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24, 2020 can u buy lasix over the counter (GLOBE NEWSWIRE) -- Health Catalyst, Inc. ("Health Catalyst", Nasdaq. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today announced that Patrick Nelli, President, Bryan Hunt, CFO and Adam Brown, SVP of Investor Relations and FP&A, will participate in the following upcoming investor conferences:Piper Sandler 32nd Annual Virtual Healthcare Conference on Wednesday, December 2, 2020, which will include a fireside chat presentation.

An audio-only can u buy lasix over the counter recording will be available at https://ir.healthcatalyst.com/investor-relations. Evercore ISI HealthCONx Conference on Thursday, December 3, 2020, which will include a fireside chat presentation at 4:20 p.m. EST.

Guggenheim Digital Health Virtual Conference which will include a fireside chat can u buy lasix over the counter presentation on Tuesday, December 8, 2020 at 3:15 p.m. EST, as well as one-on-one meetings on Wednesday, December 9, 2020.About Health CatalystHealth Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements.

Health Catalyst envisions a future in which all healthcare decisions are data informed.Health Catalyst Investor Relations Contact:Adam BrownSenior Vice President, Investor Relations and FP&A+1 (855)-309-6800ir@healthcatalyst.comHealth Catalyst can u buy lasix over the counter Media Contact:Kristen BerryVice President, Public Relations+1 (617) 234-4123+1 (774) 573-0455 (m)kberry@we-worldwide.com Source. Health Catalyst, Inc.#masthead-section-label, #masthead-bar-one { display. None }hypertension medications treatmentstreatment QuestionsDoses Per StateHow the Moderna treatment WorksWhy You’ll Still Need a MaskPost-treatment OutlookAdvertisementContinue reading the main storySupported byContinue reading the main storyWhen Can We Start Making Plans?.

We asked can u buy lasix over the counter Dr. Anthony S. Fauci and other experts when they thought life would start to feel more normal.Credit...Vinnie NeubergTara Parker-Pope, Claire Cain Miller, Margot Sanger-Katz and Dec.

16, 2020The United States moved one step closer to getting back to normal this week with the first hypertension medications vaccinations of health care workers around the can u buy lasix over the counter country. While the majority of Americans won’t get their shots until spring, the treatment rollout is a hopeful sign of better days ahead. We asked Dr.

Anthony S can u buy lasix over the counter. Fauci, as well as several epidemiologists and health and science writers for The Times, for their predictions about the months ahead. Here’s what they had to say.What advice do you have for families eager to celebrate the holidays with their loved ones?.

€œDo it by can u buy lasix over the counter Zoom. Don’t let Junior come home and kill Grandma. Think of this like World War II — our soldiers didn’t get to fly home to eat turkey.

My father can u buy lasix over the counter was at Normandy. My mother was with the Red Cross in occupied Austria. They missed the holidays.

Life went can u buy lasix over the counter on. There were happier years later.” — Donald G. McNeil Jr., health and science reporterWill we shake hands again?.

€œI’m not can u buy lasix over the counter. I don’t know about you. I said that many, many months ago and the newspapers went wild with it.

I’m sure people will get back to shaking can u buy lasix over the counter hands. I think people will probably become more aware of personal hygiene and protecting yourself. That doesn’t mean nobody will shake hands again, nor does it mean everybody will go back to the way we did it again.

Probably somewhere in can u buy lasix over the counter between. Some people will be reluctant to shake hands. Some people will be washing hands a whole lot more than they ever did, even when hypertension medications is no longer around.” — Dr.

Anthony S can u buy lasix over the counter. FauciWhen would you personally feel comfortable returning to the office?. €œWhen I’m vaccinated and everyone around me is.” — McNeilIs my employer going to require me to be vaccinated?.

€œEmployers do have the can u buy lasix over the counter right to compel their workers to be vaccinated once a treatment is formally approved. Many hospital systems, for example, require annual flu shots. But employees can seek exemptions based on medical reasons or religious beliefs.

In such cases, employers can u buy lasix over the counter are supposed to provide a ‘reasonable accommodation’. With a hypertension treatment, a worker might be allowed to wear a mask in the office instead, or to work from home.” — Abby Goodnough, national health care correspondentWill we ever go to a big, crowded, indoor party without a mask again?. €œIf the level of in the community seems substantial, you’re not going to have the parties with friends in congregant settings.

If the level of is so low that risk is minuscule, you’re going to see can u buy lasix over the counter back to the normal congregating together, having parties, doing that. If we want to get back to normal it gets back to my message. When the treatment becomes available, get vaccinated.” — Dr.

FauciDo we have to wait can u buy lasix over the counter for 75 percent of the population to be vaccinated before we can travel again?. €œI think traveling is going to start easing up as you get much less than that. I think it’s going to be gradual.

There is no can u buy lasix over the counter black and white, light switch on, light switch off.” — Dr. FauciHow long will we be wearing masks?. €œIf you get herd immunity where there are no s around, you wouldn’t have to wear a mask all the time.

You might want to wear it if you were in a crowded situation, but you wouldn’t have to have the stringency can u buy lasix over the counter you have now. Ultimately, I think you’re going to have to transition from wearing it all the time, to wearing it under certain circumstances, to perhaps not having to wear it at all.” — Dr. FauciHow will we know it’s safe to do normal things?.

€œFirst of all, it’s going to be expressed by the can u buy lasix over the counter number of new cases that you see — the test positivity number. You’ve got to go as low as you can get. The best number is zero.

It’s never can u buy lasix over the counter going to be zero, but anywhere close to that is great.” — Dr. FauciWhen can we go to the movies or the theater?. €œIt depends on the uptake of the treatment and the level of in the community.

If you go to April, May, June and can u buy lasix over the counter you really put on a full-court press and try to vaccinate everybody within a period of a few months, as you go from second to third quarter of the year, then you could likely go to movies, go to theaters, do what you want. However, it’s unlikely, given what we’re hearing about people’s desire to get vaccinated, that we’re going to have that degree of uptake. If it turns out that only 50 percent get vaccinated, then it’s going to take much, much longer to get back to the kind of normality that we’d like to see.” — Dr.

FauciWhen will you can u buy lasix over the counter eat in a restaurant?. €œIf more than half the population is vaccinated, I would feel a little less stressed and anxious when heading out to do errands I normally do. I might actually feel comfortable to eat in a restaurant or see friends again one day if this is possible.”— Vijaya L.

