The document describes the development of a traffic light alert system to improve referral processes for a Macmillan Acute Oncology Service (MAOS). The system was designed to accurately reflect the service's availability to accept referrals, ensure accountability, and expedite discharges. It uses a single web page with color-coded statuses (green, amber, red, black) and corresponding actions to guide referrals. Early results suggest the system improves communication between referrers and MAOS and engagement in expediting discharges. If successful, the alert system may be adopted by other acute assessment areas and oncology services.
Communications in US Emergency DepartmentsCory Mann
Emergency Departments have a plethora of communications challenges, with more hand offs and methods of communication used than other areas of hospitals. See the full research findings by Cory Mann Market Insight in the attached report.
EMS Compass Overview Call For Measures May 2015Nick Nudell
The EMS Compass Initiative opened a call for measures to be submitted during May 2015. This provides an overview of the project and how these performance measures will be designed by EMS and used by EMS providers. The measures will demonstrate the value of EMS care for a community and for patients.
Communications in US Emergency DepartmentsCory Mann
Emergency Departments have a plethora of communications challenges, with more hand offs and methods of communication used than other areas of hospitals. See the full research findings by Cory Mann Market Insight in the attached report.
EMS Compass Overview Call For Measures May 2015Nick Nudell
The EMS Compass Initiative opened a call for measures to be submitted during May 2015. This provides an overview of the project and how these performance measures will be designed by EMS and used by EMS providers. The measures will demonstrate the value of EMS care for a community and for patients.
Selecting the Right Meaningful Use Criteria for Your Practice - October 25, 2010Cientis Technologies
Speaker: Peter Basch, MD, FACP, Medical Director, Ambulatory EHR and Health IT Policy, MedStar Health. He is a Senior Fellow with the Center for American Progress, practices general internal medicine in Washington, DC. Dr. Basch is an early adopter of electronic health records and e-prescribing.
Dr. Basch explained the Stage 1 Meaningful Use Criteria including the 15 Core Measures you must meet plus how to select the 5 Menu Measures that are most appropriate to your practice.
CPOE - Computerized Physician Order EntryKristie Brown
CPOE is now a requirement for ARRA. This talks about the items that need to be focused on for CPOE implementations. It is geared towards MEDITECH, but the ideas can be used for any EMR system. Check out the excelhcg youtube channel for a video presentation.
The Lung Cancer Demonstration Project: Implementation and evaluation of a lun...Cancer Institute NSW
The Royal Prince Alfred Hospital lung MDT was established in 1984. Historically, information about MDT decision making was captured as free text in the electronic medical record, including patient investigation and staging. This information was accessible to clinical staff; however, it was not routinely distributed to GPs involved in the patient's care. We identified a potential gap in the current reporting and communication processes.
Physician resistance as a barrier to implement clinical information systems b...Healthcare consultant
In summary, physician resistance toward implementation of clinical information systems is a major barrier. Strategies acknowledged under various categories to overwhelm this barrier provide hope to organizations that are eager to take on this adventure. Decision makers carry the chief responsibility to put in advance clear rules to facilitate physicians’ participation in the implementation process to eliminate their later on opposition.
The prestigious ACR accreditation is awarded only to facilities that prove during a rigorous peer-review evaluation that they meet specific Practice Guidelines and Technical Standards developed by the ACR.
Poster presented at ECE Maastricht 2015 LBacelar-NicolauLBNicolau
"Screening Policies in Health Impact Assessment: easier decision making through cluster analysis" went very well. Many interesting questions and comments at the end!
With almost half of oncology studies failing due to a lack of patient retention, there is a critical need to develop more efficient and patient focused strategies. Jessica Thilaganathan at CRF Health sits down with International Clinical Trials to explain why electronic clinical outcome solutions could be the answer. (Published with permission of International Clinical Trials).
A Dartmouth Microsystem Assessment was conducted to examine a hospital unit\\’s functionality and to highlight opportunities for improvement. To enhance the gathering of data, a statistical tool was created to measure a wider sample population. The CNL student implemented a more reliable and valid data gathering system. The nurse educator asked to use the graduate student’s tool on the unit and throughout the hospital.
