There is a need for CHD secondary prevention in primary care. This need has been addressed providing specialized clinics run by nurses or GPs. Whether with this clinics we are meeting this need is a question to be answered.
Mobility is Medicine
Loretta Schoen Dillon, PT, DPT, MS
Director of Clinical Education and Clinical Associate Professor
UTEP Physical Therapy Program
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
Mobility is Medicine
Loretta Schoen Dillon, PT, DPT, MS
Director of Clinical Education and Clinical Associate Professor
UTEP Physical Therapy Program
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
Determinants of Fall Risk and Injury in Hispanic Elderly Living in El Paso Community
Guillermina Solis, PhD, RN, F/GNP
Vanessa Guerrero, RN
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
Multiple Chemical Sensitivities - A Proposed Care Model v2zq
Multiple Chemical Sensitivities - A Proposed Care Model - Resources for Healthy Children www.scribd.com/doc/254613619 - For more information, Please see Organic Edible Schoolyards & Gardening with Children www.scribd.com/doc/254613963 - Gardening with Volcanic Rock Dust www.scribd.com/doc/254613846 - Double Food Production from your School Garden with Organic Tech www.scribd.com/doc/254613765 - Free School Gardening Art Posters www.scribd.com/doc/254613694 - Increase Food Production with Companion Planting in your School Garden www.scribd.com/doc/254609890 - Healthy Foods Dramatically Improves Student Academic Success www.scribd.com/doc/254613619 - City Chickens for your Organic School Garden www.scribd.com/doc/254613553 - Huerto Ecológico, Tecnologías Sostenibles, Agricultura Organica www.scribd.com/doc/254613494 - Simple Square Foot Gardening for Schools - Teacher Guide www.scribd.com/doc/254613410 - Free Organic Gardening Publications www.scribd.com/doc/254609890 ~
Assessment of cardiovascular disease risk among qatari patients with type 2 p...Dr. Anees Alyafei
Original Research Paper on the Assessment of Cardiovascular Disease Risk on Qatari Diabetics. The behavior of two risk prediction tools categorized patients differently.
https://www.researchgate.net/publication/340895704_Assessment_of_Cardiovascular_Disease_Risk_among_Qatari_Patients_with_Type_2_Diabetes_Mellitus_Attending_Primary_Health_Care_Centers_2014
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
-To characterize the utilization pattern of preventive care services impacting cardiovascular outcomes in a U.S population using a national database
-To predict the trends in cardiovascular preventive care services in a U.S. population
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
National reports point towards disparities in the utilization of preventive care services but sparse literature exists regarding predicting utilization pattern of preventive care services.
METHODS: The 2007 Medical Expenditure Panel Survey (MEPS), a national probability sample survey of the ambulatory civilian US population, was analyzed to determine demographic patterns of utilization. Recommendations by JNC-VII and NCEP were used to determine guideline adherence to blood pressure and cholesterol checkup respectively. Utilization of blood pressure screening and cholesterol checkup services were used as the dependent variable while age, gender, race, ethnicity, insurance status, perceived health status were used as independent variables. Since guidelines differ for people with elevated blood pressure, respondents with elevated blood pressure were identified in the MEPS database by self-reported diagnosis. Descriptive statistics were used to describe the population, chi-square analysis was used to determine the group differences for the categorical variables. Multivariate logistic regression model was built to predict odds of utilizing appropriate preventive se!
rvices. All analysis was carried out using SAS v9.1.
RESULTS: Total number of adult respondents was 20,434 of which data was available for blood pressure checkup for 20,187 respondents and 15,784 respondents for cholesterol checkup. Overall, respondents were found to adhere to guideline recommendations for getting the blood pressure (n=17,959, 89.0%) and cholesterol (n=14,956, 94.7%) check-up done. A univariate chi-square analysis showed statistically significant differences across all independent variables between people who utilized the preventive care service and those who didn t for blood pressure checkup (p<0><0>65) had much higher odds of using the blood pressure (OR=2.815, CI=2.317-3.420 ) and cholesterol (OR=3.190, CI=2.396-4.!
249 ) preventive services. Males had much lower odds of getting blood pressure (OR=0.350, CI=0.318-0.384) and cholesterol (OR=0.597, CI=0.516-0.692) checks done compared to females. Odds of utilization were nearly similar for all races. Uninsured had lower odds for blood pressure (OR=0.282, CI=0.253-0.315) and cholesterol (OR=0.314, CI=0.262-0.376) use compared to privately insured people.
CONCLUSIONS: Overall MEPS respondents adhered to blood pressure and cholesterol check up guidelines. The study was however successful in identifying existing age, race, income, insurance status related disparities in US population.
