The document discusses issues with the modern healthcare system including a reductionist approach, unrealistic expectations of health, and the failure to address behavioral factors. It argues that defining health as complete well-being has medicalized society and generated unnecessary demand. Bloodletting was the dominant medical practice for over 2000 years based on the ancient humoral theory but provided no improvement in life expectancy. While reductionism led to advances in the 20th century, a holistic approach is also needed. The key is developing self-awareness among both patients and clinicians to reconcile physical, psychological and social well-being.
An Introduction to Health Care ManagementPreji M P
This is an Introduction to Health Tourism specialization students duly catering to the syllabus of Health care Management paper with a focus on basic anatomy and physiology.
Niek Klazinga | Performance reporting in OECD countriesSax Institute
Dr Niek Klazinga (Head of the Health Care Quality Indicators Project in the OECD Health Division) spoke with the HARC network in December 2014 about current developments in performance measurement and reporting.
HARC stands for the Hospital Alliance for Research Collaboration. HARC is a collaborative network of researchers, health managers, clinicians and policy makers based in NSW, Australia managed by the Sax Institute.
HARC Forums bring members of the HARC network together to discuss the latest research and analysis about important issues facing our hospitals.
For more information visit saxinstitute.org.au.
The revised OECD Health Systems Performance Framework: methodological issues ...Sax Institute
The OECD is a leading organization in the international measurement of health system performance. The OECD Expert Group on Health Care Quality Indicators (HCQI) has recently revised its performance framework, identifying core indicators and highlighting new directions. Although improving, the capacity of countries to deliver more accurate standardized indicators still needs to be fostered. A particular aspect that deserves attention is the design, planning and implementation of public performance reporting. Such activity, strictly interrelated to the capacity of the information infrastructure, also depends from cultural, organizational and political conditions that can be differently present at the international level. The applicability of standardized principles and the evidence of improved outcomes due to public reporting systems is still questioned to a large extent. A first international conference on the topic of hospital performance reporting has been organized in Rome, Italy in 2014, followed by a second event held in Seoul, South Korea, in 2015. In his talk, Fabrizio Carinci will present recent developments of OECD projects, including:
• state of the art in the definition of OECD performance indicators
• challenges emerging from OECD R&D studies
• transferability and use of definitions at sub-national and provider level
• applicability for hospital performance benchmarking and geographical variation
• limitations imposed by the legislation on privacy and data protection
• an overarching vision of “essential levels of health information”
Through practical examples drawn from his direct experience as Member of the Bureau of the HCQI and other relevant Boards, Prof. Fabrizio Carinci will discuss the state of the art, the role played by national governments (including Australia), and potential avenues for mutual collaboration.
An Introduction to Health Care ManagementPreji M P
This is an Introduction to Health Tourism specialization students duly catering to the syllabus of Health care Management paper with a focus on basic anatomy and physiology.
Niek Klazinga | Performance reporting in OECD countriesSax Institute
Dr Niek Klazinga (Head of the Health Care Quality Indicators Project in the OECD Health Division) spoke with the HARC network in December 2014 about current developments in performance measurement and reporting.
HARC stands for the Hospital Alliance for Research Collaboration. HARC is a collaborative network of researchers, health managers, clinicians and policy makers based in NSW, Australia managed by the Sax Institute.
HARC Forums bring members of the HARC network together to discuss the latest research and analysis about important issues facing our hospitals.
For more information visit saxinstitute.org.au.
The revised OECD Health Systems Performance Framework: methodological issues ...Sax Institute
The OECD is a leading organization in the international measurement of health system performance. The OECD Expert Group on Health Care Quality Indicators (HCQI) has recently revised its performance framework, identifying core indicators and highlighting new directions. Although improving, the capacity of countries to deliver more accurate standardized indicators still needs to be fostered. A particular aspect that deserves attention is the design, planning and implementation of public performance reporting. Such activity, strictly interrelated to the capacity of the information infrastructure, also depends from cultural, organizational and political conditions that can be differently present at the international level. The applicability of standardized principles and the evidence of improved outcomes due to public reporting systems is still questioned to a large extent. A first international conference on the topic of hospital performance reporting has been organized in Rome, Italy in 2014, followed by a second event held in Seoul, South Korea, in 2015. In his talk, Fabrizio Carinci will present recent developments of OECD projects, including:
• state of the art in the definition of OECD performance indicators
• challenges emerging from OECD R&D studies
• transferability and use of definitions at sub-national and provider level
• applicability for hospital performance benchmarking and geographical variation
• limitations imposed by the legislation on privacy and data protection
• an overarching vision of “essential levels of health information”
Through practical examples drawn from his direct experience as Member of the Bureau of the HCQI and other relevant Boards, Prof. Fabrizio Carinci will discuss the state of the art, the role played by national governments (including Australia), and potential avenues for mutual collaboration.
