Objective
Safer Healthcare Now!, a program of the Canadian Patient Safety Institute, invites you to participate in the Canadian VTE Audit, designed to establish a national perspective of VTE thromboprophylaxis rates and raise awareness of appropriate VTE prophylaxis.
VTE is one of the most common and preventable complications of hospitalization and is a Required Organizational Practice (ROP) of Accreditation Canada.
By participating in the national audit day you will be a part of a movement aimed at preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) in hospital patients.
Watch the recording: http://bit.ly/1wfinCE
Purpose of the Call:
Review the results of the National VTE audit
Discuss lessons learned from the audit – strengths and areas for improvement
Gather ideas for future steps for implementation of VTE prophylaxis
National Comparative Audit of Lower Gastrointestinal Bleeding and the Use of Blood: Findings and Interpretations
This audit examined practice and outcomes for 2,528 patients admitted with lower gastrointestinal bleeding (LGIB) across 143 UK hospitals. Key findings included inappropriate transfusion in 27% of patients, only 26% receiving endoscopy within 24 hours, and 49% having no investigations to identify the bleeding source. Performance was compared against 17 evidence-based standards, identifying opportunities for improvement particularly around medicines management and timely investigation. Interpretations highlighted the benefits of centralized specialized care for LGIB patients, including more consistent guideline-based care, regular auditing, teaching and lower costs through reduced variation.
This document summarizes an audit of adult patient characteristics, management, and outcomes related to acute lower gastrointestinal bleeding (LGIB) at hospitals in the UK, including Aintree University Hospital. The audit examined 2,528 patients across 174 UK hospitals and 52 patients at Aintree based on 17 standards of care. Key findings included that 49% of UK patients and 33% of Aintree patients had no inpatient investigations to identify the bleeding source. Performance against the standards was variable both nationally and at Aintree, indicating opportunities for improvement in LGIB management and care.
The document summarizes results from the National Abdominal Aortic Aneurysm Screening Programme in England. Over 1.5 million men were screened, with over 18,000 large AAAs detected. Nearly 14,000 men are in surveillance and over 3,400 men have been treated. The programme is optimizing to reduce surveillance intervals and improve uptake. Research is ongoing on quality of life for men in surveillance and outcomes for those with subaneurysmal aortas. Draft NICE guidelines recommend screening and surveillance protocols. The future of the programme involves monitoring these changes and improving care for men identified.
Health outcome measurments that matter to patientsEuropa Uomo EPAD
The document describes standardized outcome measures for localized prostate cancer developed with input from 300 experts globally. It includes measures for acute complications, survival rates, disease control, patient-reported health status, and hormonal therapy side effects. For patient-reported health status, it specifically describes the Expanded Prostate cancer Index Composite-26 (EPIC-26) questionnaire which measures quality of life across domains of urinary, bowel, and sexual function and hormonal therapy side effects.
Point of Care Diagnostics: Revenue Growth, New Entrants, InvestmentBruce Carlson
The document discusses point-of-care (POC) testing, which involves diagnostic tests performed near patients outside of centralized laboratories. It estimates the global POC diagnostics market was $17 billion in 2014 and is projected to grow to $18.7 billion by 2016. Key drivers of growth include rapid results to inform immediate treatment decisions, expanded test menus, and advances enabling quantitative lab-quality results. Major diseases addressed by POC solutions discussed are colorectal cancer, cardiovascular disease, and diabetes.
This report assesses the introduction of two laparoscopic procedures - laparoscopic inguinal hernia repair (LIHR) and laparoscopic assisted hysterectomy (LAH) - in Australia. Literature reviews found insufficient evidence to determine if the procedures provided clear benefits over open surgery. Surveys of 15 Australian hospitals performing LIHR found a lack of consistency in surgeon training and little prospective audit of clinical outcomes. Similarly for LAH, literature reviews revealed inadequacies in study size and quality of evidence. The case studies highlighted variations in record keeping between hospitals, limiting the conclusions that could be drawn. Overall, the report found a need for higher quality studies to properly evaluate these new laparoscopic procedures.
Objective
Safer Healthcare Now!, a program of the Canadian Patient Safety Institute, invites you to participate in the Canadian VTE Audit, designed to establish a national perspective of VTE thromboprophylaxis rates and raise awareness of appropriate VTE prophylaxis.
VTE is one of the most common and preventable complications of hospitalization and is a Required Organizational Practice (ROP) of Accreditation Canada.
By participating in the national audit day you will be a part of a movement aimed at preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) in hospital patients.
Watch the recording: http://bit.ly/1wfinCE
Purpose of the Call:
Review the results of the National VTE audit
Discuss lessons learned from the audit – strengths and areas for improvement
Gather ideas for future steps for implementation of VTE prophylaxis
National Comparative Audit of Lower Gastrointestinal Bleeding and the Use of Blood: Findings and Interpretations
This audit examined practice and outcomes for 2,528 patients admitted with lower gastrointestinal bleeding (LGIB) across 143 UK hospitals. Key findings included inappropriate transfusion in 27% of patients, only 26% receiving endoscopy within 24 hours, and 49% having no investigations to identify the bleeding source. Performance was compared against 17 evidence-based standards, identifying opportunities for improvement particularly around medicines management and timely investigation. Interpretations highlighted the benefits of centralized specialized care for LGIB patients, including more consistent guideline-based care, regular auditing, teaching and lower costs through reduced variation.
This document summarizes an audit of adult patient characteristics, management, and outcomes related to acute lower gastrointestinal bleeding (LGIB) at hospitals in the UK, including Aintree University Hospital. The audit examined 2,528 patients across 174 UK hospitals and 52 patients at Aintree based on 17 standards of care. Key findings included that 49% of UK patients and 33% of Aintree patients had no inpatient investigations to identify the bleeding source. Performance against the standards was variable both nationally and at Aintree, indicating opportunities for improvement in LGIB management and care.