Reducing Stroke Readmissions in Acute Care Setting.docxdanas19
Reducing Stroke Readmissions in Acute Care Setting
Contents
Introduction: 2
Objective of the study: 3
Readmission Factors: 3
Statins: 3
Long term care: 4
Demographics: 4
Personal Reflections: 4
Events: 4
Empirical Evidence: 6
Interventions for discharged patients: 6
TRACS: 7
COMPASS: 7
MISTT: 8
Clinical requirement: 8
Timeline: 8
Collaboration with the preceptor: 8
Proposed evaluative criteria: 9
Evaluative criteria discussed: 9
Conclusion: 9
Bibliography 10
Introduction:
Stroke refers to a cardiovascular disease which has been one of the leading reasons for deaths and long term disability. A stroke is an abrupt onset of a neurological deficit led by a vascular rupture or blockage that reduces the blood flow to brain. Subsequently, causing death to the tissue in the brain region if interruption of the blood flow persists. The indications of stroke vary, but may include the loss of function to one side of the body, the inability to speak or talk, and reduced vision or severe headache (Poston, 2018).
Issue: Discovery Research
Over time, the financial penalties on readmissions to the hospital have been taking place, which is promoting hospitals to take measures to reduce the instance of readmissions. A variety of interventions are taking place on different levels to ensure that pre and post discharge care is in place to avoid readmissions. The efficacy of interventions is dependent on the variety of components. Single component interventions are least effective and tend to have no effect on readmissions to the hospitals. Patients that are discharged to post-acute care accommodations are subjected to multi-component interventions and readmissions have dropped drastically. These interventions work through communication, advanced planning of care, and training to tackle simple medical issues that might cause readmissions. The availability of risk stratification methods have made it easier for the hospitals to give more care and attention to the patients that are more likely to get readmitted. Home based services are provided to ensure proper medical care for the patients.
This capstone project attempts to discuss the factors causing the readmissions of stroke patients to the hospitals. The past 20 years have proven to be important in acute and inpatient stroke care however, quality of post-acute care varies specially for the patients that are discharged to home. (Condon, Lycan, & Duncan, 2016). Different reasons for stroke readmissions are to be examined in this capstone project. Expected Outcomes: Discovery Research
This project aims to take into account the reasons of stroke and readmissions after being treated for stroke. Stroke is the second primary reason of readmissions in the hospital. Major readmissions comprise of elderly people. 20-70% people who survive stroke are readmitted in the first year of their treatment (Bravata, Ho, Meehan, & Brass, 2006). Poor health conditions and high treatment costs both account for the l.
Dr John Wren
Principal Researcher Advisor
New Zealand Accident Compensation Corporation
PO Box 242, Wellington, New Zealand
john.wren@acc.co.nz
(P23, Thursday 27, Civic Room 3, 1.30)
CARDIOVASCULAR DISEASE
CARDIOVASCULAR DISEASE
Cardiovascular Disease
Introduction
Cardiovascular disease posits a major cause of premature deaths and disability throughout the world and contributes to a significant increase in healthcare costs, particularly in medication, healthcare services, and production loss. Specifically, heart diseases and stroke accommodate the highest prevalence rate in the USA; accommodate an average of 610,000 and 365,000 annual deaths from CVD (CDC, 2015). Similarly, every year, CVD causes the USA approximately, $207 billion for medication, healthcare services, and productivity loss. Noteworthy, heart diseases and stroke incidences vary with factors such as ethnicity, gender, age, and individuals with certain disorders. Similarly, the project accommodates notable articulations on intervention, comparison, outcome, and time as a fundamental consideration in heart diseases and stroke in the USA. Thus, an enriched articulation on heart diseases and stroke are underscoring for the project presentation.
Definition
According to (Mayo Clinic, 2018), Heart disease describes a condition that affects the heart; including blood vessels diseases arrhythmias, and other heart defects. Significantly, the heart disease is interchangeable for the CVD, articulating on the infections involving narrowed or blocked blood vessels, causing a heart attack, chest pain, and stroke, among other clinical presentations. Similarly, (Mayo Clinic, 2018) acknowledges that many CVD is preventable and treatable with healthy lifestyle choices.
Epidemiology
Cardiovascular diseases posits an undying cause of death in the USA, projected at 840, 678 deaths in 2016, averagely one in three deaths (Salim et al. 2020). Similarly, between 2013 and 2016 121.5 million adults Americans presented notable for of the CVD. Notably, between 2013 and 2015 direct and indirect costs of managing the CVD in the USA, recorded $213.8 billion and $137.4 billion respectively. Statistically, between 2013 and 2016, 57.1% of non-HN black females and 60.1% of non-HN black males presenting CVD manifestations (Salim et al. 2020). According to the researcher causes of the CVD Include atherosclerosis resulting from an unhealthy diet, lacking exercise, overweight, and smoking. In the epistemology studies, risk factors such as age, sex, family history, smoking, chemotherapy and radiation drugs, high blood pressure, poor diet, obesity, physical inactivity, stress, and poor hygiene are underscoring risk factors in the CVD (Mayo Clinic, 2018). Thus, heart disease epistemological indicates the patterns, causes, risk factors, and specific populations in the USA.