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
The MHA program’s case competition showcases the knowledge and skills gained throughout the rigorous curriculum into an end-of-first year integrative experience.
This presentation highlights the work done by two other exceptional students and myself in a team effort that addresses the challenges facing a complex health care organization through an in-depth analysis and corresponding action plan.
Stephen Morgan, M.D.
Senior Vice President, Chief Medical Information Officer
Carilion Clinic
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.
Medical practice (Africa vs North America) Dr Louis Uwaifo, MDdruwaifol
Compare and contrast medical practice in Africa and North America, 2 different continents with unique differences in their practice of medicine, mindful of developing and developed statuses respectively. Live session includes clinical case scenarios discussions and video clips
Question of Quality Conference 2016 - Patient Experience - Innovation in pati...HCA Healthcare UK
The South Somerset Symphony Programme is one of nine Primary and Acute Care systems (PACs) Vanguards born out of Simon Stevens’ Five Year Forward View. To address the problems of an ageing population and an increased burden of long-term conditions, it is essential to have a coordinated response across sectors, putting the patient at the centre of care. The session will look at a joint venture that will hold a single budget for the population and how this enables them to target resources to parts of the system where they can make the most difference to patients.
Medical practice (africa vs north america) dr louis uwaifo, m.dpeaceohue
Medical practice is as diverse as medicine itself! Let us attempt to compare and contrast medical practice in Africa and North America, 2 different continents, each unique in its practice of medicine. Live session includes case discussions of various scenarios
Keynote presentation delivered by Dr Irem Patel, Integrated Consultant Respiratory Physician, Kings Health Partners, at the Pan London Airways Network Summer Meeting 2016
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
The MHA program’s case competition showcases the knowledge and skills gained throughout the rigorous curriculum into an end-of-first year integrative experience.
This presentation highlights the work done by two other exceptional students and myself in a team effort that addresses the challenges facing a complex health care organization through an in-depth analysis and corresponding action plan.
Stephen Morgan, M.D.
Senior Vice President, Chief Medical Information Officer
Carilion Clinic
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.
Medical practice (Africa vs North America) Dr Louis Uwaifo, MDdruwaifol
Compare and contrast medical practice in Africa and North America, 2 different continents with unique differences in their practice of medicine, mindful of developing and developed statuses respectively. Live session includes clinical case scenarios discussions and video clips
Question of Quality Conference 2016 - Patient Experience - Innovation in pati...HCA Healthcare UK
The South Somerset Symphony Programme is one of nine Primary and Acute Care systems (PACs) Vanguards born out of Simon Stevens’ Five Year Forward View. To address the problems of an ageing population and an increased burden of long-term conditions, it is essential to have a coordinated response across sectors, putting the patient at the centre of care. The session will look at a joint venture that will hold a single budget for the population and how this enables them to target resources to parts of the system where they can make the most difference to patients.
Medical practice (africa vs north america) dr louis uwaifo, m.dpeaceohue
Medical practice is as diverse as medicine itself! Let us attempt to compare and contrast medical practice in Africa and North America, 2 different continents, each unique in its practice of medicine. Live session includes case discussions of various scenarios
Keynote presentation delivered by Dr Irem Patel, Integrated Consultant Respiratory Physician, Kings Health Partners, at the Pan London Airways Network Summer Meeting 2016
The shaky foundations of science slides - James FodorAdam Ford
See: http://2014.scifuture.org/abstract-the-shaky-foundations-of-science-an-overview-of-the-big-issues-james-fodor/ - Many people think about science in a fairly simplistic way: collect evidence, formulate a theory, test the theory. By this method, it is claimed, science can achieve objective, rational knowledge about the workings of reality. In this presentation I will question the validity of this understanding of science. I will consider some of the key controversies in philosophy of science, including the problem of induction, the theory-ladenness of observation, the nature of scientific explanation, theory choice, and scientific realism, giving an overview of some of the main questions and arguments from major thinkers like Popper, Quine, Kuhn, Hempel, and Feyerabend. I will argue that philosophy of science paints a much richer and messier picture of the relationship between science and truth than many people commonly imagine, and that a familiarity with the key issues in the philosophy of science is vital for a proper understanding of the power and limits of scientific thinking.
