This document appears to be a flow sheet or encounter form for patients with diabetes and possible coronary artery disease. It includes sections for collecting past medical history, diagnostic and clinical data over time including glycemic control, symptoms, blood pressure, lifestyle factors like smoking and exercise, and medications including anti-platelets, ACE/ARB inhibitors, and statins. Fields are included to track values over time and note if treatment needs to be adjusted.
Health screening services provides various health screenings and tests to assess people's overall health and wellness. Screenings can check things like blood pressure, cholesterol, diabetes risk, and other common health issues. The results of the screenings are reviewed with participants to provide an overall health status and catch any potential problems early.
Pharmacotherapy of cardiac arrhythmiasVikas Sharma
This document discusses the pharmacotherapy of cardiac arrhythmias. It begins with an overview of cardiac electrophysiology and mechanisms of arrhythmias. It then classifies antiarrhythmic drugs and discusses their mechanisms and uses for treating various arrhythmias. The document focuses on sodium channel blockers, beta blockers, and drugs that prolong the action potential. It provides details on specific drugs like quinidine, amiodarone, and sotalol.
Congestive heart failure occurs when the heart cannot pump enough blood to meet the body's needs. Symptoms result from blood backing up in the heart and lungs. The main drugs used to treat CHF are ACE inhibitors, ARBs, diuretics, beta-blockers, digoxin, and vasodilators. Digoxin works by inhibiting the sodium-potassium pump, raising intracellular calcium levels, increasing calcium release from the sarcoplasmic reticulum, and enhancing the actin-myosin interaction to strengthen contraction and cardiac output.
Excretion and kinetic of eliminatoin.. dr. kiran 15th feb 2021Kiran Piparva
This document discusses drug elimination and excretion. It covers the following key points in 3 sentences:
The main routes of drug elimination are metabolism, which inactivates drugs, and excretion through the kidneys, liver, lungs, intestines and other routes. Renal excretion involves glomerular filtration, tubular reabsorption and tubular secretion, with the kidney able to excrete water soluble drugs under 500 Daltons. Drug clearance, half-life, and principles of repeated dosing like the plateau effect determine the kinetics of drug elimination from the body over time.
42 pages editable MS Word document with detailed explanations, auditor tips and recommendations - our ISO 45001 Audit checklist can be utilized in a number of ways. The ISO 45001:2018 Audit checklist:
- provides a complete understanding of how to verify compliance with the requirements of all ISO 45001:2018 clauses;
- can be used as practice for internal auditors workshops.
- allows every employee to check his/her activity performance in compliance with the new requirements of ISO 45001:2018 and more.
This document discusses normal cardiac conduction and arrhythmias. It describes:
1. The cardiac conduction system including the sinoatrial node, atrioventricular node, bundle of His, and Purkinje fibers which coordinate heart rhythm.
2. Mechanisms of arrhythmias including abnormal impulse generation (automatic arrhythmias) and abnormal impulse conduction (reentrant arrhythmias).
3. Classes of antiarrhythmic drugs (class I-IV) and their mechanisms and effects on cardiac conduction and arrhythmias. The four classes include sodium channel blockers, beta blockers, potassium channel blockers, and calcium channel blockers.
This document discusses angina pectoris, or chest pain caused by reduced blood flow to the heart. It defines three main types of angina - stable, unstable, and Prinzmetal's variant - based on the characteristics and triggers of the chest pain. The document then reviews several classes of drugs used to treat angina, including nitrates, beta-blockers, calcium channel blockers, and nicorandil. It provides details on the pharmacological mechanisms and clinical uses of individual drugs within these classes, such as nitroglycerin, metoprolol, verapamil, and nicorandil. Adverse effects are also outlined for each medication.
Saxagliptin is a competitive inhibitor of the DPP4 enzyme, which normally inactivates the incretin hormones GLP-1 and GIP within minutes after they are released from the small intestine in response to eating. By inhibiting DPP4, saxagliptin slows the inactivation of these incretin hormones, increasing their concentrations in the bloodstream and effects on the body.
Health screening services provides various health screenings and tests to assess people's overall health and wellness. Screenings can check things like blood pressure, cholesterol, diabetes risk, and other common health issues. The results of the screenings are reviewed with participants to provide an overall health status and catch any potential problems early.