The document summarizes results from the National Abdominal Aortic Aneurysm Screening Programme in England. Over 1.5 million men were screened, with over 18,000 large AAAs detected. Nearly 14,000 men are in surveillance and over 3,400 men have been treated. The programme is optimizing to reduce surveillance intervals and improve uptake. Research is ongoing on quality of life for men in surveillance and outcomes for those with subaneurysmal aortas. Draft NICE guidelines recommend screening and surveillance protocols. The future of the programme involves monitoring these changes and improving care for men identified.
Health outcome measurments that matter to patientsEuropa Uomo EPAD
The document describes standardized outcome measures for localized prostate cancer developed with input from 300 experts globally. It includes measures for acute complications, survival rates, disease control, patient-reported health status, and hormonal therapy side effects. For patient-reported health status, it specifically describes the Expanded Prostate cancer Index Composite-26 (EPIC-26) questionnaire which measures quality of life across domains of urinary, bowel, and sexual function and hormonal therapy side effects.
Point of Care Diagnostics: Revenue Growth, New Entrants, InvestmentBruce Carlson
The document discusses point-of-care (POC) testing, which involves diagnostic tests performed near patients outside of centralized laboratories. It estimates the global POC diagnostics market was $17 billion in 2014 and is projected to grow to $18.7 billion by 2016. Key drivers of growth include rapid results to inform immediate treatment decisions, expanded test menus, and advances enabling quantitative lab-quality results. Major diseases addressed by POC solutions discussed are colorectal cancer, cardiovascular disease, and diabetes.
This report assesses the introduction of two laparoscopic procedures - laparoscopic inguinal hernia repair (LIHR) and laparoscopic assisted hysterectomy (LAH) - in Australia. Literature reviews found insufficient evidence to determine if the procedures provided clear benefits over open surgery. Surveys of 15 Australian hospitals performing LIHR found a lack of consistency in surgeon training and little prospective audit of clinical outcomes. Similarly for LAH, literature reviews revealed inadequacies in study size and quality of evidence. The case studies highlighted variations in record keeping between hospitals, limiting the conclusions that could be drawn. Overall, the report found a need for higher quality studies to properly evaluate these new laparoscopic procedures.
This document discusses issues with the current healthcare system in India and proposes solutions. It outlines problems like neglected public health facilities, high costs of medical instruments, corruption, and inequity in access to healthcare. Specific issues mentioned are high morbidity and mortality rates. Proposed solutions include developing low-cost diagnostic devices, banning private practice for government doctors, improving access to oxygen and blood banks, and subsidizing healthcare costs for low-income groups. The document discusses benefits and drawbacks of government hospitals and private hospitals. It argues for the importance of addressing these healthcare problems from the perspective of biomedical engineers.
2016 11-17 Oncology by design 2016 course, Amsterdam, Alain van GoolAlain van Gool
Lecture on the the role of biomarkers in oncology drug development, given to a group of pharmaceutical industry specialists, in tandem with a lecture on oncology companion diagnostics given by Martina Kaufmann.
2016 11-15 Lygature partnership meetup, Utrecht, Alain van GoolAlain van Gool
Contribution to the opening of the Joint Innovation Mile in the Beatrix building in Utrecht, home of the offices of Lygature, HealthRI, BBMRI-NL and others to follow.
MADD Hawaii: Dan Galanis, PhD. - Drug Use and Injury in HawaiiMADD Hawaii
Dr. Galanis, Epidemiologist at Hawaii Dept. of Healthy Injury Prevention System Branch, presented at MADD Hawaii's Drugs & Driving, A Call to Action conference in Oct. of 2018. Galavis presented data collected from FARS (Fatality Analysis Reporting System, National Highway Traffic Safety Admin.), Hawaii Trauma Registry and Hospital billing data.
Point of care testing market and forecast to 2016 global analysisRenub Research
Renub Research (http://www.renub.com/report/point-of-care-testing-market-and-forecast-to-2016-global-analysis-88) has announced the addition of the "Point of Care Testing Market and Forecast to 2016: Global Analysis" report to its offering
Point of Care Testing Market and Forecast to 2016: Global Analysis - Market Overview
The concept of Point of Care Testing (POCT), also known as bedside, near-patient testing and decentralized testing, relates to tests that are conducted by clinical operators at the site of patient care where immediate medical action is taken on the results. The fact that point of care (POCT) represents a departure from conventional laboratory medicine has created new opportunities in the field of diagnostics industry. Technical advancements over recent years have helped point of care testing (POCT) to grow with double digit CAGR from 2009 to 2011 and evolve into a vital diagnostic tool. It is predicted that point of care testing market will be approximately US$ 25 Billion by 2016.
Blood glucose test controls a lion’s market share of around 70% for the year 2011 and it is expected to continue its dominance till 2016. Rest of all the others point of care tests market share covered in this report are in single digit. Infectious disease testing market is expected to double by 2016 from its market of 2011. As countries are making the healthcare more and more accessible to people, the demand for various point of care testing is keep on rising. The point of care testing market has become an established sector worldwide and will continue to provide vital contribution in in-vitro diagnostics industry.
This 83 page report contains 26 Figures and 12 Tables provides a comprehensive analysis of the emerging point of care tests market segments, including their dynamics, size, growth, regulatory requirements, technological trends, competitive landscape, and emerging opportunities for instrument and consumable suppliers. Renub Research report entitled “Point of Care Testing Market and Forecast to 2016: Global Analysis” report also provides market landscape and market share information in the point of care testing market. The report brings together major merger & acquisition, distribution agreement, licensing deals information in point of care testing market. The report also entails major drivers and challenges of point of care testing market.
