A talk I gave in Al-Zaem Al-Azhary university on Thursday, 15/5/2014
Outline:
What do we mean by breaking bad news (BBN)?
Which news is bad? really bad? Like really, really bad !
Why should we care about BBN?
Ethical
Professional
Legal
BBN as part of the Communication Cycle/Pathway
Practical approaches to BBN:
SPIKES
ABCDE
BREAKS
The Do Not's in BBN
Last semester's lecture on truth telling and breaking bad news to patients. It was presented by Dr Ghaiath Hussein for Farabi Medical College medical students.
A talk I gave in Al-Zaem Al-Azhary university on Thursday, 15/5/2014
Outline:
What do we mean by breaking bad news (BBN)?
Which news is bad? really bad? Like really, really bad !
Why should we care about BBN?
Ethical
Professional
Legal
BBN as part of the Communication Cycle/Pathway
Practical approaches to BBN:
SPIKES
ABCDE
BREAKS
The Do Not's in BBN
Last semester's lecture on truth telling and breaking bad news to patients. It was presented by Dr Ghaiath Hussein for Farabi Medical College medical students.
BBN - Breaking Bad News is difficult task for Junior doctors in India as it was not in the Curriculum unlike Western countries. So this slide will give you the Facts / Methods with Description of one method & Key points.
This presentation deals with principles of basic communication skills, importance of it for Doctors and medical students. It also addresses the basic elements Doctor patient communication skills, kalmazoo Consensus working model for Clinical interview, 5 A model guidelines for the behaviour changes.
Doctor patient communication @Mustafa Kemal UniversityDainius Jakučionis
Lecture I gave at Mustafa Kemal University in Turkey, Antakya. Main topic is about doctor patient communication, which could help to increase health outcomes. Important subject about patient-centered communication and approach.
Lecture 14 & 15 truth telling and breaking bad news (BBN)Dr Ghaiath Hussein
A lecture on truth telling & breaking bad news (BBN) delivered to Alfarabi Medical College undergraduate medical students in the week starting 04.12.2016
There is an evident deficiency on how best to break bad news in medicine. This is an essential communication skill that our patients expect of us. It is an essential requisite of Good Medical Practice. This presentation is part of a course held at Al Hammadi Hospital, Suwaidi, Riyadh, KSA on Breaking Bad News. 2017
This presentation mainly explains about the type of patients that are encountered in day to day practice as well as how each of them should be handled to improve the communication between a doctor and the patient.
IBD is very important topic even though the disease is prevalent in western countries. This PPT covers both the diseases side by side for comparing at same time and having an idea about them all together.
BBN - Breaking Bad News is difficult task for Junior doctors in India as it was not in the Curriculum unlike Western countries. So this slide will give you the Facts / Methods with Description of one method & Key points.
This presentation deals with principles of basic communication skills, importance of it for Doctors and medical students. It also addresses the basic elements Doctor patient communication skills, kalmazoo Consensus working model for Clinical interview, 5 A model guidelines for the behaviour changes.
Doctor patient communication @Mustafa Kemal UniversityDainius Jakučionis
Lecture I gave at Mustafa Kemal University in Turkey, Antakya. Main topic is about doctor patient communication, which could help to increase health outcomes. Important subject about patient-centered communication and approach.
Lecture 14 & 15 truth telling and breaking bad news (BBN)Dr Ghaiath Hussein
A lecture on truth telling & breaking bad news (BBN) delivered to Alfarabi Medical College undergraduate medical students in the week starting 04.12.2016
There is an evident deficiency on how best to break bad news in medicine. This is an essential communication skill that our patients expect of us. It is an essential requisite of Good Medical Practice. This presentation is part of a course held at Al Hammadi Hospital, Suwaidi, Riyadh, KSA on Breaking Bad News. 2017
This presentation mainly explains about the type of patients that are encountered in day to day practice as well as how each of them should be handled to improve the communication between a doctor and the patient.
IBD is very important topic even though the disease is prevalent in western countries. This PPT covers both the diseases side by side for comparing at same time and having an idea about them all together.
Breaking bad news strategies (A case study on Mattel recall)Hoang Minh Chau
Breaking bad news strategies: A case study on Mattel recall.
Done by Hoang Minh Chau, Mike Mirucki, Shahazeen Shaheer, Flavio Gomez & Mohammed Shieraz.
University of Bradford @ MDIS, Singapore.
October 2008.
Lecture 14 & 15 truth telling & breaking bad news (BBN)Dr Ghaiath Hussein
Truth telling & breaking bad news (BBN) in the practice of medicine. The ethical principles and the practical skills needed for breaking unfavourable news, with emphsis on the Islamic aspects and the practice in Saudi Arabia
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
Title: Sense of Taste
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 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.
