinctive modality of perception which merits its own consideration, and which may have a particular role to play in medical education can you buy over the counter lasix and understanding.2 3 The clothing we wear has a strong impact on how we are perceived.

For example, commentary in this journal on the ‘white coat’ observes that while it may rob the medical doctor of individuality, it nonetheless grants an elevated status4. In contrast, the patient hospital gown may rob patients of individuality in a way that stigmatises them,5 reducing their status in the ward, and ultimately dehumanises them, in conflict with the humanistic approaches seen as central to the best practice in the care of older patients, and particularly those living with dementia.6The broad context of our concern is the visibility of patients and their needs. We draw on observations made during an ethnographic study of the everyday care of people living with dementia within acute hospital can you buy over the counter lasix wards, to consider how patients’ clothing may impact on the way they were perceived by themselves and by others. Hence, we draw on this ethnography to contribute to discussion of the ‘medical gaze’ in a specific and informative context.The acute setting illustrates a situation in which there are great many biomedical, technical, recording, and timetabled routine task-oriented demands, organised and delivered by different staff members, together with demands for care and attention to particular individuals and an awareness of their needs.

Within this ward setting, we focus on patients who are living with dementia, since this group may be particularly vulnerable to a dehumanising gaze.6 We frame our discussion within the broader context of the general philosophical question of how we acquire knowledge of different types, and the moral consequences of this, particularly knowledge through visual perception.Debates throughout the history of philosophy raise questions about the nature and sources of our knowledge. Contrasts are often drawn between more can you buy over the counter lasix reliable or less reliable knowledge. And between knowledge that is more technical or ‘objective’, and knowledge that is more emotionally based or more ‘subjective’. A frequent point can you buy over the counter lasix of discussion is the reliability and characteristics of perception as a source of knowledge.

This epistemological discussion is mostly focused on vision, indicating its particular importance as a mode of perception to humans.7Likewise, in ethics, there is discussion of the origin of our moral knowledge and the particular role of perception.8 There is frequent recognition that the observer has some significant role in acquiring moral knowledge. Attention to qualities of the moral observer is not in itself a denial of moral reality. Indeed, it is the very essence of an ethical response to the world to recognise the deep reality of others as can you buy over the counter lasix separate persons. The nature of ethical attention to the world and to those around us is debated and has been articulated in various ways.

The quality of ethical attention may vary and achieving a high level of ethical attention may require certain conditions, certain virtues, and the time and mental space to attend to the situation and claims of the other.9Consideration has already been given to how different modes of attention to the world might be of relevance to the practice of medicine. Work that examines different ways of processing information, and of interacting with and being in the world, can be found in Iain McGilchrist’s The Master and His Emissary,10 where he draws on neurological discoveries and applies his ideas to the development of can you buy over the counter lasix human culture. McGilchrist has recently expanded on the relevance of understanding two different approaches to knowledge for the practice of medicine.11 He argues that task-oriented perception, and a wider, more emotionally attuned awareness of the environment are necessary partners, but may in some circumstances compete, with the competitive edge often being given to the narrower, task-based attention.There has been critique of McGilchrist’s arguments as well as much support. We find his work a can you buy over the counter lasix useful framework for understanding important debates in the ethics of medicine and of nursing about relationships of staff to patients.

In particular, it helps to illuminate the consequences of patients’ dress and personal appearance for how they are seen and treated.Dementia and personal appearanceOur work focuses on patients living with dementia admitted to acute hospital wards. Here, they are a large group, present alongside older patients unaffected by dementia, as well as younger patients. This mixed population provides a useful setting to consider the impact of personal appearance on different patient groups.The role of appearance in the presentation of the self has been explored extensively by Tseëlon,12 13 drawing can you buy over the counter lasix on Goffman’s work on stigma5 and the presentation of the self14 using interactionist approaches. Drawing on the experiences on women in the UK, Tseëlon argues Goffman’s interactionist approach best supports how we understand the relationship appearance plays in self presentation, and its relationships with other signs and interactions surrounding it.

Tseëlon suggests that understandings in this area, in the role appearance and clothing have in the presentation of the self, have been restricted by the perceived trivialities of the topic and limited to the field of fashion studies.15The personal appearance of older patients, and patients living with dementia in particular, has, more recently, been shown to be worthy of attention and of particular significance. Older people are often assumed to be left out of fashion, yet a concern with appearance remains.16 17 Lack of attention to clothing and to personal care may be one sign of the varied symptoms associated with cognitive impairment can you buy over the counter lasix or dementia, and so conversely, attention to appearance is one way of combatting the stigma associated with dementia. Families and carers may also feel the importance of personal appearance. The significant body of work by Twigg and Buse in this field in particular draws attention to the role clothing can you buy over the counter lasix has on preserving the identity and dignity or people living with dementia, while also constraining and enabling elements of care within long-term community settings.16–19 Within this paper, we examine the ways in which these phenomena can be even more acutely felt within the impersonal setting of the acute hospital.Work has also shown how people living with dementia strongly retain a felt, bodily appreciation for the importance of personal appearance.

The comfort and sensuous feel of familiar clothing may remain, even after cognitive capacities such as the ability to recognise oneself in a mirror, or verbal fluency, are lost.18 More strongly still, Kontos,20–22 drawing on the work of Merleau-Ponty and of Bourdieu, has convincingly argued that this attention to clothing and personal appearance is an important aspect of the maintenance of a bodily sense of self, which is also socially mediated, in part via such attention to appearance. Our observations lend support to Kontos’ hypothesis.Much of this previous work has considered clothing in the everyday life of people living with dementia in the context of community or long-term residential care.18 Here, we look at the visual impact of clothing and appearance in the different setting of the hospital ward and consider the consequent implications for patient care. This setting enables us to consider how the short-term and unfamiliar environments of the acute ward, together with the contrast between personal and institutional attire, impact on the perception of the patient by self and by others.There is a body of literature that examines the work of restoring the appearance of residents within long-term community care settings, for instance Ward et al’s work that demonstrates the importance of hair and grooming as a key component of care.23 24 The work of Iltanen-Tähkävuori25 examines the usage of garments designed for long-term care settings, exploring the conflict between clothing used to prevent undressing or facilitate the delivery of care, and the distress such clothing can cause, being powerfully symbolic of can you buy over the counter lasix lower social status and associated with reduced autonomy.26 27Within this literature, there has also been a significant focus on the role of clothing, appearance and the tasks of personal care surrounding it, on the older female body. A corpus of feminist literature has examined the ageing process and the use of clothing to conceal ageing, the presentation of a younger self, or a ‘certain’ age28 It argues that once the ability to conceal the ageing process through clothing and grooming has been lost, the aged person must instead conceal themselves, dressing to hide themselves and becoming invisible in the process.29 This paper will explore how institutional clothing within hospital wards affects both the male and female body, the presentation of the ageing body and its role in reinforcing the invisibility of older people, at a time when they are paradoxically most visible, unclothed and undressed, or wearing institutional clothing within the hospital ward.Institutional clothing is designed and used to fulfil a practical function.

Its use may therefore perhaps incline us towards a ‘task-based’ mode of attention, which as McGilchrist argues,10 while having a vital place in our understanding of the world, may on occasion interfere with the forms of attention that may be needed to deliver good person-oriented care responsive to individual needs.MethodsEthnography involves the in-depth study of people’s actions and accounts within their natural everyday setting, collecting relatively unstructured data from a range of sources.30 Importantly, it can take into account the perspectives of patients, carers and hospital staff.31 Our approach to ethnography is informed by the symbolic interactionist research tradition, which aims to provide an interpretive understanding of the social world, with an emphasis on interaction, focusing on understanding how action and meaning are constructed within a setting.32 The value of this approach is the depth of understanding and theory generation it can provide.33The goal of ethnography is to identify social processes within the data. There are multiple complex and nuanced interactions within these clinical settings that are capable of ‘communicating many messages at once, even of subverting on one level what it appears to be “saying” on can you buy over the counter lasix another’.34 Thus, it is important to observe interaction and performance. How everyday care work is organised and delivered. By obtaining observational data from within each institution on the everyday work of hospital wards, their can you buy over the counter lasix family carers and the nursing and healthcare assistants (HCAs) who carry out this work, we can explore the ways in which hospital organisation, procedures and everyday care impact on care during a hospital admission.

It remedies a common weakness in many qualitative studies, that what people say in interviews may differ from what they do or their private justifications to others.35Data collection (observations and interviews) and analysis were informed by the analytic tradition of grounded theory.36 There was no prior hypothesis testing and we used the constant comparative method and theoretical sampling whereby data collection (observation and interview data) and analysis are inter-related,36 37 and are carried out concurrently.38 39 The flexible nature of this approach is important, because it can allow us to increase the ‘analytic incisiveness’35 of the study. Preliminary analysis of data collected from individual sites informed the focus of later stages of sampling, data collection and analysis in other sites.Thus, sampling requires a flexible, pragmatic approach and purposive and maximum variation sampling (theoretical sampling) was used. This included five can you buy over the counter lasix hospitals selected to represent a range of hospitals types, geographies and socioeconomic catchments. Five hospitals were purposefully selected to represent a range of hospitals types.

Two large university teaching hospitals, two medium-sized general hospitals and one smaller general hospital. This included one urban, two inner city and two hospitals covering a mix of rural and suburban catchment areas, all situated within England and Wales.These sites represented can you buy over the counter lasix a range of expertise and interventions in caring for people with dementia, from no formal expertise to the deployment of specialist dementia workers. Fractures, nutritional disorders, urinary tract and pneumonia40 41 are among the principal causes of admission to acute hospital settings among people with dementia. Thus, we can you buy over the counter lasix focused observation within trauma and orthopaedic wards (80 days) and medical assessment units (MAU.

75 days).Across these sites, 155 days of observational fieldwork were carried out. At each of the five sites, a minimum of 30 days observation took place, split between the two ward types. Observations were carried out by two can you buy over the counter lasix researchers, each working in clusters of 2–4 days over a 6-week period at each site. A single day of observation could last a minimum of 2 hours and a maximum of 12 hours.

A total of 684 hours of observation were conducted for this study. This produced approximately 600 000 can you buy over the counter lasix words of observational fieldnotes that were transcribed, cleaned and anonymised (by KF and AN). We also carried out ethnographic (during observation) interviews with trauma and orthopaedic ward (192 ethnographic interviews and 22 group interviews) and MAU (222 ethnographic interviews) staff (including nurses, HCAs, auxiliary and support staff and medical teams) as they cared for this patient group. This allowed us to question what they are doing and why, and what are the caring practices of ward staff when interacting with people living with can you buy over the counter lasix dementia.Patients within these settings with a diagnosis of dementia were identified through ward nursing handover notes, patient records and board data with the assistance of ward staff.

