The document discusses primary care and its role in an effective healthcare system. It outlines that primary care provides integrated, accessible care that focuses on prevention, chronic disease management, and care coordination. This results in better health outcomes and lower costs compared to healthcare systems without a strong primary care foundation. The principles of good primary care are described, including access, continuity, comprehensive team-based care, community orientation, and evidence-based practice. The patient-centered medical home model aims to incorporate these primary care principles.
Patient Centered Medical home talk at WVUPaul Grundy
To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today?
All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care)
3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
Palliative care white paper for RegenceErin Codazzi
Writing this white paper for Regence was a humbling experience, connecting directly with the doctors, nurses, nonprofits and industry influencers dedicated to elevating the awareness for palliative care. It's an important topic and one every one of us should start talking about, as daunting as it may be. Grateful to the team at Regence for letting me dig deep on this one. Read the press release: http://news.regence.com/releases/regence-blueshield-releases-findings-on-the-importance-of-a-holistic-approach-to-palliative-care
Patient Centered Medical home talk at WVUPaul Grundy
To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today?
All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care)
3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
Palliative care white paper for RegenceErin Codazzi
Writing this white paper for Regence was a humbling experience, connecting directly with the doctors, nurses, nonprofits and industry influencers dedicated to elevating the awareness for palliative care. It's an important topic and one every one of us should start talking about, as daunting as it may be. Grateful to the team at Regence for letting me dig deep on this one. Read the press release: http://news.regence.com/releases/regence-blueshield-releases-findings-on-the-importance-of-a-holistic-approach-to-palliative-care
Health Economics In Clinical Trials - Pubricapubrica101
Pubrica specializes in Health Economics in Clinical Trials, offering comprehensive support to ensure the economic aspects of your trial are effectively managed. From cost-effectiveness analysis to budgeting and reimbursement strategies, we help you optimize the economic outcomes of your trial. With Pubrica's expertise, you can navigate the complex landscape of health economics in clinical trials with confidence.
For more information, please refer to our service- https://pubrica.com/blog/research/health-economics-in-clinical-trials/ & Order now - https://pubrica.com/order-now/
Contact Our UK Medical Author’s;
Our email id – sales@pubrica.com
Contact No. +91 9884350006
The mission of the program is to sensitize the elderly about how they could get access to their medicine. The primary goal is to ensure that older adults are living well by getting access to their medicines when they want them depending on their condition
Two major trends dominate healthcare in the United States. Chronic Illness is on the rise, meaning American's are having more difficulty than ever attaining mental and physical wellness. Providers are facing an unfriendly business of medicine environment requiring them to solve complex management problems while maintaining a high level of clinical excellence. The payment goal posts have moved requiring providers to understand and measure the value they provide to patients, not just the services they complete or perform. As providers struggle to understand the meaning of value in medicine and what outcomes qualify, consumers continually turn to alternative medicine and wellness initiatives to maintain their health.
Improving the resilience of vulnerable populationsArete-Zoe, LLC
Vulnerable populations in terms of health care disparities include the economically disadvantaged and uninsured, the elderly, and people with chronic health conditions. Low-education status compounds the problem and leads to poorer outcomes than in people with the same disease but higher educational status. Significant disparities include namely risk factors relating to morbidity and mortality and access to healthcare. In the domain of physical health, the worst affected are people with chronic health conditions such as respiratory diseases and metabolic syndrome, including hyperlipidemia and diabetes, and resulting in heart diseases and hypertension. Vulnerable populations often experience accumulation of problems that are multiplied by poor health, yet the medical and non-medical needs of these populations are still underestimated. A significant number of vulnerable people with at least one chronic condition skip purchasing prescription drugs because of the costs involved. The most relevant risk factors that result in poor access to health care include low income and uninsured status, in combination with a lack of regular care. Chronic conditions such as dyslipidemia may not be particularly apparent now, yet represent a high risk of future disability (“Vulnerable Populations: Who Are They?”, 2006).