10 Point of Care Test Segments Covered in this Report
Blood Glucose Testing, Cardiac Marker Testing, Lipid Panel/Cholesterol Testing, Blood Coagulation Testing, Infectious Disease Testing, Urinalysis Testing, Drug of Abuse Testing, Fecal Occult Blood Testing, Pregnancy & Fertility Testing and Tumor Marker Testing
EPharma day munich - RBM with EU Clinical Trials RegulationArtem Andrianov
The new EU Clinical Trials Regulation (CTR) becomes applicable not earlier than on 28th of May 2016. It introduces a number of changes in the clinical trial’s application, operations, documentation, and assessment. Although CTR is not taking the direct reference on RbM, it refers to principles of Good Clinical Practice (GCP) and Quality by Design (QbD). These principles are the underlying in RbM as well. Therefore, the author offers to apply RbM as a practical mechanism and process in order to embrace the new EU regulation.
Diabetic eye screening 1 April 2015 to 31 March 2016 data slide setMike Harris
This document provides charts and data to support the annual NHS Diabetic Eye Screening Programme report for the period of April 1, 2015 to March 31, 2016. It includes information on eligible patients, screening outcomes, referrals to eye hospitals, and notes on data quality for individual screening services. Definitions of key terms and codes for the 90 screening services across England are also provided.
C2 Reimbursement Perspectives on Precision MedicineEmilie Adams
This document summarizes a presentation on reimbursement perspectives for precision medicine. It discusses:
1) The promise of precision medicine in tailoring treatments to a patient's specific biomarkers or genetic profile, leading to better outcomes. Examples are given of targeted therapies approved for lung cancer subtypes.
2) Best practices from other countries in implementing precision medicine, such as France's national network of molecular testing centers to ensure equal access. Challenges discussed include getting the right test to the right patient at the right time for the right price.
3) Recommendations to optimize precision medicine in the future, such as establishing molecular testing programs and guidelines to help integrate testing into clinical practice and minimize delays in treatment. Time
This document discusses developing patient safety practices in surgery. It notes that 234 million operations are performed globally each year, but surgical complications occur in 3-16% of cases, resulting in up to 1 million deaths annually. Checklists have been shown to reduce mortality, complications, surgical site infections, and reoperations. Proper site marking and a surgical timeout are emphasized to perform the right procedure on the correct patient. Non-technical skills like communication, leadership, and situation awareness are also important for safety. The document calls for recognizing surgery as a public health issue, increased outcome surveillance, and applying existing safety knowledge to improve practices.
Point of care testing (POCT) involves diagnostic testing performed near the patient to provide rapid results and faster treatment decisions. POCT uses small sample volumes and less invasive collection methods. A wide range of tests are available as waived tests under CLIA regulations. While POCT provides advantages of convenience and speed, it also presents quality challenges if not properly managed and standardized across locations and personnel. Effective organization and standardization of POCT is needed to ensure quality results and prevent errors.
This document discusses several points related to the affordability and reimbursement of treatments for rare bleeding disorders:
1) It describes different reimbursement strategies from least to most restrictive, including risk sharing arrangements and technology leasing where payment is based on outcomes rather than just products delivered.
2) It provides examples of risk sharing funding models used for Trastuzumab and how net health benefits were positive after shorter time periods under a technology leasing model.
3) It discusses the experience with the gene therapy Glybera, including uniQure deciding not to renew its marketing authorization due to limited usage and high monitoring costs required by regulators.
4) It reviews health technology assessments of Glybera in France
Record of NHS Screening e-learning completionMike Harris
This document records Jonathan Waldheim's completion of various e-learning modules related to NHS screening programmes. It shows the dates that modules within different screening program topics were completed, including antenatal and newborn screening, sickle cell and thalassaemia screening, newborn blood spot screening, fetal anomaly scanning, nuchal translucency screening, sickle cell and thalassaemia laboratory techniques, newborn hearing screening, newborn and infant physical examination, abdominal aortic aneurysm screening, and 18-20 week fetal anomaly ultrasound scanning. The document provides details on over 50 individual e-learning modules and the dates they were completed from 2014 to 2017.
Point of Care Testing for Enhancing Patient Centered Planned Care DeliveryPAFP
PAFP 2013 Regional Lecture Series
Session 1 - Northeast
Presenter: Linda Thomas-Hemak, MD
The Wright Center for Primary Care
Broadcast live through the PAFP Community.
October 2nd, 2013 12pm - 1pm
Nw biotech fundamentals day 2 session 4 medical devices and diagnosticsNicholas Weston Lawyers
In this presentation:
• Definition of Medical devices and Diagnostics
• The stages of an R&D project
• The state of the art
• Regulatory nuances
• Future trends
• Challenges and opportunities
• Case studies and examples
Spontaneous adverse event reporting to the US FDA was encouraged using an easy-to-use Web and mobile app along with engagement of a Facebook patient group, specifically for Essure, a hysteroscopic sterilization device. A total of 1349 valid reports were received through the app over approximately 19 months, equivalent to 15 times more reports than through traditional channels, with high completeness scores. The reports were characterized including symptoms and outcomes reported, and the motivations and incentives in this engagement model for pharmacovigilance are discussed.
1) The document outlines the consensus approach to managing non-variceal upper GI bleeding, including risk stratification, endoscopic treatment, and the role of PPIs.
2) Early endoscopy within 24 hours allows for safe discharge of low risk patients and improves outcomes for high risk patients through endoscopic hemostasis.
3) Combination endoscopic therapy with injection followed by thermal treatment is the most effective approach for achieving hemostasis.
4) High dose intravenous PPIs reduce recurrent bleeding rates and improve mortality when used in conjunction with endoscopic hemostasis in patients with high risk stigmata.
Should we give a PPI IV before endoscopy in patients with upper GI bleeding?Waleed Mahrous
Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding - SIGN , BSG , NICE , ACG , AGA , ASGE Guidelines
Should we give a PPI IV before endoscopy in patients with upper GI bleeding?
Approach to patients with upper gi bleedingRajesh S
This document provides an overview of a seminar on gastrointestinal bleeding. It begins with an introduction and outline. It then covers topics like the anatomy of the GI tract and sources of bleeding. Diagnostic assessments including history, exams, and tests are reviewed. Approaches to resuscitation, classification of shock, and fluid management are outlined. Etiologies of upper and lower GI bleeding like ulcers, varices, and tumors are summarized. Endoscopic and surgical management strategies are also discussed. Risk factors for poor prognosis with GI bleeding are listed. The document concludes with a risk score to predict need for intervention in GI bleeding cases.
