john sharvill
Aged 64,semi retired GP Living in Kent.
Enjoys cycling walking and 5/10 k
Location kent england
Activity
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john sharvill made a comment
Link did notvwork
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john sharvill made a comment
Useful article and helpful to give feedback
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john sharvill made a comment
Child video link did not open
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john sharvill made a comment
Again, pre covid. No mention of compression only cpr.
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john sharvill made a comment
In my area we have found that the data base for aed held by the 999 service is not up to date. Many have access codes on which our ambulance service does not recognise. I think a problem also in some areas of Wales. Ideally aed. Should not be in a locked cabinet as this potentially wastes time
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john sharvill made a comment
Perhaps written pre covid.. ?
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john sharvill made a comment
Definitely teach to children, ideally through play
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john sharvill made a comment
Trying to find evidence of benefit for many items is hard, even the time honoured application of ice may do more harm than good,and early mobilisation is sometimes better than rest.
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john sharvill made a comment
I would suggest a lot of the above is of low or no value (cough medicine and safety pins} what I would add is a bottle of water.
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john sharvill made a comment
I am involved in teaching first aid so other people’s views and advice will help me
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john sharvill made a comment
I particularly welcomed the evidence links in week 2. there is so much 'stuff' talked about especially by celebrities that having good evidence is paramount; in a society where social media dominates its important to have information one can trust. thanks
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john sharvill made a comment
how had covid affected city dwellers eating-the eat out generation? has this led to a healthier or worse diet i wonder
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john sharvill made a comment
the maintenance is the hard part especially as convenience foods are so much quicker after a busy day
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john sharvill made a comment
reduce red meat
smaller portions and use fruit and yoghurt as a desert -
john sharvill replied to Katrina S
Interesting. I don't think this forum is the place to debate religion but climate change is not a thing I 'believe in' it is a series of facts -rising sea levels, rising carbon dioxide levels , shrinking ice caps at the poles and in Greenland are not for debate its is happening.
What is concerning re diets though is if governments advocate frequent red... -
john sharvill made a comment
as other have said time is the main factor as well as cost. so food preparation needs to be a social activity not a chore (plainly not always!) some foods like nuts in Uk are found in small quantities and expensive. Bulk buying may be cheaper but needs space to strore and knowldge re shelf life. Uk homes are getting smaller all the time since our...
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john sharvill made a comment
Nepalese Dahl with cauliflower curry (+/- rice not needed but always coems with it)
Sardines sandwiches (no beuuter needed but have to be eaten alone from those not liking the smell
fresh roasted fish with a lemon mustard and capsicom sauce with wilted greens and garlic
normal fat yogurt with fresh fruit as a desert -
john sharvill made a comment
hard not to have butter as part of dairy and then needing fermented dairy as well plus milk in tea.. easy to go over the top here.
i find people frequently underestimate the amount of soft fruit they consume (thinking of weight and diabetes here not mental health, as 1 small banana or 10 grapes= 1 portion or 10 mgm of carbohydrate but i though you can be... -
john sharvill replied to Katrina S
Hi. why do you feel red meat is important. In Uk we are i think on the whole moving away from this due to it devastating enviromental impact if consumed frequently
if the trend for red meat continues to change diets of India and China a disaster awaites mankind very soon and worry re this has for many young peopel I msuspect a much greater impact on their... -
john sharvill made a comment
high calory intake when most of us need 1800 to 2000 calories. red meat we are trying to steer away from for enviromantal reasons. is it in the Australian guidlines for science reasons , farming industry or lifestyle of the bbq (all reasonable!)
Does it specify olive oil must not be heated? the differnet vegetabel oild all have markedly differnet tolerances... -
john sharvill made a comment
good and bad experience.