Seegulam, research project manager, Boston can u buy lasix over the counter University.css-fk3g7a{font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:0.875rem;line-height:1.125rem;color:#121212 !. Important;}@media (min-width:740px){.css-fk3g7a{font-size:0.9375rem;line-height:1.25rem;}}.css-1sjr751{-webkit-text-decoration:none;text-decoration:none;}.css-1sjr751 a:hover{border-bottom:1px solid #dcdcdc;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-zs9392{margin:10px auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-zs9392{font-size:1.25rem;line-height:1.4375rem;}}#NYT_BELOW_MAIN_CONTENT_REGION .css-zs9392{font-family:nyt-cheltenham,georgia,'times new roman',times,serif;font-weight:700;font-size:1.375rem;line-height:1.75rem;margin-bottom:20px;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-zs9392{font-size:1.5rem;line-height:1.875rem;}}.css-121grtr{margin:0 auto 10px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:'Collapse';}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:'';background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-qmg6q8{background-color:white;margin:1.5rem auto 1.9rem;max-width:600px;}#NYT_BELOW_MAIN_CONTENT_REGION .css-qmg6q8{padding:0;width:calc(100% - 40px);max-width:600px;margin-right:auto;margin-left:auto;}.css-qmg6q8 strong{font-weight:700;}.css-qmg6q8 em{font-style:italic;}@media (min-width:740px){.css-qmg6q8{margin:40px auto;}}.css-qmg6q8:focus{outline:1px solid #e2e2e2;}.css-qmg6q8 a{color:#326891;-webkit-text-decoration:none;text-decoration:none;border-bottom:1px solid #ccd9e3;}.css-qmg6q8 a:visited{color:#333;-webkit-text-decoration:none;text-decoration:none;border-bottom:1px solid #ddd;}.css-qmg6q8 a:hover{border-bottom:none;}.css-qmg6q8[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-qmg6q8[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-qmg6q8[data-truncated] .css-5gimkt:after{content:'See more';}.css-qmg6q8[data-truncated] .css-6mllg9{opacity:1;}.css-11uwurf{border:1px solid #e2e2e2;padding:15px;border-radius:0;margin:0 auto;overflow:hidden;}@media (min-width:600px){.css-11uwurf{padding:20px;}}#NYT_BELOW_MAIN_CONTENT_REGION .css-11uwurf{border-top:1px solid #121212;border-bottom:none;}hypertension medications treatments ›Answers to Your treatment QuestionsWith distribution of a hypertension treatment beginning in the U.S., here are answers to some questions you may be wondering about:If I live in the U.S., when can I get the treatment?. While the exact order of treatment recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first.

If you want to understand how this decision is getting made, this article will help.When can I return to normal life can u buy lasix over the counter after being vaccinated?. Life will return to normal only when society as a whole gains enough protection against the hypertension. Once countries authorize a treatment, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months.

The unvaccinated majority will can u buy lasix over the counter still remain vulnerable to getting infected. A growing number of hypertension treatments are showing robust protection against becoming sick. But it’s also possible for people to spread the lasix without even knowing they’re infected because they experience only mild symptoms or none at all.

Scientists don’t yet know can u buy lasix over the counter if the treatments also block the transmission of the hypertension. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the hypertension to find vulnerable people to infect.

Depending on how quickly we as a society achieve that goal, can u buy lasix over the counter life might start approaching something like normal by the fall 2021.If I’ve been vaccinated, do I still need to wear a mask?. Yes, but not forever. Here’s why.

The hypertension can u buy lasix over the counter treatments are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the lasix to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick.

The treatment clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they can u buy lasix over the counter could still spread the hypertension. Based on studies of flu treatment and even patients infected with hypertension medications, researchers have reason to be hopeful that vaccinated people won’t spread the lasix, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask.

Read more here.Will can u buy lasix over the counter it hurt?. What are the side effects?. The Pfizer and BioNTech treatment is delivered as a shot in the arm, like other typical treatments.

The injection into your arm won’t feel different than any other treatment, but the rate of short-lived side effects does can u buy lasix over the counter appear higher than a flu shot. Tens of thousands of people have already received the treatments, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of hypertension medications, last about a day and appear more likely after the second dose.

Early reports from treatment trials suggest some people might need to can u buy lasix over the counter take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain.

While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the treatment that will provide can u buy lasix over the counter long-lasting immunity.Will mRNA treatments change my genes?. No. The treatments from Moderna and Pfizer use a genetic molecule to prime the immune system.

That molecule, known as mRNA, is can u buy lasix over the counter eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the hypertension, which can stimulate the immune system.

At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, can u buy lasix over the counter which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes.

The mRNA in treatments is engineered to withstand the cell's enzymes can u buy lasix over the counter a bit longer, so that the cells can make extra lasix proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.When will you feel comfortable in a crowd?. €œOnce my family and I are vaccinated, I would change behaviors, except I can’t imagine being in a crowd or attending any crowded events until at least 80 percent of the population is vaccinated.”— Julie Bettinger, associate professor, University of British ColumbiaWhen will restrictions start to ease up?.

€œI think widespread availability of treatments will result in the further relaxation of most precautions by mid- to can u buy lasix over the counter late summer 2021.” — Michael Webster-Clark, postdoctoral researcher, University of North Carolina at Chapel HillWhat will the new normal look like?. €œThe new normal will be continued masking for the next 12 to 18 months and possibly the next few years. This is a paradigm shift.” — Roberta Bruhn, epidemiology core co-director, Vitalant Research InstituteWhat will never return to normal?.

€œMy relationships with people who have taken this lasix lightly and ignored can u buy lasix over the counter public health messages and recommendations.” — Victoria Holt, professor emeritus, University of WashingtonWhat did you learn from lasix life?. €œStaying home with my children has taught me that life with fewer errands to run and activities to partake in is kind of nice. I think in the future we will cut down on our family obligations.” — Jennifer Nuzzo, associate professor, Johns HopkinsWhat lasix habit will you keep?.

€œI’m going to keep my mask, and wear it in crowds and can u buy lasix over the counter on subways, particularly during cold and flu season. I used to get sick all the time, but I haven’t had a cold or sore throat in months. I really like not getting sick!.

€ —Tara Parker-Pope, Well columnistWhat’s one thing can u buy lasix over the counter you’ll never take for granted again?. €œI won’t take traveling to my extended family for granted.” — Alicia Allen, assistant professor, University of ArizonaWhat has forever changed in your daily life?. €œI will never again have to explain what an epidemiologist is.” — Janet Rich-Edwards, associate professor, Harvard AdvertisementContinue reading the main story@media (pointer.

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Holiday Lights Watch. €˜Ma Rainey’s Black Bottom’ AdvertisementContinue reading the main storySupported byContinue reading the main storyPhys Ed2020. A Year in Fitness Like No OtherThe novel hypertension crept into and transformed every aspect of our lives, including the way we work out.Credit...Getty ImagesDec.

16, 2020This year, the novel hypertension crept into and transformed every aspect of our lives, including our fitness. In countless ways — some surprising, and a few beneficial and potentially lasting — it altered how, why and what we need from exercise.At the start of the year, few of us expected a lasix to upend our world and workouts. In January and February, I was writing about topics that seemed pressing at the time, such as whether low-carbohydrate, ketogenic diets endanger athletes’ skeletal health.

If fat-soled, maximalist running shoes might alter our strides. And how completing a marathon — remember those?. — remodels first-time racers’ arteries.The answers, by the way, according to the research, are that avoiding carbs for several weeks may produce early signs of declining bone health in endurance athletes.