March 2001I N S T I T U T E O F M E D I C I N E Shap.docxwkyra78
March 2001
I N S T I T U T E O F M E D I C I N E
Shaping the Future for Health
CROSSING THE QUALITY CHASM:
A NEW HEALTH SYSTEM FOR THE 21ST CENTURY
The U.S. health care delivery system does not provide consistent, high-quality medical care to all people. Americans should be able to count on receiving care that meets their needs and is based on the best scien
tific knowledge--yet there is strong evidence that this frequently is not the
case. Health care harms patients too frequently and routinely fails to deliver
its potential benefits. Indeed, between the health care that we now have and
the health care that we could have lies not just a gap, but a chasm.
A number of factors have combined to create this chasm. Medical sci
ence and technology have advanced at an unprecedented rate during the past
half-century. In tandem has come growing complexity of health care, which
today is characterized by more to know, more to do, more to manage, more to
watch, and more people involved than ever before. Faced with such rapid
changes, the nation’s health care delivery system has fallen far short in its
ability to translate knowledge into practice and to apply new technology
safely and appropriately. And if the system cannot consistently deliver to-
day’s science and technology, it is even less prepared to respond to the ex
traordinary advances that surely will emerge during the coming decades.
The public’s health care needs have changed as well. Americans are
living longer, due at least in part to advances in medical science and techno l
ogy, and with this aging population comes an increase in the incidence and
prevalence of chronic conditions. Such conditions, including heart disease,
diabetes, and asthma, are now the leading cause of illness, disability, and
death. But today’s health system remains overly devoted to dealing with
acute, episodic care needs. There is a dearth of clinical programs with the
multidisciplinary infrastructure required to provide the full complement of
services needed by people with common chronic conditions.
The health care delivery system also is poorly organized to meet the
challenges at hand. The delivery of care often is overly complex and uncoor
dinated, requiring steps and patient “handoffs” that slow down care and de-
crease rather than improve safety. These cumbersome processes waste re-
sources; leave unaccountable voids in coverage; lead to loss of information;
Faced with such
rapid changes, the
nation’s health care
delivery system has
fallen far short in its
ability to translate
knowledge into
practice and to ap
ply new technology
safely and appro
priately.
CARE SYSTEM
Supportive
payment and
regulatory en
vironment
Organizations
that facilitate
the work of
patient-
centered teams
High perform
ing patient-
centered teams
Outcomes:
• Safe
• Effective
• Efficient
• Personalized
• Timely
• Equitable
REDESIGN IMPERATIVES: SIX CHALLENGES
• Reeng.
Leanne Wells, Chief Executive Officer, Consumers Health Forum of Australia, gave the Ian Webster Health for All Oration to the annual forum of the Centre for Primary Health Care and Equity on 13 August 2015.
A health system, also sometimes referred to as health care system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.
Health systems are responsible for delivering services that improve, maintain or restore the health of individuals and their communities.
Common elements in virtually all health systems are primary healthcare and public health measures.
The Rise of Chronic Illness & Healthcare's Failed Value PropositionNick Gaudiosi
Using my personal health journey as a backdrop, this presentation looks at the healthcare economy and the intersection of medicine and wellness. I am not a clinician, but a healthcare marketer and executive with insights about how to build a category leading brand in the health & wellness economy. Building a leading health and wellness brand has a lot to do with authenticity. The next few slides are about my personal journey – and my authenticity in the health and wellness space – as a patient, consumer, caregiver, executive and innovator. Part I takes a brief look at the Rise of Chronic Illness and Healthcare's Failed Value Proposition. In Parts II. - IV, we explore how American's have extreme difficulty attaining wellness and why the cards are stacked against healthcare providers. Then we look at the business of wellness and the patient of the future.
Health Economics In Clinical Trials - Pubricapubrica101
Pubrica specializes in Health Economics in Clinical Trials, offering comprehensive support to ensure the economic aspects of your trial are effectively managed. From cost-effectiveness analysis to budgeting and reimbursement strategies, we help you optimize the economic outcomes of your trial. With Pubrica's expertise, you can navigate the complex landscape of health economics in clinical trials with confidence.
