The document provides an overview of the ACERS (Acute COPD Early Response Service) team and COPD services in Hackney. The summary is:
- The ACERS team introduces their service model which provides rapid community response for COPD exacerbations and ongoing chronic disease management.
- COPD is projected to be the third leading cause of death by 2020. The ACERS team aims to provide comprehensive, integrated care to meet the needs of COPD patients in Hackney.
- Resources and support available include the NHS London Respiratory Team, British Lung Foundation, NICE guidelines, and the National COPD Project which focuses on reducing readmissions.
The latest guidelines on the management of a COPD patient ( Stable COPD, patient with an exacerbation of COPD), latest modalities of treatment of a COPD patient
The latest guidelines on the management of a COPD patient ( Stable COPD, patient with an exacerbation of COPD), latest modalities of treatment of a COPD patient
COPD is a lung disease that makes it hard to breathe. It is caused by damage to the lungs over many years, usually from smoking.
The main symptoms are:
• A long-lasting (chronic) cough.
• Mucus that comes up when you cough.
• Shortness of breath that gets worse when you exercise.
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COPD is a lung disease that makes it hard to breathe. It is caused by damage to the lungs over many years, usually from smoking.
The main symptoms are:
• A long-lasting (chronic) cough.
• Mucus that comes up when you cough.
• Shortness of breath that gets worse when you exercise.
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F-32 & 33, 1st Floor
DLF Centre Point, Sector – 11,
Bata Mor, Main Mathura Road,
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Commissioning Care Pathways for Chronic DiseasesJames Gupta
Commissioning Care Pathways for Chronic Diseases / Long Term Conditions
This was a presentation I made recently for a conference on Long Term Conditions which was unfortunately cancelled, but I had already written and researched the slides so wanted to put them up for people to see!
Explains how to commission effective services to deal with patients suffering from long-term (chronic) conditions
How to manage a case of acute exacerbation of COPD according to GOLD guidelines. Sincere thanks to Dr. Amardeep Toppo who has prepared most of this presentation.
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
It contains :
- The new GOLD classification of severity
- The new GOLD treatment guidelines for the treatment of
COPD
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Presentation delivered by Dr Ellie Hitchman, Speciality Doctor and Kim Barlow, Specialist Physiotherapst from St Joseph's Hospice, Hackney, at the Pan London Airways Network Winter Meeting 2016
Plenary Sue Hill and Robert Winter - Improving outcomes for people with respi...NHS Improvement
Improving outcomes for people with respiratory disease: Keeping up the momentum
Professor Sue Hill and Dr Robert Winter
Joint National Clinical Directors for Respiratory Disease
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
Enhanced recovery care pathways: a better journey for patients seven days a week and a better deal for the NHS - presentation from the Health and Care Innovation Expo 2014 - Sue Cottle, Amy Kerr and Neil Betteridge
Introduction to Supporting recovery in Primary Care using Proactive Framework...Innovation Agency
Presentation by Julia Reynolds, Associate Director for Transformation - Innovation Agency at the Supporting recovery in Primary Care using Proactive Frameworks for Long Term Conditions event on Thursday 15 September 2022.
Presentation by Dr Martin Myers MBE, PhD, FRCPath, Consultant Clinical Biochemist, Lancashire Teaching Hospitals NHS Foundation Trust at ECO 19: Care closer to home on Tuesday 9 July at Deepdale Stadium.
Chronic Obstructive Pulmonary Disease (COPD) is the third-leading cause of death in America, yet less than 9 percent of those patients near the end of life are admitted to hospice. These slides looks at the effects of COPD and other Advanced Lung Diseases (ALD) and how palliative care and hospice can improve patient care and clinical outcomes.
NOTICE:
This Webinar was intended to provide general educational information only. The information presented should not be viewed as specific medical advice regarding a particular patient. It is always a medical provider’s responsibility to individually assess and evaluate each patient before providing that patient medical advice or initiating any medical intervention.
Chronic Obstructive Pulmonary Disease (COPD) by Dr Kemi DeleKemi Dele-Ijagbulu
Presentation on definition and general overview of COPD, how to differentiate COPD from Asthma, how to make diagnosis of COPD, simple tools for assessment of COPD; available therapeutic options; as well as management of stable COPD, COPD exacerbations and comorbidities
Enhanced Recovery After Surgery (ERAS®) is the Enhanced Recovery After Surgery (ERAS®) is the implementation of patient-focused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidence-based, interdisciplinary perioperative guidelines.
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Innovative and Community Partnered Pulmonary Rehabilitation for Seniors in NBDataNB
1 in 9 New Brunswick (NB) citizens over the age of 35 have a chronic obstructive pulmonary disease (COPD) diagnosis; this incidence increases to 1 in 5 over the age of 65. COPD admissions (3100/annum) are second only to childbirth in NB and COPD accounts for 5.2% of NB deaths.