Clinical Presentations
Cardiovascular disease acclaims clinical presentations that may differ between men and women. According to (Mayo Clinic, 2018), men present significant chest pain that women and women clinical presentations such as shortness in breathing, nausea, and fatigue are more evident than in men. Admi ...
Determinants of Fall Risk and Injury in Hispanic Elderly Living in El Paso Community
Guillermina Solis, PhD, RN, F/GNP
Vanessa Guerrero, RN
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
Multiple Chemical Sensitivities - A Proposed Care Model v2zq
Multiple Chemical Sensitivities - A Proposed Care Model - Resources for Healthy Children www.scribd.com/doc/254613619 - For more information, Please see Organic Edible Schoolyards & Gardening with Children www.scribd.com/doc/254613963 - Gardening with Volcanic Rock Dust www.scribd.com/doc/254613846 - Double Food Production from your School Garden with Organic Tech www.scribd.com/doc/254613765 - Free School Gardening Art Posters www.scribd.com/doc/254613694 - Increase Food Production with Companion Planting in your School Garden www.scribd.com/doc/254609890 - Healthy Foods Dramatically Improves Student Academic Success www.scribd.com/doc/254613619 - City Chickens for your Organic School Garden www.scribd.com/doc/254613553 - Huerto Ecológico, Tecnologías Sostenibles, Agricultura Organica www.scribd.com/doc/254613494 - Simple Square Foot Gardening for Schools - Teacher Guide www.scribd.com/doc/254613410 - Free Organic Gardening Publications www.scribd.com/doc/254609890 ~
Assessment of cardiovascular disease risk among qatari patients with type 2 p...Dr. Anees Alyafei
Original Research Paper on the Assessment of Cardiovascular Disease Risk on Qatari Diabetics. The behavior of two risk prediction tools categorized patients differently.
https://www.researchgate.net/publication/340895704_Assessment_of_Cardiovascular_Disease_Risk_among_Qatari_Patients_with_Type_2_Diabetes_Mellitus_Attending_Primary_Health_Care_Centers_2014
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
-To characterize the utilization pattern of preventive care services impacting cardiovascular outcomes in a U.S population using a national database
-To predict the trends in cardiovascular preventive care services in a U.S. population
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
National reports point towards disparities in the utilization of preventive care services but sparse literature exists regarding predicting utilization pattern of preventive care services.
METHODS: The 2007 Medical Expenditure Panel Survey (MEPS), a national probability sample survey of the ambulatory civilian US population, was analyzed to determine demographic patterns of utilization. Recommendations by JNC-VII and NCEP were used to determine guideline adherence to blood pressure and cholesterol checkup respectively. Utilization of blood pressure screening and cholesterol checkup services were used as the dependent variable while age, gender, race, ethnicity, insurance status, perceived health status were used as independent variables. Since guidelines differ for people with elevated blood pressure, respondents with elevated blood pressure were identified in the MEPS database by self-reported diagnosis. Descriptive statistics were used to describe the population, chi-square analysis was used to determine the group differences for the categorical variables. Multivariate logistic regression model was built to predict odds of utilizing appropriate preventive se!
rvices. All analysis was carried out using SAS v9.1.
RESULTS: Total number of adult respondents was 20,434 of which data was available for blood pressure checkup for 20,187 respondents and 15,784 respondents for cholesterol checkup. Overall, respondents were found to adhere to guideline recommendations for getting the blood pressure (n=17,959, 89.0%) and cholesterol (n=14,956, 94.7%) check-up done. A univariate chi-square analysis showed statistically significant differences across all independent variables between people who utilized the preventive care service and those who didn t for blood pressure checkup (p<0><0>65) had much higher odds of using the blood pressure (OR=2.815, CI=2.317-3.420 ) and cholesterol (OR=3.190, CI=2.396-4.!
249 ) preventive services. Males had much lower odds of getting blood pressure (OR=0.350, CI=0.318-0.384) and cholesterol (OR=0.597, CI=0.516-0.692) checks done compared to females. Odds of utilization were nearly similar for all races. Uninsured had lower odds for blood pressure (OR=0.282, CI=0.253-0.315) and cholesterol (OR=0.314, CI=0.262-0.376) use compared to privately insured people.
CONCLUSIONS: Overall MEPS respondents adhered to blood pressure and cholesterol check up guidelines. The study was however successful in identifying existing age, race, income, insurance status related disparities in US population.
Reducing Stroke Readmissions in Acute Care Setting.docxdanas19
Reducing Stroke Readmissions in Acute Care Setting
Contents
Introduction: 2
Objective of the study: 3
Readmission Factors: 3
Statins: 3
Long term care: 4
Demographics: 4
Personal Reflections: 4
Events: 4
Empirical Evidence: 6
Interventions for discharged patients: 6
TRACS: 7
COMPASS: 7
MISTT: 8
Clinical requirement: 8
Timeline: 8
Collaboration with the preceptor: 8
Proposed evaluative criteria: 9
Evaluative criteria discussed: 9
Conclusion: 9
Bibliography 10
Introduction:
Stroke refers to a cardiovascular disease which has been one of the leading reasons for deaths and long term disability. A stroke is an abrupt onset of a neurological deficit led by a vascular rupture or blockage that reduces the blood flow to brain. Subsequently, causing death to the tissue in the brain region if interruption of the blood flow persists. The indications of stroke vary, but may include the loss of function to one side of the body, the inability to speak or talk, and reduced vision or severe headache (Poston, 2018).