In Uk the term nutritionalist is not a recognised monitored profession and lots of personal agendas (often financial( and frankly cranky opinions hide behind people using this label. many people told of multiple allergies and intolerance by fraudulent practitioners leading to unfounded beliefs in people so told that are hard to... -
john sharvill made a comment
mediterranean diet has good evidence in cardiovascular disease especially when nuts are added. this trial adds fish oils. all seem to make sense
improving the mental well being of younger generations a massive problem world wide as depression is set to become one of the major health issue (as some others are tackled) though diet only one component of this... -
certainly true that most in the UK have low vitamin d levels. what is lacking is any good evidence that supplements do an awful lot of good (surprisingly)
.what is sad is that so few people are aware of iffcial advice for decades to take vit d supplements -
john sharvill made a comment
in UK we have another series of MasterChef. I am not a cook but copying their ''skills test with new foods and techniques has improved both my and my wife's mood
I am not normally a breakfast eater (I am believer in 13 hr fasting) but miss the social aspect of breakfast as I normally eat lunch 'on the go' at workNeither of these is in my view food...
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john sharvill made a comment
a health diet is important for physical and mental health
there is some evidence that supplements may help some people some of the time and even if this is placebo if affordable and safe may well be useful as well as other lifestyle as it empowers people to help themselves a huge amount of science is out there and I hope the interactions diet exercise ... -
good to know what is in but marketing can overwhelm
ie 'contains no added sugar (but has loads of apple juice a source of sugar but not included in warning)
low fat (but usually means more sugar)
recommended by nutritionist , a category of no professional standard in UK
isotonic' sport drink etc meaningless hype -
john sharvill made a comment
this section is I think the main aim of me attending this course. If there was an easy answer i suspect we would all be on it. I was unaware that light therapy had eny evidence for non season mood disorder nor that sleep deprivation may help-it is often one of the main worries/symptoms of major depression so would be scared at making worse!
so fish oils... -
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I have a pretty varied diet including fibre fermentable products fruit etc and on travelling I assume pick up bugs, good and bad from other countries especially when living in rural areas
Though I love the ideas of pro and pre biotics there is really little hard reproducible evidence of significant long term benefits in population groups. Why is that? -
john sharvill made a comment
very hard to differentiate between direct effect and effects via microbiome. bread makes me sleep cheese makes me dream white wine gives me restless leg syndrome. alcohol reduces essential tremor all food related but I don't know enough to know if direct or indirect
a radical change such a to a ketogenic diet will have both direct indirect and genomic... -
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a hugely interesting area. in a time of covid and perhaps over cleaning of hands and surfaces (when not in an at risk situation) one wonders what will happen to gut microbiome. we know that already many bugs are developing resistance to common chemicals
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john sharvill made a comment
Again great references. I had not considered the immune function of the peritoneum and pleura before
UK diet guidelines seem to be '5 a day' reduce salt and sugar and alcohol limits but beyond that probably not known by the majority of the population High resistance from industry to legislate to a healthier diet (trans fat banning, food labelling , folate... -
john sharvill made a comment
So much to learn
the comments re vitamin d below are interesting s lots of associations between low levels and all sorts of diseases but very little evidence that supplements do anything except in severe deficiency with rickets. Emerging very weak links that supplements in women may reduce severe covid (but not in men) Also of note that UK recommended... -
exciting references. I am confused re the conclusion re hippocampus size when they say does does not affect decline with age though (below)
then on depression. when vit c levels increase after anti depressant medication is this INDEPENDENT of a better diet when feeling better or is somehow the blood level of a water soluble short half life vitamin changed... -
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can we have a direct reference for the evidence re diet and hipocampus size. lots of indirect links and associations but the direct evidence as quoted would be good to see
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john sharvill made a comment
interesting subject. as omnivores we are fortunate to be able to adapt to booth whims and food shortages and seem to thrive on the whole. For most of us excessive food is the problem.
A samll minority certainly have their physical and mental health modifiable by diet and the social enviroment within which it is consumed. there will be a very high placebo... -
john sharvill replied to Linda Sweet
in children the effect of sugar colourings and Cola are often so obvious , perhaps less so in adults
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Week one an introduction.Hoping weeek 2 will be more specific
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USA guidelines re fat vs sugar are widely discredited
fe encourage 13 hr fasting as the norm even though large evidence basis for this
simple supplementation eg fluoride in low fluoride areas, folic acid to flour simple and cheap but not done inUK for political reasons
the amount of food thrown away and the rejection by the big supermarkets of wriong shape... -
john sharvill made a comment
after a year of trying to avoid red meats they gradually creep back in!
time in prep can be time spend well especially if a joint task but for this you need time and space!
