A presentation made by Frankie Vitone during the free public forum "Continuing the Conversation: a discussion on preparing for end-of-life care" on February 6, 2014 at the United Steelworkers Hall in Sudbury, Ontario.
Frankie Vitone is the Senior Director of Care Coordination at the North East Community Care Access Centre.
Learn more about the forum at http://www.hsnsudbury.ca/events
Transforming End of Life Care in Acute Hospitals AM Workshop 4: Advance Care ...NHS Improving Quality
Transforming End of Life Care in Acute Hospitals AM Workshop 4: Advance Care Planning, sharing perspectives presented by Dr David Howlett, Dilan Joshi, Sarah French, Sherree Fagge, Brighton and Sussex University Hospitals NHS Trust and Dr Karen Groves, Queens Court Hospice
NHSE South 7DS Webinar - How 7 day therapy services can become business as us...NHS England
This webinar gives an example of how the role of Allied Health Professionals is improving care and flow across seven days a week.
Caroline Poole from NHS Improvement gives a brief update on the AHP ‘Flow Collaborative’ and Vicki Sheen from Torbay and South Devon NHS Foundation Trust describes the impact of therapy teams providing a seven day service and how this has become business as usual.
Transforming End of Life Care in Acute Hospitals AM Workshop 6: Helping you t...NHS Improving Quality
Transforming End of Life Care in Acute Hospitals AM Workshop 6: Helping you to ‘Transform’ your local services, open to wannabee, new or established organisations participating in the Transform programme. Find out about the Transformathon… you will hear it here first! by Maggie Morgan-Cooke, Jennifer Clemo, NHS England and Anita Hayes, The National Council for Palliative Care
Transforming End of Life Care in Acute Hospitals AM Workshop 4: Advance Care ...NHS Improving Quality
Transforming End of Life Care in Acute Hospitals AM Workshop 4: Advance Care Planning, sharing perspectives presented by Dr David Howlett, Dilan Joshi, Sarah French, Sherree Fagge, Brighton and Sussex University Hospitals NHS Trust and Dr Karen Groves, Queens Court Hospice
NHSE South 7DS Webinar - How 7 day therapy services can become business as us...NHS England
This webinar gives an example of how the role of Allied Health Professionals is improving care and flow across seven days a week.
Caroline Poole from NHS Improvement gives a brief update on the AHP ‘Flow Collaborative’ and Vicki Sheen from Torbay and South Devon NHS Foundation Trust describes the impact of therapy teams providing a seven day service and how this has become business as usual.
Transforming End of Life Care in Acute Hospitals AM Workshop 6: Helping you t...NHS Improving Quality
Transforming End of Life Care in Acute Hospitals AM Workshop 6: Helping you to ‘Transform’ your local services, open to wannabee, new or established organisations participating in the Transform programme. Find out about the Transformathon… you will hear it here first! by Maggie Morgan-Cooke, Jennifer Clemo, NHS England and Anita Hayes, The National Council for Palliative Care
Transforming End of Life Care in Acute Hospitals PM Workshop 6: Working toget...NHS Improving Quality
Transforming End of Life Care in Acute Hospitals PM Workshop 6: Working together - Building on the best by Professor Bee Wee, NHS England, Adrienne Betteley, Macmillan Cancer Support, Anita Hayes, The National Council for Palliative Care
Seven Day Services - Top tips to engage your stakeholders in the delivery of ...NHS England
This presentation describes the strategic plan and journey of how Universal Hospital Southampton NHS Foundation Trust have developed and implemented out of hours and seven day services, using innovative workforce models and supporting culture change. This has led to improvements in patient outcomes, patient and staff experience and more effective patient pathways.
06: Implementation of ICF in an inpatient rehabilitation centre at Madwaleni ...ICF Education
Poster presentation at the 2nd International Symposium: ICF Education. 30 June 2017 (Cape Town).
THEME: ICF as catalyst for interprofessional education and collaborative practice
http://www.icfeducation.org
Personal Health Budgets and Continuing HealthcareMS Trust
This presentation by Gill Ruecroft, Commissioning Manager, provides an overview of Personal Health Budgets (PHBs) and demonstrates the effectiveness of PHBs through case studies.