Issue: Discovery Research
Over time, the financial penalties on readmissions to the hospital have been taking place, which is promoting hospitals to take measures to reduce the instance of readmissions. A variety of interventions are taking place on different levels to ensure that pre and post discharge care is in place to avoid readmissions. The efficacy of interventions is dependent on the variety of components. Single component interventions are least effective and tend to have no effect on readmissions to the hospitals. Patients that are discharged to post-acute care accommodations are subjected to multi-component interventions and readmissions have dropped drastically. These interventions work through communication, advanced planning of care, and training to tackle simple medical issues that might cause readmissions. The availability of risk stratification methods have made it easier for the hospitals to give more care and attention to the patients that are more likely to get readmitted. Home based services are provided to ensure proper medical care for the patients.
This capstone project attempts to discuss the factors causing the readmissions of stroke patients to the hospitals. The past 20 years have proven to be important in acute and inpatient stroke care however, quality of post-acute care varies specially for the patients that are discharged to home. (Condon, Lycan, & Duncan, 2016). Different reasons for stroke readmissions are to be examined in this capstone project. Expected Outcomes: Discovery Research
This project aims to take into account the reasons of stroke and readmissions after being treated for stroke. Stroke is the second primary reason of readmissions in the hospital. Major readmissions comprise of elderly people. 20-70% people who survive stroke are readmitted in the first year of their treatment (Bravata, Ho, Meehan, & Brass, 2006). Poor health conditions and high treatment costs both account for the l.
Dr John Wren
Principal Researcher Advisor
New Zealand Accident Compensation Corporation
PO Box 242, Wellington, New Zealand
john.wren@acc.co.nz
(P23, Thursday 27, Civic Room 3, 1.30)
CARDIOVASCULAR DISEASE
CARDIOVASCULAR DISEASE
Cardiovascular Disease
Introduction
Cardiovascular disease posits a major cause of premature deaths and disability throughout the world and contributes to a significant increase in healthcare costs, particularly in medication, healthcare services, and production loss. Specifically, heart diseases and stroke accommodate the highest prevalence rate in the USA; accommodate an average of 610,000 and 365,000 annual deaths from CVD (CDC, 2015). Similarly, every year, CVD causes the USA approximately, $207 billion for medication, healthcare services, and productivity loss. Noteworthy, heart diseases and stroke incidences vary with factors such as ethnicity, gender, age, and individuals with certain disorders. Similarly, the project accommodates notable articulations on intervention, comparison, outcome, and time as a fundamental consideration in heart diseases and stroke in the USA. Thus, an enriched articulation on heart diseases and stroke are underscoring for the project presentation.
Definition
According to (Mayo Clinic, 2018), Heart disease describes a condition that affects the heart; including blood vessels diseases arrhythmias, and other heart defects. Significantly, the heart disease is interchangeable for the CVD, articulating on the infections involving narrowed or blocked blood vessels, causing a heart attack, chest pain, and stroke, among other clinical presentations. Similarly, (Mayo Clinic, 2018) acknowledges that many CVD is preventable and treatable with healthy lifestyle choices.
Epidemiology
Cardiovascular diseases posits an undying cause of death in the USA, projected at 840, 678 deaths in 2016, averagely one in three deaths (Salim et al. 2020). Similarly, between 2013 and 2016 121.5 million adults Americans presented notable for of the CVD. Notably, between 2013 and 2015 direct and indirect costs of managing the CVD in the USA, recorded $213.8 billion and $137.4 billion respectively. Statistically, between 2013 and 2016, 57.1% of non-HN black females and 60.1% of non-HN black males presenting CVD manifestations (Salim et al. 2020). According to the researcher causes of the CVD Include atherosclerosis resulting from an unhealthy diet, lacking exercise, overweight, and smoking. In the epistemology studies, risk factors such as age, sex, family history, smoking, chemotherapy and radiation drugs, high blood pressure, poor diet, obesity, physical inactivity, stress, and poor hygiene are underscoring risk factors in the CVD (Mayo Clinic, 2018). Thus, heart disease epistemological indicates the patterns, causes, risk factors, and specific populations in the USA.
Clinical Presentations
Cardiovascular disease acclaims clinical presentations that may differ between men and women. According to (Mayo Clinic, 2018), men present significant chest pain that women and women clinical presentations such as shortness in breathing, nausea, and fatigue are more evident than in men. Admi ...