Many modern home designs lack space to enjoy cooking, though traditional cooking done on a one ring fire pit seems to be able to make great meals
Access to good fresh fish is so... -
john sharvill made a comment
Exercise. the park run movement has probably been one of the most successful motivators but slammed by lockdown; though more people are now exercising as something to do, may be the wrong groups. Food banks for the impoverished are not great sources of fresh food sadly
In the reference they quote mindfulness. though the recent 'trendy' solution and seems to... -
john sharvill made a comment
wealth distribution is worsening worldwide and also in the uk. in theory housing developments also support social housing' but builders often find ways to bypass this or worse landlords buy up special housing and charge 'market rents'
large food producers are very reluctant to change food to healthier varieties unless forced say by trans fat bans in us and... -
even genetic factors can be changed as we see from the f=effects of diet on genomics switching on and off gene activation
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so many interacting factors. does worry that diet may be poor cause more harm than a poor diet? does having a parent with mental health issues affect the food options for the family. use of social media exposes us to food adverts often of low diet value, etc etc.
being positive about many aspects may be the key ,ie finding the good bits of one environment-... -
john sharvill made a comment
I am increasingly confused as to what is ''normal' and what any person can expect in changes in their mood and happiness without it now being defined as a mental health disorder needing 'help'. Are we in some ways making the milder form of distress such as after exam failure or relationship breakdowns in the same basket as severe depression that stops normal...
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I understand that they are linked in both directions both directly and indirectly
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I wonder if it is more than the 'content' food but also the context and social interactions involved in preparing and eating it, as well as the parcels it comes in-grazing gorging fixed timing vs sleep patterns etc as well as the balance ie olive oil on your tomatoes affects the absorption. complex
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john sharvill made a comment
I live in England and a part time semi retired GP.I am interested in the relationships of diet, gut biome, exercise and genomics and how they in turn affect bodily function including mood. The conflicting' expert' advice is confusing- ie many think overnight fasting is good some, think ketogenic diets are but others say these are myths and things like omega...
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john sharvill made a comment
references were very good and copied for reference and future action
future learn courses always good to hear others comments
thanks
ps i am doing it for the second time and continue to learn -
john sharvill made a comment
I think these 2 questions already answered
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john sharvill made a comment
how can one influence the safeguarding process to make referral into it easier and to ensure that feedback follows
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john sharvill made a comment
I hate to admit that I don't recall ever having safeguarding supervision or the offer of it. at practice level I have had support guidance and signposting from safeguarding lead and this itself is a newish concept. Acting now more as a locum in 4 or 5 different nhs organisations I am not in any 'system to offer support on a regular basis. I suspect I am not alone
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personal journey.. another look back of what could be done which we seen in adult and child safeguarding
do different? highlight notes of vulnerable people (already done) as with multiple part time work force people don't always know the patient they are seeing just as we mark notes of children on protection registers
share with primary care team as they... -
john sharvill made a comment
how are the different agencies going to communicate and who starts the ball rolling if she does not give consent?
ie mental health can talk to gp as in normal practice
most of those on the course have emphasised they will be documenting
do drug and alcohol need to be able to talk to gp at a professional level if they have concerns and at the same...
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john sharvill made a comment
the summary id not reflect the start of the meeting when there was lots of 'blaming' even if not overt
the is good insight and reflection for all participants
I am copying the link to finding urgent mental health care 24hrs a day in the uk and this perhaps needs sharing widely especially for those people who move around a... -
john sharvill made a comment
thoughts- realisation that things could have been done better
reflections-how they and their practice can enable this in the future -
john sharvill made a comment
good practice to share information and develop a chronology. sad that the first time all agencies know of each other is with look backs
as stated below nobody deliberately does not want to help .once we get to reviews the worry of being blamed may taint the written record with retrospective interpretation of what was possible (for instance if in the...