The PSCI Cost-Quality (Triple Aim) Analyzer for Acute Care module blends three streams of data – financial, clinical quality, and patient experience. Using Total Quality Management (TQM) principles, the module reveals root causes of cost/quality variance through easy point-and-click drill-downs.
1
QQUALITY IMPROVEMENT STUDENT PROJECT PROPOSAL:
IMPROVING HANDOFFS IN SAN FRANCISCO GENERAL
HOSPTITAL’S EMERGENCY DEPARTMENT
TMIT Student Projects QuickStart Package ™
1. BACKGROUND
Setting: Emergency departments are “high-risk” contexts; they are over-crowded and
overburdened, which can lead to treatment delays, patients leaving without being seen by a
clinician, and inadequate patient hand-offs during changing shifts and transfers to different
hospital services (Apker et al., 2007). This project will focus on the Emergency Departments in
county hospitals, specifically San Francisco General Hospital. SFGH has the only Trauma Center
(Level 1) available for the over 1.5 million people living and working in San Francisco County
(SFGH website)
Health Care Service: This paper will focus on intershift transfers, the process of transferring a
patient between two providers at the end of a shift, which can pose a major challenge in a busy
emergency department setting.
Problem: According to the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO), poor communication between providers is the root cause of most sentinel events,
medical mistakes, and ‘‘near misses.” Furthermore, a recent survey of 264 emergency
department physicians noted that 30% of respondents reported an adverse event or near miss
related to ED handoffs (Horwitz, 2008). A similar survey notes that 73.5% of hand-offs occur in
a common area within the ED, 89.5% of respondents stated that there was no uniform written
policy regarding patient sign-out, and 50.3% of those surveyed reported that physicians sign out
2
patient details verbally only (Sinha et al., 2007). At SFGH, handoffs occur in the middle of the
ED hallway, usually next to a patient’s gurney. Sign-out is dependent on the Attending and
Residents on a particular shift; thus, it is non-uniform, and hand-offs are strictly verbal.
Barriers to Quality: In a 2005 article in Academic Medicine, four major barriers to effective
handoffs were identified: (1) the physical setting, (2) the social setting, and (3) communication
barriers. Most of these barriers are present during intershift transfers at SFGH. The physical
setting is usually in a hallway, next to a whiteboard, never in private. Presentations are frequently
interrupted, and background noise is intense from the chaos of an overcrowded emergency room.
Attendings frequently communicate with each other and assume that the resident can hear them.
Solet et al. suggests that Residents are unlikely to ask questions during a handoff if the
information is coming from an Attending physician. All transfers are verbal, none are
standardized, and time pressures are well known, since sign-out involves all working physicians
in the ED at one time.
2. THE INTERVENTION
The Institute for Health Care Improvement (IHI) lays out several steps for conducting a quality
improvement ...
Selecting the Right Meaningful Use Criteria for Your Practice - October 25, 2010Cientis Technologies
Speaker: Peter Basch, MD, FACP, Medical Director, Ambulatory EHR and Health IT Policy, MedStar Health. He is a Senior Fellow with the Center for American Progress, practices general internal medicine in Washington, DC. Dr. Basch is an early adopter of electronic health records and e-prescribing.
Dr. Basch explained the Stage 1 Meaningful Use Criteria including the 15 Core Measures you must meet plus how to select the 5 Menu Measures that are most appropriate to your practice.
CPOE - Computerized Physician Order EntryKristie Brown
CPOE is now a requirement for ARRA. This talks about the items that need to be focused on for CPOE implementations. It is geared towards MEDITECH, but the ideas can be used for any EMR system. Check out the excelhcg youtube channel for a video presentation.
The Lung Cancer Demonstration Project: Implementation and evaluation of a lun...Cancer Institute NSW
The Royal Prince Alfred Hospital lung MDT was established in 1984. Historically, information about MDT decision making was captured as free text in the electronic medical record, including patient investigation and staging. This information was accessible to clinical staff; however, it was not routinely distributed to GPs involved in the patient's care. We identified a potential gap in the current reporting and communication processes.