For more information, please refer to our service- https://pubrica.com/blog/research/health-economics-in-clinical-trials/ & Order now - https://pubrica.com/order-now/
Contact Our UK Medical Author’s;
Our email id – sales@pubrica.com
Contact No. +91 9884350006
The mission of the program is to sensitize the elderly about how they could get access to their medicine. The primary goal is to ensure that older adults are living well by getting access to their medicines when they want them depending on their condition
Two major trends dominate healthcare in the United States. Chronic Illness is on the rise, meaning American's are having more difficulty than ever attaining mental and physical wellness. Providers are facing an unfriendly business of medicine environment requiring them to solve complex management problems while maintaining a high level of clinical excellence. The payment goal posts have moved requiring providers to understand and measure the value they provide to patients, not just the services they complete or perform. As providers struggle to understand the meaning of value in medicine and what outcomes qualify, consumers continually turn to alternative medicine and wellness initiatives to maintain their health.
Improving the resilience of vulnerable populationsArete-Zoe, LLC
Vulnerable populations in terms of health care disparities include the economically disadvantaged and uninsured, the elderly, and people with chronic health conditions. Low-education status compounds the problem and leads to poorer outcomes than in people with the same disease but higher educational status. Significant disparities include namely risk factors relating to morbidity and mortality and access to healthcare. In the domain of physical health, the worst affected are people with chronic health conditions such as respiratory diseases and metabolic syndrome, including hyperlipidemia and diabetes, and resulting in heart diseases and hypertension. Vulnerable populations often experience accumulation of problems that are multiplied by poor health, yet the medical and non-medical needs of these populations are still underestimated. A significant number of vulnerable people with at least one chronic condition skip purchasing prescription drugs because of the costs involved. The most relevant risk factors that result in poor access to health care include low income and uninsured status, in combination with a lack of regular care. Chronic conditions such as dyslipidemia may not be particularly apparent now, yet represent a high risk of future disability (“Vulnerable Populations: Who Are They?”, 2006).
March 2001I N S T I T U T E O F M E D I C I N E Shap.docxwkyra78
March 2001
I N S T I T U T E O F M E D I C I N E
Shaping the Future for Health
CROSSING THE QUALITY CHASM:
A NEW HEALTH SYSTEM FOR THE 21ST CENTURY
The U.S. health care delivery system does not provide consistent, high-quality medical care to all people. Americans should be able to count on receiving care that meets their needs and is based on the best scien
tific knowledge--yet there is strong evidence that this frequently is not the
case. Health care harms patients too frequently and routinely fails to deliver
its potential benefits. Indeed, between the health care that we now have and
the health care that we could have lies not just a gap, but a chasm.
A number of factors have combined to create this chasm. Medical sci
ence and technology have advanced at an unprecedented rate during the past
half-century. In tandem has come growing complexity of health care, which
today is characterized by more to know, more to do, more to manage, more to
watch, and more people involved than ever before. Faced with such rapid
changes, the nation’s health care delivery system has fallen far short in its
ability to translate knowledge into practice and to apply new technology
safely and appropriately. And if the system cannot consistently deliver to-
day’s science and technology, it is even less prepared to respond to the ex
traordinary advances that surely will emerge during the coming decades.
The public’s health care needs have changed as well. Americans are
living longer, due at least in part to advances in medical science and techno l
ogy, and with this aging population comes an increase in the incidence and
prevalence of chronic conditions. Such conditions, including heart disease,
diabetes, and asthma, are now the leading cause of illness, disability, and
death. But today’s health system remains overly devoted to dealing with
acute, episodic care needs. There is a dearth of clinical programs with the
multidisciplinary infrastructure required to provide the full complement of
services needed by people with common chronic conditions.
