Rina Matala
I am a Lecturer at the University of East Anglia and a Community Pharmacist. I am the Dysphagia MOOC co-ordinator.
Location University of East Anglia Norwich UK
Activity
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Rina Matala replied to Abigail Orok
@CarolineIwegbu You need to upgrade to get a certificate but you do get confirmation of completing the course.
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Rina Matala replied to maryann bissong
Welcome Maryann. We hope you enjoy the course!
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Rina Matala replied to Elizabeth F
You are Welcome Elizabeth. You are certainly not alone. Enjoy the course.
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Rina Matala replied to Abigail Orok
Hello Abigail. As you progress through the course you will be able to identify the best ways in which to administer medicines to people who have swallowing difficulties and what you need to consider when doing so.
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Rina Matala replied to Isatu Conteh
Hello Isatu, thanks for your question. This all depends on what the medication is and whether is has any special release properties or coatings on the tablet. Its best to check for each medication with the relevant medicines information sources.
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@CK Hi, You are on the right lines. Sometimes existing licensed medicinal products are not appropriate to meet patient need therefore unlicensed medicines may be used. This may be the case if patients cannot swallow tablets of a certain licensed medication but a liquid version is not made by the manufacturer. Also for the paediatric population who may require...
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Rina Matala replied to Joanna Charles
@JoannaCharles Dysphagia can be a symptom of esophageal stricture, which is the abnormal narrowing of the esophagus.
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When you're actively eating and swallowing, you don't trigger the sensory nerves in the back and sides of the throat that cause the gag reflex. BUT if you are eating a large mouthful of something unchewed or viscous (like pudding) or are putting something that isn't food deeply into your mouth, it can activate those sensory nerves to initiate the gag reflex....
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Hi Pallavi,
It is more often difficult to swallow thin liquids as it is more difficult to control and manipulate in the mouth and during the swallow process and the risk of it being aspirated into the lungs is high.Thanks for the question
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Hi Wendy
Epiglottic dysfunction is usually from a traumatic (e.g intubation, lesions) or neuromuscular cause. If you are experiencing these symptoms or are concerned I suggest you speak to your doctor for investigation. -
an interesting read - https://www.ncbi.nlm.nih.gov/m/pubmed/20385891/
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Rina Matala replied to Helen B
Very often colours are selected by the manufacturer because they are more attractive to the consumer, however sometimes specific colours are also used for their binding properties that hold the tablet together e.g cobalt. :)
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Rina Matala replied to Helen B
Hi Helen,
Historically, excluding women in clinical trials has been due to a lack of knowledge about the biological differences between men and women and fluctuating hormones could complicate the design of the study and the interpretation of the results.
Women are better represented in today's field of clinical studies. :) -
Rina Matala replied to Helen B
Hi Helen, this would in the medical field mean most efficient and least expensive approaches. :)
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national foundations of swallowing disorders :)
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Rina Matala replied to Michael Dunne
Hi Michael, you can find a glossary of terms in step 1.15 :) I hopee that helps!
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Rina Matala replied to Karen C
Hi Karen, you may find this source useful, it looks into the types of dysphagia and the most common causes. http://www.spg.pt/wp-content/uploads/2015/11/2014-dysphagia.pdf I hope this helps.
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Hi Karen, you may find more information here https://www.retainedneonatalreflexes.com.au/test-at-hom/
I hope this helps. -
Thank you for the feedback Andrea, I will get that fixed :)
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Rina Matala replied to Christiana Liddle
These are all valid questions that you would need to consider when providing care to this patient. Well done.
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Hi Christina, usually the desiccant is hidden well. Some medicines have them in the blister pack as a larger tablet shape, some have the desiccant in little plastic canisters or bags similar to what you would find in a new handbag. Others have them incorporated into the lid of the medicine, therefore it is important to keep the medicine in the original...
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Rina Matala replied to Alexandra Jerchel
Hi Alexandra,
I am no expert on Anorexia and dysphagia, but you may find this an interesting read http://www.gaudianiclinic.com/gaudiani-clinic-blog/2016/1/11/dysphagia-why-difficulty-swallowing-is-a-serious-red-flag-in-anorexia-nervosa I hope this helps -
Hi Samantha, yes risk of airborne particles is present for all crushing methods particularly using a pestle and mortar. The 'NEWT Guidelines for the administration of medication to patients with enteral feeding tubes or swallowing difficulties' states that administrators should prepare a tablet by crushing it with a pestle and mortar, a tablet crusher, or...