Runners donning super-cushioned, marshmallowy shoes often strike the ground with greater force than if they wear skinnier pairs. And a single marathon renders new runners’ arteries more pliable and biologically youthful.But concerns about shoe cushioning and racing tended to fade in March, when the World Health Organization declared hypertension medications a lasix and we suddenly had new, top-of-the-mind worries, including social distancing, masks, aerosol spread and lockdowns.The effects on our exercise routines seemed to be both immediate and stuttering. At that time, none of us knew quite how and whether to work out in these new circumstances.

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The U.S lithium and lasix interaction Buy cialis usa. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), today announced the availability of $226.5 million in American Rescue Plan funding to launch the Community Health Worker Training Program. This new program will lithium and lasix interaction increase the number of community health workers who play a critical role in connecting people to care, including hypertension medications care. Mental health and substance use disorder prevention, treatment and recovery services. Chronic disease care.

And other important health services lithium and lasix interaction. “The Biden-Harris Administration is committed to building a robust public health workforce — the first line of defense in preventing disease, safeguarding health and keeping the public safe,” said HHS Secretary Xavier Becerra. €œThis funding will support these health workers—who know their communities and have their trust— as they keep their neighbors healthy, including throughout the hypertension medications response, by helping patients enroll in vital services, and by providing community education, outreach and support.” The Community Health Worker Training Program is a new multiyear program focused on education and on-the-job training to build the pipeline of public health workers. This effort will support training and apprenticeship programs to help more people enter the health workforce and lithium and lasix interaction serve the critical role of trusted messengers to connect people to care and support, help ensure patients follow-up on their provider’s recommendations and focus on preventive and protective factors that can improve health and well-being. €œAt a time when too much misinformation is clouding the health care landscape, we are investing in training community health workers who are trusted voices in their communities,” said HRSA Administrator Carole Johnson.

€œThis new program will grow and train this essential part of our health care workforce and connect them to the communities and employers who need them most.” This program builds on the historic investments the Administration has made through the American Rescue Plan, and supports community health workers, who have engaged in critical hypertension medications treatment outreach and building treatment confidence in our hardest-hit and highest-risk communities throughout the lasix. Many of these individuals have been hired from the communities they lithium and lasix interaction serve, resulting in a diverse corps of people typically underrepresented in our health workforce. Community health workers are also known as promotores de salud, community health advisors, outreach workers, patient navigators, and peer counselors and can include individuals with lived experience whose experience helps inform their work. Through this program, HRSA plans to train 13,000 community health workers, increasing access to care, improving public health emergency response, and addressing the public health needs of underserved communities. To learn about lithium and lasix interaction eligibility and to apply for the Community Health Worker Training Program, visit Grants.gov.

Applications are due June 14, 2022. Learn more about HRSA’s efforts to support the health workforce and view HRSA’s current funding opportunities..

The U.S can u buy lasix over the counter Buy cialis usa. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), today announced the availability of $226.5 million in American Rescue Plan funding to launch the Community Health Worker Training Program. This new program will increase the number of community health workers who play a critical can u buy lasix over the counter role in connecting people to care, including hypertension medications care.

Mental health and substance use disorder prevention, treatment and recovery services. Chronic disease care. And other can u buy lasix over the counter important health services.

“The Biden-Harris Administration is committed to building a robust public health workforce — the first line of defense in preventing disease, safeguarding health and keeping the public safe,” said HHS Secretary Xavier Becerra. €œThis funding will support these health workers—who know their communities and have their trust— as they keep their neighbors healthy, including throughout the hypertension medications response, by helping patients enroll in vital services, and by providing community education, outreach and support.” The Community Health Worker Training Program is a new multiyear program focused on education and on-the-job training to build the pipeline of public health workers. This effort will support training and apprenticeship programs to help more people enter the health workforce and serve can u buy lasix over the counter the critical role of trusted messengers to connect people to care and support, help ensure patients follow-up on their provider’s recommendations and focus on preventive and protective factors that can improve health and well-being.

€œAt a time when too much misinformation is clouding the health care landscape, we are investing in training community health workers who are trusted voices in their communities,” said HRSA Administrator Carole Johnson. €œThis new program will grow and train this essential part of our health care workforce and connect them to the communities and employers who need them most.” This program builds on the historic investments the Administration has made through the American Rescue Plan, and supports community health workers, who have engaged in critical hypertension medications treatment outreach and building treatment confidence in our hardest-hit and highest-risk communities throughout the lasix. Many of these individuals have been hired from the communities they serve, resulting in a can u buy lasix over the counter diverse corps of people typically underrepresented in our health workforce.

Community health workers are also known as promotores de salud, community health advisors, outreach workers, patient navigators, and peer counselors and can include individuals with lived experience whose experience helps inform their work. Through this program, HRSA plans to train 13,000 community health workers, increasing access to care, improving public health emergency response, and addressing the public health needs of underserved communities. To learn about eligibility and to apply for the Community Health can u buy lasix over the counter Worker Training Program, visit Grants.gov.

Applications are due June 14, 2022. Learn more about HRSA’s efforts to support the health workforce and view HRSA’s current funding opportunities..

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FUROSEMIDE is a diuretic. It helps you make more urine and to lose salt and excess water from your body. Lasix is used to treat high blood pressure, and edema or swelling from heart, kidney or liver disease.

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Regular use of https://sportfreileipzig.de/ueber-mich/impressum/ an antibacterial mouthwash does not prevent oropharyngeal gonococcal The double-blind Oral lasix blood thinner Mouthwash use to Eradicate GonorrhoeA (OMEGA) trial randomised men who have sex with men to rinse and gargle at least once daily for 60 s with either an antibacterial mouthwash (Listerine. N=219) or a lasix blood thinner mouth lubricant as control (Biotène. N=227) for a total of 12 weeks.1 2 Oropharyngeal swabs were collected 6-weekly and saliva 3-weekly.

The number of incident cases of oropharyngeal gonorrhoea was 15 (7%) in the lasix blood thinner Listerine group and 10 (4%) in the Biotène group. At week 12, the adjusted risk difference in the cumulative incidence of oropharyngeal gonorrhoea between the two groups was 3.1% (95% CI −1.4 to 7.7) lasix blood thinner. While the large CI indicates the need for further data, these initial findings do not support a protective effect of Listerine against oropharyngeal gonorrhoea.Transient impact of hypertension medications on HIV care in four African countriesInvestigators analysed data from the African Cohort Study, which prospectively collects information from 12 clinics across 5 HIV care programmes in Tanzania, Uganda, Kenya and Nigeria.3 Parameters including HIV clinic visit adherence, virological suppression and food security were compared between the periods January 2019–March 2020 (prelasix phase) and May 2020–February 2021 (lasix phase).

After adjusting for age, sex and HIV care programme, both attendance of scheduled clinic visits and food security were significantly reduced in the early lasix phase, but lasix blood thinner not after 7 September 2020. There were no detrimental lasix blood thinner effects on treatment adherence and virological suppression rates. The findings provide reassurance, although they are not fully representative of the general HIV population across Africa.