Pharmacotherapy of cardiac arrhythmiasVikas Sharma
This document discusses the pharmacotherapy of cardiac arrhythmias. It begins with an overview of cardiac electrophysiology and mechanisms of arrhythmias. It then classifies antiarrhythmic drugs and discusses their mechanisms and uses for treating various arrhythmias. The document focuses on sodium channel blockers, beta blockers, and drugs that prolong the action potential. It provides details on specific drugs like quinidine, amiodarone, and sotalol.
Congestive heart failure occurs when the heart cannot pump enough blood to meet the body's needs. Symptoms result from blood backing up in the heart and lungs. The main drugs used to treat CHF are ACE inhibitors, ARBs, diuretics, beta-blockers, digoxin, and vasodilators. Digoxin works by inhibiting the sodium-potassium pump, raising intracellular calcium levels, increasing calcium release from the sarcoplasmic reticulum, and enhancing the actin-myosin interaction to strengthen contraction and cardiac output.
Excretion and kinetic of eliminatoin.. dr. kiran 15th feb 2021Kiran Piparva
This document discusses drug elimination and excretion. It covers the following key points in 3 sentences:
The main routes of drug elimination are metabolism, which inactivates drugs, and excretion through the kidneys, liver, lungs, intestines and other routes. Renal excretion involves glomerular filtration, tubular reabsorption and tubular secretion, with the kidney able to excrete water soluble drugs under 500 Daltons. Drug clearance, half-life, and principles of repeated dosing like the plateau effect determine the kinetics of drug elimination from the body over time.
42 pages editable MS Word document with detailed explanations, auditor tips and recommendations - our ISO 45001 Audit checklist can be utilized in a number of ways. The ISO 45001:2018 Audit checklist:
- provides a complete understanding of how to verify compliance with the requirements of all ISO 45001:2018 clauses;
- can be used as practice for internal auditors workshops.
- allows every employee to check his/her activity performance in compliance with the new requirements of ISO 45001:2018 and more.
This document discusses normal cardiac conduction and arrhythmias. It describes:
1. The cardiac conduction system including the sinoatrial node, atrioventricular node, bundle of His, and Purkinje fibers which coordinate heart rhythm.
2. Mechanisms of arrhythmias including abnormal impulse generation (automatic arrhythmias) and abnormal impulse conduction (reentrant arrhythmias).
3. Classes of antiarrhythmic drugs (class I-IV) and their mechanisms and effects on cardiac conduction and arrhythmias. The four classes include sodium channel blockers, beta blockers, potassium channel blockers, and calcium channel blockers.
This document discusses angina pectoris, or chest pain caused by reduced blood flow to the heart. It defines three main types of angina - stable, unstable, and Prinzmetal's variant - based on the characteristics and triggers of the chest pain. The document then reviews several classes of drugs used to treat angina, including nitrates, beta-blockers, calcium channel blockers, and nicorandil. It provides details on the pharmacological mechanisms and clinical uses of individual drugs within these classes, such as nitroglycerin, metoprolol, verapamil, and nicorandil. Adverse effects are also outlined for each medication.
Saxagliptin is a competitive inhibitor of the DPP4 enzyme, which normally inactivates the incretin hormones GLP-1 and GIP within minutes after they are released from the small intestine in response to eating. By inhibiting DPP4, saxagliptin slows the inactivation of these incretin hormones, increasing their concentrations in the bloodstream and effects on the body.
Role of pharmacist in pharmacovigilance fieldSollers College
Pharmacists play a crucial role in pharmacovigilance by using electronic health records and pharmacovigilance systems to more quickly identify adverse drug reactions, thereby reducing healthcare costs. They can recognize adverse drug reactions in countries with questionable drug quality control. About 73% of pharmacists work in settings like hospitals and pharmacies where they may encounter adverse drug events. Pharmacists are drug experts trained to ensure medications are generally safe and hazardous drugs are removed from the market. Their involvement in pharmacovigilance is important for improving medication safety and outcomes and decreasing health costs globally.
This document discusses bioassays used to test the potency and quality of insulin and digitalis injections. It describes the standard preparations and units used, preparation of standard and test solutions, experimental conditions, procedures, and methods of analysis for the mouse convulsion method, rabbit blood sugar method (for insulin) and guinea pig method (for digitalis). The goal is to compare the hypoglycemic or lethal effects of test solutions to standardized preparations and determine the potency of the test samples.
