patient safety and staff Management system ppt.pptxanjalatchi
Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
Nursing Management Gibbs Model of Reflectionemilyparker01
Myocardial infarction occurs due to inadequate blood supply to the heart muscles, leading to sudden premature death. The condition leads to permanent damage to the heart muscles (Kushner FG, 2009). The total number of deaths attributed by cardiovascular disease numbers to 30.5% worldwide showcasing the graveness of the condition. In Australia, measure portions of the myocardial infarction patients suffers from ventricular fibrillation prior to getting any medical aid or intervention. According to 2011 statistics, the total number of deaths due to cardiovascular disease accounts for 45,600 which shares 31% of the total number of deaths occurred in the same year.
Medical Professionalism, Doctor Patient Relationship, Do's and Don'tNavneet Ranjan
Medical Professionalism, Doctor Patient Relationship, Do's and Don't
How to tackle aggressive patients
How to find red flag sign of possible violence
Etc
Do's for medical resident and any field
Tips and tricks
Doctor ethics
This talk aims to empower the participant by educating them on what the holistic model of health is and what therapies are available and which ones are more suited to different conditions.
For info log on to www.healthlibrary.com. "Wellbeing: An Introduction of the Holistic Health Model" By Mr. Vatsal Doctor held on 12 Oct 2015.
Person centered care models with reference to dementia care, has demonstrated positive outcomes for behavioral disturbance. This presentation will increase awareness and understanding about person-centered care for people with dementia. Discussion includes complex needs of people with dementia, leading to compromised behavioral symptoms; including non-pharmacological approaches, sleep-wake-cycle disturbance, verbal outbursts and aggression. Further discussion encompasses evidence based outcomes with the use of person centered care that focuses on preserving the "personhood" of the individual.
patient safety and staff Management system ppt.pptxanjalatchi
Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
Nursing Management Gibbs Model of Reflectionemilyparker01
Myocardial infarction occurs due to inadequate blood supply to the heart muscles, leading to sudden premature death. The condition leads to permanent damage to the heart muscles (Kushner FG, 2009). The total number of deaths attributed by cardiovascular disease numbers to 30.5% worldwide showcasing the graveness of the condition. In Australia, measure portions of the myocardial infarction patients suffers from ventricular fibrillation prior to getting any medical aid or intervention. According to 2011 statistics, the total number of deaths due to cardiovascular disease accounts for 45,600 which shares 31% of the total number of deaths occurred in the same year.
Medical Professionalism, Doctor Patient Relationship, Do's and Don'tNavneet Ranjan
Medical Professionalism, Doctor Patient Relationship, Do's and Don't
How to tackle aggressive patients
How to find red flag sign of possible violence
Etc
Do's for medical resident and any field
Tips and tricks
Doctor ethics
This talk aims to empower the participant by educating them on what the holistic model of health is and what therapies are available and which ones are more suited to different conditions.
For info log on to www.healthlibrary.com. "Wellbeing: An Introduction of the Holistic Health Model" By Mr. Vatsal Doctor held on 12 Oct 2015.
Person centered care models with reference to dementia care, has demonstrated positive outcomes for behavioral disturbance. This presentation will increase awareness and understanding about person-centered care for people with dementia. Discussion includes complex needs of people with dementia, leading to compromised behavioral symptoms; including non-pharmacological approaches, sleep-wake-cycle disturbance, verbal outbursts and aggression. Further discussion encompasses evidence based outcomes with the use of person centered care that focuses on preserving the "personhood" of the individual.
Planning the implementation of an EMR or EHR, then you need to understand the basics of defining your clinical workflow. This presentation was made at a variety of medical conferences
Neoplasia: Is the abnormal growth and proliferation of abnormal cells or abnormal amounts of cells due to a benign or malignant process. There can be benign tumors, or neoplasms, and malignant ones.
Nursing is a profession that is based on collaborative relationship with clients and colleagues but, when two or more people view issues from different perspectives these relationships can be compromised by violence.
Care of Sickle Cell Disease Patients: Process Improvement & Change with NursesTosin Ola-Weissmann
Populations with SCD are at risk for disparities primarily because of the lack of knowledge on the part of the healthcare providers regarding the disease; inadequate pain management and prejudice among the staff (Tanabe & Myers, 2007).