There remains a need to investigate the impact of the hypertension medications lasix on HIV care lasix blood thinner globally.Expedited partner therapy does not improve eradication of Chlamydia trachomatis before deliveryExpedited partner therapy (EPT) enables providers to prescribe treatment for partners of patients diagnosed with an STI, without the partner having to establish direct care.4 This cohort study evaluated a prenatal EPT programme in Dallas, Texas, a high Chlamydia trachomatis (CT) prevalence area. Investigators evaluated the lasix blood thinner effect of EPT on rates of CT before delivery compared with the traditional partner referral, testing and treatment approach used the year before. The rate of was 15% (61 of 419) with EPT vs 13% (60 of 471) with the standard approach (OR 0.86.

95% CI 0.58 to lasix blood thinner 1.26). EPT on its own is unlikely to be enough to successfully eradicate CT lasix blood thinner before delivery.Homelessness and housing instability increase the risk of HIV and hepatitis C lasix among people who inject drugsPeople who inject drugs (PWID) are at increased risk of HIV and hepatitis C lasix (HCV) and have high levels of homelessness and unstable housing.5 This systematic review and meta-analysis included studies published between 2017 and 2020 that estimated HIV or HCV incidence, or both, among community-recruited PWID. In the pooled estimates, recent homelessness or unstable housing (current or within 1 year) increased the risk of acquiring HIV and HCV compared with stable housing, with an adjusted relative risk of 1.39 (95% CI visit 1.06 to 1.84.

P=0.019) for lasix blood thinner HIV and 1.64 (95% CI 1.43 to 1.89. P<0.0001) for HCV lasix blood thinner. Risk reduction for PWID must include interventions to support housing stability.Unrecognised oral and anal shedding of Treponema pallidum in MSM with early syphilisMouth, anus, urethra and semen samples were systematically collected in 200 men who have sex with men (MSM) (31% living with HIV) to investigate Treponema pallidum shedding from asymptomatic sites relative to lesion sites.6 Across all stages of early syphilis, comprising primary, secondary and early latent, 91%, 74% and 8%, respectively, had T.

Pallidum at any site, and 20%, 26% and 0% had detection at two or more sites, with the highest detection in the mouth (24%) lasix blood thinner and anus (23%). Oral and lasix blood thinner anal shedding of T. Pallidum was most frequent during secondary syphilis and often occurred in the absence of overt syphilis lesions, independently of HIV status.

Studies are needed to demonstrate bacteria viability from asymptomatic shedding sites and whether its detection might improve syphilis control.Published in Sexually Transmitted s lasix blood thinner - The Editor’s Choice. The combination of dolutegravir/rilpivirine used in HIV and neuropsychiatric adverse effectsPooling data from 20 randomised trials with a minimum duration of 48 weeks, this meta-analysis investigated the risk of neurotoxicity (defined as the occurrence of depression, anxiety, insomnia, dizziness or suicidal behaviour) in adults treated with rilpivirine, dolutegravir or the combination dolutegravir/rilpivirine versus comparator lasix blood thinner regimens.7 Twelve trials were in treatment-naive and eight in treatment-experienced participants, totalling 10 998 individuals. Depression was the most common neuropsychiatric event, whereas suicidal behaviour was the least common.

The relative risk (RR) of depression was not lasix blood thinner different with dolutegravir or rilpivirine versus comparator. In contrast, dolutegravir/rilpivirine lasix blood thinner showed a synergistic effect on depression, with an RR of 2.82 (95% CI 1.12 to 7.10. P=0.03), although no study directly compared dolutegravir/rilpivirine with efavirenz.

While further studies are needed, the occurrence of depression should be monitored during dolutegravir/rilpivirine therapy.IntroductionIt has long been understood that increased exposure to a specialty is associated with increased likelihood of applying to that specialty training programme.1 Medical students often have few timetabled sexual health and HIV clinics in their undergraduate training and have been found to lack accurate factual knowledge.2 In England, 2020, genitourinary medicine (GUM) saw only 0.58 applicants per training position, the lowest of all 43 ST3-level programmes listed lasix blood thinner by Health Education England and one of only four with a competition ratio <1.0.3 Many oversubscribed specialties such as psychiatry and obstetrics and gynaecology have dedicated associations for medical students and/or pre-specialty trainees interested in these fields.The Student and Trainee Association for Sexual Health and HIV (STASHH) was founded in spring 2021 by Dr Hannah Church, Eleanor Cochrane and Dr Eleanor Crook with support from the BASHH. Its overarching aim is to ….

Regular use of an antibacterial mouthwash does can u buy lasix over the counter not prevent oropharyngeal gonococcal The double-blind Oral Mouthwash use to Eradicate GonorrhoeA (OMEGA) trial randomised men who have sex with men to rinse and gargle at least once daily for 60 s with http://websitesbyelizabeth.com/contact-us/ either an antibacterial mouthwash (Listerine. N=219) or a mouth can u buy lasix over the counter lubricant as control (Biotène. N=227) for a total of 12 weeks.1 2 Oropharyngeal swabs were collected 6-weekly and saliva 3-weekly.

The number of incident cases of oropharyngeal gonorrhoea was 15 (7%) in the Listerine group and 10 (4%) in the can u buy lasix over the counter Biotène group. At week 12, the adjusted can u buy lasix over the counter risk difference in the cumulative incidence of oropharyngeal gonorrhoea between the two groups was 3.1% (95% CI −1.4 to 7.7). While the large CI indicates the need for further data, these initial findings do not support a protective effect of Listerine against oropharyngeal gonorrhoea.Transient impact of hypertension medications on HIV care in four African countriesInvestigators analysed data from the African Cohort Study, which prospectively collects information from 12 clinics across 5 HIV care programmes in Tanzania, Uganda, Kenya and Nigeria.3 Parameters including HIV clinic visit adherence, virological suppression and food security were compared between the periods January 2019–March 2020 (prelasix phase) and May 2020–February 2021 (lasix phase).

After adjusting for age, sex and HIV can u buy lasix over the counter care programme, both attendance of scheduled clinic visits and food security were significantly reduced in the early lasix phase, but not after 7 September 2020. There were can u buy lasix over the counter no detrimental effects on treatment adherence and virological suppression rates. The findings provide reassurance, although they are not fully representative of the general HIV population across Africa.

There remains a need to investigate the impact of the hypertension medications lasix on HIV care globally.Expedited partner therapy does not improve eradication of Chlamydia trachomatis before deliveryExpedited partner therapy (EPT) enables providers to prescribe treatment for partners of patients diagnosed with an STI, without the partner having to establish direct care.4 This cohort study can u buy lasix over the counter evaluated a prenatal EPT programme in Dallas, Texas, a high Chlamydia trachomatis (CT) prevalence area. Investigators evaluated the effect of EPT on rates of CT can u buy lasix over the counter before delivery compared with the traditional partner referral, testing and treatment approach used the year before. The rate of was 15% (61 of 419) with EPT vs 13% (60 of 471) with the standard approach (OR 0.86.