Following the provision of written and verbal information about the study, and the expression of willingness to take part, written consent was taken from patients, staff and visitors directly observed or spoken to as part of the study.To optimise the generalisability of our findings,42 our approach emphasises the importance of comparisons across sites,43 with theoretical saturation achieved following the search for negative cases, and on exploring a diverse and wide range of data. When no additional empirical data were found, we concluded that the analytical categories were saturated.36 44Grounded theory and ethnography are complementary traditions, with grounded theory strengthening the ethnographic aims of achieving a theoretical interpretation of the data, while the ethnographic approach prevents a rigid application of grounded theory.35 Using an ethnographic approach can mean that everything within a setting is treated as data, which can lead to large volumes of unconnected data and a descriptive analysis.45 This approach provides a middle ground in which the ethnographer, often seen as a passive observer of the social world, uses grounded theory to provide a systematic approach to data collection and analysis that can be used to develop theory to address the interpretive realities of participants within this setting.35Patient and public involvementThe data presented in this paper are drawn from a wider ethnographic study supported by an advisory group of people living with dementia and their family carers. It was this advisory group that informed us of the need of a better understanding of the impacts of the everyday can you buy over the counter lasix care received by people living with dementia in acute hospital settings. The authors met with this group on a regular basis throughout the study, and received guidance on both the design of the study and the format of written materials used to recruit participants to the study.

The external oversight group for this study included, and was chaired, by carers of people living with dementia. Once data analysis was complete, the can you buy over the counter lasix advisory group commented on our initial findings and recommendations. During and on completion of the analysis, a series of public consultation events were held with people living with dementia and family carers to ensure their involvement in discussing, informing and refining our analysis.FindingsWithin this paper, we focus on exploring the medical gaze through the embedded institutional cultures of patient clothing, and the implications this have for patients living with dementia within acute hospital wards. These findings emerged from our wider analysis of our ethnographic study examining ward cultures of care and the experiences of can you buy over the counter lasix people living with dementia.

Here, we examine the ways in which the cultures of clothing within wards impact on the visibility of patients within it, what clothing and identity mean within the ward and the ways in which clothing can be a source of distress. We will look at how personal grooming and appearance can affect status within the ward, and finally explore the removal of clothing, and the impacts of its absence.Ward clothing culturesAcross our sites, there was variation in the cultures of patient clothing and dress. Within many can you buy over the counter lasix wards, it was typical for all older patients to be dressed in hospital-issued institutional gowns and pyjamas (typically in pastel blue, pink, green or peach), paired with hospital supplied socks (usually bright red, although there was some small variation) with non-slip grip soles, while in other wards, it was standard practice for people to be supported to dress in their own clothes. Across all these wards, we observed that younger patients (middle aged/working age) were more likely to be able to wear their own clothes while admitted to a ward, than older patients and those with a dementia diagnosis.Among key signifiers of social status and individuality are the material things around the person, which in these hospital wards included the accoutrements around the bedside.

Significantly, it was observed that people living with dementia were more likely to be wearing an institutional hospital gown or institutional pyjamas, and to have little to individuate the person at the bedside, on either their cabinet or the mobile tray table at their bedside. The wearing of institutional clothing was typically connected to fewer personal items on display can you buy over the counter lasix or within reach of the patient, with any items tidied away out of sight. In contrast, younger working age patients often had many personal belongings, cards, gadgets, books, media players, with young adults also often having a range of ‘get well soon’ gifts, balloons and so on from the hospital gift shop) on display. This both afforded some elements of familiarity, but also marked the person out as someone with can you buy over the counter lasix individuality and a certain social standing and place.Visibility of patients on a wardThe significance of the obscurity or invisibility of the patient in artworks depicting doctors has been commented on.4 Likewise, we observed that some patients within these wards were much more ‘visible’ to staff than others.

It was often apparent how the wearing of personal clothing could make the patient and their needs more readily visible to others as a person. This may be especially so given the contrast in appearance clothing may produce in this particular setting. On occasion, this may be remarked on by staff, and the resulting attention received favourably by the patient.A member of the bay team returned to a patient and found can you buy over the counter lasix her freshly dressed in a white tee shirt, navy slacks and black velvet slippers and exclaimed aloud and appreciatively, ‘Wow, look at you!. €™ The patient looked pleased as she sat and combed her hair [site 3 day 1].Such a simple act of recognition as someone with a socially approved appearance takes on a special significance in the context of an acute hospital ward, and for patients living with dementia whose personhood may be overlooked in various ways.46This question of visibility of patients may also be particularly important when people living with dementia may be less able to make their needs and presence known.

In this example, a whole bay of patients was seemingly ‘invisible’. Here, the ethnographer is observing a four-bed can you buy over the counter lasix bay occupied by male patients living with dementia.The man in bed 17 is sitting in his bedside chair. He is dressed in green hospital issue pyjamas and yellow grip socks. At 10 a.m., the physiotherapy team come and can you buy over the counter lasix see him.

The physiotherapist crouches down in front of him and asks him how he is. He says he is unhappy, and the physiotherapist explains that she’ll be back later to see him again. The nurse checks on him, asks him if he wants a pillow, and puts it behind his head explaining to him, ‘You need to sit in the chair for can you buy over the counter lasix a bit’. She pulls his bedside trolley near to him.

With the help of a Healthcare Assistant they make the bed. The Healthcare Assistant chats to him, puts cake out for can you buy over the counter lasix him, and puts a blanket over his legs. He is shaking slightly and I wonder if he is cold.The nurse explains to me, ‘The problem is this is a really unstimulating environment’, then says to the patient, ‘All done, let’s have a bit of a tidy up,’ before wheeling the equipment out.The neighbouring patient in bed 18, is now sitting in his bedside chair, wearing (his own) striped pyjamas. His eyes are open, and he is looking can you buy over the counter lasix around.

After a while, he closes his eyes and dozes. The team chat to patient 19 behind the curtains. He says he doesn’t want to sit, and they say that is fine unless the doctors tell them otherwise.The nurse puts music on an old can you buy over the counter lasix radio with a CD player which is at the doorway near the ward entrance. It sounds like music from a musical and the ward it is quite noisy suddenly.

She turns down the volume a bit, but it is very jaunty and upbeat. The man in bed can you buy over the counter lasix 19 quietly sings along to the songs. €˜I am going to see my baby when I go home on victory day…’At ten thirty, the nurse goes off on her break. The rest of the team are spread can you buy over the counter lasix around the other bays and side rooms.

There are long distances between bays within this ward. After all the earlier activity it is now very calm and peaceful in the bay. Patient 20 is sitting in the chair tapping his feet to the music can you buy over the counter lasix. He has taken out a large hessian shopping bag out of his cabinet and is sorting through the contents.

There is a lot of paperwork in can you buy over the counter lasix it which he is reading through closely and sorting.Opposite, patient 17 looks very uncomfortable. He is sitting with two pillows behind his back but has slipped down the chair. His head is in his hands and he suddenly looks in pain. He hasn’t can you buy over the counter lasix touched his tea, and is talking to himself.

The junior medic was aware that 17 was not comfortable, and it had looked like she was going to get some advice, but she hasn’t come back. 18 drinks his tea and looks at a wool twiddle mitt sleeve, puts it down, and dozes. 19 has finished all his coffee and manages to put the cup down on the trolley.Everyone is tapping their feet can you buy over the counter lasix or wiggling their toes to the music, or singing quietly to it, when a student nurse, who is working at the computer station in the corridor outside the room, comes in. She has a strong purposeful stride and looks irritated as she switches the music off.

It feels can you buy over the counter lasix like a jolt to the room. She turns and looks at me and says, ‘Sorry were you listening to it?. €™ I tell her that I think these gentlemen were listening to it.She suddenly looks very startled and surprised and looks at the men in the room for the first time. They have all stopped tapping can you buy over the counter lasix their toes and stopped singing along.

She turns it back on but asks me if she can turn it down. She leaves and goes back to her paperwork outside. Once it is turned back on everyone starts tapping their toes again can you buy over the counter lasix. The music plays on.

€˜There’ll be bluebirds over the white can you buy over the counter lasix cliffs of Dover, just you wait and see…’[Site 3 day 3]The music was played by staff to help combat the drab and unstimulating environment of this hospital ward for the patients, the very people the ward is meant to serve. Yet for this member of ward staff the music was perceived as a nuisance, the men for whom the music was playing seemingly did not register to her awareness. Only an individual of ‘higher’ status, the researcher, sitting at the end of this room was visible to her. This example illustrates the general question of the visibility or otherwise of patients can you buy over the counter lasix.

Focusing on our immediate topic, there may be complex pathways through which clothing may impact on how patients living with dementia are perceived, and on their self-perception.Clothing and identityOn these wards, we also observed how important familiar aspects of appearance were to relatives. Family members may be distressed if they find the person they knew so well, looking markedly different. In the example below, a mother and two adult daughters visit the father of the family, who is not visible to them as the person can you buy over the counter lasix they were so familiar with. His is not wearing his glasses, which are missing, and his daughters find this very difficult.

Even though he looks very different following his admission—he has lost a large amount of weight and has sunken cheekbones, and his skin has taken on a darker hue—it is his glasses which are a key concern for the family in their recognition of their father:As I enter the corridor to go back to the ward, I meet the wife and daughter of the patient in bed 2 in the hall and walk with them back can you buy over the counter lasix to the ward. Their father looks very frail, his head is back, and his face is immobile, his eyes are closed, and his mouth is open. His skin looks darker than before, and his cheekbones and eye sockets are extremely prominent from weight loss. €˜I am like a bird can you buy over the counter lasix I want to fly away…’ plays softly in the radio in the bay.

I sit with them for a bit and we chat—his wife holds his hand as we talk. His wife has to take two busses to get to the hospital and we talk about the potential care home they expect her husband will be discharged to. They hope it will be close because can you buy over the counter lasix she does not drive. He isn’t wearing his glasses and his daughter tells me that they can’t find them.

We look in the can you buy over the counter lasix bedside cabinet. She has never seen her dad without his glasses. €˜He doesn’t look like my dad without his glasses’ [Site 2 day 15].It was often these small aspects of personal clothing and grooming that prompted powerful responses from visiting family members. Missing glasses and missing teeth were notable in this regard (and with the follow-up visits from the relatives of discharged patients trying to retrieve these can you buy over the counter lasix now lost objects).

The location of these possessions, which could have a medical purpose in the case of glasses, dental prosthetics, hearing aids or accessories which contained personal and important aspects of a patient’s identity, such as wallets or keys, and particularly, for female patients, handbags, could be a prominent source of distress for individuals. These accessories to personal clothing were notable on these wards by their everyday absence, hidden away in bedside cupboards or simply not brought in with the patient at admission, and by the frequency with which patients requested and called out for them or tried to look for them, often in repetitive cycles that indicated their underlying anxiety about these belongings, but which would become invisible to staff, becoming an everyday background intrusion to the work of the wards.When considering the visibility and recognition of individual persons, missing glasses, especially glasses for distance vision, have a particular significance, for without them, a person may be less able to recognise and interact visually with others. Their presence facilitates the subject can you buy over the counter lasix of the gaze, in gazing back, and hence helps to ground meaningful and reciprocal relationships of recognition. This may be one factor behind the distress of relatives in finding their loved ones’ glasses to be absent.Clothing as a source of distressAcross all sites, we observed patients living with dementia who exhibited obvious distress at aspects of their institutional apparel and at the absence of their own personal clothing.

Some older patients were clearly able to verbalise their understandings of can you buy over the counter lasix the impacts of wearing institutional clothing. One patient remarked to a nurse of her hospital blue tracksuit. €˜I look like an Olympian or Wentworth prison in this outfit!. The latter I expect…’ The staff laughed as they walked her out of the bay (site 3 day 1).Institutional clothing may be a source of distress to patients, although can you buy over the counter lasix they may be unable to express this verbally.

