To generate new, patient-centered insights into diagnostic error, we convened diverse groups in public deliberation to recommend and evaluate actions that patients and/or their advocates would be willing and able to perform to improve diagnostic quality.
New York State Drug Court Program: The
participant will be able to: Demonstrate the efficacy of
patient navigation in order to improve maternal/child
health outcomes and parenting skills for the court
involved population.
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
This infographic speaks to the challenges Emergency Departments face in caring and following up with the growing population of patients they see, and demonstrates how some EDs are seeing measurable improvements in care, patient satisfaction and efficiency.
Partnering with Patients, Families and Communities for Health: A Global Imper...EngagingPatients
Engagement is an essential tool to improving global health. This report introduces a new framework for engagement to help countries assess current programs and think strategically about future engagement opportunities. It spotlights barriers to engagement and offers concrete examples of effective engagement from around the globe.
New York State Drug Court Program: The
participant will be able to: Demonstrate the efficacy of
patient navigation in order to improve maternal/child
health outcomes and parenting skills for the court
involved population.
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
This infographic speaks to the challenges Emergency Departments face in caring and following up with the growing population of patients they see, and demonstrates how some EDs are seeing measurable improvements in care, patient satisfaction and efficiency.
Partnering with Patients, Families and Communities for Health: A Global Imper...EngagingPatients
Engagement is an essential tool to improving global health. This report introduces a new framework for engagement to help countries assess current programs and think strategically about future engagement opportunities. It spotlights barriers to engagement and offers concrete examples of effective engagement from around the globe.
Clinical practice guidelines and quality metrics often emphasize effectiveness over patient-centered care. In this article, the authors offer three approaches to personalizing quality measurement to ensure patient preferences and values guide all clinical decisions.
Weitzman 2013: State Health Policy Initiatives as Drivers for Improving Care...CHC Connecticut
Sue Birch presents on State Health Policy Initiatives as Drivers for Improving Care Outcomes: Colorado's Accountable Care Collaborative at the 2013 Weitzman Symposium
In first of two-part series, Pamela Greenhouse explores the differences and similarities of the Patient and Family Centered Care Methodology and Practice (PFCC M/P) and leean process improvement approachs, such as Lean, Six Sigma and Toyota. She believes that the PFCC M/P can be the unifying theme for health care, incorporating both process improvement and performance improvement.
This resource summarizes the eight recommendations outlined in the Institute of Medicine's a new consensus study entitled, Improving Diagnosis in Health Care. The recommendations are aimed at making diagnoses more accurate, reliable, efficient, and safe. This work is a continuation of the IOM’s Quality Chasm series.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Angela Coulter, Informed Medical Decisions Foundation
Dominick Frosch, Gordon and Betty Moore Foundation
Floyd J. Fowler, Informed Medical Decisions Foundation
Innovations conference 2014 erica wales does an online anti-cancer medicati...Cancer Institute NSW
Erica Wales - Does an Online Oral Anti-cancer Medication Education Program Targeted at Community Pharmacists Improve their Knowledge and Confidence in Dispensing Oral Anti-cancer Medication
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
John E. Wennberg, The Dartmouth Institute
Clinical practice guidelines and quality metrics often emphasize effectiveness over patient-centered care. In this article, the authors offer three approaches to personalizing quality measurement to ensure patient preferences and values guide all clinical decisions.
Weitzman 2013: State Health Policy Initiatives as Drivers for Improving Care...CHC Connecticut
Sue Birch presents on State Health Policy Initiatives as Drivers for Improving Care Outcomes: Colorado's Accountable Care Collaborative at the 2013 Weitzman Symposium
In first of two-part series, Pamela Greenhouse explores the differences and similarities of the Patient and Family Centered Care Methodology and Practice (PFCC M/P) and leean process improvement approachs, such as Lean, Six Sigma and Toyota. She believes that the PFCC M/P can be the unifying theme for health care, incorporating both process improvement and performance improvement.