Physician resistance as a barrier to implement clinical information systems b...Healthcare consultant
In summary, physician resistance toward implementation of clinical information systems is a major barrier. Strategies acknowledged under various categories to overwhelm this barrier provide hope to organizations that are eager to take on this adventure. Decision makers carry the chief responsibility to put in advance clear rules to facilitate physicians’ participation in the implementation process to eliminate their later on opposition.
The prestigious ACR accreditation is awarded only to facilities that prove during a rigorous peer-review evaluation that they meet specific Practice Guidelines and Technical Standards developed by the ACR.
Poster presented at ECE Maastricht 2015 LBacelar-NicolauLBNicolau
"Screening Policies in Health Impact Assessment: easier decision making through cluster analysis" went very well. Many interesting questions and comments at the end!
With almost half of oncology studies failing due to a lack of patient retention, there is a critical need to develop more efficient and patient focused strategies. Jessica Thilaganathan at CRF Health sits down with International Clinical Trials to explain why electronic clinical outcome solutions could be the answer. (Published with permission of International Clinical Trials).
A Dartmouth Microsystem Assessment was conducted to examine a hospital unit\\’s functionality and to highlight opportunities for improvement. To enhance the gathering of data, a statistical tool was created to measure a wider sample population. The CNL student implemented a more reliable and valid data gathering system. The nurse educator asked to use the graduate student’s tool on the unit and throughout the hospital.
The PSCI Cost-Quality (Triple Aim) Analyzer for Acute Care module blends three streams of data – financial, clinical quality, and patient experience. Using Total Quality Management (TQM) principles, the module reveals root causes of cost/quality variance through easy point-and-click drill-downs.
1
QQUALITY IMPROVEMENT STUDENT PROJECT PROPOSAL:
IMPROVING HANDOFFS IN SAN FRANCISCO GENERAL
HOSPTITAL’S EMERGENCY DEPARTMENT
TMIT Student Projects QuickStart Package ™
1. BACKGROUND
Setting: Emergency departments are “high-risk” contexts; they are over-crowded and
overburdened, which can lead to treatment delays, patients leaving without being seen by a
clinician, and inadequate patient hand-offs during changing shifts and transfers to different
hospital services (Apker et al., 2007). This project will focus on the Emergency Departments in
county hospitals, specifically San Francisco General Hospital. SFGH has the only Trauma Center
(Level 1) available for the over 1.5 million people living and working in San Francisco County
(SFGH website)
Health Care Service: This paper will focus on intershift transfers, the process of transferring a
patient between two providers at the end of a shift, which can pose a major challenge in a busy
emergency department setting.
Problem: According to the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO), poor communication between providers is the root cause of most sentinel events,
medical mistakes, and ‘‘near misses.” Furthermore, a recent survey of 264 emergency
department physicians noted that 30% of respondents reported an adverse event or near miss
related to ED handoffs (Horwitz, 2008). A similar survey notes that 73.5% of hand-offs occur in
a common area within the ED, 89.5% of respondents stated that there was no uniform written
policy regarding patient sign-out, and 50.3% of those surveyed reported that physicians sign out
2
patient details verbally only (Sinha et al., 2007). At SFGH, handoffs occur in the middle of the
ED hallway, usually next to a patient’s gurney. Sign-out is dependent on the Attending and
Residents on a particular shift; thus, it is non-uniform, and hand-offs are strictly verbal.
Barriers to Quality: In a 2005 article in Academic Medicine, four major barriers to effective
handoffs were identified: (1) the physical setting, (2) the social setting, and (3) communication
barriers. Most of these barriers are present during intershift transfers at SFGH. The physical
setting is usually in a hallway, next to a whiteboard, never in private. Presentations are frequently
interrupted, and background noise is intense from the chaos of an overcrowded emergency room.
Attendings frequently communicate with each other and assume that the resident can hear them.
Solet et al. suggests that Residents are unlikely to ask questions during a handoff if the
information is coming from an Attending physician. All transfers are verbal, none are
standardized, and time pressures are well known, since sign-out involves all working physicians
in the ED at one time.