It was presented at the MS Trust Annual Conference in November 2014.
Learning from the National Care of the Dying 2014 AuditMarie Curie
Dr Phil McCarvill, Head of Policy and Public Affairs at Marie Curie speaks at Improving End of Life Care on 'Learning ' on 10 December, 2014.
Phil makes reference to the National Care of the Dying Audit which was carried out by the Royal College of Physicians, with the Marie Curie Palliative Care Institute Liverpool.
Presentation given by Noreen Cushen-Brewster & Heather Howman of NHS Great Yarmouth and Waveney Integrated Care System at the Improving access to seven day services event. Crawley 11 March 2015.
Christine Samosa & Paula Roles - Our current workforce challenges.Innovation Agency
Presentation by Christine Samosa, Strategic Workforce Lead, Health and Care Partnership for Cheshire & Merseyside and Paula Roles, Strategic Workforce/HR Lead, Health and Care Partnership for Cheshire & Merseyside: Our current workforce challenges on Wednesday 13 March 2019 at Haydock Park Racecourse.
A presentation made by Lise Poratto-Mason during the free public forum "Continuing the Conversation: a discussion on preparing for end-of-life care" on February 6, 2014 at the United Steelworkers Hall in Sudbury, Ontario.
Lise Poratto-Mason is a partner with the law firm of MASON PORATTO-MASON LLP.
Learn more about the forum at http://www.hsnsudbury.ca/events
A presentation made by Dr. Andrew Knight during the free public forum "Continuing the Conversation: a discussion on preparing for end-of-life care" on February 6, 2014 at the United Steelworkers Hall in Sudbury, Ontario.
Dr. Knight is a General Practitioner at the Northeast Cancer Centre and he is the Education Co-chair of the Palliative Care Education Committee and is an Assistant Professor of Family Medicine at the Northern Ontario School of Medicine. He is a Past Chair of the Canadian Association of General Practitioners in Oncology (CAGPO) and is currently the Palliative Care Lead for LHIN 13.
Learn more about the forum at http://www.hsnsudbury.ca/events
Transforming End of Life Care in Acute Hospitals PM Workshop 6: Working toget...NHS Improving Quality
Transforming End of Life Care in Acute Hospitals PM Workshop 6: Working together - Building on the best by Professor Bee Wee, NHS England, Adrienne Betteley, Macmillan Cancer Support, Anita Hayes, The National Council for Palliative Care
Seven Day Services - Top tips to engage your stakeholders in the delivery of ...NHS England
This presentation describes the strategic plan and journey of how Universal Hospital Southampton NHS Foundation Trust have developed and implemented out of hours and seven day services, using innovative workforce models and supporting culture change. This has led to improvements in patient outcomes, patient and staff experience and more effective patient pathways.
06: Implementation of ICF in an inpatient rehabilitation centre at Madwaleni ...ICF Education
Poster presentation at the 2nd International Symposium: ICF Education. 30 June 2017 (Cape Town).
THEME: ICF as catalyst for interprofessional education and collaborative practice
http://www.icfeducation.org
Personal Health Budgets and Continuing HealthcareMS Trust
This presentation by Gill Ruecroft, Commissioning Manager, provides an overview of Personal Health Budgets (PHBs) and demonstrates the effectiveness of PHBs through case studies.
It was presented at the MS Trust Annual Conference in November 2014.
Learning from the National Care of the Dying 2014 AuditMarie Curie
Dr Phil McCarvill, Head of Policy and Public Affairs at Marie Curie speaks at Improving End of Life Care on 'Learning ' on 10 December, 2014.
Phil makes reference to the National Care of the Dying Audit which was carried out by the Royal College of Physicians, with the Marie Curie Palliative Care Institute Liverpool.
Presentation given by Noreen Cushen-Brewster & Heather Howman of NHS Great Yarmouth and Waveney Integrated Care System at the Improving access to seven day services event. Crawley 11 March 2015.