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Thank you Linda! Yes I am sure Harry Potter is familiar with the NEWT guidelines! I am glad you are enjoying the course. Thanks for your feedback. Rina
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Hi Nicola, its precisely that, the long term is largely unknown. The safety outcome past 10-20 years is not known at this stage studies have been conducted looking into the safety within 5 years of procedure. No additional objective safety and efficacy evidence has been published. Intensive post-marketing surveillance, device registries, and long-term clinical...
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Hi Eddy,
I am pleased you are finding the course useful. Unfortunately, I cannot direct you to a web page for Costa Rica. I can suggest you contact your pharmacist or equivelent medicines information department for a guide to use. Also look for nursing or speech and language therapy guides in Costa Rica. In the UK we have the NEWT guidelines and Handbook of... -
Rina Matala replied to Carol Seward
Hi Carol,
If a person has advanced cancer, they might not have the strength to fight off an infection, even with strong antibiotics. If they can't eat and drink, they are less able to cope with infections. Cancer cells can affect the bone marrow. Eventually, they might not have enough healthy bone marrow to make blood cells. A drop in white blood cells means... -
Hi Brendan,
Thanks for your comment. It is assessed on each individual case. It is important for patients especially those with dementia find pleasure in eating. This is something that carers are encouraged to explore with the patient and make sure their needs are being met.
In advanced dementia, this can be more difficult. Feeding tubes are not regarded... -
Rina Matala replied to Nicola James
Hi Nicola, this is always a very difficult scenario in any case. Ultimately if the person is of sound mind, their wishes must be respected. The thing that cannot be refused is basic care such as personal care - washing etc...
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Hi Puspa,
There are issues of dissolution of certain medications, which can impede bioavailability and ability to reach a therapeutic plasma level. You can find more info on page 4 https://www.prescqipp.info/thickeners-for-dysphagia/send/169-thickeners-for-dysphagia/1939-bulletin-100-thickeners-for-dysphagia -
Rina Matala replied to Nicola James
Very well thought out Nicola.
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Rina Matala replied to Zaki Orya
Hi Zaki,
Just to clarify, the swallowing difficulties are due to the stroke as this a common cause of dysphagia.
Rina -
Good point Juliane. This is a big issue in the community. There is actually a new charter for care workers (UK) due to being launched. This directly impacts on the training care workers are required to have with regards to residents and swallowing difficulties. I will post more information when it comes out. I hope this helps.
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Hi Dawn,
Referrals can be made by the GP, district nurse, health visitor, or your child's nursery staff.
You can also refer yourself to your local speech and language therapy service. You do not have to wait for someone else to refer you.
Thanks
Rina -
Rina Matala replied to Nicola James
Hi Nicola. Dysphagia is the term used for swallowing difficulty - so a sign of an underlying problem. Thanks. Rina
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Hi Nicola,
In the UK, the recommendation is that, because of uncertainty over longer-term safety and inconclusive efficacy evidence, the procedure should only be used with special arrangements for clinical governance, consent and audit or research. This means in special circumstances for refractory reflux disease. I hope this helps. Rina -
Hi Nicola, yes you are correct. It's usually severe reflux disease (not controlled by medication) which over time can lead to dysphagia. Thanks for your question. Rina
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Hi Nicola, Stretta is a procedure used in reflux disease, in most cases, severe reflux over time leads to dysphagia. As not all dysphagia is caused by reflux this would not be offered as first line treatment. Also, the evidence, cost, risks and side effects of this procedure needs to be considered for all patients. Thanks for your comment. Rina
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Rina Matala replied to Steven Stone
Hi Steven, there are varying degrees of dysphagia and sometimes it's something as simple as posture adjustment that can make a big difference. There are several options available depending on the severity of the swallowing difficulty before an NG tube is considered.