Kontos has shown how people living with dementia may retain an awareness at a bodily level of the demands of etiquette.20 Likewise, in our study, a man living with dementia, wearing a very large institutional pyjama top, which had no collar and a very low V neck, continually tried to pull it up to cover his chest. The neckline was particularly low, because the pyjamas were far too large for him. He continued to fiddle with his very low-necked can you buy over the counter lasix top even when his lunch tray was placed in front of him. He clearly felt very uncomfortable with such clothing.

He continued using his hands to try to pull it up can you buy over the counter lasix to cover his exposed chest, during and after the meal was finished (site 3 day 5).For some patients, the communication of this distress in relation to clothing may be liable to misinterpretation and may have further impacts on how they are viewed within the ward. Here, a patient living with dementia recently admitted to this ward became tearful and upset after having a shower. She had no fresh clothes, and so the team had provided her with a pink hospital gown to wear.‘I want my trousers, where is my bra, I’ve got no bra on.’ It is clear she doesn’t feel right without her own clothes on. The one-to-one healthcare assistant assigned to this can you buy over the counter lasix patient tells her, ‘Your bra is dirty, do you want to wear that?.

€™ She replies, ‘No I want a clean one. Where are my trousers?. I want them, I’ve lost them.’ The healthcare assistant repeats the explaination that her clothes are dirty, and can you buy over the counter lasix asks her, ‘Do you want your dirty ones?. €™ She is very teary ‘No, I want my clean ones.’ The carer again explains that they are dirty.The cleaner who always works in the ward arrives to clean the floor and sweeps around the patient as she sits in her chair, and as he does this, he says ‘Hello’ to her.

She is very teary and explains that she has lost her clothes can you buy over the counter lasix. The cleaner listens sympathetically as she continues ‘I am all confused. I have lost my clothes. I am all confused can you buy over the counter lasix.

How am I going to go to the shops with no clothes on!. €™ (site 5 day 5).This person experienced significant distress because of her absent clothes, but this would often be simply attributed to confusion, seen as a feature of her dementia. This then can you buy over the counter lasix may solidify staff perceptions of her condition. However, we need to consider that rather than her condition (her diagnosis of dementia) causing distress about clothing, the direction of causation may be the reverse.

The absence of her own familiar clothing contributes significantly to her distress and disorientation can you buy over the counter lasix. Others have argued that people with limited verbal capacity and limited cognitive comprehension will have a direct appreciation of the grounding familiarity of wearing their own clothes, which give a bodily felt notion of comfort and familiarity.18 47 Familiar clothing may then be an essential prop to anchor the wearer within a recognisable social and meaningful space. To simply see clothing from a task-oriented point of view, as fulfilling a simply mechanical function, and that all clothing, whether personal or institutional have the same value and role, might be to interpret the desire to wear familiar clothing as an ‘optional extra’. However, for those patients most at risk of disorientation can you buy over the counter lasix and distress within an unfamiliar environment, it could be a valuable necessity.Personal grooming and social statusIncluding in our consideration of clothing, we observed other aspects of the role of personal grooming.

Personal grooming was notable by its absence beyond the necessary cleaning required for reasons of immediate hygiene and clinical need (such as the prevention of pressure ulcers). Older patients, and particular those living with dementia who were unable to carry out ‘self-care’ independently and were not able to request support with personal grooming, could, over their admission, become visibly unkempt and scruffy, hair could be left unwashed, uncombed and unstyled, while men could become hirsute through a lack of shaving. The simple act of a visitor dressing and grooming a patient as they prepared for discharge could transform their appearance and leave that patient looking more alert, appear to having increased capacity, than when sitting ungroomed in their bed or bedside chair.It is important to consider the impact of appearance can you buy over the counter lasix and of personal care in the context of an acute ward. Kontos’ work examining life in a care home, referred to earlier, noted that people living with dementia may be acutely aware of transgressions in grooming and appearance, and noted many acts of self-care with personal appearance, such as stopping to apply lipstick, and conformity with high standards of table manners.

Clothing, etiquette can you buy over the counter lasix and personal grooming are important indicators of social class and hence an aspect of belonging and identity, and of how an individual relates to a wider group. In Kontos’ findings, these rituals and standards of appearance were also observed in negative reactions, such as expressions of disgust, towards those residents who breached these standards. Hence, even in cases where an individual may be assessed as having considerable cognitive impairment, the importance of personal appearance must not be overlooked.For some patients within these wards, routine practices of everyday care at the bedside can increase the potential to influence whether they feel and appear socially acceptable. The delivery of routine timetabled care at the bedside can you buy over the counter lasix can impact on people’s appearance in ways that may mark them out as failing to achieve accepted standards of embodied personhood.

The task-oriented timetabling of mealtimes may have significance. It was a typical observed feature of this routine, when a mealtime has ended, that people living with dementia were left with visible signs and features of the mealtime through spillages on faces, clothes, bed sheets and bedsides, that leave them at risk of being assessed as less socially acceptable and marked as having reduced independence. For example, a volunteer attempts to ‘feed’ a person living with dementia, when she gives up and leave the bedside (this woman can you buy over the counter lasix living with dementia has resisted her attempts and explicitly says ‘no’), remnants of the food is left spread around her mouth (site E). In a different ward, the mealtime has ended, yet a large white plastic bib to prevent food spillages remains attached around the neck of a person living with dementia who is unable to remove it (site X).Of note, an adult would not normally wear a white plastic bib at home or in a restaurant.

It signifies a task-based apparel can you buy over the counter lasix that is demeaning to an individual’s social status. This example also contrasts poignantly with examples from Kontos’ work,20 such as that of a female who had little or no ability to verbalise, but who nonetheless would routinely take her pearl necklace out from under her bib at mealtimes, showing she retained an acute awareness of her own appearance and the ‘right’ way to display this symbol of individuality, femininity and status. Likewise, Kontos gives the example of a resident who at mealtimes ‘placed her hand on her chest, to prevent her blouse from touching the food as she leaned over her plate’.20Patients who are less robust, who have cognitive impairments, who may be liable to disorientation and whose agency and personhood are most vulnerable are thus those for whom appropriate and familiar clothing may be most advantageous. However, we found can you buy over the counter lasix the ‘Matthew effect’ to be frequently in operation.

To those who have the least, even that which they have will be taken away.48 Although there may be institutional and organisational rationales for putting a plastic cover over a patient, leaving it on for an extended period following a meal may act as a marker of dehumanising loss of social status. By being able to maintain familiar clothing and adornment to visually display social standing and identity, a person living with dementia may maintain a continuity of selfhood.However, it is also possible that dressing and grooming an older person may itself be a task-oriented institutional activity in certain contexts, as discussed by Lee-Treweek49 in the context of a nursing home preparing residents for ‘lounge view’ where visitors would see them, using residents to ‘create a visual product for others’ sometimes to the detriment of residents’ needs. Our observations regarding the importance of patient appearance must therefore be considered as part of the care can you buy over the counter lasix of the whole person and a significant feature of the institutional culture.Patient status and appearanceWithin these wards, a new grouping of class could become imposed on patients. We understand class not simply as socioeconomic class but as an indicator of the strata of local social organisation to which an individual belongs.

Those in the lowest classes may have limited opportunities to participate in society, and we observed the ways in which this applied to the people living with dementia within these can you buy over the counter lasix acute wards. The differential impact of clothing as signifiers of social status has also been observed in a comparison of the white coat and the patient gown.4 It has been argued that while these both may help to mask individuality, they have quite different effects on social status on a ward. One might say that the white coat increases visibility as a person of standing and the attribution of agency, the patient gown diminishes both of these. (Within these wards, although white coats were not to can you buy over the counter lasix be found, the dress code of medical staff did make them stand out.

For male doctors, for example, the uniform rarely strayed beyond chinos paired with a blue oxford button down shirt, sleeves rolled up, while women wore a wider range of smart casual office wear.) Likewise, we observed that the same arrangement of attire could be attributed to entirely different meanings for older patients with or without dementia.Removal of clothes and exposureWithin these wards, we observed high levels of behaviour perceived by ward staff as people living with dementia displaying ‘resistance’ to care.50 This included ‘resistance’ towards institutional clothing. This could include pulling up or removing hospital gowns, removing institutional pyjama trousers or pulling up gowns, and standing with gowns untied and exposed at the back (although this last example is an unavoidable design feature of the clothing itself). Importantly, the removal of clothing was can you buy over the counter lasix limited to institutional gowns and pyjamas and we did not see any patients removing their own clothing. This also included the removal of institutional bedding, with instances of patients pulling or kicking sheets from their bed.

These acts could and was often can you buy over the counter lasix interpreted by ward staff as a patient’s ‘resistance’ to care. There was some variation in this interpretation. However, when an individual patient response to their institutional clothing and bedding was repeated during a shift, it was more likely to be conceived by the ward team as a form of resistance to their care, and responded to by the replacement and reinforcement of the clothing and bedding to recover the person.The removal of gowns, pyjamas and bedsheets often resulted in a patient exposing their genitalia or continence products (continence pads could be visible as a large diaper or nappy or a pad visibly held in place by transparent net pants), and as such, was disruptive to the norms and highly visible to staff and other visitor to these wards. Notably, unlike other behaviours considered by staff to be disruptive or inappropriate within these wards such can you buy over the counter lasix as shouting or crying out, the removal of bedsheets and the subsequent bodily exposure would always be immediately corrected, the sheet replaced and the patient covered by either the nurse or HCA.

The act of removal was typically interpreted by ward staff as representing a feature of the person’s dementia and staff responses were framed as an issue of patient dignity, or the dignity and embarrassment of other patients and visitors to the ward. However, such responses to removal could lead to further cycles of removal and replacement, leading to an escalation can you buy over the counter lasix of distress in the person. This was important, because the recording of ‘refusal of care’, or presumed ‘confusion’ associated with this, could have significant impacts on the care and discharge pathways available and prescribed for the individual patient.Consider the case of a woman living with dementia who is 90 years old (patient 1), in the example below. Despite having no immediate medical needs, she has been admitted to the MAU from a care home (following her husband’s stroke, he could no longer care for her).

Across the can you buy over the counter lasix previous evening and morning shift, she was shouting, refusing all food and care and has received assistance from the specialist dementia care worker. However, during this shift, she has become calmer following a visit from her husband earlier in the day, has since eaten and requested drinks. Her care home would not readmit her, which meant she was not able to be discharged from the unit (an overflow unit due to a high number of admissions to the emergency department during a patch of exceptionally hot weather) until alternative arrangements could be made by social services.During our observations, she remains calm for the first 2 hours. When she does talk, she is very loud and high pitched, but this is normal can you buy over the counter lasix for her and not a sign of distress.

For staff working on this bay, their attention is elsewhere, because of the other six patients on the unit, one is ‘on suicide watch’ and another is ‘refusing their medication’ (but does not have a diagnosis of dementia). At 15:10 patient can you buy over the counter lasix 1 begins to remove her sheets:15:10. The unit seems chaotic today. Patient 1 has begun to loudly drum her fingers on the tray table.