Key Topics:
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
3. “Nothing travels faster than the speed of light with the
possible exception of bad news, which obeys its own special
laws‘’
……….. Douglas Adams
4. What is a bad news?
“……… any information which adversely and seriously affects an
individual’s view of his or her future. ‘’
……………….. Buckman, 1992.
5. Examples:
Death of a patient
Life threatening conditions, e.g.: MI, Carcinoma
Any condition where emergency surgery needed, e.g.: Acute gangrenous
intestinal obstruction, rupture of any aneurismal artery.
Chronic illness, e.g.: chronic pancreatitis
Failure of a surgery
6. To Whom BBN can be given?
To the patient
To the
parents of a
patient
To the legal
guardian
7. What patient/patient party expect:
For themselves:
• more time to talk
• show feelings
From the doctors:
• more information, caring, hopefulness, confidence
• a familial face
8. What are the Challenges in BBN?
Lack of:
Guidelines
Training
Experience
Good role models
Concerns of:
The provider
The patient & family
12. Case Discussion:
Abdullah is a patient of yours who comes to see you one day
with his wife Sharefa. Sharefa is also a patient of yours who
was admitted to hospital for investigations for liver. The results
of the liver biopsy showed a well differentiated hepatocellular
carcinoma. This result had been disclosed to Abdullah only. He
has come to you today asking for your assistance in telling his
wife the results of her investigations.
How would you handle this situation?
13. Methods of BBN:
Rabow and Mc phee - ABCDE approach
Baile and Buckman - SPIKES approach
SAAIQ emergency approach – Pakistan
BREAKS approach – IJPC
SAD NEWS approach - Canada
14. SPIKES protocol
S – Setting
P – Patient’s perception
I – Invitation
K – Knowledge
E – Empathy
S – Summary
15. SPIKES
Settings and listening skills:
(1) Where to break news.
eg: A quiet room preferably not during ward round.
(2) By appointment.
eg: After ward round, at 3p.m.
(3) Ask whether prefers to have relatives.
(4) Physical context of interview.
eg: Sitting down, body language, eye contact
(5) Introduce your self and ascertain how others are related to the patient.
(6) Listening skills – open questions to start, do not interrupt.
16.
17. SPIKES
Patient’s perception:
(1) Ask what he already knows about the medical condition or what he suspects.
(2) Listen to level of comprehensions.
(3) Accept denial but do not confront at this stage.
18. SPIKES
Invitation to give information:
(1) Ask patient if s/he wishes to know the details of the medical condition and/or
treatment.
(2) Accept patient’s right not to know.
(3) Offer to answer questions later if s/he wishes.
19. SPIKES
Knowledge:
(1) Use language intelligible to patient.
(2) Give to patient’s level – Consider educational level, socio-cultural background, current
emotional state
(3) In small chunks
(4) Check whether patient understood what you said.
(5) Respond to patients reactions as they occur.
(6) Give any positive aspects first.
eg: Cancer has not spread to lymph nodes, highly responsive to therapy, treatment available
locally etc.
(7) Give facts accurately about treatment options, prognosis, costs etc.
20. SPIKES
Explore emotions/Empathy:
(1) Identify emotion.
(2) Identify cause/source of emotion.
(3) Respond in a way that you have recognized connection between 1 and 2.
(4) In empathetic response not necessary for you to feel same emotion or agree
to patient’s view point.
21.
22. SPIKES
Strategy and summary:
(1) Close the interview.
(2) Ask whether they want to clarify something else.
(3) Offer agenda for the next meeting.
eg: I will speak to you again when we have the opinion of cancer specialist.
25. Emotional responses to a bad news:
Denial
Despair
Anger
Bargaining
Depression
Acceptance
26. How to overcome the Emotional responses:
1. If patient begins to cry
(a) Allow sometime to cry.
(b) Could say, “I can see you are very upset”
(c) Could touch the patient appropriately.
(d) After a few moments you should continue talking even if patient
continue to cry.
27. 2. If patient becomes angry
(a) Defensive or irritation with patient are unhelpful.
(b) Acknowledge patient’s position and avoid talking about it.
28. 3. If the patient refuses to accept the diagnosis
(a) Explore reasons for patient’s denial.
(b) Do not be combative.
(c) Appreciate that there is an information gap and try to educate the
patient.
(d) Check that patient has a clear understanding of the problem.
(e) Empathize with patient.
(f) Get family members involved if appropriate.
(g) Give time to adjust to new information.
29. What not to do…….
1. Jargon and technical language
2. Euphemisms
3. Evasion
4. Conflicting informations
5. “everything is going to be fine’’
30.
31. The Task of Breaking Bad News:
“If we do it badly, the patients or family members
may never forgive us; if we do it well, they may
never forget us.”
……………(Buckman, 1992)