The document summarizes the evolution of back pain care models in the UK from a structuralist model pre-1990s to the current community MSK hub model. It finds that while most patients are appropriately managed in a "one-stop shop" model through CATS services staffed by ESPs, some with complex or disabling back pain frequently reconsult. The document proposes a new integrated model of back pain care centered around supported self-care, evidence-based treatment, lifestyle modification and navigation to resources. It argues that sports and musculoskeletal physicians can provide valuable leadership, education and clinical skills to these services, including competency in spinal interventions and helping ensure compliance with treatment guidelines.
The Role of Health Services Research in a Learning Healthcare SystemAcademyHealth
Dr. David Atkins, U.S. Department of Veterans Affairs, presented at AcademyHealth's 2012 Capitol Hill briefing entitled "Health and the Deficit: Using Health Services Research to Reduce Costs and Improve Quality."
DASH - does arthritis self-management help?epicyclops
This lecture was given by Dr Marta Buszewicz, General Practitioner from North London and Senior Lecturer in Community Based Teaching & Research at UCL, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. Her lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
Delivery of eQIPP through a seven day working physiotherapy service for cardi...NHS Improving Quality
Delivery of eQIPP through a seven day working physiotherapy service for cardio-thoracic surgery patients
South Tees Hospitals NHS Foundation Trust
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
Three Dimensions of Care for Diabetes (3DFD) – diabetes management for people...NHS Improving Quality
Three Dimensions of Care for Diabetes (3DFD) – diabetes management for people with psychological / social needs, by King's College Hospital NHS Foundation Trust, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners
Convocation feb 2014 uds 2 r qi slidesMarion Sills
Sills MR. Leveraging SAFTINet resources to enhance value in performance measurement. Annual Convocation of the Scalable Architecture for Federated Translational Inquiries Network (SAFTINet). Aurora, Colorado, February 2014.
For more information on SAFTINet, please see http://www.ucdenver.edu/academics/colleges/medicalschool/programs/outcomes/COHO/saftinet/Pages/default.aspx
The Role of Health Services Research in a Learning Healthcare SystemAcademyHealth
Dr. David Atkins, U.S. Department of Veterans Affairs, presented at AcademyHealth's 2012 Capitol Hill briefing entitled "Health and the Deficit: Using Health Services Research to Reduce Costs and Improve Quality."
DASH - does arthritis self-management help?epicyclops
This lecture was given by Dr Marta Buszewicz, General Practitioner from North London and Senior Lecturer in Community Based Teaching & Research at UCL, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. Her lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
Delivery of eQIPP through a seven day working physiotherapy service for cardi...NHS Improving Quality
Delivery of eQIPP through a seven day working physiotherapy service for cardio-thoracic surgery patients
South Tees Hospitals NHS Foundation Trust
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
Three Dimensions of Care for Diabetes (3DFD) – diabetes management for people...NHS Improving Quality
Three Dimensions of Care for Diabetes (3DFD) – diabetes management for people with psychological / social needs, by King's College Hospital NHS Foundation Trust, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners
Convocation feb 2014 uds 2 r qi slidesMarion Sills
Sills MR. Leveraging SAFTINet resources to enhance value in performance measurement. Annual Convocation of the Scalable Architecture for Federated Translational Inquiries Network (SAFTINet). Aurora, Colorado, February 2014.
For more information on SAFTINet, please see http://www.ucdenver.edu/academics/colleges/medicalschool/programs/outcomes/COHO/saftinet/Pages/default.aspx
Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter.
Better Care for clients and families experiencing or at risk for stroke or transient ischemic attacks (TIA's) using telehealth and multidisciplinary and inter-regional resources was realized in Sunrise Health Region over the course of a two year pilot.
Better Care
Jacquie Holzmann, Sunrise Health Region, Shannon Schmidt, Sunrise Health Region
Recent advances in the evidence base for technology-based behavioral health applications have provided clinicians a better understanding and guidance on the integration of these tools into clinical care. Participants will learn about research findings on current technologies in use in clinical practice, such as audio conferencing, video conferencing, and virtual reality, in addition to tools available for use between patients, such as the use of websites and mobile applications and wearable sensors.