2. THE INTERVENTION
The Institute for Health Care Improvement (IHI) lays out several steps for conducting a quality
improvement ...
1
QUALITY IMPROVEMENT STUDENT PROJECT PROPOSAL:
IMPROVING HANDOFFS IN SAN FRANCISCO GENERAL
HOSPTITAL’S EMERGENCY DEPARTMENT
TMIT Student Projects QuickStart Package ™
1. BACKGROUND
Setting: Emergency departments are “high-risk” contexts; they are over-crowded and
overburdened, which can lead to treatment delays, patients leaving without being seen by a
clinician, and inadequate patient hand-offs during changing shifts and transfers to different
hospital services (Apker et al., 2007). This project will focus on the Emergency Departments in
county hospitals, specifically San Francisco General Hospital. SFGH has the only Trauma Center
(Level 1) available for the over 1.5 million people living and working in San Francisco County
(SFGH website)
Health Care Service: This paper will focus on intershift transfers, the process of transferring a
patient between two providers at the end of a shift, which can pose a major challenge in a busy
emergency department setting.
Problem: According to the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO), poor communication between providers is the root cause of most sentinel events,
medical mistakes, and ‘‘near misses.” Furthermore, a recent survey of 264 emergency
department physicians noted that 30% of respondents reported an adverse event or near miss
related to ED handoffs (Horwitz, 2008). A similar survey notes that 73.5% of hand-offs occur in
a common area within the ED, 89.5% of respondents stated that there was no uniform written
policy regarding patient sign-out, and 50.3% of those surveyed reported that physicians sign out
2
patient details verbally only (Sinha et al., 2007). At SFGH, handoffs occur in the middle of the
ED hallway, usually next to a patient’s gurney. Sign-out is dependent on the Attending and
Residents on a particular shift; thus, it is non-uniform, and hand-offs are strictly verbal.
Barriers to Quality: In a 2005 article in Academic Medicine, four major barriers to effective
handoffs were identified: (1) the physical setting, (2) the social setting, and (3) communication
barriers. Most of these barriers are present during intershift transfers at SFGH. The physical
setting is usually in a hallway, next to a whiteboard, never in private. Presentations are frequently
interrupted, and background noise is intense from the chaos of an overcrowded emergency room.
Attendings frequently communicate with each other and assume that the resident can hear them.
Solet et al. suggests that Residents are unlikely to ask questions during a handoff if the
information is coming from an Attending physician. All transfers are verbal, none are
standardized, and time pressures are well known, since sign-out involves all working physicians
in the ED at one time.
2. THE INTERVENTION
The Institute for Health Care Improvement (IHI) lays out several steps for conducting a quality
improvement ...
Improving Physician Communications in HealthcareTelmediq
As one the leading hospitalist groups in the U.S., Sound Physicians knows that strong communications and cutting-edge mobile applications help their physicians collaborate to deliver world-class inpatient care.
Ward Handover enables a more efficient handover of patients between shifts enabling a more effective patient discharge process. The solution is split into two parts, based around 6PM's CareSolutions database:
Ward Handover System:
A proven ward handover application which enables clinical staff to maximize their care time whilst delivering a single view of the patient by allowing them to enter the discharge notes into a single location that may be accessed by all clinical teams involved in the patient's care – including doctors, ward nurses, specialist nurses and Allied health Professionals. The system therefore allows predictability of bed utilization to maximize their occupancy and assists the bed management team in proactive assessment whilst reducing overall costs of related activities.
Patient Discharge Reporting:
The second part of the solution is real time reporting. The solution takes feeds from the Trust's CRS application every 15 minutes regarding patient status and predicted discharge dates which is then used to create a number of reports for ward staff regarding the workload and patient status. These reports can then be viewed either by ward staff or by consultants.
Capstone Project Change Proposal Presentation for Faculty Review a.docxbartholomeocoombs
Capstone Project Change Proposal Presentation for Faculty Review and Feedback
Assessment Description
Create a 10-15 slide Power Point presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders. Include the intervention, evidence-based literature, objectives, resources needed, anticipated measurable outcomes, and how the intervention would be evaluated. Submit the presentation in the digital classroom for feedback from the instructor.