This document discusses nervous system agents called adrenergic agonists and antagonists, as well as cholinergic agonists and anticholinergics. It describes their mechanisms of action, effects, indications, pharmacokinetics, contraindications and cautions. Adrenergic agonists bind to adrenergic receptors to mimic epinephrine. They increase heart rate, contractility and blood pressure. Alpha-specific agonists primarily bind to alpha receptors. Beta-specific agonists primarily bind to beta receptors and are used for bronchodilation. Adrenergic antagonists competitively block adrenergic receptors. Cholinergic agonists mimic acetylcholine to stimulate muscarinic receptors and
This document summarizes several antihyperlipidemic agents including ezetimibe, bile acid sequestrants, HMG-CoA reductase inhibitors (statins), fibrates, and nicotinic acid. It provides details on their mechanisms of action, pharmacological effects, indications, adverse reactions, contraindications, and interactions. The key points are:
1. Ezetimibe works by inhibiting cholesterol absorption in the intestine and lowers LDL levels the most. Bile acid sequestrants work by binding bile acids in the intestine and lowering LDL levels.
2. Statins are the first line treatment as they lower cholesterol synthesis in the liver and have pleiotropic effects in
This document discusses neuroleptics (antipsychotic drugs) and their mechanisms and uses. It covers:
1) The main classes of neuroleptics including typical (first generation) and atypical (second generation) antipsychotics and their mechanisms of action, primarily blocking dopamine D2 receptors.
2) The dopamine hypothesis of schizophrenia which proposes excessive dopamine activity plays a role, and how neuroleptics act to block this.
3) Other indications for neuroleptics beyond schizophrenia, including bipolar mania, psychosis with other disorders, and non-psychiatric uses for their antiemetic effects.
The document discusses how neurons can release multiple neurotransmitters called cotransmitters in addition to their primary transmitter, with examples including peptides, purines, nitric oxide, and prostaglandins released along with acetylcholine and norepinephrine. It notes that cotransmitters often have different time courses of action than the primary transmitter and may also serve as alternative transmitters. Cotransmission has been demonstrated in various autonomic nerves innervating tissues like the gut, vas deferens, urinary tract, and blood vessels.
This document provides a map showing the locations of Family Health Teams across Northern Ontario implemented in three waves:
1) The map shows the locations of Family Health Teams in various communities across Northern Ontario, grouped into large, community, small, and rural sites.
2) The Family Health Teams were implemented in three waves, with teams in different regions of Northern Ontario launching in each wave.
3) The map identifies the regions covered by each wave and provides the number of family physicians in each type of site to characterize their size.
Family Health Teams have been established across Northern Ontario in 3 waves:
- Wave 1 included large teams of 21-30 family physicians, community teams of 11-20 physicians, and small/rural teams of 5 or fewer physicians. Teams were located in communities across central, eastern, western and Champlain regions.
- Wave 2 expanded coverage with additional large, community and small/rural teams in northeast, northwest, southeast, southwest and Toronto regions.
- Wave 3 further increased access with more large teams in central, eastern and western regions and additional community and small/rural teams across the north.
This document provides guidance on managing waiting times in the NHS in Scotland. It outlines 10 golden rules for waiting time management that put the patient's interests first. It emphasizes the importance of appropriate referrals, adequate services, clinical prioritization of patients, and keeping patients informed of wait times. The document stresses partnership between primary and secondary care and accurate information on waiting lists. It discusses initiatives to treat backlogs versus long-term strategies to close gaps between demand and capacity. NHS Boards are asked to develop local plans that meet and exceed national targets through leadership, risk assessment, resource planning, and patient consultation.
This guidebook shares stories from nine Ontario communities that have undertaken healthy community initiatives. The stories describe their experiences and processes to raise awareness, build connections, and take action around health issues. Community members then reflected on these stories and identified "words of wisdom" from their experiences. Finally, the guidebook provides a framework and questions to help other communities document and share their own stories to guide their healthy community efforts.
The document provides tips and tools for registered dietitians working in interdisciplinary primary care settings. It outlines a proposed model for nutrition services with the RD responsible for overall management and the most in-depth nutrition counselling. It describes assessing community needs, nutrition screening, referral processes, nutrition advice and counselling. A typical nutrition counselling process is outlined including pre-screening referrals, initial visits, nutrition planning visits, follow-up visits and coordinating with the interdisciplinary team. Various tools developed in a demonstration project are also included to support RDs.
This document outlines a screening project conducted with primary care providers to identify at-risk women and incorporate screening tools for alcohol, smoking, and abuse into practice. It provided a screening and resource package, conducted academic detailing, and administered pre- and post-test questionnaires. The results showed increased screening rates for tobacco, alcohol, and abuse from pre- to post-test. While the response rate for the post-test was lower, providers reported increased use of screening tools and community referrals. The academic detailing approach was found useful by most providers.