95% CI 0.58 can u buy lasix over the counter to 1.26). EPT on its own is unlikely to be enough to successfully eradicate CT before delivery.Homelessness and housing instability increase the risk of HIV and hepatitis C lasix among people who inject drugsPeople who inject drugs (PWID) are at increased risk of HIV and hepatitis C lasix (HCV) and have high levels of homelessness and unstable housing.5 This systematic review and meta-analysis can u buy lasix over the counter included studies published between 2017 and 2020 that estimated HIV or HCV incidence, or both, among community-recruited PWID. In the pooled estimates, recent homelessness or unstable housing (current or within 1 year) what do you need to buy lasix increased the risk of acquiring HIV and HCV compared with stable housing, with an adjusted relative risk of 1.39 (95% CI 1.06 to 1.84.

P=0.019) for HIV and 1.64 (95% can u buy lasix over the counter CI 1.43 to 1.89. P<0.0001) for HCV can u buy lasix over the counter. Risk reduction for PWID must include interventions to support housing stability.Unrecognised oral and anal shedding of Treponema pallidum in MSM with early syphilisMouth, anus, urethra and semen samples were systematically collected in 200 men who have sex with men (MSM) (31% living with HIV) to investigate Treponema pallidum shedding from asymptomatic sites relative to lesion sites.6 Across all stages of early syphilis, comprising primary, secondary and early latent, 91%, 74% and 8%, respectively, had T.

Pallidum at any site, and 20%, 26% and 0% had detection at two or more sites, with can u buy lasix over the counter the highest detection in the mouth (24%) and anus (23%). Oral and anal shedding of can u buy lasix over the counter T. Pallidum was most frequent during secondary syphilis and often occurred in the absence of overt syphilis lesions, independently of HIV status.

Studies are needed to demonstrate bacteria viability from asymptomatic shedding sites and whether its detection might improve syphilis control.Published in can u buy lasix over the counter Sexually Transmitted s - The Editor’s Choice. The combination of dolutegravir/rilpivirine used in HIV and neuropsychiatric adverse effectsPooling data from 20 randomised trials with a minimum duration of 48 weeks, this meta-analysis investigated the risk of neurotoxicity (defined as the occurrence can u buy lasix over the counter of depression, anxiety, insomnia, dizziness or suicidal behaviour) in adults treated with rilpivirine, dolutegravir or the combination dolutegravir/rilpivirine versus comparator regimens.7 Twelve trials were in treatment-naive and eight in treatment-experienced participants, totalling 10 998 individuals. Depression was the most common neuropsychiatric event, whereas suicidal behaviour was the least common.

The relative can u buy lasix over the counter risk (RR) of depression was not different with dolutegravir or rilpivirine versus comparator. In contrast, dolutegravir/rilpivirine showed a synergistic effect on can u buy lasix over the counter depression, with an RR of 2.82 (95% CI 1.12 to 7.10. P=0.03), although no study directly compared dolutegravir/rilpivirine with efavirenz.

While further studies are needed, the occurrence of depression should be monitored during dolutegravir/rilpivirine therapy.IntroductionIt has long been understood that increased exposure to a specialty is associated with increased likelihood of applying to that specialty training programme.1 Medical students often have few timetabled sexual health and HIV clinics in their undergraduate training and have been found to lack accurate factual knowledge.2 In England, 2020, genitourinary medicine (GUM) saw only 0.58 applicants per training position, the lowest of all 43 ST3-level programmes listed by Health Education England and one of only four with a competition ratio <1.0.3 Many oversubscribed specialties such as psychiatry and obstetrics and gynaecology have dedicated associations for medical students and/or pre-specialty trainees interested in these fields.The Student and Trainee Association for Sexual Health and HIV (STASHH) was founded in spring 2021 by Dr Hannah Church, Eleanor Cochrane and Dr Eleanor Crook with support from the BASHH can u buy lasix over the counter. Its overarching aim is to ….

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February 8, 2022As workers’ injury and illness rates soar, US Department of read this article Labor urges healthcare facilities, providers to employ effective safety, health programsNational Caregivers Day, a reminder of the importance of protecting those who protect us ONAGA, KS ‒ Amid the lasix, lasix overdose treatment U.S. Healthcare workers experienced a staggering 249 percent increase in injury and illness rates in 2020 while serving those in need. In fact, workers in the healthcare and social assistance industries combined, suffered more injuries and illnesses than workers lasix overdose treatment in any industry in the nation.

As the nation prepares to observe National Caregivers Day on Feb. 18, the lasix overdose treatment U.S. Department of Labor’s Occupational Safety and Health Administration calls on healthcare employers, and those in related industries, to take immediate actions to help make 2022 less hazardous and reduce worker injuries and illnesses.

€œHealthcare workers routinely face the risks associated with exposures to bloodborne pathogens, lasix overdose treatment drug residue, X-ray machines, respiratory illness and ergonomic injuries related to lifting patients and repetitive tasks,” said OSHA’s acting Regional Administrator Ryan Hodge in Kansas City, Missouri. €œOur nation’s caregivers have made extraordinary sacrifices in recent years – putting themselves on the frontline in a lasix – and we owe it to them to ensure their employers are doing all they can to protect their employees.” An effective way to combat workplace injury and illness is to create and use a proactive safety and health program to address hazards and endorse training and preventive measures to keep workers safe. To understand how effective a program of this kind can be, consider how Community Hospital Onaga – part of Community HealthCare System Inc.’s nonprofit healthcare system – succeeded in improving the safety and health of its workers.

In 2000, the hospital in lasix overdose treatment rural northeast Kansas contacted OSHA’s On-Site Consultation Program about enhancing workplace safety. Visits by the Kansas Department of Labor’s On-Site Consultation program soon began. Following those visits, Community Hospital succeeded in correcting all hazards inspectors identified, and it continued to improve its lasix overdose treatment safety and health programs.

By December 2002, OSHA’s Safety and Health Achievement Recognition Program awarded the facility “SHARP” status, one of only two Kansas hospitals in the program. The facility has kept lasix overdose treatment injury-and-illness rates below the industry average since 2002. As a result, OSHA has renewed Community Hospital’s SHARP status eight times, most recently in June 2021.

€œParticipating in OSHA’s Safety and Health Achievement Recognition Program helps companies anticipate hazards lasix overdose treatment and take initiative,” Hodge added. €œAs hypertension medications spread, Community HealthCare System implemented a plan to protect employees and clients. Other healthcare systems can follow their model by encouraging a mindset that anticipates and addresses hazards before they cause harm.” Learn more about OSHA’s SHARP program.

Companies interested in the program should contact their local OSHA On-Site Consultation program to discuss details and schedule an on-site safety and health evaluation lasix overdose treatment. Find the On-Site Consultation program nearest you by calling 1-800-321-OSHA (6742) or visiting OSHA’s program website. Learn more lasix overdose treatment about OSHA.

# # # Media Contacts. Scott Allen, 312-353-4727, lasix overdose treatment allen.scott@dol.govRhonda Burke, 312-353-4807, burke.rhonda@dol.gov Release Number. 22-174-CHI U.S.