Running head CREATING A PLAN OF CARE .docxsusanschei
Running head: CREATING A PLAN OF CARE 1
CREATING A PLAN OF CARE 10
Creating a Plan of Care
South University
NSG4055 Illness & Disease Management across Life Span
Professor
Creating a Plan of Care
The chronic disease selected for the plan of care is cardiovascular disease. This disease continues to pose major challenges not only for patients and their family members but also to the nation’s health care system. The rationale for choosing cardiovascular disease is because of the high rates of mortality and the effects of the co-morbidities associated with the chronic illness. According to Santulli (2013), cardiovascular disease is the single leading cause of fatalities in the United States, accounting for approximately 600,000 deaths annually. In 2011, approximately 26.6 million Americans were living with the chronic disease. The health care costs associated with the disease account for more than $500 billion annually. There are also many disparities in prevalence of risk factors, mortality, access to treatment and treatment outcomes based on race/ethnicity, socioeconomic status, gender, age and geographic area. Hence, tackling the disease should be a major priority for the US government. The main objective of the Healthy People 2020 initiative for cardiovascular disease is “improving cardiovascular health through early detection, prevention and treatment of the risk factors for stroke and heart attack”. This report outlines a comprehensive plan of care that can help in addressing and mitigating cardiovascular disease.
Holistic Plan of Care
Creating a holistic plan of care will indeed be essential for ensuring that people with chronic conditions such as cardiovascular disease lead a healthy life. Cardiovascular disease has a significant impact on the patient and the health care system. Apart from the emotional distress, patients with this condition also face some financial burdens, social burdens and increased levels of discrimination (Earnshaw & Quinn, 2012). In the course of completing the project, I administered a questionnaire to a coworker by the initials C.K. during week 2 to find out how she deals with the condition.
The questionnaire looked into various aspects such as family history, related medical conditions, the risk factors of cardiovascular disease, lifestyle choices and the coping strategies or support received by the patient. Understanding all these aspects can help in developing a well-managed care plan (Larsen & Lubkin, 2013). The results of the questionnaire revealed that C.K. observes healthy lifestyle, has the right levels of support and adheres to the medication regimen. All these factors helped her to cope effectively with the condition. However, even though she attested to leading a healthy lifestyle, C.K. also revealed that her family faced s ...
Sir Muir Gray, Chief Knowledge Officer, NHS intoduces the NHS Atlas of Variation, to show show the NHS are maximising values for populations and individuals.
Cardiorespiratory Fitness, Health Outcomes, and Health Care Costs: The Case f...Firstbeat Technologies
Physical inactivity is becoming a world-wide epidemic – and the consequences can be both costly and deadly. This was outlined by Dr. Jonathan Myers who, citing a range of studies and recent research results, was able to show hard-hitting data related to the correlation between fitness (or lack thereof) and poor health. Myers argues fitness may well be a better marker than traditional risk factors for CVD and all-cause mortality. Amongst the eye-opening findings presented to the audience was that, for the first time, global deaths-per-year due to physical inactivity are higher than for smoking.
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.
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.
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.
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
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
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CHD Secondary Prevention Clinics in Primary Care; a critical assessment
1. SUMMATIVE ASSESSMENT
HSE 21
HEALTH SERVICES EVALUATION
Number: 21344
26 April 2004
2. Health Services Evaluation. Number: 21344
Title:
Matching provision with need. CHD Secondary Prevention Clinics in Primary Care; a
critical assessment.
Introduction
With the term Coronary Heart Disease (CHD) I will be referring to angina,
myocardial infarction and heart failure.
Coronary heart disease in the form of myocardial infarction first came to attention to
the medical profession early in the 20th century. Mortality from CHD increased
dramatically after the First World War and had assumed epidemic proportions in
Western populations during the 60s and 70s being responsible for almost a third of
deaths in those populations. Although its mortality rate has being gradually falling in
the last 20 years in certain populations, it still remains the leading cause of death in
developed countries (Walker, 2001).
In the year 2000, the Department of Health presented the National Service Framework
(NSF) for Coronary Heart Disease, which set out the standards and services that
should be available in the country for the prevention, diagnosis and treatment of
CHD. The NSF describes service models that can enable the efficient delivery of
those standards and explains how the standards can be delivered. The objective is to
reduce premature deaths from CHD and promote faster and equal access to high
quality services (DOH, 2000).
Based on the NSF standards of preventing CHD in primary care, the new GP contract
is giving incentives to GPs to identify people with established CHD and offer them
comprehensive advice and appropriate treatment to reduce their risks. GPs are
encouraged to provide special clinics (nurse run and doctor supported) to implement
secondary prevention (DOH, 2000) with two objectives: modify the factors that affect
the risk of CHD: exercise, diet, smoking, blood pressure, cholesterol and provide
appropriate and evidence based treatment (aspirin, statins, ACE inhibitors, B-
Blockers).
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3. Health Services Evaluation. Number: 21344
The objective of this assignment is to critically assess the need for those CHD Clinics
in primary care, analyse the way those clinics are provided and discuss the best way
those clinics could be evaluated.