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john sharvill made a comment
I likes the 3 conversation rule
I was addended by the dementia case 'gp would not visit' -
most individuals involved here has only one meeting with her different ambulance crews as an example except for the drug team who did on one occasion have her in for rehab . easy to point fingers here but if we take that client group as a whole we know they often have to fund their habit through crime and often neglect themselves;( except celebrities where...
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john sharvill made a comment
can someone comment on how long to keep notes as data protection says only as long as needed.
Medical notes now on computer seem to be lifelong but commonly get' lost 'electronically when transferring between systems and areas and paper notes in the past had a finite storage time ie children up to 25 etc -
john sharvill made a comment
do well.
1.write electronic notes so handwriting not a major issue
2 under 'comments' share my thinking about actions or no action and safety net and follow up
3 if involving others add that either then and then if done there and then or add later making clear that notes added later. If that discussion led me to change actions then act on those... -
john sharvill made a comment
plainly good documentation essential. it therefor stands that time and resources to make that documentation are needed;
not always the case for either or both . opportunity cost also needs considering though may not be well received on this forum but with demand for time >>> than supply 15 minuets documenting is one less appointment. Solution???
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john sharvill replied to Gibi Biju
not sure if on this course but the story is that the check list for total engine failure on commercial airliners is remarkably short. we know that surgical check lists save lives
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john sharvill made a comment
yes can save a life (simply put flagging major allergy) but needs to be visible and concise (as well as readable and accessible) with the important points at the beginning and in bold
think of a psychiatric letter. often 3-5 pages long. as a great over simplification it sometimes seems the longer the document the less useful it is and seems to list problems... -
john sharvill made a comment
when I work in a/e the nurses seem able to access a data base to see if someone is linked to safeguarding. this resource not known to me as a gp
feedback after reporting is very rare. this does not lead to feeling of being involved; ie confidentiality seems to only work one way. why is that? -
john sharvill made a comment
as mentioned before coffee room chats and clinical meeting are really useful
support from my safeguarding lead increasingly useful
one would ideally like to be able to chat with other agencies informally and anonymously at first if no consent -
john sharvill made a comment
This week I have been sent another large volume of information re IG the main thrust being about being careful not to breach IG rules as opposed to sharing. Informal anonymous 'chats' used to be quite easy with social services and safeguarding but I think (and may be wrong) that this has now been stopped. They were really useful in helping to decide re...
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john sharvill made a comment
Pete seems to have been doing a good job; but when contact was lost the story stops. in reality this again is a common scenario with people with drug and alcohol problems and we don't live in a perfect world so NO blame should be directed to him.
Back to the narrative she was known to an anti slavery charity and I ask where is their legal and moral duty and... -
getting advice from my defence organisation(i am a gp) is often the next step when their is doubt
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john sharvill made a comment
did she or did she nit have a mild learning difficulty seems almost a red herring here. consent from Sophia to share information important and as a gp this would then need advice as to breaching this. as others have commented if one develops a relationship then sometimes this can be agreed to but at the same time risks the clinician being even deeper in...
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john sharvill made a comment
useful references BUT THE ONE TO THER HOUSE OF COMMONS ACTUALLY LINKS TO A gp PRACTICE
if giving 'evidence ' from notes important to just repeat that and not give an opinion or interpret them especially if you don't know the person who wrote them, nor to criticise the writer
realising this is an acted scenario perhaps we are having exaggerated caricatures -
very defensive and early risk of looking in the wrong direction(who said mild learning disability etc) so good that this was pointed out. the chair used the words 'surely' in terms of what she perceived the GP should do suggesting little insight into the reality of every day GP work in the real world.