The health care delivery system also is poorly organized to meet the
challenges at hand. The delivery of care often is overly complex and uncoor
dinated, requiring steps and patient “handoffs” that slow down care and de-
crease rather than improve safety. These cumbersome processes waste re-
sources; leave unaccountable voids in coverage; lead to loss of information;
Faced with such
rapid changes, the
nation’s health care
delivery system has
fallen far short in its
ability to translate
knowledge into
practice and to ap
ply new technology
safely and appro
priately.
CARE SYSTEM
Supportive
payment and
regulatory en
vironment
Organizations
that facilitate
the work of
patient-
centered teams
High perform
ing patient-
centered teams
Outcomes:
• Safe
• Effective
• Efficient
• Personalized
• Timely
• Equitable
REDESIGN IMPERATIVES: SIX CHALLENGES
• Reeng.
Leanne Wells, Chief Executive Officer, Consumers Health Forum of Australia, gave the Ian Webster Health for All Oration to the annual forum of the Centre for Primary Health Care and Equity on 13 August 2015.
A health system, also sometimes referred to as health care system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.
Health systems are responsible for delivering services that improve, maintain or restore the health of individuals and their communities.
Common elements in virtually all health systems are primary healthcare and public health measures.
The Rise of Chronic Illness & Healthcare's Failed Value PropositionNick Gaudiosi
Using my personal health journey as a backdrop, this presentation looks at the healthcare economy and the intersection of medicine and wellness. I am not a clinician, but a healthcare marketer and executive with insights about how to build a category leading brand in the health & wellness economy. Building a leading health and wellness brand has a lot to do with authenticity. The next few slides are about my personal journey – and my authenticity in the health and wellness space – as a patient, consumer, caregiver, executive and innovator. Part I takes a brief look at the Rise of Chronic Illness and Healthcare's Failed Value Proposition. In Parts II. - IV, we explore how American's have extreme difficulty attaining wellness and why the cards are stacked against healthcare providers. Then we look at the business of wellness and the patient of the future.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
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.
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
Follow us on: Pinterest
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
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
CHAPTER 1 family medicine.pptx
1. CHAPTER 1: PRIMARY CARE AND THE
EVOLVING US HEALTH CARE SYSTEM.
FAMILY MEDICINE 1
2. CLINICAL OBJECTIVES
• CLINICAL OBJECTIVES
• 1. To present evidence supporting the role of primary care in an ettective health
care system.
• 2. To describe the principles of good primary care.
• 3. To describe how primary care is evolving to provide higher quality care, and
the innovations within healthcare that are fostering this evolution.
3. US HEALTH CARE HIGH COST AND MIXED RESULTS
• Several reports have compared US health care with that of other developed countries.
• Among the points that can be made about these comparisons are the following:
• US health care is expensive, consuming 16% of our gross domestic product. Switzerland,
which has the second most expensive health care system in the world, spends 61% as much
as we do per capital.
• In spite of the money we spend, the United States lags behind every one of these comparison
nations except Mexico in the key health care outcome indicators of life expectancy and infant
mortality.
• Our increased health care costs are not due to having too many doctors or using hospitals
too much. The United States is in the middle of the pack in both measures of health care
resources; in fact, our hospital utilization is less than that of Germany, France, Switzerland,
and the United Kingdom.
• One contributing factor to the high cost of US medicine appears to be overemphasis on
technology, and the potential for its use to be influenced by financial interests. Compared
with most other industrialized nations, the US excels in performance of computerized
tomography scans,magnetic resonance imaging studies e.t.c.
4. • One contributing factor to the high cost of US medicine appears to be
overemphasis on technology, and the potential for its use to be influenced by
financial interests. Compared with most other industrialized nations, the US
excels in performance of computerized tomography scans , magnetic resonance
imaging studies e.t.c.
• Another contributing factor appears to be the fragmentation and administrative
complexity and resultant inefficiencies of the US health care system, with little
continuity or coordination of care, which has been implicated not only in higher
costs of care but also in the high frequency of medical errors.