She still can you buy over the counter lasix has not been brought more milk, which she requested from the HCA an hour earlier. The bay that patient 1 is admitted to is a temporary overflow unit and as a result staff do not know where things are. 1 has moved her sheets off her legs, her bare knees peeking out over the top of piled sheets.15:15. The nurse in charge can you buy over the counter lasix says, ‘Hello,’ when she walks past 1’s bed.

1 looks across and smiles back at her. The nurse in charge explains to her that she needs to shuffle up the can you buy over the counter lasix bed. 1 asks the nurse about her husband. The nurse reminds 1 that her husband was there this morning and that he is coming back tomorrow.

1 says that he hasn’t can you buy over the counter lasix been and she does not believe the nurse.15:25. I overhear the nurse in charge question, under her breath to herself, ‘Why 1 has been left on the unit?. €™ 1 has started asking for somebody to come and see her. The nurse in charge tells 1 that she needs to do some jobs first and then will come can you buy over the counter lasix and talk to her.15:30.

1 has once again kicked her sheets off of her legs. A social worker comes onto the unit can you buy over the counter lasix. 1 shouts, ‘Excuse me’ to her. The social worker replies, ‘Sorry I’m not staff, I don’t work here’ and leaves the bay.15:40.

1 keeps kicking sheets off her bed, otherwise the unit can you buy over the counter lasix is quiet. She now whimpers whenever anyone passes her bed, which is whenever anyone comes through the unit’s door. 1 is the only elderly patient on the unit. Again, the nurse can you buy over the counter lasix in charge is heard sympathizing that this is not the right place for her.16:30.

A doctor approaches 1, tells her that she is on her list of people to say hello to, she is quite friendly. 1 tells can you buy over the counter lasix her that she has been here for 3 days, (the rest is inaudible because of pitch). The doctor tries to cover 1 up, raising her bed sheet back over the bed, but 1 loudly refuses this. The doctor responds by ending the interaction, ‘See you later’, and leaves the unit.16:40.

1 attempts to talk to the new nurse can you buy over the counter lasix assigned to the unit. She goes over to 1 and says, ‘What’s up my darling?. €™ It’s hard to follow 1 now as she sounds very upset. The RN’s first instinct, like with the doctor and the can you buy over the counter lasix nurse in charge, is to cover up 1 s legs with her bed sheet.

When 1 reacts to this she talks to her and they agree to cover up her knees. 1 is talking about how her husband won’t come and can you buy over the counter lasix visit her, and still sounds really upset about this. [Site 3, Day 13]Of note is that between days 6 and 15 at this site, observed over a particularly warm summer, this unit was uncomfortably hot and stuffy. The need to be uncovered could be viewed as a reasonable response, and in fact was considered acceptable for patients without a classification of dementia, provided they were otherwise clothed, such as the hospital gown patient 1 was wearing.

This is an example can you buy over the counter lasix of an aspect of care where the choice and autonomy granted to patients assessed as having (or assumed to have) cognitive capacity is not available to people who are considered to have impaired cognitive capacity (a diagnosis of dementia) and carries the additional moral judgements of the appropriateness of behaviour and bodily exposure. In the example given above, the actions were linked to the patient’s resistance to their admission to the hospital, driven by her desire to return home and to be with her husband. Throughout observations over this 10-day period, patients perceived by staff as rational agents were allowed to strip down their bedding for comfort, whereas patients living with dementia who responded in this way were often viewed by staff as ‘undressing’, which would be interpreted as a feature of their condition, to be challenged and corrected by staff.Note how the same visual data triggered opposing interpretations of personal autonomy. Just as in the example above where distress over loss of familiar can you buy over the counter lasix clothing may be interpreted as an aspect of confusion, yet lead to, or exacerbate, distress and disorientation.

So ‘deviant’ bedding may be interpreted, for some patients only, in ways that solidify notions of lack of agency and confusion, is another example of the Matthew effect48 at work through the organisational expectations of the clothed appearance of patients.Within wards, it is not unusual to see patients, especially those with a diagnosis of dementia or cognitive impairment, walking in the corridor inadvertently in some state of undress, typically exposed from behind by their hospital gowns. This exposure in itself is of course, an intrinsic functional feature can you buy over the counter lasix of the design of the flimsy back-opening institutional clothing the patient has been placed in. This task-based clothing does not even fulfil this basic function very adequately. However, this inadvertent exposure could often be interpreted as an overt act of resistance to the ward and towards staff, especially when it led to exposed genitalia or continence products (pads or nappies).We speculate that the interpretation of resistance may be triggered by the visual prompt of disarrayed clothing and the meanings assumed to follow, where lack of decorum in attire is interpreted as indicating more general behavioural incompetence, cognitive impairment and/or standing outside the social order.DiscussionPrevious studies examining the significance of the visual, particularly Twigg and Buse’s work16–19 exploring the materialities of appearance, emphasise its key role in self-presentation, visibility, dignity and autonomy for older people and especially those living with dementia in care home settings.

Similarly, care home studies have demonstrated that institutional clothing, designed to facilitate task-based care, can be potentially dehumanising or and distressing.25 26 Our findings resonate with this work, but find that for people living with dementia within a key site of care, the acute ward, can you buy over the counter lasix the impact of institutional clothing on the individual patient living with dementia, is poorly recognised, but is significant for the quality and humanity of their care.Our ethnographic approach enabled the researchers to observe the organisation and delivery of task-oriented fast-paced nature of the work of the ward and bedside care. Nonetheless, it should also be emphasised the instances in which staff such as HCAs and specialist dementia staff within these wards took time to take note of personal appearance and physical caring for patients and how important this can be for overall well-being. None of our observations should be read as critical of any individual staff, but reflects longstanding institutional cultures.Our previous work has examined how readily a person living with dementia within a hospital wards is vulnerable to dehumanisation,51 and to their behaviour within these wards being interpreted as a feature of their condition, rather than a response to the ways in which timetabled care is delivered at their bedside.50 We have also examined the ways in which visual stimuli within these wards in the form of signs and symbols indicating a diagnosis of dementia may inadvertently focus attention away from the individual patient and may incline towards simplified and inaccurate categorisation of both needs and the diagnostic category of dementia.52Our work supports the analysis of the two forms of attention arising from McGilchrist’s work.10 The institutional culture of the wards produces an organisational task-based technical attention, which we found appeared to compete with and reduce the opportunity for ward staff to seek a finer emotional attunement to the person they are caring for and their needs. Focus on can you buy over the counter lasix efficiency, pace and record keeping that measures individual task completion within a timetable of care may worsen all these effects.

Indeed, other work has shown that in some contexts, attention to visual appearance may itself be little more than a ‘task’ to achieve.49 McGilchrist makes clear, and we agree, that both forms of attention are vital, but more needs to be done to enable staff to find a balance.Previous work has shown how important appearance is to older people, and to people living with dementia in particular, both in terms of how they are perceived by others, but also how for this group, people living with dementia, clothing and personal grooming may act as a particularly important anchor into a familiar social world. These twin aspects of clothing and appearance—self-perception can you buy over the counter lasix and perception by others—may be especially important in the fast-paced context of an acute ward environment, where patients living with dementia may be struggling with the impacts of an additional acute medical condition within in a highly timetabled and regimented and unfamiliar environment of the ward, and where staff perceptions of them may feed into clinical assessments of their condition and subsequent treatment and discharge pathways. We have seen above, for instance, how behaviour in relation to appearance may be seen as ‘resisting care’ in one group of patients, but as the natural expression of personal preference in patients viewed as being without cognitive impairments. Likewise, personal grooming might impact favourably on a patient’s alertness, visibility and status within the ward.Prior work has demonstrated the importance of the medical gaze for the perceptions of the patient.

Other work has also shown how older people, and in particular people living with dementia, may be thought to be beyond concern for appearance, yet this does not can you buy over the counter lasix accurately reflect the importance of appearance we found for this patient group. Indeed, we argue that our work, along with the work of others such as Kontos,20 21 shows that if anything, visual appearance is especially important for people living with dementia particularly within clinical settings. In considering the task of washing the patient, Pols53 considered ‘dignitas’ in terms of aesthetic values, in comparison to humanitas conceived as citizen values of equality between persons. Attention to dignitas in the form of appearance may be a way of facilitating the treatment by others of a person can you buy over the counter lasix with humanitas, and helping to realise dignity of patients.Data availability statementNo data are available.

Data are unavailable to protect anonymity.Ethics statementsPatient consent for publicationNot required.Ethics approvalEthics committee approval for the study was granted by the NHS Research Ethics Service (15/WA/0191).AcknowledgmentsThe authors acknowledge funding support from the NIHR.Notes1. Devan Stahl can you buy over the counter lasix (2013). €œLiving into the imagined body. How the diagnostic image confronts the lived body.” Medical Humanities.

Medhum-2012–010286.2. Joyce Zazulak et al. (2017). "The art of medicine.

Arts-based training in observation and mindfulness for fostering the empathic response in medical residents.” Medical Humanities. Medhum-2016-011180.3. E Forde (2018). "Using photography to enhance GP trainees’ reflective practice and professional development." Medical Humanities.

Medhum-2017-011203.4. Caroline Wellbery and Melissa Chan (2014) “White coat, patient gown.” Medical Humanities. Medhum-2013–0 10 463.5. E Goffman (1990a).

Stigma. Notes on the management of spoiled identity, Penguin.6. J Bridges and C Wilkinson (2011). €œAchieving dignity for older people with dementia in hospital.” Nursing Standard 5 (29).7.

J Dancy (1985). Contemporary Epistemology, John Wiley and Sons.8. D McNaughton (1988). Moral Vision.

Blackwell.9. S Weil (1953). Gravity and Grace. U of Nebraska Press.10.

I McGilchrist (2009). The Master and his Emissary. The divided brain and the making of the western world. New Haven and London, Yale University Press.11.

Iain McGilchrist (2011). €œPaying attention to the bipartite brain.” The Lancet 377 (9771). 1068–1069.12. Efrat Tseëlon (1992).

€œSelf presentation through appearance. A manipulative vs a dramaturgical approach”. Symbolic Interaction, 15(4). 501–514.13.

E Tseëlon (1995). The masque of femininity. The presentation of woman in everyday life. London.

Sage.14. E Goffman (1990b). The Presentation of Self in Everyday Life Penguin15. Efrat Tseëlon (2001).

€œFashion research and its discontents”. Fashion Theory, 5 (4). 435–451.16. Julia Twigg (2010a).

€œClothing and dementia. A neglected dimension?. € Journal of Ageing Studies 24(4). 223–230.17.

Julia Twigg and Christina E Buse (2013). €œDress, dementia and the embodiment of identity.” Dementia 12(3). 326–336.18. C.

E Buse and J. Twigg (2015). €œClothing, embodied identity and dementia. Maintaining the self through dress.” Age, Culture, Humanities (2).19.

Christina Buse and Julia Twigg (2018). €œDressing disrupted. Negotiating care through the materiality of dress in the context of dementia.” Sociology of Health &. Illness, 40(2).

340-352.20. PIA C Kontos (2004). Ethnographic reflections on selfhood, embodiment and Alzheimer's disease. Ageing &.