PICOT Question (See other file uploaded)
Interventions
Falling incidences can cause several complications, including health care costs, severe health issues, immobility, etc. With the severity of this issue, appropriate interventions should take place. In this context, proper monitoring is one of the significant interventions to prevent this incidence (Huang et al., 2020). Hence, incorporating educated and efficient technicians while providing patient care can be an essential step. Yet, due to decreased mobility or functionality, older people often require help in doing basic activities, in this aspect, providing help to the patients while changing to hospital-approved gowns (Liu-Ambrose et al., 2019). In addition, one significant and effective intervention is providing quick education to the patient regarding fall prevention strategies (Radecki, Reynolds & Kara, 2018). Another critical aspect is providing a safe environment for clinical care. Outpatient clinics should improve their workflow and environmental condition, such as removing hazardous materials, and keeping the floor clean and dry, so that the clinic can provide a safe area for older patients. These interventions can help prevent falls (Guirguis-Blake et al., 2018).
Benchmark - Capstone Change Project Objectives
1. Prevent elderly falls in an outpatient radiology clinic.
Rationale: Falls occur as age advances due to individual risk factors or environmental factors. For example, gait or balance deficits, chronic conditions, medications, and footwear the patient is wearing. Assisting these patient populations can prevent falls in the department.
2. Educate patients and people in the community on how to prevent falls.
Rationale: Educate patients regarding physical changes and chronic health conditions that cause or probability of falls.
3. Provide a safe environment for clinical care in the outpatient clinical setting.
Rationale: Design the clinical area accessible to patients in wheelchairs, with assistive devices, and with mobility deficits. Have handrails on walls and hallways for support, clean, non-skid floors, and lighted pathways in hallways, rooms, and bathrooms.
4. A patient care technician (PCT) is available in the outpatient clinical area for patients.
Rationale: Having a PCT in the clinical area, especially around the dressing rooms, would benefit the patients needing help when changing to hospital-approved gowns and monitoring patients for risk.
Marita Schifalacqua, RN, MSN, NEA-BC, FAAN,
Chris Costello, MEng, MBA, and Wendy Denman, RNC, BBM, BSN, MSN
Roadmap for Planned Change, Part 2
Bar-Coded Medication Administration
hange—savored by some and feared by many.
How do you as nurse leaders use your
knowledge and insight to move forward and transfer
your vision for quality and safety into reality? What do
you need to do to get key stakeholders on the bus and,
in some cases, even drive the bus? The roadmap for
planned change allows for an infrastructure of thought
brought to increase the likelihood for successful
change. Successful change is important to our patients
and to us as providers of that care.
This article, the second of a two-part series,
focuses on the application of change theory and the
elements of project management most critical to
successfully implementing a bar-coded medication
administration (BCMA) program. Examples will be
from one hospital’s experience, Saint Francis Medical
Center in Grand Island, Nebraska, to a health
system’s (Catholic Health Initiatives, Denver, Colorado)
approach to planning for 30 hospitals.
The definition of the BCMA program includes a
consistent, integrated information technology strategy,
with a focus on point-of-care BCMA to ensure that the
right person receives the right medication, in the right
dosage, via the right route, at the right time (five
rights). The bar code on medication is scanned before
administration to patients.
C
April 200932 Nurse Leader
Nurse Leader 33www.nurseleader.com
APPLICATION OF CHANGE THEORY AND
PROJECT MANAGEMENT
The first article discusses concepts and tools of both change
leadership and project management that lend support in plan-
ning and managing large- or small-scale change. Change lead-
ership is a common methodology of theory and tools that,
when used routinely, are central to integrating a change man-
agement model with the people side of change.
Project management is an application of knowledge, skills,
tools, and techniques customized to the initiative.The project
management elements discussed in the first article that are
most critical to successfully implementing planned change are
project charter, project budget and budget management, proj-
ect plan and schedule management, project staff organization,
project communications management, and project risk and
issue management.