Christine Samosa & Paula Roles - Our current workforce challenges.Innovation Agency
Presentation by Christine Samosa, Strategic Workforce Lead, Health and Care Partnership for Cheshire & Merseyside and Paula Roles, Strategic Workforce/HR Lead, Health and Care Partnership for Cheshire & Merseyside: Our current workforce challenges on Wednesday 13 March 2019 at Haydock Park Racecourse.
A presentation made by Lise Poratto-Mason during the free public forum "Continuing the Conversation: a discussion on preparing for end-of-life care" on February 6, 2014 at the United Steelworkers Hall in Sudbury, Ontario.
Lise Poratto-Mason is a partner with the law firm of MASON PORATTO-MASON LLP.
Learn more about the forum at http://www.hsnsudbury.ca/events
A presentation made by Dr. Andrew Knight during the free public forum "Continuing the Conversation: a discussion on preparing for end-of-life care" on February 6, 2014 at the United Steelworkers Hall in Sudbury, Ontario.
Dr. Knight is a General Practitioner at the Northeast Cancer Centre and he is the Education Co-chair of the Palliative Care Education Committee and is an Assistant Professor of Family Medicine at the Northern Ontario School of Medicine. He is a Past Chair of the Canadian Association of General Practitioners in Oncology (CAGPO) and is currently the Palliative Care Lead for LHIN 13.
Learn more about the forum at http://www.hsnsudbury.ca/events
A presentation made by Sr. Costanza Romano during the free public forum "Continuing the Conversation: a discussion on preparing for end-of-life care" on February 6, 2014 at the United Steelworkers Hall in Sudbury, Ontario.
Sister Costanza Romano is the Team Lead for Spiritual and Religious Care for St. Joseph’s Health Centre, Sudbury.
Learn more about the forum at http://www.hsnsudbury.ca/events
A presentation made by Dr. Harvey Chochinov during the free public forum "How to Start the Conversation: a discussion on preparing for end-of-life care" on January 9, 2014 at the United Steelworkers Hall in Sudbury, Ontario.
Dr. Harvey Chochinov is Distinguished Professor of Psychiatry at the University of Manitoba, Director of the Manitoba Palliative Care Research Unit at Cancer Care Manitoba, and the holder of the only Canada Research Chair in Palliative Care.
Learn more about the forum at http://www.hsnsudbury.ca/events
A presentation made by Dr. Brian Goldman during the free public forum "How to Start the Conversation: a discussion on preparing for end-of-life care" on January 9, 2014 at the United Steelworkers Hall in Sudbury, Ontario.
Dr. Brian Goldman is an Emergency Department physician at Mount Sinai Hospital in Toronto and host of the national CBC radio program “White Coat, Black Art”.
Learn more about the forum at http://www.hsnsudbury.ca/events
“PARKOVY”
Convention & Exhibition Center in Kiev: all-inclusive for business. Situated in the very heart of Kyiv-city.
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The space transformation technology.
You can use 25 conference rooms (50 m² and more) at the same time.
The Congress Hall of «Parkovy»: 4 000 m² of venue for greatest events in Ukraine.
2 ball-rooms 300 m² each one can be used for banqueting, parties, exhibitions etc.
Heliport as a unique event venue: 5 500 m² of greatest event-effect.
The exhibition area: transforming the space. Total exhibition area – 14 500 m² with separate entrances. 9 000 m² of covered exhibition area and 5 500 m² of open exhibition area.
Unique possibility of providing exhibitions and other events at heliport.
Do you know what questions to ask your care provider to help improve your safety as a patient?
For Canadian Patient Safety Week 2016 our patients and staff participated in a variety of activities to promote patient safety at HSN. One of these activities was to have you share important questions you could ask your care provider.
Here is what you had to say
#AskListenTalk #CanadianPatientSafetyWeek
Overview of recommendations for quality care at the end of life for Lesbian, Gay, Bisexual, Transgender, and Questioning or GenderQueer patients. Caring as a cultural competency.
right conversations, right people, right time
27 January 2011 - National End of Life Care Programme
This is the final report from the communication skills pilot project, which funded pilot sites to explore training need, provision, strategy and sustainability. Service users and other partners also contributed to the project.
It celebrates the NEoLCP's work in equipping our workforce with the confidence and competence to respectfully and compassionately care for individuals and their families towards the end of life.