Society, 24(6). 829–849.21. P. C Kontos (2005).

€œEmbodied selfhood in Alzheimer's disease. Rethinking person-centred care.” Dementia 4 (4). 553–570.22. P.

C Kontos and G. Naglie (2007). €œBridging theory and practice. Imagination, the body, and person-centred dementia care.” Dementia 6 (4).

549–569.23. Richard Ward et al. (2016a). €œâ€˜Gonna make yer gorgeous’.

Everyday transformation, resistance and belonging in the care-based hair salon.” Dementia, 15(3). 395–413.24. Richard Ward, Sarah Campbell, and John Keady (2016b). €œAssembling the salon.

Learning from alternative forms of body work in dementia care.” Sociology of Health &. Illness, 38(8). 1287–1302.25. Sonja Iltanen-Tähkävuori, Minttu Wikberg, and Päivi Topo (2012).

Design and dementia. A case of garments designed to prevent undressing. Dementia, 11(1). 49–59.26.

Päivi Topo and Sonja Iltanen-Tähkävuori (2010). €œScripting patienthood with patient clothing.” Social Science &. Medicine, 70(11). 1682–1689.27.

Julia Twigg (2010b). €œWelfare embodied. The materiality of hospital dress. A commentary on Topo and Iltanen-Tähkävuori”.

Social Science and Medicine, 70(11), 1690–1692.28. Kathleen Woodward (2006). €œPerforming age, performing gender” National Women’s Studies Association (NWSA) Journal 18(1). 162–89.29.

K.M Woodward (1999). Introduction. In K.M. Woodward (ed.), Figuring Age.

Women, Bodies and Generations (pp. Ix-xxix). Bloomington. Indiana University Press.30.

M Hammersley and P Atkinson (1989). Ethnography. Principles in practice. London.

Routledge.31. V. J Caracelli (2006). Enhancing the policy process through the use of ethnography and other study frameworks.

A mixed-method strategy. Research in the Schools, 13(1). 84–92.32. W Housley and P Atkinson (2003).

Interactionism, Sage33. M Hammersley (1987) What's Wrong with Ethnography?. Methodological Explorations. London.

Routledge34. V Turner and E Bruner (1986). The Anthropology of Experience New York. PAJ Publications.

2435. K Charmaz and RG Mitchell (2001). €˜Grounded theory in ethnography’ in Atkinson P. (Ed) Handbook of Ethnography, 2001.

160-174. Sage. London36. B Glaser and A Strauss (1967).

The Discovery of Grounded Theory. London. Weidenfeld and Nicholson, 24(25). 288–30437.

Juliet M. Corbin and Anselm Strauss (1990). Grounded theoryrResearch. Procedures, canons, and evaluative criteria.

J Green (1998). Commentary. Grounded theory and the constant comparative method. BMJ (Clinical research ed.), 316 (7137),:1064.39.

Roy Suddaby (2006). €œFrom the editors. What grounded theory is not.” Academy of management journal, 49(4). 633–642.40.

Elizabeth L Sampson et al. (2009). €œDementia in the acute hospital. Prospective cohort study of prevalence and mortality”.

British Journal of Psychiatry,195(1). 61–66. Doi:10.1192/bjp.bp.108.05533541. C Pinkert and B Holle (2012).

€œPeople with dementia in acute hospitals. Literature review of prevalence and reasons for hospital admission”. Z. Gerontol.

Geriatr. 45. 728–734.42. Robert E Herriott and William A.

Firestone (1983) “Multisite qualitative policy research. Optimising description and generalizability”. Education Research 12:14–1943. F Vogt (2002).

€œNo ethnography without comparison. The methodological significance of comparison in ethnographic research” Studies in Education Ethnography 6:23–4244. Benjamin Saunders et al. (2018).

€œSaturation in qualitative research. Exploring its conceptualization and operationalization.” Quality and Quantity 52 (4). 1893–1907.45. A Coffey and P Atkinson (1996).

Making sense of qualitative data. Complementary research strategies. Sage Publications, Inc.46. Paula Boddington and Katie Featherstone (2018).

€œThe canary in the coal mine. Continence care for people with dementia in acute hospital wards as a crisis of dehumanisation”. Bioethics, 32(4). 251–260.47.

Christina Buse et al. (2014). €œLooking “out of place”. Analysing the spatial and symbolic meanings of dementia care settings through dress.” International Journal of Ageing and Later Life 9 (1).

€œThe Matthew effect in science. The reward and communication systems of science are considered.” Science 159 (3810). 56–63.49. Geraldine Lee-Treweek (1997) “Women, resistance and care.

An ethnographic study of nursing auxiliary work” Work, Employment and Society, 11(1). 47–6350. Katie Featherstone et al. (2019b).

€œRefusal and resistance to care by people living with dementia being cared for within acute hospital wards. An ethnographic study” Health Service and Delivery Research51. Katie Featherstone, Andy Northcott, and Jackie Bridges (2019a). €œRoutines of resistance.

An ethnography of the care of people living with dementia in acute hospital wards and its consequences.” International Journal of Nursing Studies.52. K Featherstone, A Northcott, and P Boddington (2020). €œUsing signs and symbols to identify hospital patients with a dementia diagnosis. Help or hindrance to recognition and care?.

€ Narrative Inquiry in Bioethics53. Jeannette Pols (2013). €œWashing the patient. Dignity and aesthetic values in nursing care” Nursing Philosophy, 14(3).

How should I use Lasix?

Take Lasix by mouth with a glass of water. You may take Lasix with or without food. If it upsets your stomach, take it with food or milk. Do not take your medicine more often than directed. Remember that you will need to pass more urine after taking Lasix. Do not take your medicine at a time of day that will cause you problems. Do not take at bedtime.

Talk to your pediatrician regarding the use of Lasix in children. While this drug may be prescribed for selected conditions, precautions do apply.

Overdosage: If you think you have taken too much of Lasix contact a poison control center or emergency room at once.

NOTE: Lasix is only for you. Do not share Lasix with others.

Lasix diuretic otc

Protecting the safety and health of essential workers who support America’s food security—including the meat, poultry, and pork processing lasix online in canada industries—is a top priority for the Occupational Safety and lasix diuretic otc Health Administration (OSHA). OSHA and the Centers for Disease Control and Prevention issued additional guidance to reduce the risk of exposure to the hypertension and keep workers safe and healthy in the meatpacking and meat processing industries —including those involved in beef, pork, and poultry operations. This new guidance provides specific recommendations for employers to meet their obligations to protect workers in these facilities, where people lasix diuretic otc normally work closely together and share workspaces and equipment.

Here are eight ways to help minimize meat processing workers’ exposure to the hypertension. Screen workers before they enter the workplace. If a worker becomes sick, send them home and disinfect their workstation and lasix diuretic otc any tools they used.

Move workstations farther apart. Install partitions between workstations using strip curtains, plexiglass, or similar materials. To limit lasix diuretic otc spread between groups, assign the same workers to the same shifts with the same coworkers.

Prevent workers from using other workers’ equipment. Allow workers to wear face coverings when entering, inside, and exiting the facility. Encourage workers to report any safety and health concerns to their lasix diuretic otc supervisors.

OSHA is committed to ensuring that workers and employers in essential industries have clear guidance to keep workers safe and healthy from the hypertension—including guidance for essential workers in construction, manufacturing, package delivery, and retail. Workers and employers who have questions or concerns about workplace safety can contact OSHA online or by phone at 1-800-321-6742 (OSHA). You can find additional resources and lasix diuretic otc learn more about OSHA’s response to the hypertension at www.osha.gov/hypertension.

Loren Sweatt is the Principal Deputy Assistant Secretary for the U.S. Department of Labor’s Occupation Safety and Health Administration Editor’s Note. It is important to note that information and guidance about hypertension medications continually evolve as conditions online pharmacy lasix change lasix diuretic otc.

Workers and employers are encouraged to regularly refer to the resources below for updates:The sixth annual National Apprenticeship Week (NAW) is Nov. 8-14. It’s a great time to learn more about lasix diuretic otc the benefits of apprenticeship, or to get the word out about your program!.

Join the U.S. Department of Labor and representatives from business, labor, education and more virtually and in-person with socially distanced events. If you’re planning to host an event during NAW, here lasix diuretic otc are some resources you should know about.

Start with our event planning toolkit. Need more inspiration?. See last year's NAW report for ideas lasix diuretic otc.

Find tips in our promotion toolkit on how to spread the word. Download customizable print materials, including flyers and fact sheets. Register your event so we can include it on our map lasix diuretic otc.

If you’re interested in learning more about apprenticeship, explore our interactive map to find a NAW event near you. You can also visit Apprenticeship.gov for answers to common questions. No matter what industry you’re in, or what career you have in mind, apprenticeship can work for you.

Share your NAW activities on social media this November using the hashtag #NAW2020. To learn more about National Apprenticeship Week 2020 and explore all NAW events, visit Apprenticeship.gov/NAW..

Protecting the safety can you buy over the counter lasix and health of essential workers http://www.ec-paul-bert-schiltigheim.ac-strasbourg.fr/lelementaire/nos-projets/ce1-basket-ball-a-lecole-paul-bert/ who support America’s food security—including the meat, poultry, and pork processing industries—is a top priority for the Occupational Safety and Health Administration (OSHA). OSHA and the Centers for Disease Control and Prevention issued additional guidance to reduce the risk of exposure to the hypertension and keep workers safe and healthy in the meatpacking and meat processing industries —including those involved in beef, pork, and poultry operations. This new guidance provides specific recommendations for employers to meet their obligations to protect workers in can you buy over the counter lasix these facilities, where people normally work closely together and share workspaces and equipment.

Here are eight ways to help minimize meat processing workers’ exposure to the hypertension. Screen workers before they enter the workplace. If a worker becomes sick, send them home can you buy over the counter lasix and disinfect their workstation and any tools they used.

Move workstations farther apart. Install partitions between workstations using strip curtains, plexiglass, or similar materials. To limit can you buy over the counter lasix spread between groups, assign the same workers to the same shifts with the same coworkers.

Prevent workers from using other workers’ equipment. Allow workers to wear face coverings when entering, inside, and exiting the facility. Encourage workers to report any safety and health can you buy over the counter lasix concerns to their supervisors.

OSHA is committed to ensuring that workers and employers in essential industries have clear guidance to keep workers safe and healthy from the hypertension—including guidance for essential workers in construction, manufacturing, package delivery, and retail. Workers and employers who have questions or concerns about workplace safety can contact OSHA online or by phone at 1-800-321-6742 (OSHA). You can find additional resources and learn more about OSHA’s response to the hypertension at www.osha.gov/hypertension can you buy over the counter lasix.

Loren Sweatt is the Principal Deputy Assistant Secretary for the U.S. Department of Labor’s Occupation Safety and Health Administration Editor’s Note. It is important to note that information low cost lasix and guidance about hypertension medications continually evolve as conditions change can you buy over the counter lasix.

Workers and employers are encouraged to regularly refer to the resources below for updates:The sixth annual National Apprenticeship Week (NAW) is Nov. 8-14. It’s a great time can you buy over the counter lasix to learn more about the benefits of apprenticeship, or to get the word out about your program!.

