This presentation by Professor Adrian Edwards and Dr Freya Davies from the Institute of Primary Care and Public Health at Cardiff University looks at the experiences of patients, carers and clinicians at the stage of transition to SPMS.
It was presented at the MS Trust Annual Conference in November 2014.
This presentation by Jeremy Chataway and Susan Hourihan from the National Hospital of Neurology and Neurosurgery provides an overview of how to identify the transition to secondary progressive MS and how to assist people with MS in the transition stage.
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
This lecture was given by Dr Cathy Price, Consultant in Pain Management for the Southampton University Hospitals NHS Trust, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. Her lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
This presentation by Jeremy Chataway and Susan Hourihan from the National Hospital of Neurology and Neurosurgery provides an overview of how to identify the transition to secondary progressive MS and how to assist people with MS in the transition stage.
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
This lecture was given by Dr Cathy Price, Consultant in Pain Management for the Southampton University Hospitals NHS Trust, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. Her lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
Decide treatment - a new approach to better healthØystein Eiring
Better treatment, better health! People often experience suboptimal health because treatment is not optimal. A new approach is being developed - enabling patients and doctors to improve treatment and improve health.
clinical assessment approach for GP and Family Physicians. How to take history and do physical examination, with tips on communication skills. done by Mohammed Majdou Alghamdi, Family Medicine Physician from Makkah Academy for Family Medicine. a primary health care setting.
This is the slidedeck of our Health Smartees Webinar, presented by Saartje Van den Branden on Wednesday 12 March, 2014. The presentation elaborates on a Roche Customer Consulting Board case study.
Decide treatment - a new approach to better healthØystein Eiring
Better treatment, better health! People often experience suboptimal health because treatment is not optimal. A new approach is being developed - enabling patients and doctors to improve treatment and improve health.
clinical assessment approach for GP and Family Physicians. How to take history and do physical examination, with tips on communication skills. done by Mohammed Majdou Alghamdi, Family Medicine Physician from Makkah Academy for Family Medicine. a primary health care setting.
This is the slidedeck of our Health Smartees Webinar, presented by Saartje Van den Branden on Wednesday 12 March, 2014. The presentation elaborates on a Roche Customer Consulting Board case study.
A medical error is a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment.
Mental health refers to the maintenance of successful mental activity.
This includes maintaining productive daily activities and maintaining fulfilling relationships with others.
It also includes maintaining the abilities to adapt to change and to
cope with stresses.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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.
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Exploring the transition to secondary progressive MS (SPMS): patient, carer and professional perspectives
1.
2. Introduction to our research
Methods – What we did
Presentation of results – Key themes for patients,
carers and professionals
Practice Implications – Breakout activity
Translating our results into recommendations
Your feedback on our suggestions
3. Known to be difficult for clinicians to
confidently identify(1)
Known to be a potentially difficult stage for
patients(2)
BUT little research has looked specifically at
the experiences of patients(3), carers and
clinicians at this stage
4. Identify the support needs of patients with MS
around the transition
Identify the support needs of their carers
Identify the educational needs of health care
professionals working with patients at this
stage
5. Cardiff MS database(4)
contains details of over
2200 patients with MS
Collects information
from clinical encounters
on disease course,
relapses and EDSS
Supplemented by an
annual patient
questionnaire
Time to reach SPMS in years
Years
Solid line = adult onset
Dotted line = paediatric onset
Median time in years to reach
SPMS shown (5)
6. Semi-structured interviews with patients, carers and clinicians
Focus groups for validation of initial findings with patients
and carers
Written validation exercise with clinicians and educationalists
7. Twenty patients were interviewed, eight also
attended a focus group
Aged 33-67
75% female
6-34 years since diagnosis
EDSS 4 – 7.5
Clinician diagnoses of RRMS, SPMS and SPMS
with relapses
8. Thirteen carers were interviewed, 1new carer
attended a focus group
Aged 36-76
8 male, 6 female
Relationship to person with MS = 8 partners,
4 parents, 1 sibling, 1 close friend.
Time as a carer = 4-37 years
9. 2 Consultant Neurologists
3 MS nurses
1 Neurophysiotherapist,
1 Occupational therapist (Neurology)
1 Neuropsychologist
1 District nurse
1 GP with an interest in neurology
1 Social worker
10. Qualitative thematic analysis
Three groups initially considered separately
Patient and carer data analysed together due
to significant overlap
Health professional data analysed separately
13. P008: I knew over time
because I couldn’t walk as far
as I used to, just slowed down
a bit, so I knew it was
happening, I was well aware of
it really.