This resource summarizes the eight recommendations outlined in the Institute of Medicine's a new consensus study entitled, Improving Diagnosis in Health Care. The recommendations are aimed at making diagnoses more accurate, reliable, efficient, and safe. This work is a continuation of the IOM’s Quality Chasm series.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Angela Coulter, Informed Medical Decisions Foundation
Dominick Frosch, Gordon and Betty Moore Foundation
Floyd J. Fowler, Informed Medical Decisions Foundation
Innovations conference 2014 erica wales does an online anti-cancer medicati...Cancer Institute NSW
Erica Wales - Does an Online Oral Anti-cancer Medication Education Program Targeted at Community Pharmacists Improve their Knowledge and Confidence in Dispensing Oral Anti-cancer Medication
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
John E. Wennberg, The Dartmouth Institute
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
This presentation will cover information about polypharmacy in older populations. The presentation will allow explain the use of technology such as HomeMeds as a tool to prevent adverse reactions in older populations.
IntroductionThe introduction of the Affordable Care Act in Ameri.docxnormanibarber20063
Introduction
The introduction of the Affordable Care Act in America was highly beneficial since it increased the number of low-income covered by Medicaid. It ensures that they are able to acquire medical coverage and access to healthcare services. Essentially, they have an opportunity to increase their eligibility despite their poverty level state. The Act has been able to improve the quality of Medicaid in the country to the same level as Medicare. Currently, people who fall between ages 19 to 64 and below the federal poverty level of 133% can be covered under Medicaid.3 Before the introduction of ACA, such patients would not be eligible.
Stakeholders
The Medicaid program affects different groups of people in the country. Millions of people have a direct stake in the program, meaning any changes will directly affect their decisions on health care coverage. They include low-income earners, the federal government, private insurance companies, and healthcare providers.
Overview
The Affordable Care Act certainly affected the number of people covered under Medicaid. Moreover, the amount of healthcare coverage in the county had a direct correlation with the availability of the Act in the United Sates. Currently, questions have been circulating as to whether the Act should be revised. However, the pertinent issue that arises from such questions is the manner in which any changes in the Federal Law might affect the Medicaid program. The program covers approximately 50 million Americans from low-earning families.1 Medicaid involves a partnership between the Federal and local governments over funding. It is optional for states to participate in the program, but all local governments are currently involved in the partnership. For a state to participate, it has to meet federal requirements. One of the requirements is that the state cover a particular group of people and offer certain benefits.
However, most of the eligibility in the program is dependent upon a person's income and the category in which he or she belongs. Many young adults with no children previously lacked coverage because they did not fall under the categories provided for by the program.
However, the Federal poverty guidelines would help to solve this problem since it lists a cut-off point for young adults with low income. The program now has a component that facilitates reporting of quality through patient measurements. An example is patient satisfaction and adherence to treatment, which has reportedly dropped by 40%.2 The challenge is that the program may fail to be beneficial for patients who need it since they may be turned away by healthcare providers. The component entails utilizing the measurements to determine choices of reimbursement. There is a risk that providers might begin turning away patients from low-income backgrounds
Analysis
The program has come a long way since it was first enacted, but there is the risk that such a measure might lock out large sections of .
Module 5 (week 9) - InterventionAs you continue to work on your .docxroushhsiu
Module 5 (week 9) - Intervention
As you continue to work on your assignment, you will be pulling in some information from your work throughout this course. For one part of this presentation, you will be identifying the current problem (or opportunity for change). This was part of your discussion in the week 2 assignment PowerPoint.
You will also propose an evidence-based intervention to address this particular problem. This intervention should be derived from the literature you have found and presented in your critical appraisal template.
As you have seen, these assignments have provided you the ability to identify a problem, develop a PCIOT question, search for evidence related to this PICOT, critically appraise the evidence for a solution to the problem, and now you will identify the solution and disseminate the results.
You are well on your way to becoming evidence-based practitioners!
Week 9!
Nice work on last week’s discussion. As you have discovered, decision aids can be very helpful when providing information for patients and families.
This week, you will continue to work on your assignment for this module. This will be an 8-9 slide PowerPoint presentation in which you will recommend an evidence-based practice change. Review the 4 articles you critiqued to determine what practice change is supported by the literature.
Some of the content for this assignment will be taken from your previous work and some will be new. This PowerPoint is a total of 8-9 slides.
Please review the full assignment details located under the learning resources for module 5.
