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On 12th December 2013, Dr Hannan (GP / family physician) along with Marilyn Gollom (patient) presented this talk to Health 2.0 Manchester. You can watch the talk by going to http://www.htmc.co.uk/pages/pv.asp?p=htmc0519.
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It’s been said that patient engagement develops naturally when there is a regular, focused communication between patient and provider and it leads to behaviors that meet or more closely approach treatment guidelines. It is also believed that patients engaged in their own care make fewer demands on the health care system and more importantly, they experience improved health. Patients who are educated about both their condition and their care are also patients who are most likely to get and stay healthy. In fact, many believe that empowering patients to actively process information, decide how that information fits into their lives, and act on those decisions is a key driver to improving care and reducing costs.
Research shows that informed and engaged patients take a more active role in their own care and furthermore, health care organizations are slowly discovering how patient engagement contributes to their financial and quality objectives. Patient engagement essentially revolves around the theory that if patients understand their condition, know the symptoms to watch for, know why they’re taking medication for example and how to implement the necessary lifestyle changes, the chances of them getting and staying healthy are significantly improved and when you proactively engage patients in their care, the quality of that care improves.
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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
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Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
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FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
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Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
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Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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20231108 Access and prospective access - FINAL.pptx
1. Access and
Prospective Access
• Dr Amir Hannan, @amirhannan
• Full-time General Practitioner
• Haughton Thornley Medical Centres, Hyde, Cheshire
• Chair West Pennine Local Medical Committee
• Chair Association of Greater Manchester Local Medical Committees
• Chair, World Health Innovation Summit
2. Summary
• My personal journey
• Patient access to records and
understanding
• Partnership of Trust
• Responsible Sharing
• Prospective Access
• The future
3.
4. Dr Cumming added: "It is going to be a good
practice, a smoothly-run practice and we are going
to regain the trust and confidence of the patients,
as far as anyone can."
http://news.bbc.co.uk/1/hi/health/955009.stm
5. One day in 2003….
Example photo – not a true patient
23. Paradigm Shift in Healthcare
Viewed
as better
care
Viewed
as worse
care
“Industrial Age” healthcare “Information Age” healthcare
Patients
want
System
wants
24. Paradigm Shift in Healthcare
Viewed
as better
care
Viewed
as worse
care
“Industrial Age” healthcare “Information Age” healthcare
Patients
want
System
wants
25. Passive Patient to Flying Empowered
Patient
Passive
Patient
Engage Create
interest
Inform Enable Activate
Reactivate
Build
Momentum
Flying Empowered
Patient
Safety Net
Records Access And
Understanding
Explicit consent
With thanks to Glen Griffiths @griffglen
26. Teaching moments
Age / Number of Long Term Conditions
Baby /
Child /
Teenager /
Parent
Obesity/
Alcohol
problem
Hypertension
Diabetes
Heart
disease
Heart
failure
0 1 2 3 4 5
Cost
in
£
Mental health exacerbates physical health problems even more
Dementia
6
32. Electronic health record
Extended
Access Hub
OOHs
Urgent Care
EPACCs
A&E
Summary Care Record
EMISweb
Responsible Sharing
Records Access and
Understanding Safety Checklist
Explicit Consent
Questionnaire
Would you mind if I look at your
electronic health record ?