This document discusses issues with the current healthcare system in India and proposes solutions. It outlines problems like neglected public health facilities, high costs of medical instruments, corruption, and inequity in access to healthcare. Specific issues mentioned are high morbidity and mortality rates. Proposed solutions include developing low-cost diagnostic devices, banning private practice for government doctors, improving access to oxygen and blood banks, and subsidizing healthcare costs for low-income groups. The document discusses benefits and drawbacks of government hospitals and private hospitals. It argues for the importance of addressing these healthcare problems from the perspective of biomedical engineers.
2016 11-17 Oncology by design 2016 course, Amsterdam, Alain van GoolAlain van Gool
Lecture on the the role of biomarkers in oncology drug development, given to a group of pharmaceutical industry specialists, in tandem with a lecture on oncology companion diagnostics given by Martina Kaufmann.
2016 11-15 Lygature partnership meetup, Utrecht, Alain van GoolAlain van Gool
Contribution to the opening of the Joint Innovation Mile in the Beatrix building in Utrecht, home of the offices of Lygature, HealthRI, BBMRI-NL and others to follow.
MADD Hawaii: Dan Galanis, PhD. - Drug Use and Injury in HawaiiMADD Hawaii
Dr. Galanis, Epidemiologist at Hawaii Dept. of Healthy Injury Prevention System Branch, presented at MADD Hawaii's Drugs & Driving, A Call to Action conference in Oct. of 2018. Galavis presented data collected from FARS (Fatality Analysis Reporting System, National Highway Traffic Safety Admin.), Hawaii Trauma Registry and Hospital billing data.
Point of care testing market and forecast to 2016 global analysisRenub Research
Renub Research (http://www.renub.com/report/point-of-care-testing-market-and-forecast-to-2016-global-analysis-88) has announced the addition of the "Point of Care Testing Market and Forecast to 2016: Global Analysis" report to its offering
Point of Care Testing Market and Forecast to 2016: Global Analysis - Market Overview
The concept of Point of Care Testing (POCT), also known as bedside, near-patient testing and decentralized testing, relates to tests that are conducted by clinical operators at the site of patient care where immediate medical action is taken on the results. The fact that point of care (POCT) represents a departure from conventional laboratory medicine has created new opportunities in the field of diagnostics industry. Technical advancements over recent years have helped point of care testing (POCT) to grow with double digit CAGR from 2009 to 2011 and evolve into a vital diagnostic tool. It is predicted that point of care testing market will be approximately US$ 25 Billion by 2016.
Blood glucose test controls a lion’s market share of around 70% for the year 2011 and it is expected to continue its dominance till 2016. Rest of all the others point of care tests market share covered in this report are in single digit. Infectious disease testing market is expected to double by 2016 from its market of 2011. As countries are making the healthcare more and more accessible to people, the demand for various point of care testing is keep on rising. The point of care testing market has become an established sector worldwide and will continue to provide vital contribution in in-vitro diagnostics industry.
This 83 page report contains 26 Figures and 12 Tables provides a comprehensive analysis of the emerging point of care tests market segments, including their dynamics, size, growth, regulatory requirements, technological trends, competitive landscape, and emerging opportunities for instrument and consumable suppliers. Renub Research report entitled “Point of Care Testing Market and Forecast to 2016: Global Analysis” report also provides market landscape and market share information in the point of care testing market. The report brings together major merger & acquisition, distribution agreement, licensing deals information in point of care testing market. The report also entails major drivers and challenges of point of care testing market.
10 Point of Care Test Segments Covered in this Report
Blood Glucose Testing, Cardiac Marker Testing, Lipid Panel/Cholesterol Testing, Blood Coagulation Testing, Infectious Disease Testing, Urinalysis Testing, Drug of Abuse Testing, Fecal Occult Blood Testing, Pregnancy & Fertility Testing and Tumor Marker Testing
EPharma day munich - RBM with EU Clinical Trials RegulationArtem Andrianov
The new EU Clinical Trials Regulation (CTR) becomes applicable not earlier than on 28th of May 2016. It introduces a number of changes in the clinical trial’s application, operations, documentation, and assessment. Although CTR is not taking the direct reference on RbM, it refers to principles of Good Clinical Practice (GCP) and Quality by Design (QbD). These principles are the underlying in RbM as well. Therefore, the author offers to apply RbM as a practical mechanism and process in order to embrace the new EU regulation.
Diabetic eye screening 1 April 2015 to 31 March 2016 data slide setMike Harris
This document provides charts and data to support the annual NHS Diabetic Eye Screening Programme report for the period of April 1, 2015 to March 31, 2016. It includes information on eligible patients, screening outcomes, referrals to eye hospitals, and notes on data quality for individual screening services. Definitions of key terms and codes for the 90 screening services across England are also provided.
C2 Reimbursement Perspectives on Precision MedicineEmilie Adams
This document summarizes a presentation on reimbursement perspectives for precision medicine. It discusses:
1) The promise of precision medicine in tailoring treatments to a patient's specific biomarkers or genetic profile, leading to better outcomes. Examples are given of targeted therapies approved for lung cancer subtypes.
2) Best practices from other countries in implementing precision medicine, such as France's national network of molecular testing centers to ensure equal access. Challenges discussed include getting the right test to the right patient at the right time for the right price.
3) Recommendations to optimize precision medicine in the future, such as establishing molecular testing programs and guidelines to help integrate testing into clinical practice and minimize delays in treatment. Time
This document discusses developing patient safety practices in surgery. It notes that 234 million operations are performed globally each year, but surgical complications occur in 3-16% of cases, resulting in up to 1 million deaths annually. Checklists have been shown to reduce mortality, complications, surgical site infections, and reoperations. Proper site marking and a surgical timeout are emphasized to perform the right procedure on the correct patient. Non-technical skills like communication, leadership, and situation awareness are also important for safety. The document calls for recognizing surgery as a public health issue, increased outcome surveillance, and applying existing safety knowledge to improve practices.