Please let me know if you have questions
David
Provider perspectives on the utility of a colorectal
cancer screening decision aid for facilitating shared
decision making
Paul C. Schroy III MD MPH,* Shamini Mylvaganam MPH� and Peter Davidson MD�
*Director of Clinical Research, Section of Gastroenterology, Boston Medical Center, Boston, MA, �Study Coordinator, Section of
Gastroenterology, Boston Medical Center, Boston, MA and �Clinical Director, Section of General Internal Medicine, Boston
Medical Center, Boston, MA, USA
Correspondence
Paul C. Schroy III, MD MPH
Boston Medical Center
85 E. Concord Street
Suite 7715
Boston
MA 02118
USA
E-mail: [email protected]
Accepted for publication
8 August 2011
Keywords: decision aids, informed
decision making, shared decision
making
Abstract
Background Decision aids for colorectal cancer (CRC) screening
have been shown to enable patients to identify a preferred screening
option, but the extent to which such tools facilitate shared decision
making (SDM) from the perspective of the provider is less well
established.
Objective Our goal was to elicit provider feedback regarding the
impact of a CRC screening decision aid on SDM in the primary care
setting.
Methods Cross-sectional survey.
Participants Primary care providers participating in a clinical trial
evaluating the impact of a novel CRC screening d ...
Assignment WK 9Assessing a Healthcare ProgramPolicy Evaluation.docxjesuslightbody
Assignment: WK 9Assessing a Healthcare Program/Policy Evaluation
Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.
Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.
To Prepare:
· Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
· Select an existing healthcare program or policy evaluation or choose one of interest to you.
· Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.
The Assignment: (2–3 pages)
Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:
· Describe the healthcare program or policy outcomes.
· How was the success of the program or policy measured?
· How many people were reached by the program or policy selected?
· How much of an impact was realized with the program or policy selected?
· At what point in program implementation was the program or policy evaluation conducted?
· What data was used to conduct the program or policy evaluation?
· What specific information on unintended consequences was identified?
· What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
· Did the program or policy meet the original intent and objectives? Why or why not?
· Would you recommend implementing this program or policy in your place of work? Why or why not?
· Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.
By Day 7 of Week 10
Submit your completed healthcare program/policy evaluation analysis.
Milstead, J. A., & Short, N. M. (2019).
Health policy and politics: A nurse's guide (6th ed.). Jones & Bartlett Learning.
· Chapter 7, “Health Policy and Social Program Evaluation” (pp. 116–124 only)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409875/
https://www.sciencedirect.com/science/article/pii/S0029655418300617
i J LUUU^S
.
1
Methods and Statistical Analysis
Name xxx
United State University
Course xxx
Professor xxxx
Date xxx
The Evaluative Criteria
The process of analyzing a healthcare plan to see if it meets its goals takes some time. Because it promotes an evidence-based approach, assessment is crucial in practice consignment. Evaluation can be used to assess the effectiveness of the research. It helps determine what changes could be recommended to improve service delivery and the study's persuasiveness. An impact evaluation analyzes the intervention's direct and indirect, positive and negative, planned and unplanned consequences. If an evaluation fails to deliver fresh recognition regularly, it may result in inaccurate results and conclusions. A healthcare practitioner can utilize the indicators or variables to evaluate programs and determine whether they are legal or not (Dash et al., 2019). The variables are also used to assess if the mediation is on track to meet its objectives and obligations. Participation rates, prevalence, and individual behaviors are among the measures to be addressed.
Individual behaviors are actions taken by individuals to improve their health. People have been denied the assistance and resources they seek because of ethics and plans. In addition, different people have varied perspectives about pressure ulcers treatment. Relevance refers to how the study may contribute to a worthwhile cause (Li et al., 2019). Quality variables give statistics on the precariously rising service consignment while also attempting to provide information on the part of the care that may be changed. The participation rate refers to the total number of people participating in the study.
On the other hand, individuals may be unable to engage in the study due to a lack of cultural knowledge and ineffective consent processes. The overall number of persons in a population who have a health disease at a given time is referred to as prevalence (Li et al., 2019). Although prevalence shows the rate at which new facts arrive, it aids in determining the suitable, complete outcome-positive prestige of people.
Research Approaches
The word "research approaches" refers to techniques and procedures to draw general conclusions concerning data collection, analysis, and explanation methods. In my research, I'll employ both quantitative and qualitative methods. A qualitative research technique will reveal deterrents and hindrances to practicing change by rationalizing the reasons behind specific demeanors (Li et al., 2019). Qualitative research will collect and evaluate non-numerical data to comprehend perspectives or opinions. It will also be utilized to learn everything there is to know about a subject or to develop new research ideologies.
The quantitative method focuses on goal data and statistical or numerical analysis of data collected through a questionnaire. In the healthcare field, quantitative research may develop and execute new or enhanced work meas ...