On interviewing several nurses in the hospital, many acknowledge that they have never taken care of a patient with SCD and do not know what to assess for. The only nurse with experience of taking care of a SCD patient did not know the complications of the disease and wondered why sickle cell patients “always request pain medication when it’s obvious they are not in pain.”
This presentation is a guide providing essential information to medical professionals on dealing with patients that have sickle cell anemia. In addition, the SCD questionnaire is designed to enhance the assessment of SCD patients by medical professionals in the emergency room and serve as a platform for understanding their vulnerabilities during assessment.
Emphasis of this questionnaire is placed on identifying risk factors for depression, the patient’s socio-economic barriers, lifestyle habits, transportation issues, safe home environment, effective pain management and avenues for possible genetic counseling all of which sickle cell patients have shown vulnerability to (Dorsey & Murdaugh, 2003).
Planning the implementation of an EMR or EHR, then you need to understand the basics of defining your clinical workflow. This presentation was made at a variety of medical conferences
Neoplasia: Is the abnormal growth and proliferation of abnormal cells or abnormal amounts of cells due to a benign or malignant process. There can be benign tumors, or neoplasms, and malignant ones.
Nursing is a profession that is based on collaborative relationship with clients and colleagues but, when two or more people view issues from different perspectives these relationships can be compromised by violence.
Care of Sickle Cell Disease Patients: Process Improvement & Change with NursesTosin Ola-Weissmann
Populations with SCD are at risk for disparities primarily because of the lack of knowledge on the part of the healthcare providers regarding the disease; inadequate pain management and prejudice among the staff (Tanabe & Myers, 2007).
On interviewing several nurses in the hospital, many acknowledge that they have never taken care of a patient with SCD and do not know what to assess for. The only nurse with experience of taking care of a SCD patient did not know the complications of the disease and wondered why sickle cell patients “always request pain medication when it’s obvious they are not in pain.”
This presentation is a guide providing essential information to medical professionals on dealing with patients that have sickle cell anemia. In addition, the SCD questionnaire is designed to enhance the assessment of SCD patients by medical professionals in the emergency room and serve as a platform for understanding their vulnerabilities during assessment.
Emphasis of this questionnaire is placed on identifying risk factors for depression, the patient’s socio-economic barriers, lifestyle habits, transportation issues, safe home environment, effective pain management and avenues for possible genetic counseling all of which sickle cell patients have shown vulnerability to (Dorsey & Murdaugh, 2003).
Hello my name is Tosin Ola and this presentation will highlight the risk management issue of excessive absenteeism, focus on the methods to curtail absenteeism, steps already in place, the points system, and healthy living programs.
Absenteeism is the term generally used to refer to unscheduled employee absences from the workplace (U.S. Legal, 2008., p. 1). According to the U.S. Department of Labor, companies lose approximately 2.8 million workdays a year because of employee injuries and illnesses (Gale, 2003, p. 40). Of all the expenses related to absence, unscheduled time off has the biggest impact on productivity, profitability and morale (Gale, p. 40).
The inability to plan for such absences forces hospitals to hire last-minute temporary staff (travelers and per diem nurses) at higher rates, pay more overtime to permanent staff, or add a staffing margin to replace anticipated lost labor by utilizing in-house per diem employees (L. Meyer, personal communication, December 8, 2009). All these tactics negatively affect the bottom line of the hospital in every fiscal period.
A presentation made about Sickle cell disease by Yara Mostafa, Yasser Osama, Yaser Mostafa ,Ain shams university, Medicine faculty, first year students.
The SlideShare 101 is a quick start guide if you want to walk through the main features that the platform offers. This will keep getting updated as new features are launched.
The SlideShare 101 replaces the earlier "SlideShare Quick Tour".
Senior Healthcare Consultant (Geriatric) class at Piedmont Hospitalsnomadicnurse
The first of a 2-day class on Geriatric issues for nursing staff at all 4 Piedmont hospitals funded by a HRSA Comprehensive Geriatric Education Grant 2009-2012.