CURRENT STATE ANALYSIS
Changing a process as complex as BCMA can and will
impact a variety of stakeholders. It is important to review
the process of medication administration from the time the
medication enters the facility through the time that the med-
ication is billed to the patient. Employees working in depart-
ments that will experience change with BCMA need to
know that their role is important and that their viewpoint
is valued.
Leadership
The chief nursing officer and vice president of ancillary services
were the executive cosponsors of the project.There was a
BCMA stee ...
Optimising the Model of Care for Patient Management at The Tweed Cancer Care ...Cancer Institute NSW
The commonly understood model of shift to shift nursing handover does not apply to most ambulatory day treatment units. Nonetheless, ‘handover’ of patient clinical information remains quintessential to safe clinical practice. Of considerable interest is how EMR may aid the transfer of patient clinical information in these circumstances and address the question: does this facilitate improved patient care?
Health IT Summit Houston 2014 - Case Study "EHR Optimization for Organizational Value in a Changing Healthcare Environment"
Luis Saldana, MD, MBA, FACEP
CMIO
Texas Health Resources
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
You will write two pages (not including your title page) expressin.docxdanielfoster65629
You will write two pages (not including your title page) expressing your current worldview in regard to the subject of Administration of Justice Organizations. This paper’s content will include how the presentation in the Module/Week 1 Reading & Study folder influences your worldview.
Marita Schifalacqua, RN, MSN, NEA-BC, FAAN,
Chris Costello, MEng, MBA, and Wendy Denman, RNC, BBM, BSN, MSN
Roadmap for Planned Change, Part 2
Bar-Coded Medication Administration
hange—savored by some and feared by many.
How do you as nurse leaders use your
knowledge and insight to move forward and transfer
your vision for quality and safety into reality? What do
you need to do to get key stakeholders on the bus and,
in some cases, even drive the bus? The roadmap for
planned change allows for an infrastructure of thought
brought to increase the likelihood for successful
change. Successful change is important to our patients
and to us as providers of that care.
This article, the second of a two-part series,
focuses on the application of change theory and the
elements of project management most critical to
successfully implementing a bar-coded medication
administration (BCMA) program. Examples will be
from one hospital’s experience, Saint Francis Medical
Center in Grand Island, Nebraska, to a health
system’s (Catholic Health Initiatives, Denver, Colorado)
approach to planning for 30 hospitals.
The definition of the BCMA program includes a
consistent, integrated information technology strategy,
with a focus on point-of-care BCMA to ensure that the
right person receives the right medication, in the right
dosage, via the right route, at the right time (five
rights). The bar code on medication is scanned before
administration to patients.
C
April 200932 Nurse Leader
Nurse Leader 33www.nurseleader.com
APPLICATION OF CHANGE THEORY AND
PROJECT MANAGEMENT
The first article discusses concepts and tools of both change
leadership and project management that lend support in plan-
ning and managing large- or small-scale change. Change lead-
ership is a common methodology of theory and tools that,
when used routinely, are central to integrating a change man-
agement model with the people side of change.
Project management is an application of knowledge, skills,
tools, and techniques customized to the initiative.The project
management elements discussed in the first article that are
most critical to successfully implementing planned change are
project charter, project budget and budget management, proj-
ect plan and schedule management, project staff organization,
project communications management, and project risk and
issue management.
CURRENT STATE ANALYSIS
Changing a process as complex as BCMA can and will
impact a variety of stakeholders. It is important to review
the process of medication administration from the time the
medication enters the facility through the time that the med-
ication is billed to the patient. Employ.
This month's community call is part two in a series on Clinical Transformation. The presentations will highlight how Clinical Transformation affects outcomes AND the bottom-line of health care organizations. The presentation will provide a proof point on how Clinical Transformation has a direct Return on Investment (ROI) for both the patient and the provider organization.
This topic is both clinical and administrative in nature and will likely be useful to physicians, nurses and others interested in outcomes, as well as health care CIOs, CFOs and administrators.
Please feel free to forward this invitation to any colleagues or associates who you believe would find this topic of interest or would like to participate in the discussion.