Assessment of need
Size of the problem
Prevalence. In UK the prevalence of CHD is increasing and there are around 2.65
million of people with CHD (angina or myocardial infarction), of those 1.5 million
are men and 1.15 million are women. There are geographical and ethnic
differences in the prevalence of CHD; the prevalence is higher in the North of
England and Wales than in the South of England and is higher in Indian, Pakistani
and Bangladeshi men living in UK but lower amongst Black Caribbean and
Chinese men (BHF, 2003, NAW, 2000, Stevens and Raftery, 1994).
Mortality. CHD is the most common cause of death in the UK, it is estimated that
CHD caused over 117,000 deaths in the UK in 2001. More than one in five men
and one in six women die from the CHD every year. Despite death rates from
CHD has fallen significantly in the last recent years (over 3,000 in the past year),
UK is still among the countries with higher death rates (only Finland and Ireland
have higher death rates) and rates have not been falling as fast as in some other
countries. There are important socio-economic differences in mortality and 1 in 3
of all deaths under 65 years caused by social class inequalities are due to CHD
(BHF, 2003).
Economic burden. It is estimated that CHD cost the UK economy 7 billion a year, of
those 1.7 are direct cost to the healthcare system and the rest are costs in form of
productivity losses and informal care of people with CHD. Less that 1% of the cost to
the NHS is spent in prevention (BHF, 2003).
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4. Health Services Evaluation. Number: 21344
Addressing the need
Although there is not definitive proof for all risks factors of the benefit of secondary
prevention in CHD, we have evidence that smoking cessation, blood pressure control,
cholesterol reduction and taking determinate drugs is effective (Merz et al., 1997,
Robinson and Leon, 1994, Stevens and Raftery, 1994, Bowker et al., 1996, Wood,
1998). If we consider need as “the capacity to benefit from an intervention”
(Pencheon et al., 2001) we can conclude that there is a need for measures that help
reducing the burden of CHD. Primary Care CHD clinics may be a good way of
addressing this need but we need to be sure this measures are effective, efficient and
appropriate.
In addressing need in this way we are taking an epidemiological driven approach to
prioritise health services according to needs (Stevens and Raftery, 1994, Wright et al.,
1998). Some health economists have argued that an economic approach offers a more
satisfactory framework for prioritising healthcare services (Petrou, 1998, Jones,
1998). Other authors have replied that this is why important that our interventions are
effective and efficient (Wright et al., 1998).
We have to recognize that probably this “perceived” need comes from an expert
professional point of view obtained from evidence but that patients may not recognize
or express this need (Frankel and West, 1993, Pencheon et al., 2001).
Provision of service
Clinics to prevent CHD are provided in Primary Care by GPs and practice nurses. I
have personal experience running these clinics and the first problem I encountered
was obtaining a comprehensive list of all patients with CHD in my practice. I found
that the recording of CHD was incomplete and not up to date. This problem is well
known and together with inaccuracies in recording risks factors has been described in
several studies (Bowker et al., 1996).
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5. Health Services Evaluation. Number: 21344
Effectiveness
Several studies have demonstrated that CHD secondary prevention clinics in Primary
care are effective (Campbell et al., 1998, McLeod et al., 2004). Campbell et al.
conducted a RCT involving 1173 patients in which nurse run clinics in Primary Care
produced a significant improvement in aspirin management, blood pressure
management, lipid management, physical activity and diet although had no effect on
smoking cessation. The improvement was regardless of practice baseline performance
(Campbell et al., 1998). The same authors did a follow up study and concluded that
the findings were sustained after 4 years except for exercise. The authors suggested
that nurse led clinics could led to fewer total death and coronary events (Murchie et
al., 2003).
But other studies have not been so positive, for example a study involving 1015
patients showed very poor results for CHD clinics in Primary Care. The study also
demonstrated that the management of CHD secondary prevention was significantly
worse in women than in men (Flanagan et al., 1999). Why do we have gender
differences in the provision of CHD secondary prevention? The authors suggested
that prevention strategies might be more effective in men than in women, other
studies have supported this hypothesis (Field et al., 1995).
Studies have suggested that if we want this clinics in primary care to be effective in
reducing CHD risk, they need to be coordinated with cardiac services in secondary
care (Dalal and Evans, 2003).
Alternatives
Feder et al. conducted an study providing CHD secondary prevention though postal
prompts containing recommendations for reducing the risk of another CHD event
(lifestyle changes, drugs), they also offered the patients an appointment with their GP
or practice nurse. Despite the prompts increased the consultation rates, they did not
improve the prescription of effective drugs for secondary prevention and they did not
produce reported changes in lifestyle (Feder et al., 1999).
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6. Health Services Evaluation. Number: 21344
Acceptability
Looking for effectiveness is a very good way to assess the quality of the provision of
a service but we should not forget to check patients’ satisfaction. A qualitative study
looking at patients’ and nurses’ perception of CHD secondary prevention clinics
reported that patients had generally positive views about nurse led care (Wright et al.,
2001).