The pilots carried out a training needs analysis, reviewed existing provision and benchmarked it against national competences. They then used a needs-based approach to develop new training plans. This report highlights the project's findings and identifies key messages.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Our goal is to cover the wide areas of overlap and similarities between the two disciplines, and to also make the differences between the two clearer for you.
Michelle Pilling, Lay Member Patient and Public Involvement and Deputy Chair with Dave Rogers, Head of Communications & Engagement at East Lancashire CCG
Personal Support Workers (PSWs) - Foundation of Health Care Provision (Ontario)Kelly O'Sullivan
PSWs are increasingly a vital and fundamental part of the provision of health care in Ontario. This presentation provides an overview of who are PSWs, types of work and reasons for the expansion of workers in this profession.
Making difficult decisions to ensure the future of quality health care for you.
A Derbyshire Dales District Council Area Community Forum presentation (October 2014) by Northern Derbyshire Clinical Commissioning Group
Learning Disabilities: Share and Learn WebinarNHS England
Topic One: Enhanced Care Service (ECS)
Guest speakers: Caroline Kirby - Interim Lead Complex Needs Commissioner, Angie Simmons - Team Leader, Enhanced Care Service (ECS), Ted Page - Behavioural Nurse Specialist (ECS)
and Rachel Barrett – Expert by Experience, Speakeasy Now
The presentation reflects on good practice around avoiding hospital admission in Worcestershire who have developed an enhanced care service working proactively in the community.
Topic Two: Strategic resettlement, personalisation at scale and pace
Guest speaker: Pól Toner, Head of Improvement, NHS England
The presentation considers Strategic Resettlement, which is part of the Improvement and Enablement function of the Learning Disability Programme. It is being put in place to support the delivery of a transformational change to close inpatient services and develop the appropriate scale of personalised community care for people with a learning disability and/or autism who display behaviour that challenges, as set out in Building the Right Support. The function provides additional support to local systems to accelerate discharges where appropriate, focusing specifically on patients with the most complex needs and a long length of stay (over 5 years).
http://westwood.belmontvillage.com/events/event_details/ucla-lecture-alzheimers-and-dementia-care/
UCLA Lecture: Alzheimer’s and Dementia Care
Tuesday, March 24, 2015 | 2:00 – 3:00 p.m.
Belmont Village Senior Living
10475 Wilshire Blvd., Los Angeles, CA 90024
Michelle Panlilio, GNP
Dementia Care Manager
Please join us for an informative presentation by Alzheimer’s and Dementia expert Michelle Panlilio. Ms. Panlilio will discuss the UCLA Alzheimer’s and Dementia Care program and how it addresses the complex medical, behavioral, and social needs of those affected by memory loss and cognitive impairment. The following topics will be discussed:
• Program background and benefits
• Key findings to date
• Challenges and solutions
• The future of dementia care
Beverages will be served.
RSVP to the Concierge on or before Friday, March 20 at 310.475.7501.
Designing a More Seniors-friendly Health Care System was the second in a Seniors Summit series produced by Health Sciences North. This event was held at the United Steelworkers Hall on Brady St. in Sudbury on Monday June 3, 2013. This presentation is a combination of the three presentations made by our keynote speakers: Sholom Glouberman, President of the Patients Association of Canada and Philosopher-in-Residence at the Baycrest Centre For Geriatric Care; Dr. Janet McElhaney, HSN Volunteer Association Chair in Geriatric Research, Medical Lead of Seniors Care at HSN and Senior Scientist at AMRIC and Dr. Jo-Anne Clarke, Geriatrician, Northeast Specialized Geriatric Services
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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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 Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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End of Life Public Forum 2 - Frankie Vitone - Feb. 6, 2014
1.