This presentation details the overall scenario of the pharmaceutical sector in India as well as the state of Gujarat. The presentation highlights the investment & business opportunities present in the sector owing to the robust growth of the sector in India as well as Gujarat. Various government assistance schemes & incentives further augment the business potential of the sector.
Medical Ethics is what every physician and healthcare worker should know. We need to understand Ethics and its application in various cultures, societies and its changes according to norms and values. Once society will be given health education regarding Medical Ethics many issues can be resolved in a decent manner. It ultimately gives a very positive impression of all the actions which a healthcare worker performs otherwise at times seems inappropriate by society. This is not for the sake of healthcare worker or for the patients it is primarily for the whole community.
What are the rights of patient? role of ethical committee and parameters of a physician all need to be addressed properly.
Prof. Panditrao has added his original work on the subject of 'Medical Deontology'/Medical Ethics... a Powerpoint version and updated presentation of his editorial on the same topic. He expands his own ideas, priniples and moral values on this very very important but now and virtually neglected topic. The powerpoint presentation has been updated with specific and pertinent examples so that, while training the younger generation, it can become an interactive session
Ethical issues in medicine and research:Special reference to IndiaJishnu Lalu
A detailed discussion on Ethical consideration concerning physician, patient, co-workers and research. It also discusses publication ethics and Ethics in India
1 Define health and wellness.
2 Describe factors causing significant changes in the health care delivery system and their impact on health care and the nursing profession.
3 Describe the practitioner, leadership, and research roles of nurses.
4 Describe nursing care, delivery models.
5 Discuss expanded nursing roles.
- 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
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
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
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
Dr. Barry White, former HSE National Director, Clinical Strategy and Programmes
1. Dr Barry White
Consultant Haematologist, St James’s
Hospital and former National
Director for National Clinical
Programmes
2. Ancient system of medicine
• Blood and other bodily fluid were regarded as
“humors” that had to remain in balance to maintain
health.
• Bloodletting was based on this ancient system and
was the most common medical practice for over 2000
years
• The purpose was to correct the imbalances of the
bodily fluids
• No real change in life expectancy over this period of
time
4. In 1799 George Washington (aged 65), the first U.S. president, died after having 3.75 liters of
blood removed from his body within a 10 hour period as treatment for a throat infection
5. Reductionism - “world is like a
machine composed of many smaller
parts and that it could be understood
by taking it apart and studying the
part..” Descartes
6. Holism
• A contrast to the reductionist approach is
holism or emergentism. Holism is the idea
that things can have properties (emergent
properties) as a whole that are not
explainable from the sum of their parts.
• “The whole is more than the sum of its parts”
- Aristole
7. Reductionism leads to dramatic
improvements in medicine in 20th
century
• Antibiotics
• Vaccinations
• Pharamceutical breakthrough across full
spectrum of illness (aspirin, statins, analgesia,
antihypertensives, immunosuppressants,
chemotherapy)
• Transfusion medicine
• Surgery, anaesthesia, ITU
8. Major improvements in health from
17th to 21st Century
• Life expectance 25 yrs to 80 yrs age
• Infant mortality 30-40% to 0.3%
• Child mortality before the age of 5 went from
70% to 0.4%
• Maternal mortality 3%to 0.03%
9. Has it all been good?
• Safety
– 100,000 deaths/yr in USA, 4% of hospital admissions
• Effectiveness
– 50% of patients with chronic diseases are on the right
treatment (thereafter 50-70% adherence)
•
•
•
•
•
Patient experience
Access
Equity
Cost
Clinician health
10. (i) Endemic reductionism
• Society driving endemic reductionism in healthcare – “super
specialitis”
–
–
–
–
Hospital doctors
Nurses
AHPs
GPSI
• Patient care is being reduced not just to systems but the actual
disease
• On average 17 consultants are managing the multi co-morbidity
patients that account for the majority of health spend
• While there are benefits probably driven by standardisation overall
it drives cost, risk, poor patient experience “I don’t want to be the
ball anymore”
11. (ii) Have we learnt the lessons of
improvement science?