Point of care testing (POCT) involves diagnostic testing performed near the patient to provide rapid results and faster treatment decisions. POCT uses small sample volumes and less invasive collection methods. A wide range of tests are available as waived tests under CLIA regulations. While POCT provides advantages of convenience and speed, it also presents quality challenges if not properly managed and standardized across locations and personnel. Effective organization and standardization of POCT is needed to ensure quality results and prevent errors.
This document discusses several points related to the affordability and reimbursement of treatments for rare bleeding disorders:
1) It describes different reimbursement strategies from least to most restrictive, including risk sharing arrangements and technology leasing where payment is based on outcomes rather than just products delivered.
2) It provides examples of risk sharing funding models used for Trastuzumab and how net health benefits were positive after shorter time periods under a technology leasing model.
3) It discusses the experience with the gene therapy Glybera, including uniQure deciding not to renew its marketing authorization due to limited usage and high monitoring costs required by regulators.
4) It reviews health technology assessments of Glybera in France
Record of NHS Screening e-learning completionMike Harris
This document records Jonathan Waldheim's completion of various e-learning modules related to NHS screening programmes. It shows the dates that modules within different screening program topics were completed, including antenatal and newborn screening, sickle cell and thalassaemia screening, newborn blood spot screening, fetal anomaly scanning, nuchal translucency screening, sickle cell and thalassaemia laboratory techniques, newborn hearing screening, newborn and infant physical examination, abdominal aortic aneurysm screening, and 18-20 week fetal anomaly ultrasound scanning. The document provides details on over 50 individual e-learning modules and the dates they were completed from 2014 to 2017.
Point of Care Testing for Enhancing Patient Centered Planned Care DeliveryPAFP
PAFP 2013 Regional Lecture Series
Session 1 - Northeast
Presenter: Linda Thomas-Hemak, MD
The Wright Center for Primary Care
Broadcast live through the PAFP Community.
October 2nd, 2013 12pm - 1pm
Nw biotech fundamentals day 2 session 4 medical devices and diagnosticsNicholas Weston Lawyers
In this presentation:
• Definition of Medical devices and Diagnostics
• The stages of an R&D project
• The state of the art
• Regulatory nuances
• Future trends
• Challenges and opportunities
• Case studies and examples
Spontaneous adverse event reporting to the US FDA was encouraged using an easy-to-use Web and mobile app along with engagement of a Facebook patient group, specifically for Essure, a hysteroscopic sterilization device. A total of 1349 valid reports were received through the app over approximately 19 months, equivalent to 15 times more reports than through traditional channels, with high completeness scores. The reports were characterized including symptoms and outcomes reported, and the motivations and incentives in this engagement model for pharmacovigilance are discussed.
1) The document outlines the consensus approach to managing non-variceal upper GI bleeding, including risk stratification, endoscopic treatment, and the role of PPIs.
2) Early endoscopy within 24 hours allows for safe discharge of low risk patients and improves outcomes for high risk patients through endoscopic hemostasis.
3) Combination endoscopic therapy with injection followed by thermal treatment is the most effective approach for achieving hemostasis.
4) High dose intravenous PPIs reduce recurrent bleeding rates and improve mortality when used in conjunction with endoscopic hemostasis in patients with high risk stigmata.
Should we give a PPI IV before endoscopy in patients with upper GI bleeding?Waleed Mahrous
Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding - SIGN , BSG , NICE , ACG , AGA , ASGE Guidelines
Should we give a PPI IV before endoscopy in patients with upper GI bleeding?
Approach to patients with upper gi bleedingRajesh S
This document provides an overview of a seminar on gastrointestinal bleeding. It begins with an introduction and outline. It then covers topics like the anatomy of the GI tract and sources of bleeding. Diagnostic assessments including history, exams, and tests are reviewed. Approaches to resuscitation, classification of shock, and fluid management are outlined. Etiologies of upper and lower GI bleeding like ulcers, varices, and tumors are summarized. Endoscopic and surgical management strategies are also discussed. Risk factors for poor prognosis with GI bleeding are listed. The document concludes with a risk score to predict need for intervention in GI bleeding cases.
This document discusses gastrointestinal tract bleeding. It defines upper and lower GI bleeding and provides epidemiological data. Common causes of upper GI bleeding include peptic ulcers, varices, Mallory-Weiss tears, and angiodysplasia. Lower GI bleeding is commonly caused by diverticular disease, angiodysplasia, and ischemic colitis. Management involves resuscitation, endoscopy for diagnosis and treatment, and angiography for severe or obscure bleeding. The mortality of GI bleeding remains significant.
Upper gastrointestinal bleeding is a common cause of hospitalization that can be life-threatening. It occurs at a rate of 100 cases per 100,000 people per year. Common causes are peptic ulcers, esophagitis, esophageal varices, and Mallory-Weiss tears. Management involves stabilizing the patient, monitoring for signs of bleeding and shock, transfusing blood products if needed, and locating the source of bleeding via endoscopy to stop it using methods like cauterization or banding.
This document defines different types of gastrointestinal bleeding and their associated symptoms. Upper GI bleeding originates from the esophagus, stomach or duodenum and can cause haematemesis (vomiting of blood) or coffee ground vomitus. Lower GI bleeding originates from the small bowel or colon and can cause melena (black tarry stools) or hematochezia (fresh blood in stool). The document notes that bright red haematemesis implies active upper GI bleeding, which is a major medical emergency. It also lists causes of upper GI bleeding and references management guidelines, with plans to cover differential diagnosis of GI bleeding in more detail later.
This study analyzed data from 2,668 patients in Denmark who underwent surgery for perforated peptic ulcer between 2003-2009 to evaluate the association between hourly surgical delay and 30-day survival. The results showed that for every hour of delay between admission and surgery, there was an average 2.4% decreased probability of survival. Overall, 26.5% of patients died within 30 days of surgery. Limiting surgical delay seems critically important for patients with perforated peptic ulcers.