2. An Evolving System
• New technology and best practice
• Changing community demographics,
population needs
• Need for collaboration
• Right care, right place, right time, right
provider
3. Hospice/Palliative Care – a growing issue?
• Need to support patients through their
journey
• Raison d’être for North East Hospice Palliative
Care Network, a network made up of home,
hospital, and hospice providers and
stakeholders
• Goal is to work with the North East LHIN to
improve palliative care across the northeast
7. Community
• A number of palliative services providers in
the community:
–
–
–
–
–
–
Care providers (primary)
CCAC
Community Support Services and volunteer providers
Hospital outpatient and outreach/inpatient
Long-Term Care Homes
Residential Hospice and outreach
8. North East CCAC – Professional Services
• Provide professional services:
– Care Coordination
– Therapies (Occupational and physiotherapy,
dietician, speech-language pathologist, social
worker) - internal and contracted providers
– Nursing (clinic, in-home, shift), primarily
contracted services through service providers
9. North East CCAC – Support Services
• Provide support services:
– Personal support – contracted service
– Short-term medical equipment rental
– Medical supply provision
10. North East CCAC –
Enhancing End of Life Care
• Internal initiatives to enhance chronic disease
management and end of life care
• Enhanced and new services
• Specialized knowledge and expertise
11. North East CCAC –
Enhanced End of Life Services
Enhanced personal care, nursing and therapy
services to support patients with end of life care
needs (last 90 days of life)
12. North East CCAC
Chronic Disease/Palliative Care Initiatives
•
•
•
•
Rapid Response and Telehomecare Nursing
Palliative Nurse Practitioner Program
Specialized Palliative Care Coordination Team
Enhanced palliative training for staff (multidisciplinary
palliative team pilot)
• Integrated service planning pathways and guidelines
• Provision of therapy services, medical equipment/supplies for
patients at Maison Vale Hospice
13. Warm Hearts
• Interdisciplinary education, volunteer visiting
and the Bereavement Follow-up Program
since 1989
• Accredited organization, screening process
and intensive training for volunteers
14. Warm Hearts
• Sponsor agency for the Interdisciplinary
Education Program
• www.warmhearts.ca or call 705-677-0077
• Recent/ongoing integration with Maison Vale
Hospice
15. Maison Vale Hospice
Community Outreach Services
• Shared Care Team for patients with complex
needs
– Specialized nursing
– Supportive care
– Physician/RN on-call, 24/7
– Consultation and resource
• Advanced Care Planning Strategy
16. HSN Palliative Services – Supportive Care
• Specialized individual and family counselling
• Palliative and end of life care for First Nations, Inuit, and
Métis patients and families
• Assistance with practical and financial matters
• Specialized nutrition counselling
• Physiotherapy for symptom management
• Grief counselling for caregivers and families
17. HSN Palliative Services –
Symptom Management Clinic
•
•
•
•
Control of pain and other symptoms of cancer
Emotional, social and spiritual care
Educate for informed decision-making
Grief counselling for caregivers and families
18. Maison Vale Hospice - Residential Care
• Maison Vale Hospice provides residential
hospice palliative care in a homelike
environment
• Psycho-Social/Spiritual Care Program
• Visiting Hospice Volunteer Program
19. Maison Vale Hospice –
Admission Criteria
• Placement provided by the NE CCAC - 310-CCAC
• Patient criteria:
– Over the age of 16
– “End stage” medical condition, with a life expectancy of three
(3) months or less
– Priority given to patients who live alone and cannot manage at
home alone, or hospital in-patient unable to return home
wishing for EOL care with the Hospice
– Has symptoms that can be managed by residential hospice staff
20. HSN Inpatient Palliative Care
• Focus on pain and symptom management that
cannot be provided in a community setting
• HSN Palliative Care Unit at HSN
– 6 beds
– Open to any palliative hospital patient whose EOL care
period is less than 4 weeks, or community patient with
care period of less than 3 weeks
21. Conclusion
• Providers working together to enhance care
and resources to improve information,
options and outcomes for patients and
families.
• For information please contact:
– www.northeasthealthline.ca or,
– 310-CCAC Information and Referral
Editor's Notes
Good evening. I’d like to thank you for being here this evening. Given the attendance at these two End-of-Life Care public forums, I think it is safe to say that we don’t need to hold a focus group to determine whether or not people care about the topic!
One of the things I have loved most about my career has been the variety of new and interesting experiences available. The health care system is a lot of things, but boring is not one of them.