Evidence-Based Practices & Nursing
Introduction
Normally, PICOT format is helpful in formulation of questions in an evidenced based clinical practice. PICOT generated questions generally fall under for main categories of clinical practices. These include; therapy, prevention, diagnosis, etiology as well as Prognosis. The essential elements in PICOT questions. The PICOT format is valuable in addressing research questions comprehensively. Five elements are normally addressed including; population, intervention, comparison, outcome and time as well (Riva, Malik, Burnie, Endicott, & Busse, 2012).
Summary of Case Study
The ever increasingly high incidence of breast cancer conditions has posed serious challenges in the nursing profession. Provision of appropriate healthcare to the cancer patients has been lacking leading to adverse effects of the proliferation of cancerous cells which further worsen the conditions of the patients. As primary care, clinicians have the responsibility to stressing providing healthcare services within healthcare facilities as well as monitoring treatment in home based facilities to help manage cancer condition. Most cancer patient need clinicians who practice evidence-based clinical practices (Riva, Malik, Burnie, Endicott, & Busse, 2012).
Research Question
In cancer patients receiving chemotherapy, will they have better white blood cell count monitoring with a follow-up at home versus follow-up at a health care facility during their treatment?
PICOT Format
1) P-Population: Patients aged 18-60 years-old, breast cancer who have not received chemotherapy in the past six months are subjected to the treatment. Patients with other serious health conditions such as heart diseases were excluded in the study. 30 patients, with 15patients stationed at the healthcare facility while the other 15 patients receiving home-based care, are expected to take part in the study.
2) I -Intervention: The patients will receive dosage based on the age, sex and health general body health as well as the stage of cancer cells proliferation in the body. The patients are required take the prescribed drugs at regular intervals. The subjects will be subjected to treatment under the same during the research study.
3) C-Comparison: All the subject regardless of variations in their level of dose requirement will be subjected to the same treatment for the same duration, 3months. Standardized treatment will be given to subjects with no extreme variations in their level of dose requirement and would be used as an active control group. Using this strategy, it will be possible to minimize the non-specific effects due to a group of the patient receiving treatment within the healthcare.
4) O-Outcome: The response in chemotherapy treatments will be check by examining the numbers of defective cancerous cells in the body tissues. The patients will report to the theatre in order to be examined by an oncologist. The results will be recorded i ...
Brian Draxten, Director of Resource Planning at Otter Tail Power Company, discusses how the utility makes resource decisions and how they see the energy future.
City of Morris, Minnesota: Climate Smart MunicipalityJefferson Center
Blaine Hill, the City Manager of Morris, MN, discusses the city’s efforts to make Morris climate-smart, as well as their expanding partnership with the city of Saerbeck, Germany.
Mike Reese, director of the Renewable Energy Program at the West Central Research and Outreach Center provides an "Energy 101" to residents of Stevens County.
In today's political environment, is it possible to have the kinds of conversation that makes democracy meaningful? The Twin Cities Election Forum worked to produce a list of reasons why Twin Cities voters might support each of the major-party presidential candidates and to cultivate understanding across the partisan divide.
The Stevens County Climate Dialogue is the first in a series of projects aimed at supporting rural citizens to assert leadership and build resiliency in the face of extreme weather and changing climate conditions.
The Winona County Climate Dialogue is the third in a series of projects aimed at supporting rural citizens to assert leadership and build resiliency in the face of extreme weather and changing climate conditions.
The Itasca County Climate Dialogue is the second in a series of projects aimed at supporting rural citizens to assert leadership and build resiliency in the face of extreme weather and changing climate conditions.
Informed Citizen Akron Report #3: Improving Candidate-Focused Media Coverage ...Jefferson Center
In the final deliberation, Akron-area citizens generated their recommendations for how local and Ohio-based media partners can improve issue-based coverage during the 2016 presidential election.
Informed Citizen Akron #2: Improving Candidate-Focused Media Coverage in the ...Jefferson Center
Following the momentum of the first Informed Citizen Akron, 18 Akron-area residents continued to learn from media experts, to deliberate, and to generate recommendations for how local and Ohio-based media partners can improve issue-based coverage during the 2016 presidential election.
Informed Citizen Akron #1: Improving Candidate-Focused Media Coverage in the ...Jefferson Center
This the first out of three reports in the Informed Citizen Akron project. A demographically-balanced panel of eighteen Akron-area residents met at the University of Akron Student Center to participate in the Informed Citizen Akron project, and were given the charge to learn from media experts, to deliberate, and to generate recommendations for how local and Ohio-based media partners can improve issue-based coverage during the 2016 presidential election.