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Rina Matala replied to Lorna Richardson
Hi Lorna,
Yes there are. There is information about theses in this article.
http://www.pharmaceutical-journal.com/news-and-analysis/research-and-developments-in-buccal-and-sublingual-drug-delivery-systems/11098641.articleI hope this helps
Rina
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Hi Lee,
The GMC general medical council have published some guidelines on good practice in prescribing. here are a couple of points:
1. You must make good use of the resources available to you.
2. prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health, and are satisfied that the drugs or... -
Individuals with religious or dietary restrictions forbid them from consuming gelatin capsules. Gelatin capsules are only suitable for use with powdered medications or supplements. Liquids and various other materials such as gels are not compatible with capsules made of gelatin. Cellulose based or vegetarian capsules are not made with animal...
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https://www.youtube.com/watch?v=3Q7naKeqADc this is a demo :)
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Rina Matala replied to Linda Walker
Hi Linda,
Young children (neonates) can't communicate whether pain is occurring or being reduced from pain relievers. Medical staff infer pain from facial and body expressions, which isn't always reliable. Parents seem to be becoming increasingly reluctant to enroll their children in basic research with no perceivable immediate benefit. As with adult...
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Dear Gill, you can find the information about how thickeners affect drug bioavailability here: https://www.prescqipp.info/thickeners-for-dysphagia/send/169-thickeners-for-dysphagia/1939-bulletin-100-thickeners-for-dysphagia
This also outlines the national guidance and how to use thickeners.
I hope this helps.
Rina
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Rina Matala replied to Lorna Richardson
Hi Lorna, you can find the information here: https://www.nice.org.uk/guidance/SC1/chapter/1-Recommendations#care-home-staff-giving-medicines-to-residents-without-their-knowledge-covert-administration.
Chapter 1.15 has useful information about the covert administration of medicines.I hope this helps
Rina
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Rina Matala replied to Barbara Dunn
Some patients may benefit from medications at a different time of day (consult Doctor and pharmacist).
Some patients get distressed at the sight of all the pill bottles and boxes. Are there a lot of pills, and perhaps it is an overwhelming sight? If so, take the pills out of their bottles only when needed, and leave the bottles out of sight. Some caregivers... -
Rina Matala replied to Barbara Dunn
It is important that people who have dementia feel reassured and supported while retaining some level of independence. Each person will have different needs so it's important to distinguish what would be a barrier for them in terms of adherence. When it is medication time, be sure there is a calm environment you are feeling calm. Resisting medications can be...
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Rina Matala replied to Cheryl Sherwood
Individuals with religious or dietary restrictions forbid them from consuming gelatin capsules. Gelatin capsules are only suitable for use with powdered medications or supplements. Liquids and various other materials such as gels are not compatible with capsules made of gelatin. Cellulose based or vegetarian capsules are not made with animal...
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https://www.youtube.com/watch?v=3Q7naKeqADc this is a demo :)
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Rina Matala replied to Ann Wilson
Of course Ann you can continue. Rina
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Hi Ann, Yes this is administration without the patient's knowledge - could be due to lack of capacity among other reasons.
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Hi Patrick
There are certain medication where blood levels or indicators are checked regularly e.g. warfarin and lithium however for antihypertensives the indicator is monitoring of blood pressure and pulse and is regularly reviewed if stable. If patients are suffering from hypotensive symptoms or if they have started on a new antihypertensive or have a...
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Rina Matala replied to Peter Browne
Hi Peter,
This works in occasional instances where the condition is stable for a long period of time, however where pain is concerned in most conditions there is usually a fluctuation of symptoms therefore individual ingredients would be more appropriate so the patient can tailor the dose as required. This is assuming the patient is well informed and...
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Rina Matala replied to Beverley Bagnall
Dear Beverley, there are lots of videos on youtube such as: https://www.youtube.com/playlist?list=PLxOoaF5jJoC7rQwSFjEPvk7ShcMaePNbD
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Hi
Metabolism is reduced in neonates, increases progressively during the first 6 months of life, exceeds adult rates by the first few years for some drugs, slows during adolescence, and usually attains adult rates by late puberty.
I hope that clarifies the issue.