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john sharvill made a comment
where to drw the line between important communication re changes in say health and reporting everything to 'protect the institution or watch my back'
too much dulls ones responsiveness
with greater ability to share notes for instance with GP connect some things are easier, paradoxically though it may be those who refuse to share information (a very small... -
john sharvill made a comment
complex answer.
scene setting. language barriers; safe enviroment . no distractions. active listeningnon verbal cues (cultural dependent mad worse with masks) clarification.; summarising; suggested and agreed outcomes. next steps and follow up .what to do if problems'documentation but not done at the time so time after needed to write notes. tryping in... -
john sharvill made a comment
informal coffee chats can often throw up links not known to all concerned.
this then can lead to anawareness of a problema nd ened to take action which may have been below the radar with only small pieces of the jigsaw.
since covid these chats are much less frequent and also with much less f2f contact with patients (clients) soft signs may not be picked... -
john sharvill made a comment
I think communicstion was much easier 15-20 years ago when a phone call worked now needs to be by email; this needs access to the form and computer and if working part ime major flows of information hard to join up
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john sharvill made a comment
for the sake of arguement what might have happened if a aafegurding referral had been made with her consent early on. what actions would have resulted that will change the outcome
this fisrt week had asvised us abouit section42 and look back reviews when things go wrong. can he have examples of when things go well to bolster enthusiasm?
so many examples in... -
unless a child is involved??
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good poin; the police must havea quite wide range of knowledge of illegal activity though often no proof. how often are they sharing this with other agencies or does it risk blocking investiagtionsand prosecutions or jsut drive it furtehr underground or to another area?
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john sharvill made a comment
if a child is onvolved can we not over-ride consent under the law
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john sharvill made a comment
despite what has been said the news media usually comes out with blame.
did she speak English and how easy is it to get interpeting services for ambulance when they arrive onthe scene -
john sharvill made a comment
not too sure the number of trafficed people coming into UK but multiple thousands. almost by designs they are below the radar of state agenecies and other cultures have a significant fear of the state and so reluctant to call for help
when they do call in an emergency the responding urgent services are always pressed for time with backlog of other emergencies... -
john sharvill made a comment
key players are mainly from senior level with knowldeg of proper process; also need pragmantic input from how it is in reality on the street
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john sharvill made a comment
may well be called if have signifant information hoping that enough time is given and lcoation is relevent to the case. one soemtimes has soft informationas a gp fro0m staff who live locally and hard to knwo where the bounds of evidence vs gosip lie
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john sharvill made a comment
out of hours trying to contact safeguarding can be a problem
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john sharvill made a comment
trying to find the time, the correct form or phone number, and the decision to start the process are all big hurdles in the context of where to draw the line if working in areas of social and financial deprivation
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john sharvill made a comment
an increasingly large volume of information to take in, already
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john sharvill made a comment
At risk of abuse and/or neglect in the local authority area. whether the person agrees they are at risk of negelect can often be a matter of opinion
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john sharvill made a comment
I am a UK based dr (GP)
There are frequent example of where one thinks there might be a safeguarding issue often revolving around drugs alcohol and poverty as precipitating factors , issues that are very hard to resolve -
john sharvill made a comment
the added resources are large docuemnts. are these gone through during the course or extra?
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john sharvill made a comment
safeguarding has been made much more important though harder during ''lockdowns'
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john sharvill made a comment
others views useful as we all have different experiences
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sadly not so. It relies on a call back system and if you are busy or finished work and have no longer links to the details of the problem very frustrating
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john sharvill made a comment
record
share
report
follow up -
john sharvill made a comment
annual appraisal gives an opportunity to review and analyse actions or inactions
coffee chats are really important -
john sharvill made a comment
I have never had ''supervision' in safeguarding though do have yearly meetings as part of professional development.
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need to check my contact numbers still work
perhaps flag up more people with complex needs who often present 'out of hours' to people who don't know them
Our notes contain a safeguarding need button.. I have not yet ever pressed it! Maybe I will and see what happens -
john sharvill made a comment
good relationships are so important to improve care even if not a safeguarding issue,
as a gp I still don't know what services exist here for this scenario -
john sharvill made a comment
very positive attitude from all the participants
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john sharvill made a comment
though we are hearing that this meting is not to apportion blame once it is published there will be blame in the media...
knowing ones colleagues in a locality or having mdt meeting that people actually turn up at would foster better communications -
john sharvill made a comment
agree importance of interpreters but acutely only available by phone. How do 999 call handlers manage this?
mental health have no legal right of access I think unless under mental health act assessment so if Sofia has declined potentially problems here
the reference material will take a bit of getting through-back to documentation and need for key point...