Join the U.S. Department of Labor and representatives from business, labor, education and more virtually and in-person with socially distanced events. If you’re can you buy over the counter lasix planning to host an event during NAW, here are some resources you should know about.

Start with our event planning toolkit. Need more inspiration?. See last year's NAW can you buy over the counter lasix report for ideas.

Find tips in our promotion toolkit on how to spread the word. Download customizable print materials, including flyers and fact sheets. Register can you buy over the counter lasix your event so we can include it on our map.

If you’re interested in learning more about apprenticeship, explore our interactive map to find a NAW event near you. You can also visit Apprenticeship.gov for answers to common questions. No matter what industry you’re in, or what career you have in mind, apprenticeship can can you buy over the counter lasix work for you.

Share your NAW activities on social media this November using the hashtag #NAW2020. To learn more about National Apprenticeship Week 2020 and explore all NAW events, visit Apprenticeship.gov/NAW..

Lasix water pill

For example, no increase in the risk of cancer is expected if exposure to the nitrosamine impurity below lasix water pill the acceptable level occurs every day for 70 years. The actual health risk varies from person to person. The risk depends on several factors, such as.

The daily dose of the medication how long the medication is taken the level lasix water pill of the nitrosamine impurity in the finished productPatients should always talk to their health care provider before stopping a prescribed medication. Not treating a condition may pose a greater health risk than the potential exposure to a nitrosamine impurity. What we're doing Health Canada recognizes that the nitrosamine impurity issue may cause concern for Canadians.

Your health and safety is our top priority and we will lasix water pill continue to take action to address risks and inform you of new safety information. We have created a list of all medications currently known to contain nitrosamine impurities. We will continue to update it, as needed, as more information becomes available.

As we continue to hold companies accountable for determining lasix water pill the root causes, we’re learning more about how nitrosamine impurities may have formed or be present in medications. In the meantime, we will continue to take action to address and prevent the presence of unacceptable levels of these impurities. These actions may include.

Assess the manufacturing processes of companies determine the risk to Canadians and the impact on the Canadian market test samples of drug products on the market or soon to be released to the market for NDMA and other nitrosamine impurities ask companies to stop distribution as an interim precautionary measure while we gather more information make information available to health care professionals and to patients to enable informed decisions lasix water pill regarding the medications that we takeAs the federal regulator of health products in Canada, we also. Request, confirm and monitor the effectiveness of recalls by companies as necessary conduct our own laboratory tests, where necessary, and assess if the results present a health risk to humans conduct inspections of domestic and foreign sites and restrict certain products from being on the market when problems are identifiedWe share information on potential root causes of nitrosamines identified to date in medications with Canadian drug companies. We also ask the companies to.

Review their manufacturing processes and controls take action to avoid nitrosamine impurities in all medications, as necessary test any products that could potentially contain lasix water pill nitrosamine impurities report their findings to Health Canada To better understand this global issue, we are collaborating and sharing information with international regulators, such as. U.S. Food and Drug Administration European Medicines Agency Australia’s Therapeutic Goods Administration Japan’s Ministry of Health, Labour and Welfare and Pharmaceuticals and Medical Devices Agency Switzerland’s Swissmedic Singapore’s Health Sciences AuthorityWe continue to work with companies and our international regulatory partners to.

Determine the root causes of the issue verify that appropriate actions are taken to minimize lasix water pill or avoid the presence of nitrosamine impurities We regularly communicate information on health risks, test results, recalls and other actions taken. Some of these key actions and communications include. Letter to all manufacturers (October 2, 2019).

Health Canada issued a key communication to all companies marketing human prescription and non-prescription medications requesting them to conduct detailed evaluations of their manufacturing procedures and controls lasix water pill for the potential presence of nitrosamines. The letter outlined examples of potential root causes for the presence of nitrosamines and included a request for a stepwise approach to conduct these risk assessments and expectations for any necessary subsequent actions. Nitrosamines Questions and Answers (Q&A) document (November 26, 2019).

Health Canada issued a Q&A document on issues relating to the control of lasix water pill nitrosamines in medicines. This Q&A document will be updated periodically as new information becomes available. Webinar on Nitrosamines (January 31, 2020).

The purpose of this session was to provide an opportunity for a discussion of this issue with Health lasix water pill Canada and stakeholders. Health Canada provided overviews of the situation relating to nitrosamine impurities in pharmaceuticals and stakeholders had the opportunity to share their experiences, successes and challenges in addressing the issue of nitrosamine contamination. The on-line webinar was well intended by approximately 500 participants from over 18 countries and provided valuable information to respond to this global issue.We will continue to update Canadians if a product is being recalled.

Related linksOn this page Overview One of Health Canada’s roles is to lasix water pill regulate and authorize health products that improve and maintain the health and well-being of Canadians. The hypertension medications lasix has created an unprecedented demand on Canada’s health care system and has led to an urgent need for access to health products. As part of the government's broad response to the lasix, Health Canada introduced innovative and agile regulatory measures.

These measures expedite the regulatory review of hypertension medications health products without compromising safety, efficacy lasix water pill and quality standards. These measures are helping to make health products and medical supplies needed for hypertension medications available to Canadians and health care workers. Products include.

testing devices, such lasix water pill as test kits and swabs personal protective equipment (PPE) for medical purposes, such as medical masks, N95 respirators, gowns and gloves disinfectants and hand sanitizers investigational drugs and treatments We support the safe and timely access to these critical products through. temporary legislative, regulatory and policy measures partnerships and networks with companies, provinces and territories, other government departments, international regulatory bodies and health care professionals easily accessed and available guidance and other priority information We have also taken immediate steps to protect consumers from unauthorized health products and illegal, false or misleading product advertisements that claim to mitigate, prevent, treat, diagnose or cure hypertension medications. Medical devices Medical devices play an important role in diagnosing, treating, mitigating or preventing hypertension medications.

We are expediting access to medical devices through an interim order for importing and lasix water pill selling medical devices. This interim order, which was introduced on March 18, 2020, covers medical devices such as. Since the release of the interim order, we have authorized hundreds of medical devices for use against hypertension medications.

We have also expedited the review and issuance of thousands of Medical Device Establishment Licences (MDELs). These have been issued for companies asking to lasix water pill manufacture (Class I), import or distribute medical devices in relation to hypertension medications. Testing devices Early diagnosis is critical to slowing and reducing the spread of hypertension medications in Canada.

Our initial focus during the lasix has been the scientific review and authorization of testing devices. We made it a priority to review diagnostic tests lasix water pill using nucleic acid technology. This helped to increase the number of testing devices available in Canada to diagnose active and early-stage s of hypertension medications.

We are also reviewing and authorizing serological tests that detect previous exposure to hypertension medications. In May 2020, we authorized the first serological testing device to help improve our understanding of the immune status of people lasix water pill infected. We also provided guidance on serological tests.

We continue to collaborate with the Public Health Agency of Canada’s National Microbiology Laboratory (NML) and with provincial public health and laboratory partners as they. review and engage in their own studies of serological technologies develop lasix water pill tests assess commercial tests The NML is known around the world for its scientific evidence. It works with public health partners to prevent the spread of infectious diseases.

When making regulatory decisions, we consider the data provided by the NML and provincial public health and laboratory partners. This work will facilitate access to devices that will improve our testing capacity lasix water pill. It will also support research into understanding immunity against hypertension medications and the possibility of re-.

Personal protective equipment Personal protective equipment (PPE) is key to protecting health care workers, patients and Canadians through prevention and control. We play an important role in providing guidance to companies and manufacturers lasix water pill in Canada that want to supply PPE. We are increasing the range of products available without compromising safety and effectiveness.

For example, we are. We have authorized hundreds of lasix water pill new PPE products and other devices, all while ensuring the safety and quality of PPE. Hand sanitizers, disinfectants, cleaners and soaps The hypertension medications lasix created an urgent need for disinfectants, hand sanitizers, cleaners and soaps.

To increase supply and ensure Canadians have access to these products, we. We will continue our efforts lasix water pill to support supply and access to these essential products. Drugs and treatments We are closely tracking all potential drugs and treatments in development in Canada and abroad.

We are working with companies, academic research centres and investigators to help expedite the development and availability of drugs and treatments to prevent and treat hypertension medications. Clinical trials On May 23, 2020, the Minister of Health signed a clinical trials interim order lasix water pill. This temporary measure is designed to meet the urgent need to diagnose, treat, reduce or prevent hypertension medications.

The interim order facilitates clinical trials in Canada to investigate and offer greater patient access to potential hypertension medications drugs and medical devices, while upholding strong patient safety requirements. As well, to encourage the rapid development of drugs and treatments, lasix water pill we are. prioritizing hypertension medications clinical trial applications providing regulatory agility and guidance on how clinical trials are to be conducted this encourages and supports the launch of new trials and the continuation of existing ones, as well as broader patient participation across the country working with companies outside of Canada to bring clinical trials to our country working with researchers around the world to add Canadian sites to their research efforts On May 15, 2020, we authorized Canada’s first treatment clinical trial.

Addressing critical product shortages We have taken steps to address critical product shortages caused by the hypertension medications lasix. One of these steps was lasix water pill an interim order to prevent or ease shortages of drugs, medical devices and foods for a special dietary purpose. Introduced on March 30, 2020, this interim order temporarily.

allows companies with an MDEL to import foreign devices that meet similar high quality and manufacturing standards as Canadian-approved devices makes it mandatory to report shortages of medical devices that are considered critical during the lasix allows companies with Drug Establishment Licences to import foreign drugs that meet similar high quality and manufacturing standards as Canadian-approved drugs We also work with provinces and territories, companies and manufacturers, health care providers and patient groups to strengthen the drug supply chain. To lasix water pill identify, prevent and ease shortages for Canadians, we. stepped up monitoring and surveillance activities to identify potential shortages early on have introduced temporary regulatory agility so manufacturers can ramp up production for example, increased the batch sizes regularly engaged stakeholders to share information and look at how we can prevent tier 3 drug shortages, which have the greatest impact on Canada’s drug supply and health care system helped to access extra supplies of.

Drugs, including muscle relaxants, inhalers and sedatives medical devices, such as PPE (medical masks and gowns) and ventilators Post-market surveillance activities We actively monitor the post-market safety and effectiveness of health products related to hypertension medications. For example, we lasix water pill work with industry members and health care workers to. monitor safety issues take the necessary steps to protect Canadians from the effects of harmful products To ensure the ongoing safety of marketed health products, we.

take proactive steps to identify hypertension medications-related adverse events from drugs and medical devices being used in Canada for hypertension medications proactively monitor major online retailers to identify authorized/unauthorized products making false and misleading hypertension medications claims manage risk communications for hypertension medications public advisories, information updates, health care professional communications and shortages take a proactive approach to identifying false and misleading ads for health products related to hypertension medications take part in international discussions on the real-world safety and effectiveness of hypertension medications treatments Engaging with partners and stakeholders To support access to health products for hypertension medications, we collaborate with a range of organizations and stakeholders. These include other government departments, including the Public Health Agency of Canada, as well as provinces and territories, international partners, companies and health care professionals.