Improving NHS staff experience to improve NHS staff performance:
This session focused upon the impact staff engagement and experience has on organisational performance, specifically patient experience. The session was aimed at commissioners and policy makers, and outlined why staff experience is so important. It also offered examples from an organisation that has improved staff experience to great effect.
Sally Pezaro (Centre for Technology Enabled Health Research (CTEHR), University of Coventry) and Rhian Bishop (Staff Engagement Lead at Sheffield Teaching Hospitals Foundation Trust).
Dr Geoff Waghorn is from the Queensland Center for Mental Health Research, Australia and spent 8 days based at Sainsbury Centre as part of an International Initiative for Mental Health Leadership event.
He presented an Australian perspective on IPS to a group of colleagues in London.
Originally uploaded on 28 May 2010.
Person-centred care and patient activationNuffield Trust
Richard Owen, NHS England, and Dr Natalie Armstrong of the University of Leicester present on evaluating Person Centred Care through Patient Activation Measure (PAM).
Exercise programs for people with dementia: What's the evidence?Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of exercise programs for people with dementia. Click here for access to the audio recording: https://youtu.be/jC8HhC2XFrE
Dorothy Forbes, Professor, Faculty of Nursing, University of Alberta, Edmonton led the session and presented findings from her latest Cochrane review:
Forbes, D., Forbes, S. C., Blake, C. M., Thiessen, E. J., & Forbes, S. (2015). Exercise programs for people with dementia. Cochrane Database of Systematic Reviews, 2015(4), CD006489.
As the population ages, the number of people suffering with dementia will also rise. Not only will this affect quality of life of people with dementia but will also increase the burden of family caregivers, community care, and residential care services. Exercise interventions have been identified as a potential way of reducing or delaying the progression of dementia and its symptoms. This review examines two questions: do exercise programs for older people with dementia improve cognition, activities of daily living (ADLs), challenging behaviour, depression, and mortality in older people with dementia? and; do exercise programs for older people with dementia have an indirect impact on family caregivers' burden, quality of life, and mortality?
CDV: Still a National Priority, by Huon Gray, National Clinical Director (Cardiac), NHS England and Consultant Cardiologist, University Hospitals of Southampton
Implementing a Pragmatic Trial of Physical Activity Coaching in COPDUCLA CTSI
"Lessons Learned with Implementing a Pragmatic Trial of Physical Activity Coaching in COPD"
Huong Q. Nguyen, PhD, RN
Research Scientist, Kaiser Permanente
Affiliate Associate Professor, University of Washington
A presentation of the Southern California Regional Dissemination, Implementation and Improvement Science Webinar Series.
Provided by the UCLA CTSI
Penny George™ Institute for Health and Healing: Meeting Patients Where They AreAllina Health
By Courtney Baechler, MD. A discussion about the Penny George Institute and its goal to empower patients using the mind-body-spirit approach to health, encouraging a philosophy of wellness at any stage of care. The Penny George Institute has become a national leader in holistic health care and is an important component of Allina Health efforts to achieve health care transformation through the Triple Aim.
The Broad Picture - recent developments in long-term condition managmentepicyclops
This lecture was given by Dr Aileen Keel, Deputy Chief Medical Officer for Scotland, to the North British Pain Association Spring Scientific Meeting on Friday 18th May, 2007 and forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
Reproduced with permission.
Multidisciplinary care is essential in the recovery of the oncological patien...Nata Chalanskaya
Jette Vibe-Petersen, MD, director of Copenhagen Center for Cancer and Health, presentation at the Second International Scientific and Practical Conference «Improving the quality of life of cancer patients through the development of cooperation between state, commercial and non-profit organizations». 2018-01-23, Minsk. Belarus
A customized, comprehensive approach that delivers strategic solutions to communities, physicians, hospitals & health systems. Each component builds the foundation for the next to create true physician alignment & integration.
Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter.
Better Care for clients and families experiencing or at risk for stroke or transient ischemic attacks (TIA's) using telehealth and multidisciplinary and inter-regional resources was realized in Sunrise Health Region over the course of a two year pilot.