The document discusses barriers and solutions to adopting diagnostic technologies in healthcare. It provides examples of diagnostic technologies that have been successfully adopted in the UK, such as Coaguchek for INR testing and faecal calprotectin testing. Both faced initial barriers but were able to demonstrate benefits like improved patient outcomes and efficiency. The document outlines tips for implementing diagnostics, such as collecting baseline data, gaining stakeholder support, and clearly defining the patient pathway and expected impact. Overall it advocates that diagnostic technologies can help address gaps in healthcare if barriers are overcome and benefits are demonstrated.
Dr Nick Selby - AKI detection, alerting and intervention-محول.pptxinfoomallps
This document summarizes research on acute kidney injury (AKI) conducted by Dr. Nick Selby and colleagues. It finds that AKI is common, occurring in 5-15% of hospital admissions, and associated with high mortality, especially for more severe cases. While electronic detection of AKI has improved, outcomes depend on bundled interventions like diagnosis, fluid management, and medication review. Large trials show electronic alerts with care bundles can reduce AKI duration and hospital length of stay, though not mortality. Ongoing research aims to better characterize AKI subtypes and predict non-recovery risk to guide new therapies.
This study assessed postoperative bleeding in 100 patients who underwent dental extractions while continuing their antiplatelet therapy (APT). The patients were on either mono APT (78%) or dual APT (22%). Postoperative bleeding was observed in 16 patients on mono APT at 1 hour, but in no patients at 24-48 hours. For dual APT, bleeding was observed in 10 patients at 1 hour and 1 patient at 24 hours, with no bleeding by 48 hours. Statistical analysis found the bleeding rates were significant. The results suggest that dental extractions can generally be performed safely in patients continuing APT, as postoperative bleeding is minor and can be controlled with local hemostatic measures.
'Use of linked health care data for research: experiences with the Hampshire ...Health Innovation Wessex
The document discusses the Hampshire Health Record (HHR), a database containing pseudonymized linked extracts of primary and secondary care records for about 1.3 million people in Hampshire, UK. It describes several uses of the HHR for research, including evaluating interventions, understanding variations in outcomes for conditions like COPD, and studying antibiotic prescribing in nursing homes and the incidence of chronic kidney disease and acute kidney injury. The HHR is seen as a valuable resource but also has some limitations like missing or incomplete data. Ongoing research uses the HHR to study topics like dementia pathways, cancer survivorship, and multimorbidity. Healthcare professionals report that the HHR enables informed decision making and provides a more comprehensive view of patients.
This document summarizes the results of a national audit on lower gastrointestinal bleeding (LGIB) in the UK. It found that over 2528 patients were included from 139 hospitals. Key findings include that 26.7% of patients received red blood cell transfusions, but many transfusions may have been inappropriate. Nearly half of patients had no inpatient investigations to identify the bleeding source. Access to lower GI endoscopy and interventional radiology varied between hospitals. The audit recommendations focus on improving investigation of patients, guidelines for transfusion and management of anticoagulants, and increasing access to key services including interventional radiology.
Question of Quality Conference 2016 - Healthcare Technology - Barcoding at th...HCA Healthcare UK
Both the University of Oxford and HCA have developed the use of barcoding to implement a fully electronic and paperless blood transfusion process to enhance patient safety and manage costs. A rules-based blood ordering clinical decision support system was combined with an electronic transfusion process incorporating barcode patient identification and handheld computers at the bedside. Such a system is able to alert clinicians when orders are noncompliant with current guidelines. This ensures that the correct blood is transfused to the right patient. Learn more about each organisation’s journey, how the public and private approaches, compare as well as implementation tips and lessons learned.
Dr. Ian McGowan, Chief Medical Officer at Orion Biotechnology, presented at the ASCO 2019 conference in Chicago. His presentation was in the Gastrointestinal (Colorectal) cancer track and focused on the surveillance and management of anal intraepithelial neoplasia in HIV and non-HIV infected patients.
Predictors of MDT review and the impact on lung cancer survival for HNELHD re...Cancer Institute NSW
Review by a Multidisciplinary Team (MDT) has been shown to lead to increased rates of surgical resection, radiotherapy, chemotherapy and timeliness of care. Most recently, the Victorian lung cancer patterns of care study have found that MDT review is an independent predictor of lung cancer survival.
Challenges and improvements in diagnostic services across seven day services NHS Improving Quality
Prof Erika Denton, National Clinical Director for Diagnostics. Slides from Erika's presentation at the 7 Day services events in West Midlands 11th June and East Midlands 12th June, 2014.
Pr Olivier Glehen (Lyon - France) presents HIPEC in treatment for colorectal and gastric carcinomatosis. La CHIP dans le traitement des carcinoses péritonéales d'origine colorectale et gastrique.
National Comparative Audit of Lower Gastrointestinal Bleeding and the Use of ...Raimundas Lunevicius
This audit shows that there is no such thing as acute upper gastrointestinal (UGI) bleeding or acute lower gastrointestinal (LGI) bleeding. There is acute gastrointestinal (GI) bleeding, which predominantly is one of a few emergency gastroenterological conditions. In other words, a historic agreement between clinical directors to direct a patient presenting with hematemesis to gastroenterology ward & to direct another patient with PR bleed to Emergency General Surgery Ward is not quite logical, as PR bleeding is one of the signs of acute UGI as well as LGI bleeding.
The concentration of patients in one highly specialized unit for GI bleeding management WITHIN GASTROENTEROLOGY CENTRE is the second summary key point of this audit.