• Focus is on science of discover
• Improvement science requires totally different
philosophy and methods
13. Appreciation
for a System
Theory of
Knowledge
Learning from experience
PDSA for learning and
improvement
Profound
Knowledge
Psychology
e.g. motivation
Understanding
Variation and data
14.
15. (iii) Definition of health and healing
“Health is a state of complete physical, mental
and social well-being and not merely the
absence of disease or infirmity”
Preamble to the Constitution of the World Health Organization which entered into force on 7
April 1948. The Definition has not been amended since 1948
16. Medicalisation of life
• If I am bereaved, does that mean I am unhealthy?
• 25% of teenagers suffering from mental health
problems! Is this a medical condition or part of
adolesence?
• Advances in technology have resulted in
investigation +/- treatment of many “illnesses”
e.g. early prostate cancer, non malignant breast
disease, imaging “incidentalomas”, coronary
heart disease
18. (iv) Failure to address behavioural
factors
• The commonest condition in most specialties is
“functional”
• In addition biopsy provable diseases are primarily
driven by diet, exercise, alcohol and cigarettes
• Despite this, self management and self efficacy
training is peripheral activity
• The roof is leaking and we only seem to be able to
respond by debating whether we need more
people to to empty the water or whether they
need to worker faster
19. Solutions
• Generalist provides care; specialist role is to support generalist with
smaller amount of direct patient care with exceptions of proceedures
– Standardise with specialty support
– For rare diseases or rare complication of common diseases either direct care
by specialist or specialist supports generalist delivering care e.g Project Echo
• Implement science of improvement into healthcare
• Redefine health and healing – as integration of Descartes and Aristotle
• Redefine the role of the patient and clinician; switch expectations to
patient and support self care – you are what you choose
• Create new business model, metrics and incentives to support the above
• Improve awareness to achieve technical competence, deep insight and
compassion (doctors and patients)
20. Awareness
Patient
• Recognise and respond to
the psychological and social
factors at play
• Develop the skills needed to
self care and to understand
the meaning of health and
healing
• Understand their own
limitations and distractions
• Self compassion
Clinician
• Recognise and respond to the
physical, psychological and
social factors at play and how
variaitons will impact patient
• Understand their own
limitations and distractions
• Act with technical competence
and insight
• Deeper meaning to their work
and life
• Compassionate to self and
others
23. Health and healing
• Healing and health is the ability to reconcile all
aspects of the self (physical, psychological and
social) – “to be in balance” - even in the
setting of aging, incurable illness (social,
psychological or physical) and pending death.
• To understand- we our what we choose
26. Awareness
• The central pillar is the self aware clinician and the self
aware patient
• Awareness in patient and clinician
• Insight and prediction regarding physiological,
psychological and social dimensions as well as deeper
issues relating to who we are and meaning to life for
self and the patient
• Taken far enough awareness will strike the spring of
compassion
• Ultimate goal of a Full aware clinician and patient will
find their true nature which is compassion (for self and
others)
27. Health and healing
• What is the difference between healing and curing?
• Healing – transcending suffering, illness and ultimately
death beyond cure alone
• The patient needs to, in the majority of cases, take
responsibility for being the primary treater. As such
the clinician becomes as much teacher as treater.
• We are what we choose?
• We need to prescribe training in self care and self
efficacy
28. • Domains of healthcare
• Why problems
– Reductionism vol and standardisation
– Definition of health generating demand, and
unrealistic expectation on doctor and projection
– QI and systems of healthcare
– Holistic arpproacj
29. • Most criticism of the WHO definition concerns the absoluteness of
the word “complete” in relation to wellbeing. The first problem is
that it unintentionally contributes to the medicalisation of society.
The requirement for complete health “would leave most of us
unhealthy most of the time.”4 It therefore supports the tendencies
of the medical technology and drug industries, in association with
professional organisations, to redefine diseases, expanding the
scope of the healthcare system. New screening technologies detect
abnormalities at levels that might never cause illness and
pharmaceutical companies produce drugs for “conditions” not
previously defined as health problems. Thresholds for intervention
tend to be lowered—for example, with blood pressure, lipids, and
sugar. The persistent emphasis on complete physical wellbeing …
30. Bloodletting didn’t work!
• In the 1830s, Pierre Charles Alexandre Louis
convincingly argued against the perceived effectiveness
of phlebotomy for the treatment of pneumonia and
fever. Ironically, with the gradual decline of
bloodletting there was an increase of other dangerous
and ineffective treatments, such as the use of
electricity, elixirs and potions. These medications
gained popularity for the same reason that
bloodletting had in earlier times: it sometimes worked
as a placebo. Because the patients believed that
receiving electric shock therapy would heal their illness,
the psychological factor may have been enough to
actually make them feel better.