In our Rural Climate Dialogues program, we work with rural communities to develop and implement plans to strengthen community resilience in the face of climate change. The state convening took place in Saint Paul, inviting residents of Winona, Itasca, and Stevens County to discuss sustainability goals and collaboration with state agencies.
2016 was another transformative year at the Jefferson Center. We’ve strengthened our existing partnerships and forged new relationships both in the United States and globally. We’re expanding our reach, deepening our impact in all our program areas, and advancing citizens and citizen power as the foundation of our democracy. In this report, you'll find our program highlights from this year and our outlooks for 2017.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Couples presenting to the infertility clinic- Do they really have infertility...
Clearing the Error: Patient Participation in Reducing Diagnostic Error
1. CLEARING THE ERROR
Using Public Deliberation to Define
Patient Roles as Partners in the
Diagnostic Process
The Jefferson Center, Dr. Tina Nabatchi at
Syracuse University’s Maxwell School of
Citizenship and Public Affairs, and the Society
to Improve Diagnosis in Medicine are leading
a 2 year research initiative to assess the value
of public deliberation in developing healthcare
policy and to identify roles patients are willing
and able to perform to improve diagnostic
quality. This effort is funded by the Agency for
Healthcare Research and Quality.
2. ACTIVATING PATIENTS IN POLICY
In an effort to improve health outcomes,
providers, insurers, and others are
working to more fully engage patients
in their own healthcare. These initial
efforts suggest educating patients about
their condition(s) and involving patients
in determining the nature and course of
their treatment can improve health and
reduce spending.
Building from the insight that, with a
little assistance and education, patients
can make effective decisions about their
own care, we’re exploring the value of
incorporating patient knowledge and
diversity into the development of health
policy, regulations, and institutional
practices. We chose first to focus on the
issue of diagnostic error.
We know the relationship between the
patient and their provider is a critical
determinant in effective diagnosis.
Unfortunately, many patients feel
unable to fully assert themselves as
mutual partners in the patient-provider
relationship.
To generate new, patient-centered
insight into this problem, we convened
diverse groups in public deliberation
to recommend and evaluate actions
that patients and/or their advocates
would be willing and able to perform to
improve diagnostic quality. Participants
also identified obstacles to action that
healthcare systems and providers should
address to improve diagnosis.
This report highlights those
recommendations and assesses the value
of public deliberation in developing more
effective health policy.
IMPROVINGDIAGNOSIS
What’s diagnostic error?
A diagnostic error is a missed, delayed,
or wrong diagnosis. An error is made
in about 1 of every 10 diagnoses.
Diagnostic error is a leading cause
of malpractice claims and likely a
significant factor in adverse health
events. Diagnostic error, however, is
less responsive to system-level change
than other types of medical error, which
has held up the search for solutions.
3. PATIENT-DRIVEN POLICY
Our engagement efforts consisted of
Citizens’ Jury-style public deliberation.
20 individuals were selected to
participate for six days of deliberation
over two weekends in late 2015.
Applicants were recruited from Onondaga
County, New York. The demographic
composition of the selected panel is
included in Appendix A.
Participants met for appoximately 50
hours to hear expert testimony and
feedback (expert list is in Appendix
B), share their personal stories and
expertise, and deliberate together to
recommend patient action steps. They
identified five main strategies for
addressing diagnostic error through
patient action.
1. Present symptoms clearly and
completely
2. Assert yourself in the relationship
3. Coordinate your care
4. Ensure accurate records and tests
5. Manage your care
The group also recommended sixteen
concrete action steps to support
implementation of the main strategies.
All sixteen action steps are listed in
Appendix C.
To maximize the opportunity for patients
and their advocates to succeed using
these recommendations, participants
were asked to think about potential
obstacles to pursuing the recommended
actions and identify strategies for health
systems to begin addressing those
obstacles. The identified obstacles and
top remedies are outlined in Appendix D.
Participants recommended concrete,
sound action to address the challenge
of diagnostic error. Their input
complements the recent work of
the Institute of Medicine and other
organizations by presenting a clear
patient perspective that responds to the
diversity of patient experience.
What’s a Citizens’ Jury?