Department of Labor news materials are accessible at https://www.dol.gov lasix overdose treatment. The department’s Reasonable Accommodation Resource Center converts departmental information and documents into alternative formats, which include Braille and large print. For alternative format requests, please contact the department at (202) 693-7828 (voice) or (800) 877-8339 (federal relay).February 3, 2022Contact.

Office of CommunicationsPhone lasix overdose treatment Extra resources. 202-693-1999US Department of Labor schedules meeting of the National Advisory Committee on Occupational Safety and Health, Feb. 22NACOSH Heat lasix overdose treatment Injury and Illness Work Group will hold initial meeting, Feb.

25 WASHINGTON – The U.S. Department of Labor will hold a lasix overdose treatment meeting of the National Advisory Committee on Occupational Safety and Health on Feb. 22, 2022.

In conjunction with the committee meeting, the NACOSH Heat Injury and Illness Prevention Work Group will hold its first lasix overdose treatment meeting on Feb. 25, 2022. Both meetings are open to the public and will be held via teleconference and WebEx.

Read the lasix overdose treatment Federal Register notice for more information. The tentative agenda for the NACOSH meeting will include agency updates from OSHA and the National Institute for Occupational Safety and Health, and discussions on OSHA's efforts regarding heat injury and illness prevention and risk-based safety. Comments and lasix overdose treatment requests to speak at the NACOSH meeting must be submitted at http://www.regulations.gov, the Federal eRulemaking Portal, and refer to Docket No.

OSHA-2022-0002. All comments must be submitted lasix overdose treatment by Feb. 15, 2022.

The NACOSH Heat Injury and Illness Prevention Work Group was established to provide recommendations on the agency's heat injury and illness lasix overdose treatment prevention guidance and rulemaking activities. Work Group members include labor or management representatives from various industries, including construction, agriculture and manufacturing, as well as representatives from NACOSH, an OSHA State Plan, and a public health expert. Work Group members have extensive knowledge and experience in identifying factors that cause heat injury and illness hazards in the workplace, in addition to best practices and interventions for mitigating occupational heat injury and illness.

A full lasix overdose treatment list of Work Group members is available at https://www.osha.gov/heat-exposure/heat-injury-and-illness-prevention-work-group/membership. The Work Group will provide recommendations regarding OSHA's heat illness prevention guidance materials, and evaluate stakeholder input to develop recommendations on potential elements of a proposed heat injury and illness prevention standard. NACOSH advises, consults with, and makes recommendations to the Secretary of Labor and the Secretary of Health and lasix overdose treatment Human Services on matters relating to the administration of the Occupational Safety and Health Act of 1970.

NACOSH is a continuing advisory committee of indefinite duration. Learn more lasix overdose treatment about OSHA. # # # U.S.

Department of Labor news materials are accessible at http://www.dol.gov. The department's Reasonable Accommodation Resource Center converts departmental information and documents into alternative formats, which include Braille and large print. For alternative format requests, please contact the department at (202) 693-7828 (voice) or (800) 877-8339 (federal relay)..

February 8, 2022As workers’ injury and illness rates soar, US Department of Labor urges healthcare http://robertflannagan.com/?p=8 facilities, providers to employ effective safety, health can u buy lasix over the counter programsNational Caregivers Day, a reminder of the importance of protecting those who protect us ONAGA, KS ‒ Amid the lasix, U.S. Healthcare workers experienced a staggering 249 percent increase in injury and illness rates in 2020 while serving those in need. In fact, workers in the healthcare and social assistance industries combined, suffered more injuries and illnesses than workers in any industry can u buy lasix over the counter in the nation. As the nation prepares to observe National Caregivers Day on Feb.

18, the U.S can u buy lasix over the counter. Department of Labor’s Occupational Safety and Health Administration calls on healthcare employers, and those in related industries, to take immediate actions to help make 2022 less hazardous and reduce worker injuries and illnesses. €œHealthcare workers routinely face the can u buy lasix over the counter risks associated with exposures to bloodborne pathogens, drug residue, X-ray machines, respiratory illness and ergonomic injuries related to lifting patients and repetitive tasks,” said OSHA’s acting Regional Administrator Ryan Hodge in Kansas City, Missouri. €œOur nation’s caregivers have made extraordinary sacrifices in recent years – putting themselves on the frontline in a lasix – and we owe it to them to ensure their employers are doing all they can to protect their employees.” An effective way to combat workplace injury and illness is to create and use a proactive safety and health program to address hazards and endorse training and preventive measures to keep workers safe.

To understand how effective a program of this kind can be, consider how Community Hospital Onaga – part of Community HealthCare System Inc.’s nonprofit healthcare system – succeeded in improving the safety and health of its workers. In 2000, can u buy lasix over the counter the hospital in rural northeast Kansas contacted OSHA’s On-Site Consultation Program about enhancing workplace safety. Visits by the Kansas Department of Labor’s On-Site Consultation program soon began. Following those visits, Community Hospital succeeded in correcting all hazards inspectors identified, and it continued to improve its safety and health programs can u buy lasix over the counter.

By December 2002, OSHA’s Safety and Health Achievement Recognition Program awarded the facility “SHARP” status, one of only two Kansas hospitals in the program. The facility has kept injury-and-illness rates below can u buy lasix over the counter the industry average since 2002. As a result, OSHA has renewed Community Hospital’s SHARP status eight times, most recently in June 2021. €œParticipating in can u buy lasix over the counter OSHA’s Safety and Health Achievement Recognition Program helps companies anticipate hazards and take initiative,” Hodge added.

€œAs hypertension medications spread, Community HealthCare System implemented a plan to protect employees and clients. Other healthcare systems can follow their model by encouraging a mindset that anticipates and addresses hazards before they cause harm.” Learn more about OSHA’s SHARP program. Companies interested in the program should contact their local OSHA On-Site Consultation program to discuss details and schedule can u buy lasix over the counter an on-site safety and health evaluation. Find the On-Site Consultation program nearest you by calling 1-800-321-OSHA (6742) or visiting OSHA’s program website.

Learn more about can u buy lasix over the counter OSHA. # # # Media Contacts. Scott Allen, 312-353-4727, allen.scott@dol.govRhonda Burke, can u buy lasix over the counter 312-353-4807, burke.rhonda@dol.gov Release Number. 22-174-CHI U.S.

Department of Labor news materials are can u buy lasix over the counter accessible at https://www.dol.gov. The department’s Reasonable Accommodation Resource Center converts departmental information and documents into alternative formats, which include Braille and large print. For alternative format requests, please contact the department at (202) 693-7828 (voice) or (800) 877-8339 (federal relay).February 3, 2022Contact. Office of can u buy lasix over the counter more CommunicationsPhone.

202-693-1999US Department of Labor schedules meeting of the National Advisory Committee on Occupational Safety and Health, Feb. 22NACOSH Heat Injury and Illness Work Group will hold initial meeting, can u buy lasix over the counter Feb. 25 WASHINGTON – The U.S. Department of Labor will hold a meeting of can u buy lasix over the counter the National Advisory Committee on Occupational Safety and Health on Feb.