P013: Then I go to my next
appointment, and I have this
[clinic letter] from that
appointment. I nearly froze in
my boots when I read it.
Secondary progressive multiple
sclerosis.
They never told me I had that.
So that was very shocking.
14. P038: …he [neurologist] said I don’t
need to see you anyway, and you don’t
need to have annual MRIs and you don’t
need to see the nurse every month, you
can see the nurse every 3 months
perhaps. And I thought okay, so I have
been shunted into this other group now
all of a sudden. I don’t know why. No-
one has told me why.
P044: I suppose at my
stage it doesn’t really matter
whether I am relapsing
remitting or secondary
progressive I suppose…it is
what it is sort of thing. And
I’ve learnt to manage it as
best I can.
15. A gradual personal realisation may occur
before discussion takes place
Appears to be facilitated by prior knowledge
of the likely disease course
A more sudden realisation may cause a more
marked emotional reaction
A lack of understanding about how the
‘diagnosis’ is made heightens confusion
16. C017: If it was one thing, if it
was her legs or if it was
neuralgia or if it was not being
able to get out.
But it’s the whole sweep of it,
it’s the spectrum of it
P006: Well in the beginning
you feel like you’ve been thrown
on the waste, you know the tip,
to be truthful, because I am of an
age where I had the work ethic
drilled into me
17. C017: it’s like living your life with a
weight on your back all the time, we
can’t do, we can’t plan anything,
because we don’t know what it’s
going to be like tomorrow
PO18: …with the future I try not to
think about it. I do think “Oh God, I
just want to be able to walk.” I think
if I was in a wheelchair all the time
and couldn’t walk and it’s taken that
other little bit of independence from
me, I don’t know what, I don’t want
to cope like that
19. P006: …I do a lot of yoga. So that
keeps me sort of mobile. It keeps
what I’ve got going, going. It’s
important to keep what you’ve got
P023: …it can get to me but I’ve
decided not to fight it.
Just to swing with it, climb over
fences, and adapt to it as far as I
can. And not let it beat me
20. C028: We only tend to ring her [MS
nurse] when it’s important. We
appreciate how busy she is and how
understaffed they are, but I’d say this;
when she does come back to you, she
gives you 100 percent
P13: I walk up and
down the corridor for so
many minutes and they
watch that. I don’t
understand what I’m
meant to do with that
when I go home
P022: when you are first
diagnosed you get a lot of
help, afterwards you just get
left alone, nobody does
anything and you have to
keep going on and on
saying I want this, I want
this
24. HP33: it takes a while to
know for definite if they are
in transition (nursing)
HP014: I think most of us don’t
mention it when you first think
they’re probably transient, you
probably wait a bit, until you’re
sure that they are, which may be a
bit late. And that’s part of our
anxiety I think about the
uncertainty, because we can’t
stick them in the MRI scanner and
have a result from [radiologist]
saying this person is now
progressive (medical)
HP035: maybe as
healthcare
professionals we don’t
want to accept that
conditions change
(nursing)
25. HP026: what I see in clinic is,
like, a shrug of the shoulders or,
‘it is what it is’, so there’s kind of
that resignation to that
(allied professional)
HP035: I think patients don’t
understand necessarily that relapsing
and remitting MS is likely to change
into secondary progressive MS and I
think they have quite a difficult
transition period because they, for
want of a better word and I put it in
inverted commas, they “panic”
(nursing)
26. HP014: I think it is very
difficult when someone is
relapsing to talk the sort of
doom and gloom (medical)
HP033: I don’t
suppose we
prepare them
(nursing)
HP032: it’s trying to word it without
frightening them, I know that like the
booklets [say] “they accumulate
disability slowly over time,” well that
sounds good, but not when you’re
trying to tell someone that (nursing)
HP34: Yeah it forces
me to be a bit more
kind of honest with
patients because I
know they are going to
get the exact clinical
letter (medical)
27. HP34: You still need
your part scientific
evidence as well as
“this is what I did and
it seemed to work”
(medical)
HP015: I think it is
really good to co-
work with people, I
think you learn a lot
(allied professional)
HP41: I think it’s harder to motivate yourself,
to say for this half hour, I’m gonna do that e-
learning, the phone rings, you’ve got
something else that needs doing, whereas if
you go to training, you’re there and nothing
else can happen …so for me, I much prefer
face to face
(allied professional)
28. HP034: as a
doctor you feel if
you offer them a
tablet then
somehow that
helps you feel
better at least
(medical)
HP009: some
people you can
sort of keep on
about things, you
need to do this,
and you need to do
this, and it is like
hitting a brick wall
(allied
professional)
HP015: I
probably ought
to signpost
people more
instead of
doing it all
myself
(allied
professional)
29. HP014: I don’t think you
can do it on your own. If
it’s just me in a clinic on
my own it wouldn’t work.