Better Care
Jacquie Holzmann, Sunrise Health Region, Shannon Schmidt, Sunrise Health Region
Recent advances in the evidence base for technology-based behavioral health applications have provided clinicians a better understanding and guidance on the integration of these tools into clinical care. Participants will learn about research findings on current technologies in use in clinical practice, such as audio conferencing, video conferencing, and virtual reality, in addition to tools available for use between patients, such as the use of websites and mobile applications and wearable sensors.
Improving NHS staff experience to improve NHS staff performance:
This session focused upon the impact staff engagement and experience has on organisational performance, specifically patient experience. The session was aimed at commissioners and policy makers, and outlined why staff experience is so important. It also offered examples from an organisation that has improved staff experience to great effect.
Sally Pezaro (Centre for Technology Enabled Health Research (CTEHR), University of Coventry) and Rhian Bishop (Staff Engagement Lead at Sheffield Teaching Hospitals Foundation Trust).
Dr Geoff Waghorn is from the Queensland Center for Mental Health Research, Australia and spent 8 days based at Sainsbury Centre as part of an International Initiative for Mental Health Leadership event.
He presented an Australian perspective on IPS to a group of colleagues in London.
Originally uploaded on 28 May 2010.
Person-centred care and patient activationNuffield Trust
Richard Owen, NHS England, and Dr Natalie Armstrong of the University of Leicester present on evaluating Person Centred Care through Patient Activation Measure (PAM).
Exercise programs for people with dementia: What's the evidence?Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of exercise programs for people with dementia. Click here for access to the audio recording: https://youtu.be/jC8HhC2XFrE
Dorothy Forbes, Professor, Faculty of Nursing, University of Alberta, Edmonton led the session and presented findings from her latest Cochrane review:
Forbes, D., Forbes, S. C., Blake, C. M., Thiessen, E. J., & Forbes, S. (2015). Exercise programs for people with dementia. Cochrane Database of Systematic Reviews, 2015(4), CD006489.
As the population ages, the number of people suffering with dementia will also rise. Not only will this affect quality of life of people with dementia but will also increase the burden of family caregivers, community care, and residential care services. Exercise interventions have been identified as a potential way of reducing or delaying the progression of dementia and its symptoms. This review examines two questions: do exercise programs for older people with dementia improve cognition, activities of daily living (ADLs), challenging behaviour, depression, and mortality in older people with dementia? and; do exercise programs for older people with dementia have an indirect impact on family caregivers' burden, quality of life, and mortality?
CDV: Still a National Priority, by Huon Gray, National Clinical Director (Cardiac), NHS England and Consultant Cardiologist, University Hospitals of Southampton
Implementing a Pragmatic Trial of Physical Activity Coaching in COPDUCLA CTSI
"Lessons Learned with Implementing a Pragmatic Trial of Physical Activity Coaching in COPD"
Huong Q. Nguyen, PhD, RN
Research Scientist, Kaiser Permanente
Affiliate Associate Professor, University of Washington
A presentation of the Southern California Regional Dissemination, Implementation and Improvement Science Webinar Series.
Provided by the UCLA CTSI
Penny George™ Institute for Health and Healing: Meeting Patients Where They AreAllina Health
By Courtney Baechler, MD. A discussion about the Penny George Institute and its goal to empower patients using the mind-body-spirit approach to health, encouraging a philosophy of wellness at any stage of care. The Penny George Institute has become a national leader in holistic health care and is an important component of Allina Health efforts to achieve health care transformation through the Triple Aim.
The Broad Picture - recent developments in long-term condition managmentepicyclops
This lecture was given by Dr Aileen Keel, Deputy Chief Medical Officer for Scotland, to the North British Pain Association Spring Scientific Meeting on Friday 18th May, 2007 and forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
Reproduced with permission.
Multidisciplinary care is essential in the recovery of the oncological patien...Nata Chalanskaya
Jette Vibe-Petersen, MD, director of Copenhagen Center for Cancer and Health, presentation at the Second International Scientific and Practical Conference «Improving the quality of life of cancer patients through the development of cooperation between state, commercial and non-profit organizations». 2018-01-23, Minsk. Belarus
A customized, comprehensive approach that delivers strategic solutions to communities, physicians, hospitals & health systems. Each component builds the foundation for the next to create true physician alignment & integration.