The Gold Standard intervention for COPD is Pulmonary Rehabilitation (PR). Despite the economic and pragmatic burden that COPD places on NB, access to PR continues to be a significant challenge. The purpose of our project was to develop a novel student-infused approach that increases access to PR while providing an educational experience for senior healthcare students in the treatment of COPD.
With HSPP funding, a student-infused PR clinic was created that recruited 180 healthcare students from community college and university programs. Working with experienced respiratory therapists, healthcare students delivered PR to 80 people in Saint John and Saint Stephen. Each 8-week clinic provided individuals with moderate to severe COPD the necessary skills to better self-manage their disease. Indicators of health were measured before and after each clinic, and clinically meaningful improvements occurred. PR participants walked significantly farther and reported fewer symptoms and less impact of COPD on daily life. This is initial evidence that our approach to PR was successful in the treatment of COPD.
The purpose of this presentation will be to discuss this project in greater detail, the implications of our findings, the “student-infused” model of PR, as well as our plans for the future of the project.
Presenters: Tammie Black and Dr. Kyle Brymer
Developing and implementing clinical standards for seven day servicesNHS Improving Quality
Celia Ingham Clark National Director: Reducing Premature Mortality. Slides from Celia's presentation from the 7 Day Services events West Midlands 11th June and East Midlands 12th June 2014
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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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
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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
6. COPD is projected to be the third
biggest killer by 2020
1990 2020
Ischaemic heart disease
CVD disease
Lower respiratory infection 3rd
Diarrhoeal disease
Perinatal disorders
COPD 6th
Tuberculosis
Measles Stomach cancer
Road traffic accident HIV
Lung cancer Suicide
Murray & Lopez 1997
7. Diagnosis
• Generally over 40 years1
• A smoker or ex-smoker (remember passive
smoking)
• Presentation with:
• cough
• excessive sputum
• dyspnoea (most common)
• Spirometry
• FEV1/FVC < 70%
• FEV1 – As per 2010 Guidelines
1. NICE 2010
8. No. of patients discharged with a diagnosis of COPD
900
800 830
700
600 587 617
500 508 531
400 380
300
200
100
0
2000 2001 2002 2003 2004 2005 2006 2007
Year
9.
10. Service Model
• Primary Care Support
• Community Based Rapid Response
• Emergency Department Intervention
• Early Supported Discharge
• Community Clinics
• Education
• End of Life Pathway
11. Service Philosophy
To provide a comprehensive, integrated,
responsive community-focused COPD
service, for acute exacerbations and
ongoing chronic disease management,
which meets the diverse needs of City &
Hackney patients in a sustainable and
timely manner.
12. Who are we?
• 1 wte Nurse Consultant – Matthew Hodson
• 2 wte COPD Specialist Nurses
• 4 wte COPD Senior Staff Nurses
• 2 wte COPD Specialist Physiotherapists
• 1 wte COPD Team Administrator
• Medical Consultant Lead
Base: Respiratory Offices, Homerton Hospital
13. Patient
GP
Other Practice
health
professionals nurse
ACERS
Community Clinic
Matron
Emergency
Department
Medical
Wards
14. ACERS Core Features
• Opening Hours (7 days, 8 am – 7 pm)
• Response Time (<4 hrs for community referral)
• Length of Care Package for H @ H within the
community (approx< 8 days)
• Focus on 30 and 90 days post exacerbation
• Referral in to PR – ASAP after exacerbation
• Medical Support (Close links with hospital team)
15. Clinical Responsibility
• ACERS have regular contact with
Respiratory Consultant and SpR
• Easy access to hospital diagnostics
• Regular communication with Practice
Nurse & GP
• GP asked for input with non-respiratory
problems when appropriate
16. Hospital @ Home
• Admission Avoidance – SOS Calls
• Early & Supportive Discharge
• Links with Other Local Acute Hospitals
• Acute Intervention
• Weekly MDT & Links with Respiratory Team
• Up to 14 days intervention (HV/Telephone)
• Physiotherapy Intervention
• Post exacerbation PR offered
17. Specialist COPD Case Management
• Level 1 & 2 COPD case management
• Proactive disease management can make a real
difference to patients with a single condition
provided by a specialist team
• COPD main long term condition
• Support generic workforce in managing COPD in
community links with practice nurse
• Focus on 30 and 90 day follow-up – single
pathway
18. Community Clinics
• Diagnostic and therapeutic support to
practices
• Assist in case detection / diagnosis
• Follow up of exacerbations seen at home
• Advise in the management of “difficult”
problems
• Location Homerton Hospital
19. Education
• Support LES and Non LES practices in
providing direct education to the practice in
COPD.
• In practice join COPD Clinics with PN
• Named COPD Nurse links with Practice Nurse
• Direct Access to COPD Healthcare
professional – Via fax spirometry / phone
• Email Advice
20. Education - Challenges
• Key – self management
• Understanding and accepting diagnosis
• New diagnosis – where does it start?
• NICE 2010 Guidelines – update
• Rescue Packs
• Variety of inhaler choices – but why and MDI?