A Citizens’ Jury provides everyday
citizens the opportunity to study an
issue deeply, deliberate together with
a diverse group of their peers, and
develop solutions to challenging public
issues.
A Citizens’ Jury includes:
• A random stratified sample of a
given community
• Unbiased information provided by a
diverse array of experts
• Time to study and discuss an issue
in depth
• Recommendations produced
through deliberation and voting
4. THE RESEARCH PROCESS
To assess the value of patient deliberation in developing patient and
system-focused healthcare policy and to evaluate the efficacy of the
recommended action steps, we conducted controlled research. The
research process is described in the graphic below.
Two matched panels of 20, randomly
selected and stratified to reflect the
demographics of Onondaga County, were
convened to recommed action steps for
patients to reduce errors in diagnosis.
Each group heard educational presentations from
experts on diagnosis and diagnostic error.
GROUPA GROUPB
Group B completed
questionnaires with
their individual
recommendations
for patient action
immediately after
the presentations.
Group A
questioned experts
and deliberated
for 6 days to
develop group
recommendations
for patient action.
GROUPC
A third group of 93 diverse
participants, Group C, was
convened to assess the
feasibility and impact of Group
A’s recommendations from
the perspective(s) of patients
and healthcare consumers
who didn’t hear extensive
educational presentations.
All 3 groups were surveyed before and after their participation to
assess changes in patient activation, trust in doctors, perceptions
about diagnostic error, knowledge of diagnostic error, perceptions
of patient efficacy and patient responsibilities, and overall health
literacy. A control group was also surveyed to provide baseline data
relative to the other groups.
5. RESEARCH RESULTS
Groups A, B, and C experienced statistically significant increases in patient activation, trust in
doctors, and perceptions about the seriousness of diagnostic error.
The percentage of participants who correctly answered a question measuring their knowledge
about diagnostic error increased in all three groups.
All three groups saw changes in their perceptions about patient engagement. After participation,
each group had a statistically significant change in their perceptions about responsibility for
diagnostic error and the role of patients in the diagnostic process.
Group A, the 6-day deliberation group, also experienced statistically significant increases in
correctly answering questions about health literacy after deliberation.
For all questions, effect sizes were largest among Group A, suggesting that longer-term
engagement, coupled with deliberation, promotes greater patient knowledge, activation, and
perceptions of self-efficacy.
Moderate or Major
Improvements in
Diagnostic Quality
Easy or Very Easy
to Use in Own
Healthcare
Likely or Very
Likely to Use in
Own Healthcare
Coordinate your care
Ensure accurate records and tests
Assert yourself in the relationship
Manage your care
Present symptoms clearly and completely
0% 10% 40% 50% 60% 70% 80% 90%20% 30% 100%
Groups C also evaluated Group A’s recommendations for impact on diagnostic error, ease of
use, and likelihood of use. Strong majorities thought all recommendations would likely lead to
moderate or major improvements in diagnostic quality. Participants felt recommendations 1, 2,
and 5 would be the easiest to implement in the course of their own care. Similarly, participants
said they were most likely to use recommendations 1, 2, and 5 in the course of their own care.
GROUP C’S ASSESSMENT OF PATIENT RECOMMENDATIONS
6. CONCLUSIONS AND NEXT STEPS
The work accomplished by patients and healthcare consumers during Clearing the Error
highlights the capacity of non-experts to participate meaningfully and productively
in assessing and improving healthcare policy. The recommendations to improve
diagnostic quality are on par, and in many ways more detailed, than available
recommendations from the National Academy of Medicine and others.
Clearing the Error also provides a foundation for further research to explore the role
of patients in improving diagnostic quality and in developing health policy.
Over the next 18 months, we will explore the efficacy of patient recommendations in
clinical settings, focusing first on the top 3 recommendations as assessed by Group C.
We also hope to test the relative efficacy of recommendations generated by
patients and doctors. For example, are patients more or less likely to follow similar
recommendations if they come from other patients?
If you are interested in learning more about research to implement and evaluate
patient recommendations, or if you’d like to use these recommendations in your own
research, let us know! You can reach us at arockway@jefferson-center.org
or 651-209-7672.
If you’d like additional materials from this research not included in this report,
contact Dr. Tina Nabatchi at tnabatch@maxwell.syr.edu.
7. CLEARING THE ERROR
Clearing the Error is a collaborative effort between the Jefferson Center, the Maxwell
School of Citizenship and Public Affairs at Syracuse University, and the Society to
Improve Diagnosis in Medicine, with funding from the Agency for Healthcare Research
and Quality.