Full Study: Performance Reviews Get a Failing GradeAdobe
We surveyed 1,500 U.S. office workers for their thoughts on performance reviews, and unsurprisingly, people aren't fans of them. What we did unearth though are interesting reactions and feelings about the process. Shift through the full report.
Curious about how we've ditched the reviews for the Check-In? More on that here (https://adobe.ly/2j5NLUe) with resources to employ the Check-In for your org here: http://www.adobe.com/check-in.html
Read about the amazing benefits of cumin for your health, fitness, and wellbeing. Cumin improves the quality of your life by multiple ways and the products is the 100 % safe for use in all body conditions as it is the raw and natural super food.
Want to know why homes are flying off the market in Princeton, NJ and the surrounding towns? Take a look at this grid. The inventory of available homes is down in every major market.
Austin Journal of Bioorganic & Organic Chemistry is a peer reviewed, open access journal publishes manuscripts in the following areas but not limited to structures, synthesis, kinetics, organic synthesis, physical organic chemistry, supramolecular chemistry and chemical biology.
Austin Journal of Bioorganic & Organic Chemistry accepts original research articles, review articles, commentaries, Letters, perspectives, and rapid communication on all the aspects of Bioorganic & Organic Chemistry.
TestingAR XI - Beyond the Basics - Planificación de Testing con Matriz ACCTestingAR Meetup
Usando un framework desarrollado en Google del que participó James Whittaker y que usa Testing Exploratorio Basado en riesgos, entenderemos porque puede ser que armar un plan no sirva, pero que la planificación es fundamental.
Que lo haya creado Google, ¿significa que es un framework de planificación infalible? ¡En lo absoluto! Me gusta pensar en sistemas perfectibles, en lugar de pensar en balas de plata.
Sin embargo, en ésta charla, me gustaría compartir junto a ustedes como con éste framework podemos darle estructura a la generación de ideas de pruebas, también, que podemos usarlo para promover la participación del equipo en la planificación de las mismas antes que se escriba una línea de código, encontrar gaps, o agujeros en la definición de un requerimiento, y por último, que es posible ampliar nuestra cobertura sin perder el foco sobre las prioridades.
Let's Talk Research Annual Conference - 24th-25th September 2014 (Carol Doyle)NHSNWRD
"Enhancing musculoskeletal research in primary care: engaging a community musculoskeletal physiotherapy service in research studies": Carol Doyle's presentation from the conference.
A brief introduction to what Keele's Stratified care for low back pain: Subgrouping and targeting treatment for low back pain in primary care (STarT Back).
The STarT Back approach uses a simple tool to match patients suggesting with back pain to treatment packages appropriate for them. This has been shown to decrease disability from back pain, reduce time off work, and save money by making better use of health resources.
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Dr Eileen Pepler, Academic, Researcher and Consultant in the Canadian Healthcare will discuss how NHS England work in chronic disease is being translated into a Canadian context.
7 Day Services webinar - Workforce and delivering 7 day servicesNHS England
This webinar explores how use of enhanced roles can help Trusts in the delivery of seven day services, and aims to help trusts understand the practical issues associated with developing enhanced roles and implementing these into their organisations. During this session you will hear about:
* Workforce planning and the delivery of 7 day Services. Health Education England will provide an update regarding the national picture and provide insight into innovative workforce solutions which will support the delivery of 7 Day Services
* Practical examples from colleagues in acute trusts, where new roles have been utilised in delivering the 4 priority clinical standards
Key speakers:
Kevin Moore - Head of Workforce Transformation, Health Education England
Miss Fiona Kew - Consultant Gynaecologist, Modernising the Workforce: Physician's Associates – Sheffield Teaching Hospital
Darren McGuiness - Endoscopy Manager Royal Liverpool & Broadgreen NHS Trust. Seven Day Services in Endoscopy
Nicky Taggart - General Manager, Radiology and Imaging, Royal Liverpool & Broadgreen NHS Trust. Seven day services in Radiology
National centre for sports and exercise medicine run through Sheffield teaching hospital to get Sheffield moving more and the most active city in the UK by 2020
Learn about chiropractic and how to choose a proper and qualified chiropractor quickly.
Visit http://www.chiropractorhunter.com for finding chiropractors near you!