GPs’ acceptability is obviously very important as well. Another qualitative study
demonstrated that GPs are convinced about the effectiveness of secondary prevention
in CHD but they are concerned about workload and costs. They also recognize that
they often respond to social and psychological needs rather than addressing longer
term prevention needs (Summerskill and Pope, 2002).
Evaluation
I have mentioned before several studies that looked t the effectiveness of CHD
secondary prevention clinics in primary care. Using a Donabedian approach I will
describe the way in my opinion these clinics should be evaluated:
Structure or inputs
It is the environment of care. Includes health professionals (numbers, qualifications,
way in which they are organized, hierarchical lines of command), equipment,
geographic distribution of Primary Care Centres, patients, consumables (drugs, heat,
light, laboratory reagents), demographics, etc.
Process or output
“The process is how things are organized and done” (St Leger et al., 1994). In the
case I am analysing this process can be examined in terms of indexes such as number
of consultations (volume of activity), number of referrals, number of complications,
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7. Health Services Evaluation. Number: 21344
number of complaints, geographical variation in utilization of the service and number
of re-admissions (Stevens and Raftery, 1994). Donabedian also includes accessibility
(some patients may not be able to attend CHD clinics), adequacy of the services
provided (e.g. appropriateness of test and investigations ordered during the clinics)
and interpersonal relationships between patients and heath care professionals.
Measures of process are important to define the effectiveness of an intervention but
should not be considered in isolation.
Outcome
They are the results or end-product of a programme. It shows the impact of the
programme on individuals and communities (St Leger et al., 1994, Wilkin et al.,
1992). In his case some measures of outcome are: changes in patients’ mortality and
morbidity, quality of life, satisfaction with care (Stevens and Raftery, 1994), anxieties
addressed, changes in patient’s attitudes and knowledge (e.g. changes in lifestyle) and
changes in uptake of services.
Methods
The “goal standard” method to evaluate the benefit of an intervention is the
randomized controlled trial (RCT). RCTs are difficult to conduct when assessing
complex interventions like secondary prevention clinics, some reasons for this are
contamination of the placebo or control groups, unblinded nature of the study and
difficulties with randomization (Pencheon et al., 2001).
We should not underestimate the importance of clinical audit, a tool readily available
in primary care.
Costs
The cost-effectiveness of the clinics needs to be evaluated. We have studies looking at
the cost-effectiveness of interventions looking at individual risk factors but I am not
aware of studies looking at cost-effectiveness of clinics addressing several risk
factors.
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8. Health Services Evaluation. Number: 21344
Conclusions
There is a need for CHD secondary prevention in primary care. This need has been
addressed providing specialized clinics run by nurses or GPs. Whether with this
clinics we are meeting this need is a question to be answered.
Some evidence, including a RCT (Campbell et al., 1998) is already available about
the effectiveness of CHD secondary prevention clinics in primary care. More
evidence is needed about the efficiency of these clinics.
Data recording needs to improve in clinics. As study by de Lusignan et al. showed
that educational interventions targeted at primary care professionals in the form of
data quality workshops can led to an increase in data quality in primary care (de
Lusignan et al., 2004).
Evaluation in the form of economic analyses, such as cost-effectiveness studies, is
needed to justify allocation of scarce resources to this type of intervention. We need
to answer the question of whether these clinics are beneficial enough to deserve the
high priority they are receiving.
We need to explain to the patients why we think they need these clinics but we also
have to ask them if they want this kind of services. They may not very happy having
to wait for a week to see their GP for an acute problem and the GP being busy running
CHD secondary prevention clinics.
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9. Health Services Evaluation. Number: 21344
References
BHF (2003) 'Coronary Heart Disease Statistics', British Heart Foundation,
<http://www.bhf.org.uk/professionals/index.asp?secondlevel=519&thirdlevel=
520&artID=3350>, (Accessed: 18.04.04).
Bowker, T. J., Clayton, T. C., Ingham, J., McLennan, N. R., Hobson, H. L., Pyke, S.
D., Schofield, B. and Wood, D. A. (1996) 'A British Cardiac Society survey of
the potential for the secondary prevention of coronary disease: ASPIRE
(Action on Secondary Prevention through Intervention to Reduce Events).'
Heart, 75, 334-42.
Campbell, N. C., Thain, J., Deans, H. G., Ritchie, L. D., Rawles, J. M. and Squair, J.
L. (1998) 'Secondary prevention clinics for coronary heart disease:
randomised trial of effect on health', BMJ, 316, 1434-7.
Dalal, H. M. and Evans, P. H. (2003) 'Achieving national service framework
standards for cardiac rehabilitation and secondary prevention', BMJ, 326, 481-
4.
de Lusignan, S., Hague, N., Brown, A. and Majeed, A. (2004) 'An education
intervention to improve data recording in the management of ischaemic heart
disease in primary care.' Journal of Public Health, 26, 34-7.