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I have been involved in the community end of the health care system for the past 20 years, and we have seen remarkable changes in that time. Not only in technology and best practice, but also in community demographics, health care needs of the population, and in particular, the realization that for our health care system to work for our patients, all of the players had to act like we were a system from the beginning to the end of the patient’s care journey, and indeed from the start of life, until the very end.
We have had a great deal of success in addressing barriers and improving care through collaboration, helping patients receive the right care, at the right time, from the right provider.
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So, it made sense to apply this collaborative philosophy to the growing issue of End of Life care.
It seems odd to say “growing issue”, doesn’t it? After all, they say death is one of only two sure things in life. But it is a sensitive topic, one that for many years people have been hesitant to talk about. As you have heard many times over these past two forums, however, it is not a topic we can afford to ignore any longer. The demographics of our society simply won’t allow it, but more than that, we shouldn’t allow it.
Dying with dignity, in relative comfort and peace, is something we all want, and needs to be considered a rite of passage.
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The North East Hospice Palliative Care Network, which I have been involved with since it began 8 years ago as the North East End of Life Network, is working closely with the North East LHIN to improve palliative care across the northeast.
The purpose of the Network is to work together to make the entire spectrum of hospice/palliative care needs and providers – institutional and community services, education for caregivers and patients alike, direct care, support – work as a continuum of care that supports a safe, effective, and seamless patient experience.
Because…
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As you can see, the number of community support services available are numerous – so numerous, it can be difficult to make sense of it all without a collaborative effort.
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We intend to transform delivery to develop a comprehensive, integrated continuum of care and support that wraps delivery around the adult, and their family and informal caregivers, and responds to their goals, needs and personal contexts through a virtual, extended inter-professional team.
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In order to ensure a smooth journey, we must know who is doing what, and ensure that people are receiving the right care, in the right place, at the right time, from the right provider.
We are working together to develop a system that can meet the varying levels of care and expertise that our patients will require.
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There are a number of services and providers in the community.
They include: CCAC, primary care providers, and a variety of publicly funded community support services and volunteer providers, as well as hospital outpatient, outreach and inpatient services, residential hospice, and long-term care homes.
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The CCAC provides:
Professional services in home, clinic, and congregate settings. Care coordination, occupational and physiotherapy, speech language pathology, dieticain and social work, both internal and contracted.
Clinic, in-home, and shift nursing, primarily contracted through our service providers.
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The CCAC also provides support services in the home, such as personal support, short-term medical equipment rental, and medical supply provision, the latter two of which we will also provide in the hospice setting.
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For palliative and end-of-life patients in the community, however, there are programs that go above regular service.
We, and I believe all of our partners, recognize that the End of Life journey is a journey like no other, and requires specialized knowledge and expertise.
The CCAC has been working with partners and providers to enhance End of Life care in the home.
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Enhanced hours are available to assist patients in community or returning home from hospital needing end of life care to die in dignity at home.
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Our Rapid Response nursing program is designed to smooth transitions from hospital to home for at risk patients and prevent readmission to hospital, with a focus on patients with chronic diseases.
The Telehomecare nursing program provides support for patients with Chronic Obstructive Pulmonary Disorder and Heart Failure. While these programs are not specifically End of Life programs, they do provide care and support for people with chronic disease that are life threatening.
Our Palliative Nurse Practitioner program allows us to provide in-home assessments and consultation, and also provides a liaison between the CCAC, Regional Cancer Program at Health Sciences North, and Maison Vale Hospice. These palliative nurse practitioners work closely with a physician who specializes in end of life care. This care is critical, particularly for patients with no primary care. (Stay on slide)
Our specialized palliative care coordination team is provided with education specific to and has enhanced knowledge of the end of life journey. The care coordinators on this team have a sole focus of supporting patients on their end of life journey.
Beyond supporting patients in the home, the care coordinators have a focus of avoiding Emergency Department visits and hospital admissions through proper care and pain and symptom management.
Interdisciplinary therapies can also play a critical role in end of life care. The CCAC has facilitated the ability of our therapists to receive enhance palliative training, and we are currently conducting an enhanced multidisciplinary palliative team pilot in Sudbury that takes a holistic view of all services that are required by patients on their end of life journey.