I do think that Gastroenterology Ward would be the best Ward to concentrate all patients presenting with signs of GI bleeding, for a mean patient presenting with this problem is:
(1) An elderly patient with significant comorbidities, often taking a so-called ‘blood thinner’ (aspirin, NSAIDs, and even steroids),
(2) Requiring limited volume blood transfusions - sometimes,
(3) Requiring radiological and endoscopic investigations within 24 hours / in a case of clinically significant bleeding,
(4) Not requiring urgent surgery in the absolute majority of the cases (5 emergency laparotomies in all four countries of the UK), and (5) Not having a clinical diagnosis on the day of discharge.
adult inpatient care and inpatient experience presentation - uhnd.pptAnanthakrishnanC2
This document summarizes an audit of inpatient care and experience for adults with ulcerative colitis in the UK. It discusses two parts of the audit: 1) Inpatient care, which assessed treatment for patients admitted to hospitals, collecting data on over 4,000 admissions. Key indicators like mortality, previous admissions, and medication use are presented. 2) Inpatient experience, which assessed patient care quality through nearly 1,700 post-discharge questionnaires. Key indicators like ratings of care, confidence in doctors, pain control, and cleanliness are presented. The document concludes with recommendations to improve inpatient care and experience based on the audit results.
The document discusses guidelines for colposcopy in the UK and critiques current approaches. It notes that UK guidelines are developed by the NHS Cervical Screening Programme through multi-disciplinary consensus, without formal literature reviews or grading of evidence levels. With the introduction of primary HPV screening, future guidelines will need revision to minimize unnecessary referrals and interventions while ensuring proper treatment and follow up of precancerous lesions. Key open questions include what risk thresholds warrant colposcopy referral and how to stratify management based on HPV genotype. Overall, there remains a lack of high-quality evidence to inform standardized colposcopy practices.
This document provides information about the National Emergency Laparotomy Audit (NELA) and some key performance metrics for emergency bowel surgery cases at Lewisham and Greenwich NHS Trust for the period of April to June 2022. It summarizes that 100% of high-risk cases received consultant-led care, all high-risk patients went to HDU/ITU post-op, and the best practice tariff was achieved. It encourages clinicians to risk score patients pre-operatively, consider recruiting eligible patients to the FLO-ELA trial, and provides contact details for the research team. It also reviews trauma-related services including out of hours orthopedic reviews, fascia iliaca blocks, and regional anesthesia training opportunities
This document discusses HIV and hepatitis C, and how treatment has improved outcomes. It presents two case studies of patients with advanced HIV presenting with opportunistic infections who were successfully treated. It also summarizes research showing that early antiretroviral therapy improves survival for patients with HIV/AIDS or opportunistic infections like PCP, and that cure of hepatitis C through direct-acting antivirals reduces mortality and complications like liver cancer. While treatment access has increased globally, challenges remain in testing and treating all those in need.
02 professor tony rudd london strategy.pptbluebuilding
The transformation of stroke care in London has led to significant improvements but some challenges remain. Key achievements include the establishment of 8 hyperacute stroke units (HASUs) that have increased thrombolysis rates and reduced time to treatment. Over 80% of patients now spend most of their hospital stay in dedicated stroke units. However, issues persist around some patients still going to non-HASU hospitals and ensuring sufficient community rehabilitation. Data collection needs to continue to prove the new model's benefits as the financial and policy landscape evolves.
Similar to Dr Ian Forgacs - acute upper GI bleed service provision (20)
The document discusses factors that contribute to successful change agents or "boat rockers". It identifies four key things: 1) having a strong sense of self-efficacy or belief in one's ability to create change; 2) being able to join forces with others to take action; 3) being able to achieve small wins which build momentum; and 4) viewing obstacles as challenges to overcome rather than barriers. Building self-efficacy involves tactics like starting with small, achievable changes and reframing failures as learning opportunities. Social support and learning from exemplars are also discussed.
Stopping over-medication of People with Learning Disabilities
(STOMPLD) 2016.
Reducing Inappropriate Psychotropic Drugs in People with a Learning Disability in General Practice and Hospitals in 2016.
The document discusses how change is happening more rapidly, with projects now lasting 30-60 days rather than years. It also discusses how power is shifting away from hierarchies and centralized control to networks and relationships. Leaders are needed who can operate from the "edge" and empower others through open relationships rather than closed transactions. Rebels are needed who can disrupt and challenge the status quo in a responsible way to drive innovation and new ways of thinking.
The greatest pleasure in life is doing what people say you cannot do. Anonymo...NHS Improving Quality
The document discusses issues with diagnosing and managing patients with respiratory conditions like COPD, asthma, and heart failure in primary care settings, noting evidence of high rates of misdiagnosis, underdiagnosis of comorbidities, and fragmented services. It proposes a new enhanced care/case management service called the "Breathlessness Service" to provide more coordinated care to improve outcomes for these patients experiencing breathlessness. Case studies are presented showing how the new service achieved better diagnoses and management of patients' conditions.
Presentation slides Frailty: building understanding, empathy and the skills t...NHS Improving Quality
Frailty: building understanding, empathy and the skills to support self-care
Guest speaker:Dr Dawn Moody, Director - Fusion48
An opportunity to learn about some innovative approaches to making the health and care workforce 'Fit for Frailty'* (*British Geriatrics Society 2015).
Learning outcomes:
To explore the Frailty Fulcrum as a tool for holistic assessment and management of frailty
To hear how Virtual Reality is being used to build empathy for older people living with frailty
To learn about the impact of a county-wide, multi-agency, multi-professional training an toolkit for care professionals working with older people
Resources:www.fusion48.net
Self-management in the community and on the Internet - Presentation 22nd Marc...NHS Improving Quality
LTC Lunch & Learn webinar:- 22nd March 2016
Presenter:- Pete Moore, Educator, Author & Pain Toolkit Trainer
As pain is the most daily health problem reported to a GP-
Developing a national pain strategy- reviews from around the world
Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient C...NHS Improving Quality
Speaker slides from the national conference, 'Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life', 17 March 2016
Fire service as an asset: providing telecare support in the community Webinar...NHS Improving Quality
Guest speaker: Steve Vincent - West Midlands Fire Service & Simon Brake from Coventry Council
Hosted by: Bev Matthews, Long Term Conditions Programme Lead, NHS England
Learning Outcomes:-
To better understand the role that the Fire and Rescue service can provide as a community asset to support health needs Enhancing the quality of life for people by supporting them to stay in their own home, even in a crisis
An overview of the work carried out by NHS England and NHS Improving Quality's Long Term Conditions Sustainable Improvement Team. It puts the case for why person-centred care has to be at the heart of healthcare.