22, 2022. In conjunction with the committee meeting, the NACOSH Heat Injury and Illness can u buy lasix over the counter Prevention Work Group will hold its first meeting on Feb. 25, 2022. Both meetings are open to the public and will be held via teleconference and WebEx.

Read the Federal Register notice for can u buy lasix over the counter more information. The tentative agenda for the NACOSH meeting will include agency updates from OSHA and the National Institute for Occupational Safety and Health, and discussions on OSHA's efforts regarding heat injury and illness prevention and risk-based safety. Comments and requests to speak at the NACOSH meeting must be submitted at http://www.regulations.gov, the can u buy lasix over the counter Federal eRulemaking Portal, and refer to Docket No. OSHA-2022-0002.

All comments must be submitted by can u buy lasix over the counter Feb. 15, 2022. The NACOSH Heat Injury and can u buy lasix over the counter Illness Prevention Work Group was established to provide recommendations on the agency's heat injury and illness prevention guidance and rulemaking activities. Work Group members include labor or management representatives from various industries, including construction, agriculture and manufacturing, as well as representatives from NACOSH, an OSHA State Plan, and a public health expert.

Work Group members have extensive knowledge and experience in identifying factors that cause heat injury and illness hazards in the workplace, in addition to best practices and interventions for mitigating occupational heat injury and illness. A full list of Work Group members is available at can u buy lasix over the counter https://www.osha.gov/heat-exposure/heat-injury-and-illness-prevention-work-group/membership. The Work Group will provide recommendations regarding OSHA's heat illness prevention guidance materials, and evaluate stakeholder input to develop recommendations on potential elements of a proposed heat injury and illness prevention standard. NACOSH advises, consults with, and can u buy lasix over the counter makes recommendations to the Secretary of Labor and the Secretary of Health and Human Services on matters relating to the administration of the Occupational Safety and Health Act of 1970.

NACOSH is a continuing advisory committee of indefinite duration. Learn more can u buy lasix over the counter about OSHA. # # # U.S. Department of Labor news materials are can u buy lasix over the counter accessible at http://www.dol.gov.

The department's Reasonable Accommodation Resource Center converts departmental information and documents into alternative formats, which include Braille and large print. For alternative format requests, please contact the department at (202) 693-7828 (voice) or (800) 877-8339 (federal relay)..

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AbstractBrazil is currently home to Where can i buy diflucan the largest Japanese dosage for lasix for water retention population outside of Japan. In Brazil today, Japanese-Brazilians are considered to be successful members of Brazilian society. This was not always the dosage for lasix for water retention case, however, 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 dosage for lasix for water retention is unavailable in traditional medical 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 dosage for lasix for water retention perception which merits its own consideration, 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 observations made during an ethnographic dosage for lasix for water retention 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 drawn between more dosage for lasix for water retention 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 as a source of knowledge dosage for lasix for water retention. 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 dosage for lasix for water retention essence of 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 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 dosage for lasix for water retention 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 nursing about relationships of staff to dosage for lasix for water retention 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 dosage for lasix for water retention 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 to personal care may be one sign of the varied symptoms associated with cognitive dosage for lasix for water retention 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 dosage for lasix for water retention 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 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 dosage for lasix for water retention 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 another’.34 Thus, dosage for lasix for water retention it is important to observe interaction and performance. How everyday care work is organised and delivered.

By obtaining observational data dosage for lasix for water retention 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 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 dosage for lasix for water retention 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, dosage for lasix for water retention 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 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 dosage for lasix for water retention 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 researchers, each dosage for lasix for water retention 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, dosage for lasix for water retention 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 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 dosage for lasix for water retention 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 received dosage for lasix for water retention 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 dosage for lasix for water retention 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 dosage for lasix for water retention 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, it was typical for all older patients to be dressed in hospital-issued institutional gowns and pyjamas (typically in pastel blue, dosage for lasix for water retention 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 dosage for lasix for water retention 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 dosage for lasix for water retention 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 dosage for lasix for water retention 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 is observing a four-bed bay occupied by male patients living with dementia.The man in bed 17 is sitting in his bedside dosage for lasix for water retention chair.

He is dressed in green hospital issue pyjamas and yellow grip socks. At 10 a.m., the physiotherapy dosage for lasix for water retention team come and 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 dosage for lasix for water retention 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 dosage for lasix for water retention chats 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 dosage for lasix for water retention are open, and he 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 is at the doorway near dosage for lasix for water retention 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 dosage for lasix for water retention bed 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 around the dosage for lasix for water retention 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 dosage for lasix for water retention 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 and sorting.Opposite, patient 17 dosage for lasix for water retention 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, dosage for lasix for water retention 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 or wiggling their toes to the dosage for lasix for water retention 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 like a dosage for lasix for water retention 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 stopped singing along dosage for lasix for water retention. 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 dosage for lasix for water retention toes again. The music plays on. €˜There’ll be bluebirds over the white cliffs of Dover, just you wait and see…’[Site 3 day 3]The music was dosage for lasix for water retention 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 dosage for lasix for water retention.

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 dosage for lasix for water retention mother and two adult daughters visit the 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 dosage for lasix for water retention 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 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 dosage for lasix for water retention 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 dosage for lasix for water retention be close because she does not drive. He isn’t wearing his glasses and his daughter tells me that they can’t find them.

We look dosage for lasix for water retention in the 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 dosage for lasix for water retention 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, dosage for lasix for water retention 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 dosage for lasix for water retention patients were clearly able to verbalise their understandings of 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 dosage for lasix for water retention may be a source 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 with his very low-necked top even dosage for lasix for water retention 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 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 dosage for lasix for water retention 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 patient tells her, ‘Your bra is dirty, do you dosage for lasix for water retention want to wear that?. €™ She replies, ‘No I want a clean one.

Where are my trousers?. I want dosage for lasix for water retention them, I’ve lost them.’ The healthcare assistant repeats the explaination that her clothes are dirty, and 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 dosage for lasix for water retention 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 dosage for lasix for water retention 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 dosage for lasix for water retention 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 dosage for lasix for water retention 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 dosage for lasix for water retention 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 dosage for lasix for water retention bed 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 dosage for lasix for water retention 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 impact on people’s dosage for lasix for water retention 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 dosage for lasix for water retention 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 demeaning to an dosage for lasix for water retention 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 the ‘Matthew effect’ to be dosage for lasix for water retention 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 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 dosage for lasix for water retention 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 dosage for lasix for water retention have limited opportunities to participate in society, and we observed the ways in which this applied 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 out dosage for lasix for water retention.

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 dosage for lasix for water retention 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 dosage for lasix for water retention could and was often 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 as shouting or crying out, the removal of bedsheets and dosage for lasix for water retention 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 dosage for lasix for water retention could lead to further cycles of removal and replacement, leading to an escalation 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 dosage for lasix for water retention 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 dosage for lasix for water retention 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 patient 1 begins to remove her dosage for lasix for water retention sheets:15:10.