In the meantime, we will continue to take action to address and prevent the can you buy over the counter lasix http://eng.medtech-radar.com/can-you-get-cialis-over-the-counter presence of unacceptable levels of these impurities. These actions may include. Assess the manufacturing processes of companies determine the risk to Canadians and the impact on the Canadian market test samples of drug products on the market or soon to be released to the market for NDMA and other nitrosamine impurities ask companies to stop distribution as an interim precautionary measure while we gather more information make information available to health care professionals and to patients to enable informed decisions regarding the medications that we takeAs the federal regulator of health products in Canada, we also.

Request, confirm and monitor the effectiveness of recalls by companies as necessary conduct our own laboratory tests, where necessary, and assess if the results present a health risk to humans conduct inspections of domestic and foreign sites and restrict certain products from being on the market when problems are identifiedWe share information on potential root causes of nitrosamines identified can you buy over the counter lasix to date in medications with Canadian drug companies. We also ask the companies to. Review their manufacturing processes and controls take action to avoid nitrosamine impurities in all medications, as necessary test any products that could potentially contain nitrosamine impurities report their findings to Health Canada To better understand this global issue, we are collaborating and sharing information with international regulators, such as.

U.S can you buy over the counter lasix. Food and Drug Administration European Medicines Agency Australia’s Therapeutic Goods Administration Japan’s Ministry of Health, Labour and Welfare and Pharmaceuticals and Medical Devices Agency Switzerland’s Swissmedic Singapore’s Health Sciences AuthorityWe continue to work with companies and our international regulatory partners to. Determine the root causes of the issue verify that appropriate actions are taken to minimize or avoid the presence of nitrosamine impurities We regularly communicate information on health risks, test results, recalls and other actions taken.

Some of can you buy over the counter lasix these key actions and communications include. Letter to all manufacturers (October 2, 2019). Health Canada issued a key communication to all companies marketing human prescription and non-prescription medications requesting them to conduct detailed evaluations of their manufacturing procedures and controls for the potential presence of nitrosamines.

The letter outlined examples of potential root causes for the presence of nitrosamines and included a request for a stepwise approach to conduct these risk assessments can you buy over the counter lasix and expectations for any necessary subsequent actions. Nitrosamines Questions and Answers (Q&A) document (November 26, 2019). Health Canada issued a Q&A document on issues relating to the control of nitrosamines in medicines.

This Q&A document will be updated periodically as new information becomes available can you buy over the counter lasix. Webinar on Nitrosamines (January 31, 2020). The purpose of this session was to provide an opportunity for a discussion of this issue with Health Canada and stakeholders.

Health Canada provided overviews of the situation relating to nitrosamine impurities in pharmaceuticals and stakeholders had can you buy over the counter lasix the opportunity to share their experiences, successes and challenges in addressing the issue of nitrosamine contamination. The on-line webinar was well intended by approximately 500 participants from over 18 countries and provided valuable information to respond to this global issue.We will continue to update Canadians if a product is being recalled. Related linksOn this page Overview One of Health Canada’s roles is to regulate and authorize health products that improve and maintain the health and well-being of Canadians.

The hypertension medications lasix has created an unprecedented demand on Canada’s health care system and has led to an urgent need for access to health can you buy over the counter lasix products. As part of the government's broad response to the lasix, Health Canada introduced innovative and agile regulatory measures. These measures expedite the regulatory review of hypertension medications health products without compromising safety, efficacy and quality standards.

These measures are helping to make health products and medical supplies needed for hypertension medications available to Canadians can you buy over the counter lasix and health care workers. Products include. testing devices, such as test kits and swabs personal protective equipment (PPE) for medical purposes, such as medical masks, N95 respirators, gowns and gloves disinfectants and hand sanitizers investigational drugs and treatments We support the safe and timely access to these critical products through.

temporary legislative, regulatory and policy measures partnerships and networks with companies, provinces and territories, other government departments, international regulatory bodies and health care professionals easily accessed and available guidance and other priority information We have also taken immediate steps to protect consumers from unauthorized can you buy over the counter lasix health products and illegal, false or misleading product advertisements that claim to mitigate, prevent, treat, diagnose or cure hypertension medications. Medical devices Medical devices play an important role in diagnosing, treating, mitigating or preventing hypertension medications. We are expediting access to medical devices through an interim order for importing and selling medical devices.

This interim order, which was introduced on can you buy over the counter lasix March 18, 2020, covers medical devices such as. Since the release of the interim order, we have authorized hundreds of medical devices for use against hypertension medications. We have also expedited the review and issuance of thousands of Medical Device Establishment Licences (MDELs).

These have been issued for companies asking to manufacture (Class I), import or distribute medical devices can you buy over the counter lasix in relation to hypertension medications. Testing devices Early diagnosis is critical to slowing and reducing the spread of hypertension medications in Canada. Our initial focus during the lasix has been the scientific review and authorization of testing devices.

We made it a can you buy over the counter lasix priority to review diagnostic tests using nucleic acid technology. This helped to increase the number of testing devices available in Canada to diagnose active and early-stage s of hypertension medications. We are also reviewing and authorizing serological tests that detect previous exposure to hypertension medications.

In May 2020, we authorized the first serological testing device to can you buy over the counter lasix help improve our understanding of the immune status of people infected. We also provided guidance on serological tests. We continue to collaborate with the Public Health Agency of Canada’s National Microbiology Laboratory (NML) and with provincial public health and laboratory partners as they.

review and engage in their own studies of serological technologies develop tests assess commercial tests The NML is known around the world for its scientific evidence. It works with public health partners to prevent the spread can you buy over the counter lasix of infectious diseases. When making regulatory decisions, we consider the data provided by the NML and provincial public health and laboratory partners.

This work will facilitate access to devices that will improve our testing capacity. It will also support research into understanding immunity against hypertension medications and the possibility of can you buy over the counter lasix re-. Personal protective equipment Personal protective equipment (PPE) is key to protecting health care workers, patients and Canadians through prevention and control.

We play an important role in providing guidance to companies and manufacturers in Canada that want to supply PPE. We are increasing the range of products available without compromising safety and effectiveness can you buy over the counter lasix. For example, we are.

We have authorized hundreds of new PPE products and other devices, all while ensuring the safety and quality of PPE. Hand sanitizers, disinfectants, cleaners and soaps The can you buy over the counter lasix hypertension medications lasix created an urgent need for disinfectants, hand sanitizers, cleaners and soaps. To increase supply and ensure Canadians have access to these products, we.

We will continue our efforts to support supply and access to these essential products. Drugs and treatments We are closely can you buy over the counter lasix tracking all potential drugs and treatments in development in Canada and abroad. We are working with companies, academic research centres and investigators to help expedite the development and availability of drugs and treatments to prevent and treat hypertension medications.

Clinical trials On May 23, 2020, the Minister of Health signed a clinical trials interim order. This temporary measure is can you buy over the counter lasix designed to meet the urgent need to diagnose, treat, reduce or prevent hypertension medications. The interim order facilitates clinical trials in Canada to investigate and offer greater patient access to potential hypertension medications drugs and medical devices, while upholding strong patient safety requirements.

As well, to encourage the rapid development of drugs and treatments, we are. prioritizing hypertension medications clinical trial applications providing regulatory agility and guidance on how clinical trials are to be conducted can you buy over the counter lasix this encourages and supports the launch of new trials and the continuation of existing ones, as well as broader patient participation across the country working with companies outside of Canada to bring clinical trials to our country working with researchers around the world to add Canadian sites to their research efforts On May 15, 2020, we authorized Canada’s first treatment clinical trial. Addressing critical product shortages We have taken steps to address critical product shortages caused by the hypertension medications lasix.

One of these steps was an interim order to prevent or ease shortages of drugs, medical devices and foods for a special dietary purpose. Introduced on can you buy over the counter lasix March 30, 2020, this interim order temporarily. allows companies with an MDEL to import foreign devices that meet similar high quality and manufacturing standards as Canadian-approved devices makes it mandatory to report shortages of medical devices that are considered critical during the lasix allows companies with Drug Establishment Licences to import foreign drugs that meet similar high quality and manufacturing standards as Canadian-approved drugs We also work with provinces and territories, companies and manufacturers, health care providers and patient groups to strengthen the drug supply chain.

To identify, prevent and ease shortages for Canadians, we. stepped up monitoring and surveillance activities to identify potential shortages early on have introduced temporary regulatory agility so manufacturers can ramp up production for example, increased the batch sizes regularly engaged stakeholders to share information and look at how we can prevent tier 3 drug shortages, which have the greatest impact on Canada’s drug supply and health care system helped to access extra can you buy over the counter lasix supplies of. Drugs, including muscle relaxants, inhalers and sedatives medical devices, such as PPE (medical masks and gowns) and ventilators Post-market surveillance activities We actively monitor the post-market safety and effectiveness of health products related to hypertension medications.

For example, we work with industry members and health care workers to. monitor safety issues can you buy over the counter lasix take the necessary steps to protect Canadians from the effects of harmful products To ensure the ongoing safety of marketed health products, we. take proactive steps to identify hypertension medications-related adverse events from drugs and medical devices being used in Canada for hypertension medications proactively monitor major online retailers to identify authorized/unauthorized products making false and misleading hypertension medications claims manage risk communications for hypertension medications public advisories, information updates, health care professional communications and shortages take a proactive approach to identifying false and misleading ads for health products related to hypertension medications take part in international discussions on the real-world safety and effectiveness of hypertension medications treatments Engaging with partners and stakeholders To support access to health products for hypertension medications, we collaborate with a range of organizations and stakeholders.

These include other government departments, including the Public Health Agency of Canada, as well as provinces and territories, international partners, companies and health care professionals. Engaging with stakeholders We can you buy over the counter lasix take a whole-of-government approach to address stakeholder issues by. collaborating with other government departments to ease challenges across the entire supply chain connecting companies with government decision makers who play important roles in delivering health products to Canadians These efforts create opportunities for new companies and researchers interested in helping in the fight against hypertension medications.

For example, we have worked with other departments to help new companies supply PPE to Canadians and health care workers. Some of these companies had only ever manufactured auto parts, clothing and sports equipment before the can you buy over the counter lasix lasix. We engage the health products sector in mobilizing to find hypertension medications solutions by.

meeting with industry leaders to identify and track potential health products ensuring that the regulatory review of promising health products is done in a timely manner hosting information sessions on our regulatory response maintaining a centralized hypertension medications website with relevant information for industry and health professionals Engaging with domestic partners We work closely with provincial/territorial public health partners and health system partners. For example, we can you buy over the counter lasix. share information with our provincial/territorial health partners about regulatory guidance for reprocessing N95 respirators for health professionals continue to engage and share information with our health system partners, such as health technology assessment agencies, to support efficiencies and alignment inform health professional networks of our activities and seek their perspectives on health care system priorities and challenges Engaging with international partners We are working with our international partners on a coordinated and well-aligned approach to this global lasix.

This ensures that health products are effective and quickly available to Canadians. Collaboration also helps advance the development of diagnostics, treatments and treatments that will save lives and protect the health and safety of people everywhere.