5. • In a thought-provoking essay from 2009, Atul Gawande attempted to examine
within the United States for factors impacting health care prices.
• He accomplished this by contrasting two counties in Texas that were close by and
had comparable demographics and health results but radically varied per capita
health care prices.
• He came to the conclusion that the main factor influencing health care costs was
physician behavior.
• He came to the conclusion that "the most expensive piece of medical equipment
is a doctor's pen," and that physicians are crucial in deciding both health
outcomes and health costs.
6. • But, physicians do not function in a vacuum, and the incentives and disincentives
of the system in which they operate have a significant impact on their behaviour.
• The US healthcare system has undergone a thorough review as a result of these
causes, which over the past ten years have also set in motion developments that
are altering and will continue to alter how medicine is practiced in the future.
• The Affordable Care ("health care reform") Act of 2010 included some of these
forces, but many more are currently being sponsored by businesses, governments,
or healthcare organizations.
• Yet, given how quickly the health care system is changing, it is more important
than ever for today's students and professionals to become knowledgeable about,
involved in, and leaders of the changing health system.
7. ROLE OF PRIMARY CARE IN A WELL- FUNCTIONING HEALTH CARE
SYSTEM
• The most economical health care systems in the world depend heavily on primary care
physicians. In the United States, this is also accurate.
• How does a greater emphasis on primary care lead to better, more cost-effective overall
health care? When patients have a primary care physician as the regular source of care:
• Care is integrated, personalized, and prioritized.
• Preventive services are more consistently delivered.
• Chronic diseases, such as asthma, cardiovascular disease, and diabetes, are better
managed.
• Acute problems are diagnosed and treated earlier.
• People with low incomes tend to have greater access to care and, concomitantly, fewer
disparities in health outcomes
• Primary care physicians tend to be active at a community level to improve health care
resources and attitudes for both healthy patients and those with chronic diseases.
8. • Consequently, both primary care physicians and subspecialists are necessary for a
healthy healthcare system.
• Currently, speciality care has a slight advantage in the US. The Annals of Internal
Medicine published a 2008 analysis that came to the conclusion that "investing in
primary and preventive care can result in better health outcomes, reduce costs," and
that "the nation's workforce policy must focus on ensuring an adequate supply of
primary and principal care physicians trained to manage care for the whole patient.“
9. DEFINING AND DESCRIBING PRIMARY CARE
• Primary care is defined as “integrated, accessible health care services by clinicians
who are accountable for addressing a large majority of personal health care needs,
developing a sustained partnership with patients, in the context of family and
community.
• Primary care providers include family physicians; general internists; general
pediatricians; family, adult care, and pediatric nurse practitioners; some physician
assistants; and some gynecologists.
• Because they provide care that is aimed at preventing adverse, costly events such as
hospitalizations and further morbidity, primary care physicians are well positioned to
address national health priorities.
10. • A comprehensive study of the activities of family physicians directly observed. Among
the findings of that study follows :
• An extensive variety of common, rare, and undifferentiated problems are managed in primary
care.
• Prevention is practiced broadly in primary care visits, and not just during “physicals.” During
32% of illness visits, the family physician delivers at least one service recommended by the
US Preventive Services Task Force.
• Mental health problems present frequently and are often managed without referral. For
example, in 18% of visits, family physicians either diagnose or provide counseling related to
depression or anxiety.
• Patient education is a major part of primary care practice. Fully 90% of office visits, and 19%
of visit time overall, involve patient education or health habit advice.
• Care is often provided in the context of family. Seventy percent of patients have another family
member seeing the same physician.
• Coordination of care is common. During 10% of office visits, a referral is made to a medical
specialist, mental health provider, physical therapist, social worker, or other health
professional.
11. PRINCIPLES OF A GOOD PRIMARY CARE
• Access to Care. Primary care should be readily available. Open access is one way of helping
assure this.
• Continuity of Care. Seeing the same provider over time is called continuity of care.