Six principles for engaging people and communitiesJeremy Taylor
Slides presented at King's Fund on 1 November 2016. How to make real the vision in the Five Year Forward View of "a new relationship with patients and communities"? We know a lot about the "what" and the "who" of implementation. But the "how" is still a mess. What high impact actions would make a difference to driving this agenda? I offer some thoughts. These slides are not entirely self-explanatory without the accompanying talk. Please feel free to get in touch to explore further!
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
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!
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.
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
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.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Back Pain care and NHS Community Interface Clinics: Towards a better model
1. Back Pain and the integrated community MSK Hub:
Towards a better model
Dr. Richard Collins
Sport & Musculoskeletal Physician
NHS Circle Bedfordshire MSK & Blackberry Clinic Group
2. Aims
• Historical models of Back Pain care and the evolution of MSK services
• Current status of Back Pain care within community MSK services
• Improved model of Back Pain care
• The place of SEM within this
3. Back Pain – the facts
• Very common – 33% of adults/year
• Mainly affects working age population 40-60 y/o
But……
• Major cause of disability globally
• Costs health services and national economies £££
4. Back Pain – the failures
• Rarely serious or sinister
• Very good evidence for functional restoration if given:
• Advice & reassurance
• Tailored activity & exercise
• Supported self-care
So what went wrong?
18. Strengths
• Focus for better practice
• Rapid assessment
• Improved pathways with local stakeholder engagement
• Early MDT working with shared up-skilling
Weaknesses
• Few services nationally & small scale locally
• Little improved access to other MSK services
• Hamstrung by poorer practice in other services
• Delays in onward referrals
19. However…the case was made:
• ⬇ Referrals into secondary care
• ⬇ MSK spend
• ⬆ Patient satisfaction
• No real focus on Pain Care though
2011
20. Upscaling
• More CATS commissioned or re-tendered
• Larger budgets linked to quality outcomes
• Need for capacity to bid for and run such services:
• Large NHS Partnerships
• Circle MSK
• Virgin Care
• Care UK
• Connect Health
• 2012 Health and Social Care Bill - ends PCTs & PBC
21. How do we clinically staff these larger services?
Facts:
• 2006 SEM awarded Specialty status – Some SEM GPwSIs moved away
• Reduced availability of suitably skilled MSK GPwSIs
• Some of the ‘raw’ clinical functions of the GPwSI were being acquired by ESPs
Model adopted:
• Increased utilisation of up-skilled ESPs in favour of the older ‘GPwSI-Model’
• Bedford MSK:
• 2 FTE ESP : 1 FTE SEM (older service)
• 10 FTE ESP : 1 FTE SEM (up-scaled)
22. Consultant
• 3rd view
GPwSI
• 2nd view
Patient
ESP – CATS
• Physio
• OT
• Podiatry
• Diagnostics
• Injections
Surgeons
Rheum
Pain
GP
CATS 2012+ (post SEM as a Specialty)
23. How are these services doing?
Particularly with reference to Back Pain
24. BMJ Open 2016;6:e011735.
doi:10.1136/bmjopen-2016-
011735
• 3500 patients seen by CATS in North Staffs annually (1125 would allow well powered study)
• 2166 CATS attenders consented to be followed up by questionnaire at 6 & 12 months
• Primary outcome was consultation in primary care with the same musculoskeletal problem within 12 months
• Secondary outcome measures were:
• Consultation at the CATS with the same musculoskeletal problem within 12 months
• Physical function and pain (Short Form-36)
• Anxiety and depression (Hospital Anxiety and Depression Scale)
• Time off work
• Healthcare costs
• QALYs
25. • Over 12 months, 507 (38%) re-consulted for the same problem in primary care and 345 (26%) at the CATS
• Primary care re-consultation in:
• The first 3 months (57% of re-consulters) was associated with baseline pain interference and spinal
pain
• After 3–6 months with baseline assessment by a Hospital Specialist
• Small mean improvements were seen in physical function and body pain at 6 months
• Poor physical function at 6 months was associated with obesity, chronic pain and poor baseline physical
function
• Mean 6-month cost and QALYs per patient were £422.40 and 0.257 respectively
Results
26.
27. “While most patients are appropriate for a
‘one-stop shop’ model, those with troublesome,
disabling pain and spinal pain commonly re-consult
and have ongoing problems. Services should be
configured to identify and address such clinical
complexity.”