I need the nursing staff,
and the OT and the
physio (medical)
HP40: I think it is very easy
to just say go and talk to an
MS nurse about it. Having
said that, at the MS team
often they are much more in
tune with their particular
type of patient, so you could
argue that they might
provide a better service than
the GP anyway (medical)
30. HP014: So I think it would
have to be a bit more
flexible, so you’d have to
have it at a place they can
get to, at times for
someone who is working,
especially for the
transitional phase
(medical)
HP40: … it’s hugely limited
in terms of counselling
support (medical)
HP009: …so they do like a monthly
Parkinson’s day in the day hospitals. There
isn’t that for MS and I think that would pay
dividends. Cos you would be able to keep an
eye on people and just support them as they
go along. But we can’t offer that here (allied
professional)
31.
32. Recognising and discussing the transition
◦ How do you do it now?
◦ Who is involved?
◦ What works well and what doesn’t?
◦ How could it be done better in your service?
◦ What would you like to change?
33. Promoting patient engagement with self-
management
◦ What strategies have you used in the past to
encourage patients to become more engaged in
managing their own health?
◦ What works well?
◦ What should be avoided?
◦ Your top tip for others?
34.
35. What could help patients
What could help carers
What could help clinicians
36. Information on how SPMS is confirmed, what it
means for them and what they can do now
Tools to help them get the most out of their
appointments
A range of information and support services to
allow patient choice
Help to keep active
A directory of local services
37. Recognition carers’ information needs do not
always coincide with patients’ information
needs and they may not ask for help
Opportunities to access information and
support when they need it
Knowledge of how support someone with
invisible symptoms (fatigue, cognition,
personality change)
38. Symptom specific management advice for
dealing with symptoms ‘without solutions’
Communication skills in assessing patient
information needs and breaking bad news
Self-management support training
Strategies for providing psychological
support
39. Protected time to learn
Tailored to meet personal learning needs
Multi-disciplinary in nature
A combination of interventions :
◦ Knowledge based interventions – reading, e-
learning, small group work, case discussions.
◦ Skills based interventions – hands-on workshops
◦ Reflective practice– case discussions, mentoring.
40. Facilitate continuity of care
Provide a range of support services to
increase flexibility and patient choice
Provide simple high-quality reliable sources
of information
Increase availability of psychological support
41. Thanks to all the patients, carers and health professionals
who participated in the study
Study advisory group members
Fiona Wood, Cardiff University
Neil Robertson, Professor of Neurology, C&V UHB
Rhiannon Jones, MS Specialist Nurse, C&V UHB
Gayle Sheppard, Data Manager, C&V UHB
Kate Brain, Cardiff University
Rachel Wallbank, Specialist OT, C&V UHB
Michelle Edwards, Swansea University
Barbara Stensland, Patient Representative
Rebecca Pearce, MS Society
Tracy Nicholson, MS Trust
42.
43. 1. Katz-Sand I, Krieger S, Farrell C, Miller AE. Diagnostic uncertainty during the
transition to secondary progressive multiple sclerosis. Mult Scler. 2014. Feb 3. [Epub
ahead of print]
2. Deibel F, Edwards M, Edwards, A. (2013). Patients’, carers’ and providers’
experiences and requirements for support in self-management of multiple sclerosis:
a qualitative study. European Journal for Person Centered Healthcare, 1(2), 457-467.
3. Methley A, Chew-Graham C, Campbell S, Cheraghi-Sohi S. Experiences of UK
health-care services for people with Multiple Sclerosis: a systematic narrative review.
Health Expect. 2014. Jul 2. doi: 10.1111/hex.12228. [Epub ahead of print]
4. Moore P, Harding KE, Clarkson H, Pickersgill TP, Wardle M, Robertson NP.
Demographic and clinical factors associated with changes in employment in multiple
sclerosis. Mult Scler. 2013;19(12):1647-54.
5. Harding KE, Liang K, Cossburn MD, Ingram G, Hirst CL, Pickersgill TP, et al. Long-
term outcome of paediatric-onset multiple sclerosis: a population-based study. J
Neurol Neurosurg Psychiatry. 2013;84(2):141-7.
Editor's Notes
Again a varied experience. First quote patient feels care has been inexplicably downgraded
Second patient seems to have already gone through a personal transition in accepting disease progression before SPMS has actually been confirmed. She sees SPMS as just a label.