This document outlines Saskatchewan's Action Plan for Primary Health Care, which aims to strengthen primary health care services in the province. It describes the vision for an integrated primary health care system delivered through networks of health care providers. The plan establishes defined roles for Regional Health Authorities and the government in managing, operating and funding primary health care. It also outlines characteristics of the new system and a phased implementation approach over 10 years to establish primary health care teams accessible to all residents.
The Role And Value Of Primary Care Practiceprimary
This document summarizes discussions from a 2002 conference on building consensus for healthcare reform in Canada. It includes summaries of two presentations:
1. Marie-Dominique Beaulieu's presentation on the role and value of primary care. She defines primary care and argues for strengthening it in Canada. She calls for changes like developing primary care teams with nurses and better information systems.
2. Howard Bergman's presentation in which he argues for strengthening and transforming primary care as the foundation of the healthcare system. He calls for an evidence-based approach and investing in primary care to improve health outcomes. Both agree comprehensive reform is needed, not just changes to primary care itself.
The document describes The Model for Improvement, which provides a framework for developing, testing, and implementing changes that lead to improvement. The model consists of two parts: 1) three fundamental questions to guide improvement work, and 2) Plan-Do-Study-Act cycles to test changes rapidly through small-scale trials. Using this approach can help achieve successful, low-risk change through a simple and effective process of continuous learning and adaptation.
This document summarizes the final report from the Forum on Teamworking in Primary Healthcare. The forum was convened by several national healthcare organizations to examine teamworking in primary care. The report found evidence that effective teamwork occurs when roles are clearly defined and rewarding, communication is good, and there are shared goals. It identified barriers like competing demands, status differences, and lack of resources. The report provides recommendations to improve teamworking at both the organizational and team member levels. It also highlights several examples of successful teamworking initiatives in UK primary care settings.
The document discusses strategies for improving patient flow and reducing cycle times in medical practices. It describes how mapping patient flows, measuring cycle times, and identifying interruptions can help practices pinpoint bottlenecks. Practices have found that small tests of change focused on areas like visit planning, co-locating staff, efficient office design, exam room standardization, documentation shortcuts, and streamlined check-in/out processes can uncover hidden capacity and increase revenue. The key is developing a deep understanding of the current process from the patient's perspective before envisioning an ideal flow and implementing changes while monitoring for unintended consequences. Physician leadership and a team effort are essential to successfully redirecting patient flow.
Snap%2 B Framework%2 Bfor%2 B General%2 B Practiceprimary
This document presents the Smoking, Nutrition, Alcohol and Physical Activity (SNAP) Risk Factor Framework for General Practice. The framework was developed to provide integrated approaches for general practitioners to support behavioral risk factor management for smoking, nutrition, alcohol and physical activity.
It identifies these four risk factors as major contributors to disease burden and outlines seven outcomes areas for action: organizational structures, financing, workforce development, information systems, communication, partnerships and referral networks, and research. The framework is intended to streamline support for general practices and encourage collaboration across different organizations and levels of care.
The document is the first annual report from the Health Results Team, which was created by the Minister of Health and Long-Term Care to improve patient access to healthcare in Ontario. The report details progress made in the first year to transform the healthcare system through initiatives like establishing Local Health Integration Networks, reducing wait times, implementing Family Health Teams, and improving information management. The Health Results Team worked across the healthcare community and achieved many milestones to deliver on the vision of creating a more integrated, sustainable, and patient-centered healthcare system.
This document provides updates on chronic disease management initiatives including the Chronic Disease Management Collaborative (CDMC). Key information includes:
1. An explanation of delivery system design which involves defining roles, using planned interactions, providing case management, and ensuring regular follow-up to effectively manage chronic illnesses.
2. Details on upcoming training for the Clinical Practice Redesign program and information sessions on a new diabetes education program using group visits.
3. Announcements of learning workshops and conferences on chronic disease management and diabetes.
The document discusses the role of registered dietitians in primary health care. It begins by explaining that primary health care focuses on wellness promotion rather than just illness treatment. It also notes that nutrition is important for health but access to nutrition services is limited. The document then describes key elements of primary health care, including using a population health approach, comprehensive services, coordination of care, interdisciplinary teams, and cost-effectiveness. It outlines the practice of registered dietitians in primary health care, including their skills in health promotion, education, and working with communities. Examples are provided of how dietitians contribute to quality of life, health outcomes, and cost containment through various strategies and actions.