Commissioning Integrated models of care
Kent LTC Year of Care Commissioning Early Implementer Site
Alison Davis, Integration Programme Health and Social Care, Working on behalf of Kent County Council and South Kent Coast and Thanet CCG's
4. Audit system
Research database
National survey
National clinical audits
Network
Data repository
Clinical registries
National clinical
databases
Clinical databases
Audit database
Clinical
administration
system
Surveillance system
5. IBD Standards
• Launched between Feb and
April 2009
• Copies sent to trust and Board
CEOs with the 2nd round IBD
Audit results
• Circulated to SHAs, Primary
Care Trusts, Local Health Boards
• Work to establish a political
lobby
7. Why?
Rockall 1993/4
Mortality 14% overall
33% in inpatients; 11% in emergency admissions
Endoscopy use variable
What has changed ?
Early identification of high risk patients
Therapeutic endoscopy
Drug use in AUGIB
And...
Blood transfusion in AUGIB – never audited
8. What were they looking for?
Changes in mortality
Is the Rockall score still useful
Impact of therapeutic endoscopy
Use and effect of blood transfusion
Is there a relationship between
service provision and outcome?
9. 257 UK hospitals invited
217 hospitals (84%)
8939 cases submitted
Prospective study
Web-based data entry
1090 insufficient data
1099 not UGIB
6750 analysed (76%)
10. 10% overall
Mortality
7% in those who had endoscopy
45% of deaths were in patients who did not have
endoscopy
Rockall
score
0-2 (1408)
3-5 (2204)
6-7 (942)
≥8 (435)
Expected Observed
deaths
deaths
(1993/4 risk)
2007
2
143
201
179
13
125
122
110
Relative risk
(95% CI)
7.6 (3.49 to 5.85)
0.9 (0.73 to 1.05)
0.6 (0.55 to 0.78)
0.6 (0.50 to 0.74)
11. Out of hours presentation
44% of hospitals do not have formal out of
hours rota for endoscopy
60% of patients present out of hours
19% of new admissions, 25% of inpatients
between midnight and 8am
(Not known for 14% of inpatients)
12. Service provision & mortality
40
OOH rota
35
No OOH rota
30
25
Mortality 20
15
10
5
0
0 to 2
3 to 5
6 to 8
Rockall score
>8
13. Facilities available in hospitals
admitting patients with AUGIB
100
80
60
15 sites
40
20
0
ICCU
HDU
AUGIB
unit
Radiology
Blood
transfusion
Risk adjusted mortality in these hospitals no
different to UK figure
14. Endoscopy services
58% of hospitals have daily emergency
endoscopy slot Mon-Fri
50% of patients having endoscopy had it
within 24 hours
Rockall score little impact on time to first
endoscopy
50% of score 3+ and 43% score 5+ waited more
than 24hours
15. Endoscopists
51% endoscopies performed by consultants
32% performed by trainees – 60% of these
unsupervised
56% of hospitals have formal OOH rota for
endoscopy
14% of OOH endoscopies - unsupervised trainees
WHAT CAN BE DONE?
16. All high risk patients with UGIB should be endoscoped within 24
hours, preferably on a planned list in the first instance.
For patients who require more urgent intervention either for
endoscopy, interventional radiology or surgery formal 24/7
arrangements must be available.
17. Timing of endoscopy
Offer endoscopy to unstable patients with severe acute
upper gastrointestinal bleeding immediately after
resuscitation.
Offer endoscopy within 24 hours of admission to all other
patients with upper gastrointestinal bleeding.
Units seeing more than 330 cases a year should offer
daily endoscopy lists. Units seeing fewer than 330 cases a
year should arrange their service according to local
circumstances.
NICE 2012
20. All patients with suspected UGIB should be properly assessed and risk scored on
presentation.
All patients should be resuscitated prior to therapeutic intervention.Time to
diagnostic or therapeutic intervention for your patients
All high risk patients with UGIB should be endoscoped within 24 hours, preferably
on a planned list in the first instance.
For patients who require more urgent intervention either for endoscopy,
interventional radiology or surgery formal 24/7 arrangements must be available.
21. Encourage providers to participate
34% Trusts participating
in less than 60% NCAs
2010
in 2011 fallen to 14% of Trusts
(Nossiter & Black , Brit J Healthcare Mgt 2011)
25. Risk standardised mortality ratios
Measure of difference between observed mortality
and expected from audit population
106 hospitals with OOH on call endoscopy
Median RSMR 0.85
83 hospitals without OOH on call endoscopy
Median RSMR 1.02
26. Characteristics of National Clinical Databases
•
•
•
•
•
•
Focused on health care/services
National coverage (achieved or intended)
Prospective
On-going
Recruit all patients or representative sample
Collect patient-level data
(Other clinical data collections exist but they don’t
meet these criteria eg national confidential
enquiries)
27. Why?
Rockall 1993/4
Mortality 14% overall
33% in inpatients; 11% in emergency admissions
Endoscopy use variable
What has changed ?
Early identification of high risk patients
Therapeutic endoscopy
Drug use in AUGIB
And...
Blood transfusion in AUGIB – never audited
28.
29. The UK IBD Audit: Past,
Present and Future.
On behalf of UK IBD Audit
Steering Group
Dr Ian Arnott
UK IBD Audit Clinical Director
Consultant Gastroenterologist
Western General Hospital, Edinburgh, UK
30.
31. National clinical audits in England (2012)
Clinical area
Number
Children (inc neonatal)
8
Adult acute & emergency care
10
Long term conditions
7
Surgery/interventional procedures
7
Renal disease
3
Cancer
4
Trauma
3
Psychological conditions/treatments
2
Blood transfusion
2