The Jefferson Center is a nonpartisan nonprofit that
engages Americans directly to solve shared challenges and
craft better policy. Our mission is to strengthen democracy
by advancing informed, citizen-developed solutions to
challenging public issues.
Contact: Andrew Rockway
arockway@jefferson-center.org
jefferson-center.org
The Maxwell School of Citizenship and Public
Affairs is Syracuse University’s home for innovative,
interdisciplinary teaching and research in the social
sciences, public policy, public administration, and
international relations.
Contact: Dr. Tina Nabatchi
tnabatch@maxwell.syr.edu
maxwell.syr.edu
Contact: Paul Epner
Paul.Epner@improvediagnosis.org
improvediagnosis.org
The Society to Improve Diagnosis in Medicine works to
improve diagnostic quality through research, education,
and advocacy. SIDM is committed to a world where
diagnosis is accurate, timely, and efficient.
8. Demographic Onondaga County % Actual Number
Gender
Female 51.9% 9
Male 48.1% 11
Ethnicity
Asian 3.1% 0
Black 11.0% 5
Hispanic or Latino 4.0% 1
Native American or Alaska Native 0.8% 0
Native Hawaiian or Pacific Islander 0.0% 0
White 81.1% 14
Household Location
Urban 87.41% 18
Rural 12.59% 2
Party Affiliation
Democrat 36.96% 7
Independent, Unaffiliated, Other 32.77% 6
Republican 30.27% 7
Annual Household Income
Less than $15,000 13.3% 3
$15,000-$24,999 10.5% 3
$25,000-$34,999 10.0% 6
$35,000-$49,999 12.7% 2
$50,000-$74,999 18.7% 4
$75,000-$99,999 12.4% 2
$100,000+ 22.5% 0
Age
18-34 31% 7
35-64 50% 9
65 & over 19% 4
Education
Did not complete High School 10.1% 2
High School or Equivalent 45% 8
Associate’s/Bachelor’s degree 30.4% 8
Graduate or professional degree 14.5% 2
Total Number of Participants 20
APPENDIX A - DELIBERATIVE PANEL DEMOGRAPHICS
9. APPENDIX B - EXPERT PRESENTERS
Viraj Bhise
Graduate Research Assistant, University of Texas Health Science Center at Houston
Chief Operating Officer, Health Connect Compusoft
Dr. Janice Colestro
Associate Director, Veterans Health Administration Office of Medical-Legal Affairs
Dr. Laurie C. Drill-Mellum
Chief Medical Officer, MMIC
Dr. John Ely
Physician and Professor of Family Medicine at University of Iowa
Paul Epner
Executive Vice President, Society to Improve Diagnosis in Medicine
Helen Haskell
President, Mothers Against Medical Error
Dr. Stephen Martin
Faculty, Harvard Medical School
Assistant Professor, University of Massachusetts Medical School
Kathryn McDonald
Executive Director, Center for Health Policy and Center for Primary Care and Outcomes
Research at Stanford University
Patricia McGaffigan
Chief Operating Officer and Senior VP of Programs, National Patient Safety Foundation
Dr. David Meyers
Emergency Physician, Sinai Hospital
Sue Sheridan
Director of Patient Engagement, Patient-Centered Outcomes Research Institute
Dr. Joan Von Feldt
Professor of Medicine, University of Pennsylvania Hospital
Peggy Zuckerman
Board Member, Society for Participatory Medicine
10. APPENDIX C - PATIENT RECOMMENDATIONS FOR ACTION
1) Present symptoms clearly and completely
• Be truthful about your symptoms and other behaviors when telling your doctor about your
history to ensure information is accurate.
• Be prepared to discuss your symptoms. For example, 8 characteristics of symptoms are
quantity, quality, aggravating factors, alleviating factors, setting, associated symptoms,
location, timing.
2) Assert yourself in the relationship
• Be clear, concise, and persistent in communicating your symptoms and concerns.
• Ask detailed questions of your doctor, including a plan to arrive at a diagnosis so the doctor
remains engaged and focused on your concerns. For example, “could these symptoms
indicate something else or an additional issue?”
• Notify your healthcare provider if your condition worsens, does or doesn’t improve, or if new
symptoms develop.
• If you’re concerned about the accuracy of the diagnosis, seek a second opinion.