• Annual Reviews – making changes
21. Multidisciplinary working
– COPD care should be delivered by a multidisciplinary team that
includes respiratory nurse specialists & Specialist Ward Nurses
– Consider referral to specialist departments (not just respiratory
physicians)
Specialist department Who might benefit?
Physiotherapy People with excessive sputum
Dietetic advice People with BMI that is high, low or
changing over time
Occupational therapy People needing help with daily living
activities
Social services People disabled by COPD
Multidisciplinary palliative People with end-stage COPD (and their
care teams families and carers)
[2004]
24. Outcomes that matter
• Improved Survival
• Earlier and Accurate Diagnosis
• Improved Quality of Life
• Slower disease progression
• Reduced exacerbation rate
• Reduce hospital admission & re-admission rates
• High Quality End of Life care
• Patient centred quality care
25. What does patient centred
COPD care look like
Practice
nurse
Community
GP Matron
27. Key Messages to bottle up ..
• Earlier Diagnosis
• Smoking as treatment for COPD
• Responsible Prescribing
• Pulmonary Rehabilitation
• Responsible oxygen prescribing
• Living with advanced COPD
28. …but now what do with them?
• Recognise that there is fantastic
work already happening within
current work places.
• Integration across primary and
secondary care is key in
improving the patient pathway:
- join up working
- reduce repetition
- no silo working
- patient centred care
29. Quality COPD Service
• Proactive and opportunistic case finding to minimise the impact of late
diagnosis on individuals and the healthcare system
• Quality assured, accurate diagnosis and assessment of severity and ongoing monitoring
and review of the condition through a proactive chronic disease management model.
• People with COPD are screened, assessed and managed with
pharmacological and non-pharmacological interventions in line with
NICE/quality guidelines
• People with COPD are educated and supported in the management of their
condition so that they can become active partners in care.
• Effective prevention and management of exacerbations and of hospital
Admissions
• Effective palliative, end of life care and bereavement support for people with COPD
31. Many available..
• Contact your local COPD or
Respiratory Specialist within
your local hospital or
Community Health Services
• Explore the hospital or
community website – use
COPD as a search term
• Identify your oxygen champion
• Who is leading on
Pulmonary Rehabilitation
within your local area
32. National & Resources
• National Institute for Clinical Excellence – NICE 2010 Update Guidelines
for the management of COPD in primary and secondary care
• British Lung Foundation
• Primary Care Respiratory Society (PCRS)
• NHS Improvement Programme – Lung Work stream
• NHS London Respiratory Team
• IMPRESS (BTS and PCRS)
• Association of Respiratory Nurse Specialist
33. NHS London Respiratory Team
www.london.nhs.uk/what-we-do/improving-your-services/better-quality-services/london-respiratory-team
35. National COPD Project
• Prevent COPD readmissions
• In line with NICE guidance
– Self Management Plans
– Rescue Packs
• Antiobiotic: change in sputum colour
• Corticosteroid: ↑ breathless and/or wheeze
• Admissions 1º Δ of COPD Exacerbation
• NICE: all patients who have had an exacerbation OR are
at risk of an exacerbation should get a self mx plan &
rescue medicines
38. And finally…
Even after the
COPD Annual Review
with the Practice Nurse the next
day the patient presents to the
ED department and says…
39.
40. Acknowledgements
Team
Dr A Bhowmik Respiratory Consultant
Jane Osei-Wusu COPD Clinical Nurse Specialist
Ailsa Dann COPD Clinical Physiotherapist
Arthur Tadique COPD SSN
Edmer Sayat COPD SSN
Aminata Gbla COPD SSN
Aziza Zina & Team Team Administrator
• Nancy Hallett – Chief Executive
• John Coakley – Medical Director
• Dylan Jones – General Manager for Medicine
• Louise Olley – Head of Nursing GEM
• Mervyn Freeze – Assistant GM
42. NECLES HIEC
• Reducing door to mask
time for type 2 respiratory
Lung failure
Improvement
Projects • Reducing readmissions
through provision of self
management packs
• Research to develop the
first COPD Patient
Reported Experience
PREMs Measure
• For sub- acute and
community dwelling
patients
• Benchmarking quality and
cost of COPD care across
A Year in the 4 boroughs in ONEL
Life • Providing targeted and free
training opportunities for
Primary Care Clinicians
43. A Year in the Life
Dashboards of COPD Training opportunities Building sustainable
quality care indicators delivered: changes through
circulated: Accredited spirometry networks:
Co- production of training, COPD Building awareness of
dashboards and masterclasses, Practice quality interventions
templates nurse mentorship in Making connections
Using data to drive COPD management & between teams
improvements spirometry clinics,
issuing self management Facilitating COPD leads
plans to continue improvement
process
44. Data dashboards
for smoking
status, severity of
disease, annual
reviews
performed
46. COPD training opportunities
• Accredited spirometry training
• Practice Nurse mentorship in COPD
management
• COPD masterclasses
• Performing the COPD annual review
and issuing a self management plan
• Consultant education sessions in
Practice