• Team-based, Comprehensive, Personalized Care. A family physician manages without
referral between 85% and 90% of patient problems. This provision of a wide variety of
services, covering the majority of patient needs, is termed comprehensiveness of care.
• Coordination of Care. Primary care providers help their patients negotiate the complex
health care system by serving as coordinators of care.
• Community Orientation. Although most of the physician’s work is at the patient level, good
primary care physicians also seek to improve the broader health of the community.
• Prevention Focus. Preventive care is the most common reason patients visit a family
physician’s office. Among the facets of preventive care are measures to reduce disease risk,
such as assistance with smoking cessation; immunizations; measures to prevent morbidity
in people who have established disease.
12. PRINCIPLES OF A GOOD PRIMARY CARE CONTD
• Patient Self-empowerment and Self-management. Effective chronic illness care
requires a partnership in which medical providers help the patient acquire the
knowledge, skills, and self-empowerment to manage risk factors, monitor the illness,
and make adjustments in their care.
• Evidence-based Practice. Exemplary primary care is evidence-based. By this we mean
that the primary care physician has access to and uses effectively what is available in
the literature to guide practice.
• Family Orientation. Quality primary care must take into account the family context. By
family we mean the entire range of relationships whether or not by blood or marriage
that can comprise a patient’s close social network.
• Biopsychosocial, Life-cycle Perspective. Effective primary care physicians view
patients from a broad perspective, taking into account physiology, physical illness,
emotional health, and the social, occupational, and environmental context within which
the person lives.
13. • The patient-centered medical home (PCMH) is a model of health care delivery system
reform that incorporates virtually all of the principles of family medicine elucidated
previously.
• The PCMH has four cornerstones:
• 1) comprehensive, coordinated primary care delivered by a team of providers led by the
patient’s personal physician.
• 2) patient-centered care, tailored to individual needs and preferences.
• 3) a high-tech practice model that includes patient registries, quality monitoring and
improvement, point-of-care decision support, and electronic health records.
• 4) a reimbursement system that includes payment for care coordination and for
achievement of quality of care benchmarks, as well as fee-for-service and case-mix
adjustments for practices serving patients with complex chronic illnesses and multiple
comorbid conditions.
14. • Community health centers (CHCs) are a large, growing provider of primary care, especially
for poor, minority, and uninsured Americans.
• CHCs receive federal funding to provide primary care as a major component of the “safety net”
for people with limited financial resources.
• CHCs are increasingly using electronic medical records; engaging in quality monitoring and
improvement programs and employing comprehensive health teams including physicians,
nurse practitioners, physician assistants, dentists, nutrition counselors, social workers, nurses,
and others.
• Overhead expenses from support staff devour around two-thirds of a primary care practice’s
revenue. By reducing this overhead to as low as 20% of revenue by operating on a cash only
basis with limited office staff, low overhead practices can see fewer patients per day and
charge far less per visit.
• Patients find them appealing because the total cost of care is often no more than they would
expend as the co-pay under traditional insurance.
• Physicians find them appealing because they are able to spend more time with patients and
generate a similar income to that of more traditional practices.
• Another rapidly growing form of low-overhead practice is the home care or nursing home
practice.
15. • Health Care Reform and Primary Care One of the forces most strongly shaping the direction
of health care in this decade will be implementation of the Patient
• Protection and Affordable Care Act of 2010 (“health care reform” bill). A key feature of health
care reform is investment in an improved primary care system
• Among the legislative provisions of health care reform and related congressional initiative are
the following, which directly impact primary care:
• Increased payments for primary care under Medicare and Medicaid,
• Incentives for practices to meet the requirements for certification as medical homes,
• Improved access to care for low-income and uninsured people through expansion of
community health centers and the National Health Service Corps,
• A requirement that insurance plans provide free preventive care for services that have
sufficient evidence supporting their effectiveness
• Investment in primary care training.
• Special financial incentives for practices to adopt electronic medical records and to use them
to monitor and report quality indicators.
• As a result, the coming decade will be one of rapid growth and evolution in primary care.