Thank you
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Hi Melissa
There is no evidence that homeopathic remedies interfere with conventional medicines please see the document:
http://www.medicinesresources.nhs.uk/GetDocument.aspx?pageId=781734 -
Rina Matala replied to Priscilla Richards
Massive Open Online Course :)
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Hi Katie,
This very much depends on the medicine. There are guides and information available to decide what the best course of action would be for each medicine. Each hospital has its own guidelines or there is the Handbook of Drug Administration via Enteral Feeding Tubes by R. White and The NEWT Guidelines for administration of medication to patients with...
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Hi Beverley
Paracetamol soluble is available as GSL in packs of up to 30 tablets in the UK. The idea of restricting pack size is to make it less easy for people to use too much. -
Dear Joyce,
I am not sure of the situation you are referring to, Nurses usually have doctors or pharmacists they can talk to / ring for advice. Using the medicines information number available in most countries or on call doctor or pharmacist at any time is an option. Also they may call their mentor or senior colleague. I think it is about good communication... -
Rina Matala replied to Pamela Dawkins
Hi Pamela
You may find the information here useful http://adultspeechpathology.com/wp-content/uploads/2012/09/ASP-NewsletterSpring20122.pdf. It tells you how to use the thickener with Movicol sachets or there is the option to thicken Movicol liquid formulation but please seek advice from your own doctor and pharmacist to ensure this is appropriate for you.
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Rina Matala replied to Joyce Carter
Hi Joyce, if you click on the link in the text it will take you to the Amazon page. Or type the title into Amazon.
Thanks
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Rina Matala replied to Beverley Bagnall
Hi Beverley
Patents are granted anywhere along the development lifeline of a drug and last for 20 years. This patent ensures that other companies cannot steal or copy the claims made about the drug such as the invention, design, things you write, make or produce in relation to that drug.
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Hi Beverley,
This is all the information available to the public at this stage:
Mar 15: Launch plan uncertain; no update on Special Products website
Jun 14: Special Products anticipates approval of Epistatus
Mar 14: No update available on the licence application for Epistatus
Jun 13: Special Products submit a Marketing Authorisation Application for... -
Rina Matala replied to Rachel Cowley
Hi Rachel, you can find the protocol here: http://journals.rcni.com/doi/pdfplus/10.7748/ns2002.12.17.14.43.c3319
I hope this helps. -
Rina Matala replied to Helen Field
Yes absolutely. Carers, Patient and Doctors can request that the Pharmacist de-blister and put into a bottle. That way the appropriate label can be placed on the medicines.
Thanks Beverley
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Rina Matala replied to Jillian Brannan
Hi Jillian - hopefully you can access this? https://www.researchgate.net/publication/255881761_The_impact_of_Motivational_Interviewing_MI_as_an_intervention_to_improve_medication_adherence_a_meta-analysis
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Rina Matala replied to Helen Field
Yes if there is a need due to dexterity issues then you can request tablet be de-blistered and put in a bottle.
Thanks
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Hi Pilar
The MHRA licences the specials manufacturer to make specials, it does not licence the products themselves. You therefore have some reassurance that the product has been manufactured by appropriate individuals, using appropriate equipment in an appropriate environment but there is no evidence for the product itself i.e. it has not been tested for... -
Hi Obiga - you will find this document useful - there are pro's and con's and guidelines on how this should be utilised. http://www.who.int/hac/techguidance/guidelines_for_drug_donations.pdf
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That is the same in the UK- An MHRA licensed product that is being used outside its licensed indication. :)
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Rina Matala replied to Obiga Newton
Hi Obiga,
If the person is of sound mind and has decision making capacity then their wishes must be respected in all instances.
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The 5 rights of medication administration:
the right patient
the right drug
the right dose
the right route
the right time -
Rina Matala replied to Lucy G
Yes it would in practice, however a lot of prescribers would consider the cost implication as the dispersible tablets are cheaper.
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Hi Cara
Increased viscosity impedes drug dissolution and disintegration so the bioavailability would be affected. As long as the patient doesn't suffer from dry mouth then the tablet would disintegrate.
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Rina Matala replied to Simangani Moyo
Hi Simangani
Different hospital have different policies which should be followed.
As a general rule:
62.5micrograms (tablet) ≡ 50micrograms (liquid) ≡ 40micrograms (injection)I hope that helps
Rina
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HI Sarah
Unless it is designed to do so, changing the form of medication by crushing a tablet or emptying a capsule removes the protection afforded by the Consumer Protection Act 1987 and renders the person administering the altered the medication liable for any harm caused.