Role of pharmacist in pharmacovigilance fieldSollers College
Pharmacists play a crucial role in pharmacovigilance by using electronic health records and pharmacovigilance systems to more quickly identify adverse drug reactions, thereby reducing healthcare costs. They can recognize adverse drug reactions in countries with questionable drug quality control. About 73% of pharmacists work in settings like hospitals and pharmacies where they may encounter adverse drug events. Pharmacists are drug experts trained to ensure medications are generally safe and hazardous drugs are removed from the market. Their involvement in pharmacovigilance is important for improving medication safety and outcomes and decreasing health costs globally.
This document discusses bioassays used to test the potency and quality of insulin and digitalis injections. It describes the standard preparations and units used, preparation of standard and test solutions, experimental conditions, procedures, and methods of analysis for the mouse convulsion method, rabbit blood sugar method (for insulin) and guinea pig method (for digitalis). The goal is to compare the hypoglycemic or lethal effects of test solutions to standardized preparations and determine the potency of the test samples.
This document discusses nervous system agents called adrenergic agonists and antagonists, as well as cholinergic agonists and anticholinergics. It describes their mechanisms of action, effects, indications, pharmacokinetics, contraindications and cautions. Adrenergic agonists bind to adrenergic receptors to mimic epinephrine. They increase heart rate, contractility and blood pressure. Alpha-specific agonists primarily bind to alpha receptors. Beta-specific agonists primarily bind to beta receptors and are used for bronchodilation. Adrenergic antagonists competitively block adrenergic receptors. Cholinergic agonists mimic acetylcholine to stimulate muscarinic receptors and
This document summarizes several antihyperlipidemic agents including ezetimibe, bile acid sequestrants, HMG-CoA reductase inhibitors (statins), fibrates, and nicotinic acid. It provides details on their mechanisms of action, pharmacological effects, indications, adverse reactions, contraindications, and interactions. The key points are:
1. Ezetimibe works by inhibiting cholesterol absorption in the intestine and lowers LDL levels the most. Bile acid sequestrants work by binding bile acids in the intestine and lowering LDL levels.
2. Statins are the first line treatment as they lower cholesterol synthesis in the liver and have pleiotropic effects in
This document discusses neuroleptics (antipsychotic drugs) and their mechanisms and uses. It covers:
1) The main classes of neuroleptics including typical (first generation) and atypical (second generation) antipsychotics and their mechanisms of action, primarily blocking dopamine D2 receptors.
2) The dopamine hypothesis of schizophrenia which proposes excessive dopamine activity plays a role, and how neuroleptics act to block this.
3) Other indications for neuroleptics beyond schizophrenia, including bipolar mania, psychosis with other disorders, and non-psychiatric uses for their antiemetic effects.
The document discusses how neurons can release multiple neurotransmitters called cotransmitters in addition to their primary transmitter, with examples including peptides, purines, nitric oxide, and prostaglandins released along with acetylcholine and norepinephrine. It notes that cotransmitters often have different time courses of action than the primary transmitter and may also serve as alternative transmitters. Cotransmission has been demonstrated in various autonomic nerves innervating tissues like the gut, vas deferens, urinary tract, and blood vessels.
This document provides a map showing the locations of Family Health Teams across Northern Ontario implemented in three waves:
1) The map shows the locations of Family Health Teams in various communities across Northern Ontario, grouped into large, community, small, and rural sites.
2) The Family Health Teams were implemented in three waves, with teams in different regions of Northern Ontario launching in each wave.
3) The map identifies the regions covered by each wave and provides the number of family physicians in each type of site to characterize their size.
Family Health Teams have been established across Northern Ontario in 3 waves:
- Wave 1 included large teams of 21-30 family physicians, community teams of 11-20 physicians, and small/rural teams of 5 or fewer physicians. Teams were located in communities across central, eastern, western and Champlain regions.
- Wave 2 expanded coverage with additional large, community and small/rural teams in northeast, northwest, southeast, southwest and Toronto regions.
- Wave 3 further increased access with more large teams in central, eastern and western regions and additional community and small/rural teams across the north.
This document provides guidance on managing waiting times in the NHS in Scotland. It outlines 10 golden rules for waiting time management that put the patient's interests first. It emphasizes the importance of appropriate referrals, adequate services, clinical prioritization of patients, and keeping patients informed of wait times. The document stresses partnership between primary and secondary care and accurate information on waiting lists. It discusses initiatives to treat backlogs versus long-term strategies to close gaps between demand and capacity. NHS Boards are asked to develop local plans that meet and exceed national targets through leadership, risk assessment, resource planning, and patient consultation.