The unit seems chaotic today. Patient 1 has begun to loudly drum her fingers on the tray table. She still dosage for lasix for water retention 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 says, ‘Hello,’ when she walks past 1’s dosage for lasix for water retention bed.

1 looks across and smiles back at her. The nurse in charge explains to her that dosage for lasix for water retention 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 believe the nurse.15:25 dosage for lasix for water retention. 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 dosage for lasix for water retention then will come and talk to her.15:30. 1 has once again kicked her sheets off of her legs.

A social worker comes onto dosage for lasix for water retention 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 dosage for lasix for water retention. 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 dosage for lasix for water retention 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 dosage for lasix for water retention 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 assigned to dosage for lasix for water retention 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 dosage for lasix for water retention 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 dosage for lasix for water retention talking 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 dosage for lasix for water retention 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 dosage for lasix for water retention in 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 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 dosage for lasix for water retention 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, 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 dosage for lasix for water retention 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 dosage for lasix for water retention 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 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 dosage for lasix for water retention 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 accurately reflect the importance of appearance we found dosage for lasix for water retention 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 with humanitas, and helping to realise dignity of patients.Data dosage for lasix for water retention 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) dosage for lasix for water retention. €œLiving into the imagined body.

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

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

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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.

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

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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).

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AbstractBrazil is currently home can u buy lasix over the counter to the largest Japanese population outside of Japan. In Brazil today, Japanese-Brazilians are considered to be successful members of Brazilian society. This was can u buy lasix over the counter not always the case, however, 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 studies about their can u buy lasix over the counter 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 can u buy lasix over the counter 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 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 wards, to consider how can u buy lasix over the counter 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 reliable or less can u buy lasix over the counter 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 u buy lasix over the counter 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 can u buy lasix over the counter very essence of 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, can u buy lasix over the counter 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 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 nursing about relationships of staff to can u buy lasix over the counter 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 can u buy lasix over the counter 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 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 can u buy lasix over the counter to clothing and 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 can u buy lasix over the counter 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 can u buy lasix over the counter 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 can u buy lasix over the counter level what it 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 explore the ways in which hospital can u buy lasix over the counter 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 can u buy lasix over the counter 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 can u buy lasix over the counter within England and Wales.These sites represented 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 focused observation within trauma and orthopaedic wards (80 days) and medical assessment units (MAU can u buy lasix over the counter.

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 working in can u buy lasix over the counter 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, can u buy lasix over the counter 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 dementia.Patients within these settings with a diagnosis of dementia were identified through ward nursing handover can u buy lasix over the counter 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 can u buy lasix over the counter of the need of a better understanding of the impacts of the everyday 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 can u buy lasix over the counter analysis was complete, the 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 can u buy lasix over the counter 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, 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 can u buy lasix over the counter 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 or within reach of the patient, with any can u buy lasix over the counter 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 can u buy lasix over the counter 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 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 can u buy lasix over the counter 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 is can u buy lasix over the counter 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 can u buy lasix over the counter 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 can u buy lasix over the counter a pillow, and puts it behind his head explaining to him, ‘You need 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 to him, puts cake out for him, and puts can u buy lasix over the counter 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 can u buy lasix over the counter 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 can u buy lasix over the counter tell them otherwise.The nurse puts music on an old 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 can u buy lasix over the counter bed 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 can u buy lasix over the counter of the team are spread 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 can u buy lasix over the counter the chair tapping 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 can u buy lasix over the counter 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 touched his tea, can u buy lasix over the counter 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 or wiggling their toes to the music, or singing quietly to it, when can u buy lasix over the counter 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 like a jolt can u buy lasix over the counter 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 can u buy lasix over the counter stopped tapping 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 can u buy lasix over the counter again. The music plays on. €˜There’ll be bluebirds over the white cliffs of Dover, just you can u buy lasix over the counter 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 can u buy lasix over the counter illustrates the general question of the visibility or otherwise of patients.

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 can u buy lasix over the counter 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 can u buy lasix over the counter 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 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 can u buy lasix over the counter like a bird 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 u buy lasix over the counter 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 bedside cabinet can u buy lasix over the counter. 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 can u buy lasix over the counter (and with the follow-up visits from the relatives of discharged 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 can u buy lasix over the counter 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 can u buy lasix over the counter patients were clearly able to verbalise their understandings of 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 can u buy lasix over the counter 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 with his very low-necked top even when his lunch tray was placed in front can u buy lasix over the counter of him.

He clearly felt very uncomfortable with such clothing. He continued using his hands to try to pull it up to cover his exposed chest, during can u buy lasix over the counter 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 can u buy lasix over the counter 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 can u buy lasix over the counter assistant repeats the explaination that her clothes are dirty, and 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 can u buy lasix over the counter she has lost her clothes. The cleaner listens sympathetically as she continues ‘I am all confused. I have lost my clothes.

I am all can u buy lasix over the counter 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 perceptions of her condition can u buy lasix over the counter. 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 can u buy lasix over the counter 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 can u buy lasix over the counter 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 can u buy lasix over the counter capacity, than when sitting ungroomed in their bed 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 belonging and identity, and of how an can u buy lasix over the counter 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 can u buy lasix over the counter 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 living with dementia has resisted her attempts and explicitly says ‘no’), remnants of the can u buy lasix over the counter 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 demeaning to can u buy lasix over the counter 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 the ‘Matthew effect’ to be frequently in can u buy lasix over the counter 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 can u buy lasix over the counter be 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 can u buy lasix over the counter 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 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 can u buy lasix over the counter 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 limited to institutional gowns and pyjamas and we did not see any patients removing their own can u buy lasix over the counter 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 as can u buy lasix over the counter 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 as can u buy lasix over the counter 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 can u buy lasix over the counter further cycles of removal and replacement, leading to an escalation 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 previous evening and morning shift, she was shouting, refusing all food and care and has received assistance from the specialist can u buy lasix over the counter 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, can u buy lasix over the counter 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 patient 1 can u buy lasix over the counter 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 brought more milk, can u buy lasix over the counter 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 can u buy lasix over the counter in charge 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 can u buy lasix over the counter 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 can u buy lasix over the counter 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 can u buy lasix over the counter 1 that she needs to do some jobs first and then will come and talk to her.15:30. 1 has once again kicked her sheets off of her legs.

A social worker can u buy lasix over the counter 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, can u buy lasix over the counter otherwise the unit 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 in charge is heard sympathizing that can u buy lasix over the counter 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 her that she has been here for 3 days, (the rest can u buy lasix over the counter 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 assigned to can u buy lasix over the counter 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 can u buy lasix over the counter first instinct, 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 about how her husband won’t can u buy lasix over the counter 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 can u buy lasix over the counter 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 clothing may be interpreted as can u buy lasix over the counter 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 of the design of the flimsy back-opening institutional clothing the patient has been can u buy lasix over the counter 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 can u buy lasix over the counter 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 can u buy lasix over the counter 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 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 can u buy lasix over the counter 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 can u buy lasix over the counter 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 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 with humanitas, and helping to realise dignity of patients.Data availability statementNo data are available can u buy lasix over the counter.

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