You can find more information here...
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Hi Both,
There is a pill crushing device - but you have to tip the contents onto a spoon or medicine cup to administer - or there is a device that crushes the tablets within the medicine cup so no loss from transfer!
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Hi Lucy,
There is more information to answer your question here https://www.gov.uk/guidance/apply-for-a-licence-to-market-a-medicine-in-the-uk
:)
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Rina Matala replied to Lucy G
Hi Lucy - Good question. It is accepted practice to swallow dispersible aspirin whole with a glass of water.
Thanks for the question!
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Hi Lucy,
Each pack of medicines comes with a patient information leaflet which has details of the medication within it. In the UK we have access to a database which holds these leaflets and is accessible by anyone http://www.medicines.org.uk/emc/
I hope that helps!
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Rina Matala replied to Alafiya Sachak
Hi Alafiya, it depends on the agent - a freeze dried medicine is dissolved into the saliva and swallowed where it is absorbed in the GI tract and the fast dissolving tablets are absorbed through mucous membranes in the mouth and GI tract.
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Rina Matala replied to Suzanne Webb
Hi Suzanne,
This is covered in more detail in week 5, which stresses the importance of monitoring and stopping or reducing medicines that are not required.
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Hi Pritpaul,
Don't worry you can complete the course at your own pace, it wont be taken off the platform. It just means people can't sign up to this run after the end of the week.
Regards
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Hi Catriona, have you tried using a different browser? Have you been able to open the other PDF downloads? The link has been checked and it is working.
Rina
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Rina Matala replied to Roy Toon
Dear Roy,
There is a repeat starting 22nd June 2015 and you can sign up for it on Monday onwards. Thanks -
All very valid questions Margaret. I would like to point out that dispersible is not the same as soluble so dispersing and giving part of the solution would not give homogeneous solution or dose.
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Rina Matala replied to Anna Chiric
That's correct Anna. The manufacturer is no longer liable for harm caused.
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A nurse who advises that a tablet is crushed or a capsule opened to assist with swallowing difficulties must proceed with caution. Even when an independent prescriber authorises a medicine to be administered by crushing a tablet a percentage of liability for any harm that is caused will still lie with the administering nurse.
for carers, unless instructed,... -
Once mental capacity has been determined as lacking, the ‘decision-maker’ is normally the carer responsible for the day to day care (including both care staff, relatives or friends), or a professional such as a doctor, nurse or social worker where decisions about treatment, care arrangements or accommodation have to be made. There are many conditions and this...
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Rina Matala replied to Suzanne Webb
Hi Suzanne
Incentives to prescribing physicians are suggested in countries with low rates of generic prescribing and have certainly been used in the UK. There is more of a drive to generic prescribing in the UK now. Commissioning groups have been advised by the Department of Health that the aim is to increase cost-effective prescribing tailored to the needs... -
Rina Matala replied to Fatima Hoosen
Hi Fatima, Yes this licensing does differ from country to country. The Medicines and Healthcare Products Regulatory Agency MHRA regulates medicines and medical devices in the UK.
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Rina Matala replied to Angela West
Hi Angela,
The techs have checked all of the videos on the platform and they are working. I can suggest you try a different web browser, ideally firefox. -
Rina Matala replied to Emma Catlin
Hi all, Unfortunately children in todays time are becoming more obese thus we are seeing and treating 11 year olds who weight 18 stone.
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Rina Matala replied to Paul Summerfield
Hi All, this is in fact correct! children defined as under 12 can get up to 120g (18 stone).
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Hi Jenny, the UK NHS patients rights guide states:
Young people aged 16 or over but under 18 can give independent consent to their own treatment (but can be overruled by a court order) unless the young person is incapable of giving their own consent.
Children under 16 can give their own consent to treatment provided they are judged capable by a doctor,...
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Hi Linda, I would look into getting an autodrop device.
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Hi Callum, please refer to the end of week email coming out tomorrow for the answer to your question.
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Rina Matala replied to Susan Sadler
Hi Susan, please refer to the end of week email coming out tomorrow for the answer to your question.