We are working closely with service providers to develop service planning pathways and guidelines specific to our palliative patients that seek to ensure continuity of care. are carried out consistently as intended.
We work closely with Maison Vale Hospice to provide necessary equipment and supplies to our patients, such as intravenous pumps for pain medication, wheelchairs and walkers, as well as the Ontario Drug Benefit.
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Warm Hearts has done an excellent job of providing essential end-of-life services such as education, volunteer visiting and the Bereavement Follow-up Program to help families through the grieving process since 1989. An accredited organization, Warm Hearts volunteers go through a screening process and complete thirty hours of instruction on palliative care philosophy, communication, stress management, and bereavement.
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As the sponsor agency for the Interdisciplinary Education Program, their learning programs for front-line health professionals offer orientation to basic skills and concepts of palliative care, as well as advanced palliative care education based on national principles and norms of practice as set out by the Canadian Hospice Palliative Care Association.
This helps to foster professional development of essential skills, knowledge and attitudes to help the dying individual and family through the experience of dying, from all angles - physically, socially, emotionally and spiritually. They also provide other learning opportunities through their Palliative Caregivers Learning Centre. (Website is www.warmhearts.ca or call 705-677-0077.)
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A very exciting development has been the integration of Warm Hearts - Palliative Caregivers Sudbury/Manitoulin, with the Maison Vale Hospice. This represents an excellent fit given the caring nature of both organizations. The trained Warmhearts Volunteer Visitors with continue to be called Warmhearts – because that is who they are.
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When people think of a hospice, what they usually envision is the residential care. However, beyond the residential care there are a number of community supports available through Maison Vale Hospice in addition to the volunteer program through their integration with Warm Hearts.Included in their services is a shared-care team that provides expert consultation and care for patients with complex physical, emotional, and spiritual needs in their home along with their families and provide education and additional support services to enable clients to live and die in the location of their choice. The Shared Care Team also provides pain and symptom management consultation to front line providers. Maison Vale Hospice is also engaging with the North East Hospice Palliative Care Network to develop an Advanced Care Planning strategy to promote and support patient planning.
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Through the Regional Cancer Program, Health Sciences North also reaches out into the community to support the end of life journey for cancer patients.
This is accomplished through the Supportive care services Multidisciplinary team that includes
Dieticians, Social Workers, Physiotherapists, Neuropsychologist, Speech and Language Pathologists
They provide specialized individual and family counselling, palliative and end of life care for First Nations, Inuit, and Métis patients and families, assistance with practical and financial matters, specialized nutrition counselling, physiotherapy for symptom management, and grief counselling for caregivers and families. (Next Slide)
The HSN Symptom Management Clinic is available for all adult cancer patients who are dealing with the symptoms and stress of a life-threatening cancer diagnosis.
Their goal is to provide the highest quality of life for people facing advanced cancer, providing compassionate, holistic care with expertise in pain and symptom management.
The Symptom Management team comprises Family Doctors, Registered Nurses, Advanced Practice Nurses, Administrative Associates and other allied health such as social workers and dieticians.
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They seek to provide pain and symptom control, offer emotional, social and spiritual care to patients and families that respects individual cultures values and beliefs, provide education related to end-of-life goals and options while creating an environment that encourages patients and families to make informed choices, encourage patients to ask questions about their care and ensure their decisions and choices are heard, and offer bereavement care for those who grieve.
All of these community services – HSN, Maison Vale Hospice, Warm Hearts, CCAC and nursing providers – work closely and collaboratively to assist people on their end of life journey.
Of course, there are those for whom residential care is the only option.
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It is most often the goal by the organizations involved in the network to allow people to be properly supported and be able to spend as much of their end-of-life journey in the comfort of their homes. For some, this is also where they hope the journey will end, but others seek a sort of middle ground – not home, but not a hospital.
When staying home is no longer an option, Maison Vale Hospice provides residential hospice palliative care for Sudbury-Manitoulin. With the compassionate support and quality care they offer to individuals and families in a homelike environment, residents are encouraged to realize their full potential to live even when they are dying while having their physical, psycho-social, spiritual, and practical needs met.