3) Coordinate your care
• Find a primary care provider/family doctor so that they can better coordinate and manage
your healthcare.
• Enlist a patient advocate, as needed, to assist you in coordinating care.
• Have your primary care provider manage all your records to ensure they are accessible to
other providers.
• Seek out a health system where different doctors work together frequently, share consistent
information, and coordinate services effectively.
4) Ensure accurate records and tests
• Maintain and update your own medical record, which includes test results, doctor notes,
images, communication with providers, and other information pertinent to your medical
history.
• If you have access to your electronic medical records or a patient portal, use that. If you
don’t have access, ask for a physical copy of your records and/or any recent updates.
• If you notice a factual inaccuracy with your medical record, advocate and insist to have the
error corrected.
5) Manage your care
• Ensure communications and expectations are clear between you and your healthcare
provider.
• Throughout the relationship, follow through on your health care provider’s recommendations
regarding the course of action to reach an accurate diagnosis. For example, completing lab
tests, going to appointments with specialists, and taking medications as prescribed.
• Follow up with your healthcare provider after appointments to obtain test results to ensure
proper testing was conducted. Thus, both patient and healthcare provider are accountable.
11. APPENDIX D - SYSTEM OBSTACLES AND SOLUTIONS
Different payment systems, insurance, and/or ability to pay can limit choice
and access or influence the course of diagnosis and treatment.
• Provide patients with clear, practical information about signing up for
insurance coverage
• Develop standardized pricing for medical services
• Ombudsman/liaison/advocate to help patient navigate choice when
managing cost vs. care
Fragmented, decentralized healthcare systems inhibit effective
communication and information-sharing across systems and between
providers. This fragmentation can also reduce provider collegiality/
collaborative problem solving.
• Transition from many proprietary electronic health record systems to one
system so there is greater interoperability across providers
• Primary care provider should be responsible for coordinating
communication between all different providers
• Patients go to portal to review or verify records; if they don’t have a
computer, review notes before they leave the office
• Develop protocols for sharing information between providers
Patients don’t know how to communicate symptoms effectively.
• Develop a video, poster, or handout for appointment settings, to include
potential questions for your doctor, topics to cover, and other information
so patients can “help doctors help you”
• Have a Kiosk or iPad at clinic/office that presents interactive questions to
help patients clarify 8 characteristics of their symptoms
The complexity of the healthcare system makes it difficult for patients to help
coordinate the diagnostic process (e.g. following up with multiple doctors,
tracking personal medical record and history, making sure test results are
analyzed).
• Access to patient portal in office, with opportunity to print records, notes,
treatment plan, test results, and other information
• Create a Patient Review Board for missed diagnosis to review
implementation of practices aimed at improving diagnostic quality
• A flag/notification on electronic health record when new information is
added and when primary care provider has read it
12. APPENDIX D - SYSTEM OBSTACLES AND SOLUTIONS
Culture encourages doctors to be efficient and productive; patients have
limited time to interact with doctors face-to-face.
• Doctor has another staff person write electronic medical record and
perform other tasks to allow more time for interaction with patient
• Shift culture of 15 minute appointments to 20 minutes; 5 minutes makes a
difference
• Doctor has patient information (8 characteristics of symptoms or etc.)
before appointment begins
• Change payment structure to encourage longer visits or at least focus on
better health outcomes; payment structure reflects "success rate" - such as
better health outcomes, fewer follow-up visits, etc.
• Have provider address most important issue first
Patients don't necessarily know what their options might be for asserting
themselves.
System Focus
• Mandatory debriefing between provider and patient to ensure clarity of next
steps during visit
• Change provider reimbursement system to incentivize/allow more time
with patients
Patient Focus
• Provide a handout or verbal instructions to patients that describe patient
“rights” - to ask questions; to ask for a 2nd opinion; to receive satisfactory
answers to questions; to receive a summary of what's going on with your
care
• Be persistent, be a pain in the ass
Patients don't necessarily trust providers. Provider attitudes or behavior can
inhibit patient openness, receptivity, confidence, and/or satisfaction.
• Doctor communicates uncertainty in the diagnosis appropriately. For
example, "I don't know what's wrong with you" vs. "I'm not sure what's
wrong with you, I have a few ideas, but Tests X and Y will help me make a
more accurate diagnosis."
• Have an assistant type into electronic health record during encounter so
that doctor can focus on patient conversation
• Ongoing education for providers about interacting and communicating with
patients