Buy cheap lasix online

Latest Healthy Kids News By buy cheap lasix online Alan Mozes HealthDay http://www.onprodny.com/cheap-ventolin-uk/ ReporterTUESDAY, Nov. 24, 2020 (HealthDay News)Small, powerful magnets in toys like Buckyballs building sets and jewelry kits are causing an alarming number of serious pediatric buy cheap lasix online injuries in the United States, new research warns.Analyzing national data, researchers found an 80% rise in these injuries to children from 2016 to 2019, following the repeal of a sales ban on the magnets by a federal court.When these small rare earth magnets are swallowed, the potential for serious gastrointestinal injury is high, noted study lead author Dr. Michael Flaherty.Cases are popping up all over the United States, according to a recent report from NBC News. In Indiana, a 4-year-old buy cheap lasix online boy was rushed to surgery after swallowing 27 magnetized balls.

One 2-year-old girl in Illinois needed her appendix removed in December after swallowing five of the balls. And in 2018, a Wisconsin 4-year-old needed part of his colon, intestine and appendix removed after swallowing 13 magnetic balls, the network reported.More recently, 6-year-old Cameron Moreau, of New Jersey, landed in the hospital with eight perforations to his colon after swallowing magnets from a toy he got for buy cheap lasix online his birthday. Two of the holes were so close together surgeons had to remove a portion of the colon, NBC News said.The magnets are made of neodymium, said Flaherty, a pediatric critical care physician at MassGeneral Hospital for Children in Boston.The magnets come in circular, rectangular, cylindrical or cubed form, and range from BB-pellet size to roughly 0.10 to 0.25 inches (3 to 6 mm).They're also "five to 10 times more powerful than traditional ferrite magnets," said Flaherty, "and were initially intended for commercial applications."But over time they've come to be included in a wide variety of "entertainment products," Flaherty noted. "Many products now carry warnings to keep away from children, but the small buy cheap lasix online size of the magnets and their inclusion in sets composed of many small magnets make them easily accessible to young children, even if purchased by an adult."The harm can be considerable when a child ingests two of these magnets, or a magnet with another metal object, Flaherty explained.

"This can lead to bowel walls becoming attached and kinked, leading to buy cheap lasix online catastrophic bowel injury and/or death," he said.In 2012, the U.S. Consumer Product Safety Commission (CPSC) took steps to limit their sale with voluntary recalls and safety standards. That effort culminated with a prohibition in buy cheap lasix online 2014. But in 2016 a federal court determined that the commission had overstepped its bounds, and the ban was overturned.For this study, Flaherty and his colleagues reviewed almost 37,000 emergency department visits that took place between 2009 and 2019 by kids under 18 years of age who had swallowed an object.

Data was compiled buy cheap lasix online from the U.S. National Electronic Injury Surveillance System.Just over 1,400 of the visits involved magnet ingestion or inhalation, with about 850 occurring in children younger than 6 years of age. (All magnet buy cheap lasix online ingestions were included. Rare earth magnets could not be separated out.)The investigators found that between 2012 and 2016 -- when protection efforts were underway -- pediatric emergency department visits stemming from magnet ingestions dropped significantly (from 3.58 per 100,000 persons to 2.83 per 100,000).

But from 2016 buy cheap lasix online to 2019 -- after the protections were thrown out of court -- magnet ingestions jumped to 5.16 per 100,000, an increase of more than 80%."Products with [small rare earth magnets] really should not be in any home with children under 14," Flaherty said. "The significant reduction in ER visits associated buy cheap lasix online with the CPSC's initial ban indicate that further federal action is necessary, and that industry standards should be revisited."His advice. "As the holiday season approaches, product-related hazards such as these magnets become even more of an important issue. Parents should always read labels carefully before buying any toys or sets for their children or home, to ensure they are age buy cheap lasix online appropriate.

And consult the CPSC website to check on recent toy recalls."Parents must be vigilant, another expert agreed."The problem is that a small child is a natural detective, always discovering and looking at things," said Anthony Green, chief advocacy and network officer for Safe Kids Worldwide in Washington, D.C."And the tools of investigation for a child are their fingers and their mouth," Green said. "It can be button batteries, liquid laundry packets, medications that buy cheap lasix online look like candy, or rare earth magnets. And that issue has been aggravated by hypertension medications, where everyone's at home and parents are trying to juggle both caregiving and work."In the absence of a ban, Safe Kids is trying to promote awareness of the issue, he said. Meanwhile, Green added, "what a parent can buy cheap lasix online and should do is really survey their house, and identify where children go in the house, to look for dangers that could expose a child to these magnets and serious injury."The study was published in the Nov.

24 issue of the Journal of the American Medical Association.More informationThere's more on magnet safety at the U.S. Consumer Product Safety buy cheap lasix online Commission.SOURCES. Michael R buy cheap lasix online. Flaherty, DO, pediatric critical care physician, division of pediatric critical care medicine, MassGeneral Hospital for Children, Boston.

Anthony Green, buy cheap lasix online chief advocacy and network officer, Safe Kids Worldwide, Washington, D.C.. NBC News. Journal of the American buy cheap lasix online Medical Association, Nov. 24, 2020Copyright © 2020 HealthDay.

All rights buy cheap lasix online reserved. SLIDESHOW 8 First Aid Kit Essentials for Scrapes, Cuts, Bug Bites, and More in Pictures See Slideshow.

Latest Healthy Kids News By Alan Mozes HealthDay ReporterTUESDAY, can you buy over the counter lasix Nov http://www.onprodny.com/cheap-ventolin-uk/. 24, 2020 (HealthDay can you buy over the counter lasix News)Small, powerful magnets in toys like Buckyballs building sets and jewelry kits are causing an alarming number of serious pediatric injuries in the United States, new research warns.Analyzing national data, researchers found an 80% rise in these injuries to children from 2016 to 2019, following the repeal of a sales ban on the magnets by a federal court.When these small rare earth magnets are swallowed, the potential for serious gastrointestinal injury is high, noted study lead author Dr. Michael Flaherty.Cases are popping up all over the United States, according to a recent report from NBC News. In Indiana, a 4-year-old can you buy over the counter lasix boy was rushed to surgery after swallowing 27 magnetized balls.

One 2-year-old girl in Illinois needed her appendix removed in December after swallowing five of the balls. And in 2018, a Wisconsin 4-year-old needed part of his colon, intestine and appendix removed after swallowing 13 magnetic balls, the network reported.More recently, 6-year-old Cameron Moreau, of New Jersey, landed in the hospital with eight perforations to his colon after swallowing magnets from a toy he got for can you buy over the counter lasix his birthday. Two of the holes were so close together surgeons had to remove a portion of the colon, NBC News said.The magnets are made of neodymium, said Flaherty, a pediatric critical care physician at MassGeneral Hospital for Children in Boston.The magnets come in circular, rectangular, cylindrical or cubed form, and range from BB-pellet size to roughly 0.10 to 0.25 inches (3 to 6 mm).They're also "five to 10 times more powerful than traditional ferrite magnets," said Flaherty, "and were initially intended for commercial applications."But over time they've come to be included in a wide variety of "entertainment products," Flaherty noted. "Many products now carry warnings to keep away from children, but the small size of the magnets and their inclusion in sets composed of many small magnets make them easily accessible to young children, even if purchased by an adult."The harm can be considerable when a child ingests two of these magnets, or a magnet with another metal object, can you buy over the counter lasix Flaherty explained.

"This can lead to bowel walls becoming attached and kinked, leading to catastrophic bowel injury can you buy over the counter lasix and/or death," he said.In 2012, the U.S. Consumer Product Safety Commission (CPSC) took steps to limit their sale with voluntary recalls and safety standards. That effort culminated with a prohibition can you buy over the counter lasix in 2014. But in 2016 a federal court determined that the commission had overstepped its bounds, and the ban was overturned.For this study, Flaherty and his colleagues reviewed almost 37,000 emergency department visits that took place between 2009 and 2019 by kids under 18 years of age who had swallowed an object.

Data was can you buy over the counter lasix compiled from the U.S. National Electronic Injury Surveillance System.Just over 1,400 of the visits involved magnet ingestion or inhalation, with about 850 occurring in children younger than 6 years of age. (All magnet ingestions were can you buy over the counter lasix included. Rare earth magnets could not be separated out.)The investigators found that between 2012 and 2016 -- when protection efforts were underway -- pediatric emergency department visits stemming from magnet ingestions dropped significantly (from 3.58 per 100,000 persons to 2.83 per 100,000).

But from 2016 to 2019 -- after the protections were thrown out of court -- magnet ingestions jumped to 5.16 per 100,000, an increase of more than 80%."Products with [small rare earth magnets] really should not be can you buy over the counter lasix in any home with children under 14," Flaherty said. "The significant can you buy over the counter lasix reduction in ER visits associated with the CPSC's initial ban indicate that further federal action is necessary, and that industry standards should be revisited."His advice. "As the holiday season approaches, product-related hazards such as these magnets become even more of an important issue. Parents should always read labels carefully before buying any toys or sets for their children or home, to ensure they can you buy over the counter lasix are age appropriate.

And consult the CPSC website to check on recent toy recalls."Parents must be vigilant, another expert agreed."The problem is that a small child is a natural detective, always discovering and looking at things," said Anthony Green, chief advocacy and network officer for Safe Kids Worldwide in Washington, D.C."And the tools of investigation for a child are their fingers and their mouth," Green said. "It can be button batteries, liquid laundry packets, medications that look like can you buy over the counter lasix candy, or rare earth magnets. And that issue has been aggravated by hypertension medications, where everyone's at home and parents are trying to juggle both caregiving and work."In the absence of a ban, Safe Kids is trying to promote awareness of the issue, he said. Meanwhile, Green added, "what a parent can and should do is really survey their house, and identify where children go in the house, to look for dangers can you buy over the counter lasix that could expose a child to these magnets and serious injury."The study was published in the Nov.

24 issue of the Journal of the American Medical Association.More informationThere's more on magnet safety at the U.S. Consumer Product can you buy over the counter lasix Safety Commission.SOURCES. Michael R can you buy over the counter lasix. Flaherty, DO, pediatric critical care physician, division of pediatric critical care medicine, MassGeneral Hospital for Children, Boston.

Anthony Green, chief advocacy and network officer, can you buy over the counter lasix Safe Kids Worldwide, Washington, D.C.. NBC News. Journal of the can you buy over the counter lasix American Medical Association, Nov. 24, 2020Copyright © 2020 HealthDay.

All rights reserved can you buy over the counter lasix. SLIDESHOW 8 First Aid Kit Essentials for Scrapes, Cuts, Bug Bites, and More in Pictures See Slideshow.

Lasix for swelling feet

Fate Therapeutics said Friday that an experimental, off-the-shelf immunotherapy made from lasix for swelling feet so-called natural killer cells induced complete tumor responses in just over half of the patients with advanced lymphoma treated in an early-stage clinical trial.The 56% complete response rate reported for the Fate cancer treatment, called FT516, is still preliminary — and assessed like it from just 11 patients — but it is similar to efficacy reported with other types of cell therapy. However, the durability of the response to FT516 remains an important, unanswered question. Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!. GET STARTED lasix for swelling feet Log In | Learn More What is it?. STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis.

Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. What's included?.

However, the can you buy over the counter lasix durability of the response to FT516 remains an important, unanswered question. Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!. GET STARTED Log In | Learn More What is it?.

STAT+ is STAT's premium subscription service for in-depth can you buy over the counter lasix biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. What's included?.

Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr..

.

Register for Newsletter