28. Summary
62% didn’t re-consult in Primary Care
ESP staffed model fairly effective
How can these services evolve?
What new models are emerging?
Where should the SEM clinician sit in this?
29. New Model of Back Pain Care – Core Concept
Supported
Self-Care
Evidence
Based
Treatment
Information
Screening
Lifestyle
Modification
Navigation to
Resources
HCP
Patient
‘MECC’
I chose, as my talk, a fairly wide ranging topic (as I don’t like to be too constrained!) but to focus this into some key aims I intend to explore….
Read points
Next slide:
So let’s get going and start with a summary snap shot of Back Pain..
Read slide
Next slide: ‘the failures’
Read slide
Next slide:
To answer that we need to look at the history of Back Pain care….
Don’t read slide – allow to sink in
Next slide: although Back Pain is as old as humanity itself, there was a definite shift in thinking in the late Victorian era
This was the birth of structuralism
The discovery of X-Rays allowed early pioneers to image the spine and detect structural changes.
The assumption was that all Pain could be explained by visibly altered structures.
This was accompanied by popular theories centered around:
Disc fragility
Vertebral deformity & instability
These theories naturally fed into various management strategies.
When I was a med-student in the 90s it was fairly common to see the above…
Note the corset on the outside!
We may laugh at these images but…
….as a Doctor in 2017, it’s fairly common to see the above too….
There may have been a move away from some structural models (although much remains) but the newer theories aren’t necessarily more accurate.
Next slide: What part did the health system play in propogating these models?
Read through slide
Next slide:
This system funnels patients far too easily into the….(Vortex of Chronicity)
Read through slide
Next slide: A good resource to explore some of the underlying tensions that suck people into this vortex is the….
…Physio matters Podcast (S. 39)
Give overview
Next slide: So this is how the deck was stacked against patients (and continues to be stacked against them in many areas).
But there was a sea change occurring…
…in the 1990s with a number of individuals and organisations coming together in the birth of Evidence Based Medicine in the UK
These were a few of the key levers for change:
Gordon Waddell
BMJ Clinical Evidence
NICE
Finally, cherished theories and behaviours were being put under the critical spot light
Next slide: This new wave of critical thinking was pump primed by unprecedented investment in the NHS during the early 2000s
Explain slide
I make no comment on the long term financial wisdom or planning for this investment but there is no denying it had an impact
Next slide: This impact found it’s way into new ideas for MSK commissioning
Practice Based Commissioning
MSK Services Framework
….was taken up by some entrepreneurial GPs with an interest in SEM/MSK
PGDip SEM
MSK Diplomas
working in partnership with local physio departments
Financially supported by PCTs!
This produced a new model of community MSK care which harnessed more primary care expertise
Talk through slide
Next slide: Looking at this model…
What were the strengths and weaknesses?
Read through slide
The main detractors were the Acute Trusts (for various reasons) but ultimately….
The case was largely made and central policy makers started to push for wider mobilisation
This document by the FSEM from 2011 highlights some of the CATS in which SEM Doctors were involved
However outcomes from Chronic Pain weren’t really part of the original scope
Next slide: this led to….(upscaling)
Read through slide
Next slide: These new services required staffing…
The shift to an ESP led model was partly driven by workforce necessity, partly by perceived cost savings and partly by a desire within the Physio Profession to grow its scope and role
Next slide: The new structure looked like this…
Talk through slide
Next slide: As with the GPwSI led model before it, these new services are being actively evaluated and must demonstrate value & effectiveness, so….(how are they doing?)
Do we have any emerging data on the impact of these newer CATS, particularly around Back Pain care?
Next slide: In 2016, BMJ Open published a study online….
….which represents the largest study to date of the outcomes for patients passing through a new CATS
Read through slide
What were the results?
Read through slide
The headline data table within the paper….
….shows the significant determiners of re-referral to Primary Care (a surrogate marker of ‘failed care’)
Point out Back Pain
The headline conclusion by the authors was….
Next slide: So what can we take from this emerging data?
Read through slide
Clearly there’s room for improvement (as ever!) and some CATS are pushing into the next level.