What: Clinical Transformation (Part II)
- Clinical Transformation
- a Blueprint
- in Practice
- Transformation Working Group Update
- Review of status
- Framework for Planning
- Discussion
- Open Project Updates
- OpenVista/GT.M Integration
- CCD/CCR collaboration
- Medsphere.org: Tip of the month
When: March 26, 12:30 - 2pm Pacific
Where: Dial-in: (888) 346-3950 // Participant Code: 1302465
Web conference: http://www.medsphere.com/infinite/
===
The community calls are listed on the Medsphere.org event calendar (http://medsphere.org/community-events/) and we will update each month's call as the agenda is solidified.
Details and Recording available here: http://medsphere.org/blogs/events/2009/03/26/community-call-march-2009
While the cost of living in an assisted living community is often a shock to perspective residents, it is important to understand the value proposition of any facility you are considering to fully appreciate what your money is paying for. At United Methodist Communities, our non-profit, faith based mission insures that the costs of your care, pay for your care, and not corporate profits. Visit https://umcommunities.org/
Showcases digital health implementation in Ontario
hospitals.
Each story is focused around a key challenge,
an explanation of the process taken to address it, and
a reflection on the impact
Similar to #2 Development of a traffic light alert system to improve referral processes within Southampton Macmillan Acute Oncology Service (20)
Dr Alison Young, Consultant Medical Oncology, Leeds Teaching Hospitals Trust
Dr Andrew Stewart, Haematologist and Lead for Acute Oncology, University Hospitals of the North Midlands
Ceri Stubbs, Clinical Lead, Velindre NHS Trust
Dr Sinead Clarke, Macmillan GP Advisor, Clinical Director for Performance, IT, Finance, Cancer and End of Life, South Cheshire and Vale Royal CCGs, Medical Lead for Cheshire end of Life Partnership
Dr Jackie Dominey, GP and Macmillan GP Advisor, Clinical Lead End of Life, Solihull CCG
Palliative Care and Acute Oncology IntegrationRecoveryPackage
Dr Catherine O'Doherty, Consultant in Palliative Medicine, Trust Acute Oncology Lead and Lead Cancer Clinician, Basildon and Thurrock University Hospitals NHS Foundation Trust
Karen Andrews, Head of Nursing for Macmillan/Acute Oncology and EOL services, Basildon and Thurrock University Hospitals NHS Foundation Trust
Dr Ricky Fraser, Acute Oncology Fellow, South West Wales Cancer Centre
Joanne Upton, Skin Cancer Advanced Nurse Practitioner, The Clatterbridge Cancer Centre
Dr Ashling Lillis, National Director's Clinical Fellow Macmillan Support, final year trainee in Acute Oncology
Dr Clare Philliskirk, Trainee in Acute Medicine, West Midlands
Dr Sarbit Clare, Acute Medical Consultant, Sandwell and West Birmingham Hospitals
Dr Ashling Lillis, National Director's Clinical Fellow Macmillan Support, final year trainee in Acute Oncology
Dr Clare Philliskirk, Trainee in Acute Medicine, West Midlands
Dr Sarbit Clare, Acute Medical Consultant, Sandwell and West Birmingham Hospitals
Dr Chris Jenkins, Consultant Haematologist, University Hospital of the North Midlands
Dr Andrew Stewart, Consultant Haematologist, The Royal Gwent Hospital
Dr Andrew Stewart, Consultant Haematologist, The Royal Gwent Hospital
Dr Chris Jenkins, Consultant Haematologist, University Hospital of the North Midlands
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
#2 Development of a traffic light alert system to improve referral processes within Southampton Macmillan Acute Oncology Service
1. Development of a traffic light alert system to improve
referral processes within Southampton Macmillan Acute
Oncology Service
Aim:
To develop and pilot a traffic light alert system that is universally
understood, accurately reflects service availability, ensures service
accountability, and has potential to expedite discharge processes.
Introduction:
Macmillan Acute Oncology Service (MAOS) has grown into a 7-bedded
24/7 unit, receiving a high volume of referrals for assessment/admissions
including patient/carer self-referrals and many referrals from health care
professionals (HCP), such as Clinical Nurse Specialists (CNS).