NW Ambulance,
111, District Nurses,
Single Point of
Access
EPACCs
Artificial
Intelligence
34. What is our process?
• Assume all patients / carers can have full access
• Engage our Patient Participation Group
• Patients are informed, engaged and activated in the consulting room
• To get the full “records access and understanding”
• Complete Safety Checklist questionnaire
• Opportunity to answer any questions
• Check GP electronic health record
• Add code “Patient Remote Record Access Enabled” to active problems
list
• Switch on all the subcomponents for full records access including free
text from 1/1/1900
• Send a Text Message to the patient informing them
• Email their pin numbers to them if not already been given them
• Inform them they can email the practice if they have any issues
• Publish our data every week to monitor the improvement
35. Main exclusion
• Unable to provide consent
• Dementia
• Digital Divide & no family / carer
• No time / resources to devote
• (Lack of interest)
Problem areas
• Severe mental illness
• Child protection
• Coercion
38. Challenges
• Ongoing issues around not able to sign up,
• Forgotten passwords,
• patients unsure what it means especially blood results,
• when signing people – how to onboard so patients get the best from the
practice,
• maintaining easy access for patients with the practice,
• digital divide,
• releasing admin staff to process requests
• redaction software – easy to just default to no access but this creates trust issues
• turnover of staff,
• clinicians leaving
• Trainees and medical students have no education or training
39. Type of patient How many have signed up %
Asthma 1725/1952 88%
COPD 304/397 76%
Diabetes 846/993 85%
Cancer 379/468 80%
Depression / Anxiety 3589/4134 86%
Rheumatoid Arthritis 67/78 85%
Heart disease 368/471 78%
Pregnant 94/96 97%
Learning disability 61/82 74%
Bengali patients 1427/1622 87%
Medications ordered
online
4244/12777 33%
Total patients 10464/12777 81%
https://www.htmc.co.uk/do-you-want-to-see-what-your-doctor-or-nurse-has-written-about-you-or-check-your-
gp-electronic-health-record-2/how-many-have-signed-up-for-full-records-access-and-understanding/
40. Prospective Access Patients with online accounts such as through the NHS App will be
able to read new entries, including free text, in their health record.
This change only applies to future (prospective) record entries and not
historic data.
Following proposed changes to the 2023/2024 GP contract which were announced in April, legislation has now been
passed so that new health information is available to all patients (unless they have individually decided to opt-out or
any exceptions apply) from 31 October 2023.
https://digital.nhs.uk/services/nhs-app/nhs-app-guidance-for-gp-practices/guidance-on-nhs-app-features/online-access-to-gp-health-records
41. What is wrong with prospective access
• Viewing your records including free text is not the same as booking an appointment or ordering repeat prescriptions or even
sending a message
• Different knowledge, skills and attitudes needed with knowledge development
• Clinical role that has been made into administrative
• No trusting relationship developing or seen as part of a clinical experience – Royal Colleges, GMC, NMC need to get behind
this with education, training, setting expectations, KPIs for Trusts / Boards
• Needs overhaul of NHS Choices and also all other "health education" outlets
• Not just about safeguarding concerns. What about breaking bad news, those lacking capacity, severe mental illness /
personality disorder, in coercive relationships
• What about poor record keeping and "failing practices" that have significant other problems too eg lacking staff, run by locums
where there is no continuity
• No risk sharing – onus lies completely with data controller whose thoughts are not being registered
• Access to a clinician is currently very difficult and getting worse
• Mixed economy of "lite" access and "full access to whole record"
• What happens when patients continually complain about minutiae ?
• No investment and hence no "must dos" but "nice to have" for those who have time (which nobody does) - no perceived
importance by those looking at what to do next
• Health inequalities will widen unless somebody invites them
42. Aleena Hossain,
Final Year Medical Student,
Imperial College, London 2021
https://www.bmj.com/content/380/bmj.p247
53. I feel
• 104 code for all patients to block access
unless consented safely to do so.....
• …as long as practice has a process to enable
access to records safely...
• ...and is enabled to do so with funds /
training / ongoing support in place at practice
/ PCN / locality / regional / national level
• Support is needed for Boards who have
to take ownership of this and penalties
for those not complying (incompetence,
unsafe, not In line with NHS values / purpose,
salaries linked to performance )
54. The future challenges
• Not just access but also
understanding with appropriate
consent and responsible sharing
• Mixed economy of access with lite,
prospective access to full access
• Retrospective access needs to be
looked at – electronic + paper records
• Artificial intelligence alongside human
intelligence