Next slide: What should better Back Pain (or any Chronic Pain inc. OA) look like?
It’s always easy to talk about ‘patient centered care’ but what does this actually look like?
- One approach is to see each and every encounter that the patient has with a Health Care Provider (HCP)
- as an opportunity to cover (and recover) certain key areas with the HCP acting as:
Care giver
Facilitator
Motivator
I’ll cover these areas in more detail. The concept I want to communicate is that of structured ’MECC’
Further more, each of these encounters forms part of a wider network of care.
This is why a structured approach is needed. A ‘script’ (if you like) from which everyone must speak, so as to reinforce correct messages and eradicate wrong ones.
This also points to the need for some sort of ‘system control’ to ensure these encounters aren’t silo events
Let’s drill into this more and look:
At how each of these areas works out in the context of Back Pain care
What sort of role an SEM-MSK trained Professional might play within it
To explore the role that SEM-MSK has to play requires us to consider what skills that such a clinician uniquely brings to the system.
If we are to argue for a wider role within the CATS then we need to articulate our competencies.
I considered what, in my time as a MSK Physician within Bedfordshire, I brought to the party and came up with these 5 key skills
Explain Skills
Linking these areas and skills together we can start with….
Every HCP that sees a patient with Back Pain must be competent within their scope of practice, to assess patients for:
Serious pathology
Medical complexity
Psychosocial interplay
However, determining this can be tricky and ‘hard rules’ can lead to over interpretation:
History of Cancer?
Urinary symptoms?
Night Pain?
What value does a SEM clinicians, particularly a Doctor add here?
This is where a Doctor, appropriately trained and accredited by the GMC, has the:
Knowledge
Experience
Skills
To filter the finer detail, guide and education other members of the MDT and hold senior responsibility for discharge
The buck stops with the one who has the validity to carry that decision
Next slide: Once we’ve screened the patient we move on to treatment this is where…..
NICE has recently done a LOT of heavy lifting for us with treatment guidance that we can broadly divide into 3 levels…..
Next slide: (core level)
This are the basic level of care that every patient with Back Pain, or OA Pain (or any form of ongoing pain!) should receive
Read through slide
CBT and MDT working is an essential part of higher level care and may be necessary with a number of patients
We don’t have time to describe how these services work, but I would recommend studying these two services as they are award winning and are yielding good results (click)
Finally, there is the highest level of care which only a very few patients should need to access.
I’ll discuss these in a bit but it’s important to see that they are very much part of the evidence based ‘whole’.
So, coming back to core treatments….
We can divide these roughly into:
Information & advice
Tailored activity prescription
Let’s look at the first of this…
…..Information and Knowledge
What should this look like in Back Pain Care?
Well, in many ways, it’s the most foundational aspect of Back Pain care
As we saw, there are a lot of popular myths around Back Pain so the provision of positive messaging:
Early
Repeatedly
By everyone the patient sees
Will help start to correct these myths
Next slide: in support of this messaging there is a deluge of online resources…
Click through examples
We really don’t need to re-invent the wheel here. The main obstacle is getting clinicians and patients to realise they are there and access them!
What role can the SEM clinician play in support of CATS and their Back Pain care pathways?
Go through slide
Next slide: Now let’s look at the 2nd arm of the core treatments….
Namely exercise medicine….
Next slide: PHE One You
PHE initiative is aligned with this aspect of healthcare
We know which activities will contribute to rehab and wellbeing (as well as prevention!)
We also know that encouraging the patient towards this approach involves…
Stages of change….
Pre-activity participation screening….
The SMART methodology of goal setting….
….and the correct prescription of exercise
Next slide: SEM value
What value does the SEM trained clinician add here?
This is the role, par excellence, of the SEM clinician.
It is within the syllabus and competency set for SEM
A personal testimony is my own journey of discovery, not so much into the importance but into the mechanism to provide such care
Coming to the 3rd tier of NICE validated Back Pain care…..
Namely….(Spinal Interventions)
….Spinal Interventions…..
Talk through slide
What value does a SEM-MSK add here?
Is this an area of interventional practice that SEM-MSK Doctors could (or should!) be involved in?
Certainly not as a core competency but….
Read through slide
Next slide: So, to summarise…(click)