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The Psycho-Social/Spiritual Care Program responds to these and the religious needs of residents, families, and even staff and volunteers of the Hospice. They also have an excellent and extensive volunteer program, covering everything from companionship and active listening, to the Visiting Hospice Volunteer Program that offers compassionate bedside support, including social and emotional support, help with general activities of daily living, accompaniment of clients to appointments, and caregiver respite.
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Again, however, we return to a theme – the right care, in the right place, at the right time. Through the CCAC Placement team, we are able to provide direct home to hospice admissions and are streamlining this process as much as possible in recognition that time is very often of the essence. There is admission criteria for community residential hospice care, and we must always be certain that we are meeting the needs of patients in a safe and appropriate environment.
Admission criteria for placement at Maison Vale Hospice is as follows:
Over the age of 16
“End stage” medical condition, with a life expectancy of three (3) months or less
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Priority given to patients who Live alone and cannot manage at home alone, or hospital in-patient unable to return home wishing for EOL care with the Hospice
Has symptoms that can be managed by residential hospice staff
Maison Vale Hospice offers excellent care in a peaceful setting, and many lifelong friendships and loyalties are formed during this period.
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Not long ago, people who did not die suddenly, expected to die in the hospital, or perhaps a nursing home. It was taken as a given for many that the hospital was the only place where they would receive enough care and medication to see them through their final days. But this was also at odds with what many people wanted, which was to die in a non-clinical setting. Unfortunately, the wish to die at home is not always feasible, or even possible. There are sometimes patients whose care on their end-of-life journey is too complex to be managed in the home or hospice setting. In those instances, the palliative care unit at Health Sciences North offers excellent care, taking a multidisciplinary approach to address physical, emotional, spiritual, and psychosocial concerns. There is, of course, a focus on pain and symptom management that cannot be provided in a community setting.
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The unit’s 6 dedicated beds are available not only for cancer patients, but indeed for any patient within the hospital who requires end of life care for a period that is expected to be less than 4 weeks, and also for patients from the community who may require hospital care for a period of time – usually less than 3 weeks – before they are stable enough return to the community setting. As noted, the admission criteria is strict and the goal, where possible, is to have individuals cared for in the community for as long as possible on their end-of-life journey.
Just a little while ago you heard the HSN Medical Lead for Palliative Care, Dr. Andrew Knight, speak to the medical considerations in end-of-life care. HSN is also currently involved in an education initiative to train all nurses in its medical program on palliative and end-of-life best practices, using information from the Maison Vale Hospice to ensure nurses are able to deliver enhanced care at the bedside.
It is this kind of expertise and dedication to continuous quality improvement that makes Dr. Knight, the palliative unit and staff, and HSN, such valuable partners to have at the table.
It should be noted that receiving palliative care in hospital is not truly a “choice” inasmuch as it is a happenstance – you cannot book a palliative bed at HSN. If one is admitted and is simply too sick with needs too complex, and are too far along in the end of life journey to leave, it may be the case that the journey ends in hospital.
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We must make as much information as we can available. People can visit www.northeasthealthline.ca for more information on palliative and end-of-life care in the northeast.
They can also call 310-CCAC to speak with Information and Referral staff.
One thing is abundantly clear – we need greater access to hospice care in the north, and more of it.
Because there are so many options, and so many potential scenarios in which a person may find themselves at the end of their lives, it is important that we are clear on the options that exist, and that the providers are working together to do the best we can in ensuring peoples’ end-of-life journeys conform as closely as possible to their wishes.
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This, of course, is not always possible – the end-of-life journey has more twists and turns than one can imagine, and is possibly the most personal and subjective journey one can take. No two stories are the same.
We will continue to make enhancements and to provide the best care we possibly can. We know in the coming years the need for End-of-Life and palliative care will require an even greater commitment in resources, but also more effective use of resources.
We cannot shy away from these discussions because it is too painful to acknowledge that the end of life will eventually come. Indeed, it is one of the few things we all have in common. The fact that you are here and have shown so much interest in this topic confirms that.
On behalf of the Northeast Hospice Palliative Care Network, I offer my sincere thanks. I hope this information has been useful to you.
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