This guidebook shares stories from nine Ontario communities that have undertaken healthy community initiatives. The stories describe their experiences and processes to raise awareness, build connections, and take action around health issues. Community members then reflected on these stories and identified "words of wisdom" from their experiences. Finally, the guidebook provides a framework and questions to help other communities document and share their own stories to guide their healthy community efforts.
The document provides tips and tools for registered dietitians working in interdisciplinary primary care settings. It outlines a proposed model for nutrition services with the RD responsible for overall management and the most in-depth nutrition counselling. It describes assessing community needs, nutrition screening, referral processes, nutrition advice and counselling. A typical nutrition counselling process is outlined including pre-screening referrals, initial visits, nutrition planning visits, follow-up visits and coordinating with the interdisciplinary team. Various tools developed in a demonstration project are also included to support RDs.
This document outlines a screening project conducted with primary care providers to identify at-risk women and incorporate screening tools for alcohol, smoking, and abuse into practice. It provided a screening and resource package, conducted academic detailing, and administered pre- and post-test questionnaires. The results showed increased screening rates for tobacco, alcohol, and abuse from pre- to post-test. While the response rate for the post-test was lower, providers reported increased use of screening tools and community referrals. The academic detailing approach was found useful by most providers.
This document outlines Saskatchewan's Action Plan for Primary Health Care, which aims to strengthen primary health care services in the province. It describes the vision for an integrated primary health care system delivered through networks of health care providers. The plan establishes defined roles for Regional Health Authorities and the government in managing, operating and funding primary health care. It also outlines characteristics of the new system and a phased implementation approach over 10 years to establish primary health care teams accessible to all residents.
The Role And Value Of Primary Care Practiceprimary
This document summarizes discussions from a 2002 conference on building consensus for healthcare reform in Canada. It includes summaries of two presentations:
1. Marie-Dominique Beaulieu's presentation on the role and value of primary care. She defines primary care and argues for strengthening it in Canada. She calls for changes like developing primary care teams with nurses and better information systems.
2. Howard Bergman's presentation in which he argues for strengthening and transforming primary care as the foundation of the healthcare system. He calls for an evidence-based approach and investing in primary care to improve health outcomes. Both agree comprehensive reform is needed, not just changes to primary care itself.
The document describes The Model for Improvement, which provides a framework for developing, testing, and implementing changes that lead to improvement. The model consists of two parts: 1) three fundamental questions to guide improvement work, and 2) Plan-Do-Study-Act cycles to test changes rapidly through small-scale trials. Using this approach can help achieve successful, low-risk change through a simple and effective process of continuous learning and adaptation.
This document summarizes the final report from the Forum on Teamworking in Primary Healthcare. The forum was convened by several national healthcare organizations to examine teamworking in primary care. The report found evidence that effective teamwork occurs when roles are clearly defined and rewarding, communication is good, and there are shared goals. It identified barriers like competing demands, status differences, and lack of resources. The report provides recommendations to improve teamworking at both the organizational and team member levels. It also highlights several examples of successful teamworking initiatives in UK primary care settings.
The document discusses strategies for improving patient flow and reducing cycle times in medical practices. It describes how mapping patient flows, measuring cycle times, and identifying interruptions can help practices pinpoint bottlenecks. Practices have found that small tests of change focused on areas like visit planning, co-locating staff, efficient office design, exam room standardization, documentation shortcuts, and streamlined check-in/out processes can uncover hidden capacity and increase revenue. The key is developing a deep understanding of the current process from the patient's perspective before envisioning an ideal flow and implementing changes while monitoring for unintended consequences. Physician leadership and a team effort are essential to successfully redirecting patient flow.
Snap%2 B Framework%2 Bfor%2 B General%2 B Practiceprimary
This document presents the Smoking, Nutrition, Alcohol and Physical Activity (SNAP) Risk Factor Framework for General Practice. The framework was developed to provide integrated approaches for general practitioners to support behavioral risk factor management for smoking, nutrition, alcohol and physical activity.
It identifies these four risk factors as major contributors to disease burden and outlines seven outcomes areas for action: organizational structures, financing, workforce development, information systems, communication, partnerships and referral networks, and research. The framework is intended to streamline support for general practices and encourage collaboration across different organizations and levels of care.