31. Health and healing
• Expectation that “healthcare providers” job is to
make you “healthy” i.e. complete physical,
mental and social well-being
• This is unachievable and is not consistent with
our experience of human existence which is one
of suffering (even the suffering of emptiness if
nothing is wrong), aging, illness and death
• Leads to projection (doctors fault not mine) ,
litigation and burnout
32. Reductionism
• Though the idea of reductionism has existed
since the ancient Greeks, René Descartes, a 17th
century French philosopher and scientist and
father of modern philosophy was the first to
formally state the concept.
• He stated that the world was like a machine
composed of many smaller parts and that it could
be understood by taking is apart and studying the
part before learning how they all fit into the
whole.
33. Evidence based medicine finally
identifies bloodletting as harmful
• However not without a fight
• Sir William Osler still recommended it in 1923,
Principles and Practice of Medicine
• “Many of those who have practiced blood letting were
careful and shrewd mean….it seems scarcely possible
that such men should have been utterly mistaken in
assigning advantages to this powerful means of
modifying vital actions. Imprimis non nicere, like all
proverbial morality is a maxim oftener used to justify
the coward than to guide the conscientious”, A fair trial
for bloodletting, BMJ 1871
41. Model for Improvement
Aims
Measures
Ideas
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Act
The Improvement Guide, API
Plan
Study
Do
Editor's Notes
Physicians very often didn’t do blood letting but instructed barber surgeons hence the sign for the barber reflects this work to the current day
Two lessons: 1. Patients and doctors can conspire to cause injury and death to themselves and other 2. Just because you are the most imporant person you cant avoid it – you just get killed by the best doctors
Renee Descartes a french philosopher and father of modern philosophy is instrumental in teaching and writings in determining the philopspy that has driven modern societ. He was first to introduce reductionism into western thinking. He was also founders of scietific revolution which looked at question (strucutredna), hypothesis ( helical), prediction (xshaed on x ray diffraction, experiment and analysis(suggests double helix)
Safety 100,000 deaths in US hospitals preventable errors, 4% hospital admissions due to preventable medication errors, 50% of patients on correct treatment and only 50% adherence, access issues due to demand growth in many healthcare systems. Inequity private v public and vice versa; inequity also on basis of illness or acuity; cost >10% GDP with unsustinable growth rates; clinician burnout rates of 50% due to unrealistic expectations
Recent patient where GP send email asking for case conference to the 28 consultants managing one of her patients
The definition by the WHO is important not because anyone pays attention and implements it but for 3 reasons 1. it reflects our philosophy on healthcare 2. It is totally unachievable and contradicts the basic priniciples of the cycle of life which includes suffering, illness, aging and dying. 3 it unintentionally drives the wrong behaviours (on behalf of clinicians and patients – doctors have the cures and patients just need to ask), creates unrealistic expectations, which leads to anger, frustration defensive medicine and the wrong solution
If I don’t get healthy from the doctor – I get annoyed andrhe doctor gets burnt out
Redefine the role of the patient and clinician – self efficacy as the cornerstone – in many aspects of care the patient should be treater and the clinician the teacher. Technical competence insight and compassion.
Awareness is easy to understand – it means you make fewer mistakes for one thing. But do we have to try to be compassionate? The trick for that doesn’t exist. But if you consider that compassion is simply natural, then total awareness must include awareness of our human nature. Taken far enough, awareness will strike the spring of compassion.
Assumes we can generate this state of complete physical, mental and social wellbeing? The resposnsibity is on the doctor yet the majority of attendances are driven by behaviour?
Awareness is easy to understand – it means you make fewer mistakes for one thing. But do we have to try to be compassionate? The trick for that doesn’t exist. But if you consider that compassion is simply natural, then total awareness must include awareness of our human nature. Taken far enough, awareness will strike the spring of compassion. The increased insight and awareness associated with meditation enables clinicians to attentively listen to and observe the patient, understand both the physiological and behavioural factors at play, recognize their own limitations and errors, refine their technical skills, make evidence-based decisions, and clarify their values so they can act with compassion, technical competence, presence, and insight