DOH (2000) National Service Framework for Coronary Heart Disease, Department
of Health, London.
Feder, G., Griffiths, C., Eldridge, S. and Spence, M. (1999) 'Effect of postal prompts
to patients and general practitioners on the quality of primary care after a
coronary event (POST): randomised controlled trial', BMJ, 318, 1522-6.
Field, K., Thorogood, M., Silagy, C., Normand, C., O'Neill, C. and Muir, J. (1995)
'Strategies for reducing coronary risk factors in primary care: which is the
most cost effective?' BMJ, 310, 1109-12.
Flanagan, D. E. H., Cox, P., Paine, D., Davies, J. and Armitage, M. (1999) 'Secondary
prevention of coronary heart disease in primary care: a healthy heart initiative',
QJM, 92, 245-50.
Frankel, S. and West, R. (1993) Rationing and rationality in the National Health
Service: the persistence of waiting lists., Macmillan, Basingstoke.
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10. Health Services Evaluation. Number: 21344
Jones, J. (1998) 'Clinical and economic perspectives have to be integrated when
selecting priorities for intervention', BMJ, 317, 1124.
McLeod, A. L., Brooks, L., Taylor, V., Currie, P. F. and Dewhurst, N. G. (2004)
'Secondary prevention for coronary artery disease', QJM, 97, 127-31.
Merz, C. N., Rozanski, A. and Forrester, J. S. (1997) 'The secondary prevention of
coronary artery disease.' American Journal of Medicine, 102, 572-81.
Murchie, P., Campbell, N. C., Ritchie, L. D., Simpson, J. A. and Thain, J. (2003)
'Secondary prevention clinics for coronary heart disease: four year follow up
of a randomised controlled trial in primary care', BMJ, 326, 84-9.
NAW (2000) Tackling CHD in Wales: Implementing Through Evidence, The National
Assembly for Wales, Cardiff.
Pencheon, D., Guest, C. and Melzer, D. (2001) Oxford handbook of public health
practice., Oxford University Press, Oxford.
Petrou, S. (1998) 'Health needs assessment is not required for priority setting', BMJ,
317, 1154a-.
Robinson, J. G. and Leon, A. S. (1994) 'The prevention of cardiovascular disease.
Emphasis on secondary prevention.' Med Clin North Am, 78, 69-98.
St Leger, A. S., Schnieden, H. and Walsworth-Bell, J. P. (1994) Evaluating health
services' effectiveness, Open University Press, Buckingham.
Stevens, A. and Raftery, J. (1994) Health care needs assessment : the
epidemiologically based needs assessment reviews, Radcliffe Medical,
Oxford.
Summerskill, W. and Pope, C. (2002) '"I saw the panic rise in her eyes, and evidence-
based medicine went out of the door." An exploratory qualitative study of the
barriers to secondary prevention in the management of coronary heart disease.'
Family Practice, 19, 605-10.
Walker, A. R. P. (2001) 'With increasing ageing in Western populations, what are the
prospects for lowering the incidence of coronary heart disease?' QJM, 94, 107-
12.
West, R. R. (1977) 'Geographical variation mortality from ischaemic heart disease in
England and Wales', British Journal of Preventive & Social Medicine, 31,
245-50.
Wilkin, D., Hallam, L. and Doggett, M.-A. (1992) Measures of need and outcome for
primary health care., Oxford University Press, Oxford.
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Wood, D. A. (1998) 'European and American recommendations for coronary heart
disease prevention.' Eur Heart J, 19, A12-9.
Wright, F. L., Wiles, R. A. and Moher, M. (2001) 'Patients' and practice nurses'
perceptions of secondary preventive care for established ischaemic heart
disease: a qualitative study', Journal of Clinical Nursing, 10, 180-8.
Wright, J., Williams, R. and Wilkinson, J. R. (1998) 'Health needs assessment:
Development and importance of health needs assessment', BMJ, 316, 1310-13.
Word count: 1934 (excluding references)
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Reflective statement
This assignment has constituted a challenge, as I am aware Dr West is a leading
expert in the CHD and Cardiovascular field. He is in the steering board of the
Coronary Heart Disease National Service Framework Implementation Plan for Wales
and has published several books and articles about the subject (Frankel and West,
1993, West, 1977).
I have experience running CHD secondary prevention clinics in primary care. In my
practice I started this clinics during which I saw 116 patients with history of CHD.
Although I was aware about the effectiveness of reducing risk factors in CHD I was
not fully aware of the effectiveness of these type of clinics. For me has been very
useful to do an extensive literature search looking at the evidence. This evidence is
not as strong as I expected but I think this fact should not deter us from continuing the
clinics.
As consequence of this assignment I am planning to undertake an audit of the CHD
secondary prevention clinics I have run in the last few months, I hope this will allow
me to reflect on my practice and improve the care I provide.
12