MAOS has identified difficulties in service provision including:
• highly variable workload,
• no clear agreement among HCPs about referral criteria
• how ‘out of scope’ requests are managed
Action was needed so professionals referring to MAOS understand the
current pressures on the service and take appropriate action accordingly.
Traffic light systems are universally understood. This algorithm based application was
designed to reflect service availability and expedite the discharge process.
We are currently trialling the application. Outcomes being measured are:
• ease of use,
• safety,
• accuracy in reflecting current availability to accept referrals,
• improvement in communication and clarity between referrers and MAOS,
• bed manager and consultant engagement in expediting discharges within cancer care.
The survey and focus group confirmed the
problems (given in the introduction), in
particular highlighting the lack of agreement
among HCPs about referral criteria.
Non-availability of information for referrers
about the current capacity of MAOS to accept
referrals and the apparent variability of
responses to referrals was the biggest source
of frustration and misunderstanding for
referrers.
The application developed is a single web
based page for touch screen, taking around 10
seconds to complete/update. It is available for
demonstration at the conference. A screen
shot of the application is shown in Figure 1.
Example outcomes are shown in Figure 2.
Data was collected from MAOS users to
identify and prioritise the difficulties and
successes in the referrals process by
(i) Questionnaire based survey of 3
groups (site specific CNS’, MAOS staff,
and other referring HCPs, and
(ii) a focus group of MAOS staff.
From these results, an algorithm using
parameters with corresponding
numerical values was developed into an
application for piloting within MAOS.
The parameters and values were initially
developed within the focus group and
further defined by the author.
Software development was externally
undertaken at no cost.
Discussion
Background Methods Results
Hill T, Fenton P & Johnson K. Macmillan Acute Oncology Service, University Hospital Southampton NHS Foundation Trust.
email: tamsin.hill@uhs.nhs.uk
Patient Flow:
The ability to deal with new patients is
affected by whether patients can be safely
returned home or moved elsewhere within
the hospital.
This is the biggest source of frustration for
MAOS staff and referrers.
With thanks to Dr P Fenton and Dr E Killick (both UHS) for their support. I gratefully acknowledge the contribution made by Dr Q Hill (Arqiva) and Dr GM Hayes (KCL).
Bed Availability:
Patient flow is dependent on bed availability.
Lack of bed availability is the biggest source
of frustration for MAOS staff and referrers.
Acuity:
MAOS staff felt high acuity level
reflected the inability of staff to deal
with incoming patients. An example
of this is the need to hold a patient
until an ITU bed becomes available.
At this point there are no staff
available to accept further patients
Phone calls:
MAOS manages patients in the community.
Peaks in phone calls mean one nurse
practitioner if fully utilised dealing with
telephone enquiries and screening.
Figure 1: MAOS traffic light alert application screen view
To Come In List:
Managing this list is as important
and takes as much time as dealing
with the patients you have in the
hospital. Telephone triage and risk
assessment is of critical
importance.
Status Action
Green
• Emergency reviews
• Elective and non-urgent cases
• Nurse practitioner-led reviews- full assessment and clerking
• Assist other clinical areas
Amber
• Prioritise urgent reviews
• Nurse practitioner-led reviews focussed on targeted emergency
assessment
• Quick reviews
• Stagger non-urgent jobs
• Referrers to consider CNS-led management
Red
• Emergencies only
• Referrers to consider CNS, clinic reviews
• Manage patients at home/in the community
• Teams to prioritise those in AOS in ward rounds
• Book for next day review
• Bed manager informed
Black
• All emergencies to nearest ED
• Manage other patients at home if possible
• Divert/postpone electives
• Ops to be informed – to review patients and identify those fit for
discharge
Figure 2: Example outcomes – modifiable for individual sites
If the aims of the alert system are met by the pilot:
• The alert system will be embedded within Southampton MAOS
• The hospital site management team will have an accurate reflection of MAOS current
availability to accept and review patients
• The alert system could be used in other acute assessment areas within the trust, such
as Acute Surgical Unit
• Other Acute Oncology Services could use this or a modification to meet their needs.
Future