The document is the first annual report from the Health Results Team, which was created by the Minister of Health and Long-Term Care to improve patient access to healthcare in Ontario. The report details progress made in the first year to transform the healthcare system through initiatives like establishing Local Health Integration Networks, reducing wait times, implementing Family Health Teams, and improving information management. The Health Results Team worked across the healthcare community and achieved many milestones to deliver on the vision of creating a more integrated, sustainable, and patient-centered healthcare system.
This document provides updates on chronic disease management initiatives including the Chronic Disease Management Collaborative (CDMC). Key information includes:
1. An explanation of delivery system design which involves defining roles, using planned interactions, providing case management, and ensuring regular follow-up to effectively manage chronic illnesses.
2. Details on upcoming training for the Clinical Practice Redesign program and information sessions on a new diabetes education program using group visits.
3. Announcements of learning workshops and conferences on chronic disease management and diabetes.
The document discusses the role of registered dietitians in primary health care. It begins by explaining that primary health care focuses on wellness promotion rather than just illness treatment. It also notes that nutrition is important for health but access to nutrition services is limited. The document then describes key elements of primary health care, including using a population health approach, comprehensive services, coordination of care, interdisciplinary teams, and cost-effectiveness. It outlines the practice of registered dietitians in primary health care, including their skills in health promotion, education, and working with communities. Examples are provided of how dietitians contribute to quality of life, health outcomes, and cost containment through various strategies and actions.
Rg0035 A Guideto Service Improvement Nhs Scotlandprimary
This document provides a guide to using various tools and techniques for improving health care services. It focuses on using process mapping to analyze patient journeys through the health care system. Process mapping involves capturing each step of a patient's experience in a visual map to identify issues like bottlenecks, unnecessary steps, or handoffs between staff. Preparing for process mapping by defining the scope and goals and involving relevant staff and patients is important. Once complete, process maps can reveal problems and opportunities for improving efficiency and patient experience.
This document discusses the role of dietitians in collaborative primary health care mental health programs. It was developed as part of the Canadian Collaborative Mental Health Initiative to help integrate specialized services like nutrition and mental health expertise into primary care settings. Individuals with mental health issues are often nutritionally at risk due to factors like eating disorders, mood disorders, medication side effects, poverty and more. Dietitians are uniquely qualified to assess nutritional needs in this population and develop interventions as part of mental health care teams. However, more resources and strategies are still needed to fully realize dietitians' potential contributions to mental health care.
When relationships break down in organizations, it is often due to a lack of clear communication and shared understanding. The document outlines five common types of relationship breakdowns - role confusion, conflicting priorities, hidden expectations, communication issues, and resistance to change - and recommends strategies to address each one. These strategies include sharing key information, setting interaction agreements, building communication skills, and individual coaching. Addressing the root causes through open discussion and setting clear expectations is generally more effective than superficial fixes like team-building classes.
The article discusses rethinking the challenge of change management in organizations. It argues that traditional change management focuses too much on changing individual attitudes and behaviors and not enough on changing organizational systems and structures. The article proposes an alternative framework that views organizational change as an ongoing process of adaptation and focuses on aligning organizational components like strategy, culture and structure with each other and the external environment.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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1. DIABETES (+/- coronary artery disease)
COLLABORATIVE FLOW SHEET/ ENCOUNTER FORM
♦ PATIENT NAME
PAST HISTORY
ALCOHOL OVERUSE ARRHYTHMIA: ATRIAL FIB ARRHYTHMIA: OTHER
♦ HSN # (OR OTHER UNIQUE PATIENT ID) ♦ GENDER Male
ARTHRITIS CANCER CARDIOMYOPATHY Female Undifferentiated
CHF CHRONIC LUNG DIS. DEPRESSION ♦ PHONE (INCLUDE AREA CODE) ♦ BIRTHDATE (DD-MMM-YYYY)
HYPERTENSION LIPID ABNORMALITY LIVER DYSFUNCTION
OBESITY PERIPH. VASC. DIS. RENAL DYSFUNCTION
CHART NUMBER PRACTICE NAME
STROKE/TIA SUBSTANCE ABUSE VALVULAR HD
♦ PROVIDER NAME PROVIDER ID # (MSP #)
♦ DIABETES YEAR OF DX: TYPE 1 TYPE 2 OTHER
♦ CAD ___CHRONIC ANGINA, YEAR OF DX: ___MI, YEAR OF DX: ___CABG, DATE: FRAMINGHAM
RISK
___ ___ACS/UNSTABLE ANGINA , YEAR OF DX: ___PCI/Stent. DATE: SCORE
DIAGNOSTIC/ CLINICAL DATA, BY DATE NEW DATA √ = RECALL
REVIEW ♦ = MANDATORY MOST RECENT DATA
FIELDS DATE OF VISIT:
URGENT CARE for DM &/or CAD
None (enter # of urgent visits)
ER/hospitalizations since last planned visit
CLINICAL STATUS
REVIEWED BLOOD GLUCOSE RECORDS REVIEWED
GLYCEMIC
CONTROL
♦ A1C EVERY 3 MONTHS: ENTER VALUE
TARGET ≤ 7.0% DATE OF TEST
DIABETES MEDICATIONS/INSULIN
REVIEWED ADJUSTED
Review & adjust PRN
SYMPTOMS STABLE: angina, palpitations, N/A STABLE NOT STABLE
CAD
shortness of breath, swelling, dizziness angina palp. SOB swelling dizzy
♦ BLOOD PRESSURE ENTER VALUE
HTN
TARGET ≤130/80 DATE OF TEST
3 TO 6 MONTHS
TARGET BODY MASS INDEX (BMI)
LBS KG
18.5 – 24.9 Height: Enter weight (LBS or KG)
LIFESTYLE
nd
♦ SMOKING Current 2 Hand Past Never
AEROBIC EXERCISE
YES NO IA
> 30 minutes most days, moderate intensity
OTHER LIFESTYLE FACTORS
REVIEWED
Stress, diet, alcohol
YES
♦ ANTI-PLATELET (ASA/OTHER)
NO: CI NT $ RF DA IA
YES
♦ ACE OR ARB
MEDICATIONS
NO: CI NT $ RF DA IA
YES
♦ STATIN
NO: CI NT $ RF DA IA
YES
♦ BETA-BLOCKER (IF CAD)
NO: CI NT $ RF DA IA
GENERAL REVIEW & ADJUST PRN REVIEWED ADJUSTED
LDL ENTER VALUE
Fasting lipid profile
3-6 mos (CAD)
Target < 2.5 mmol/L DATE OF TEST
(High-risk targets)
Annually OR
DYSLIPIDEMIA
ENTER VALUE
♦RATIO TOTAL CHOL
DATE OF TEST
(TOTAL CHOL/HDL)
TARGET RATIO < 4.0 ENTER VALUE
HDL
DATE OF TEST
LIPID RISK MODERATE HIGH
METER/LAB COMPARISON
FBG
COMPLETED
(Optimally, this is based on fasting glucose)
ANNUALLY AND/OR OTHERWISE NOTED
DILATED EYE EXAM DATE IA
EYE
Ophthalmologist, optometrist, retinal photo OPHTHALM OPTOM RETIN PHOTO
♦ MICROALBUMIN SCREEN ENTER NEG
Screen for
OR IA
Nephro-
RENAL
(<2.0 M: <2.8 F) (Albumin:creatinine VALUE POS
pathy
KIDNEY FUNCTION estimated CrCl SERUM CREATININE μmol/L
mL/min (Cockroft-Gault formula) DATE OF TEST
LOWER EXTREMITY EXAM
REVIEWED IA
NEURO-
PATHY
Check for peripheral anesthesia
HISTORY AND PHYSICAL: Check for pain,
REVIEWED
erectile dysfunction, gastrointestinal disturbance
ASSESS & DISCUSS SELF-MANAGEMENT REVIEWED
GOALS
ANNUAL INFLUENZA VACCINE COMPLETED DATE CI
OTHER
PNEUMOCOCCAL VACCINE COMPLETED DATE CI
♦ REFERRAL TO DIABETES EDUCATION, YES
CARDIAC REHAB, OR OTHER NO: NP TRP $ RF DA IA
CI – contraindicated NT – not tolerated $ – financial barrier RF – patient refused NP – no program available IA – Inappropriate DA – Didn’t Ask TRP– transportation barrier
Adapted from BCMA Collaborative Flowsheet FOR COMMENTS SEE NEXT PAGE Nov 8/06
2. DIABETES (+/- coronary artery disease)
COLLABORATIVE FLOW SHEET/ ENCOUNTER FORM
♦ PATIENT NAME
♦ HSN # (OR OTHER UNIQUE PATIENT ID) ♦ GENDER Male
Female Undifferentiated
♦ PHONE (INCLUDE AREA CODE) ♦ BIRTHDATE (DD-MMM-YYYY)
CHART NUMBER PRACTICE NAME
♦ PROVIDER NAME PROVIDER ID # (MSP #)
COMMENTS
Adapted from BCMA Collaborative Flowsheet Nov 8/06