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The Vulnerability of Pain
and the Pain of
Vulnerability
•esent
most
For the person in pain, so incontestably and unnegotiably pres
is it that "having pain" may come to be thought of as the
vibrant example of what it is to "have certainty," while for the
other person it is so elusive that "hearing about pain" may exist
as the primary model of what it is "to have doubt." Thus pain
comes unsharably into our midst as at once that which cannot be
denied and that which cannot be confirmed.
—ELAINE SCARRY
(1985, 4)
. . . I am bound
Upon a wheel of fire that mine own tears
Do scald like molten lead.
—WILUAM SHAKESPEARE
King Lear (IV.vii.46-48)
Chronic pain is a major public health concern in North American
society (Osterweis et al. 1987). Whether in the form of disabling
chronic lower back pain or severe migraine headaches or in the
somewhatless common types affecting neck/ face, chest/ abdomen,
arms and legs/ or the whole body, chronic pain syndromes are an
increasingly common source of disability in our time (Stone 1984).
Paradoxically, the medical profession is dangerous for chronic pain
patients. Medical care fosters addiction to narcotic analgesic drugs/
polypharmacy (the use of multiple drugs) with medications that
.^he Vulnerability- of Pain and the Pain of Vulnerability 57
exert serious side effects, overuse of expensive and risky tests, un-
^necessary surgery that can produce serious damage/ and obstacles to
[leaving the disabled role. The disability system contributes as well
:by its active disincentives for the patient to undertake rehabilitation
land to return to work. Both systems create anger and frustration for
patients and families (Katon et al. 1982; Turner and Chapman 1982).
If there is a single experience shared by virtually all chronic pain
patients it is that at some point those around them—chiefly practi-
'tioners, but also at times family members—come to question the
authenticity of the patient's experience of pain. This response con-
tributes powerfully to patients dissatisfaction with the professional
treatment system and to their search for alternatives. Chronic pain
discloses that the training and methods of health professionals ap-
pear to prevent them from effectively caring for the chronically ffl.
Redprocally, chronic pain patients are the bete noire of many health
professionals, who come to find them excessively demanding, hos-
tile, and undermining of care. A duet of escalating antagonism en-
sues, much to the detriment of the protagonists.
Chronic pain involves one of the most common processes in the
human experience of illness worldwide, a process I will refer to by
the inelegant but revealing name somaHzafion. Somatization is the
commuiucation of personal and interpersonal problems m a physi-
cal idiom of distress and a pattern of behavior that emphasizes the
seeking of medical help. Somatization is a sociophysiological con-
ti.
BBN - Breaking Bad News is difficult task for Junior doctors in India as it was not in the Curriculum unlike Western countries. So this slide will give you the Facts / Methods with Description of one method & Key points.
This is the handout for a 60 minute workshop with roleplay for the KUMC Palliative Medicine Fellowship lecture series. There is no accompanying slideset as this was a small group workshop.
Please contact with questions and see this disclaimer. This is not medical advice.
Similar to Overcoming Stigma in Sickle Cell Disease (20)
The term cultural competence consists of two words, culture and competence (Jirwe, Gerrish, & Emami, 2006). Culture is defined as the learned, shared and transmitted values, beliefs, norms and life practices of a particular group of people (Leininger & McFarland, 2002). Peoples' culture can be understood through their actions, that is, their behavioral patterns and through understanding why people act in the way they do; their functional patterns (Leininger & McFarland).
Culture can also be understood through an interpretation of one's world, through one's cognitive processes, or through a person's understanding of their world, which is linked to their symbolic interactions (Jirwe, Gerrish, & Emami, 2006). “Since cultural background greatly affects several aspects of people's lives, i.e. their beliefs, language, religion, family structure and body image, this must be considered when caring for people from other cultures” (Jirwe, Gerrish, & Emami, p. 12).
Cultural competence is a way of practicing one’s profession by being sensitive to the differences in cultures of one’s constituents and acting in a way that is respectful of the client’s values and traditions while performing those activities or procedures necessary for the client’s well-being (DeChesnay, 2008). It takes into account the cultural differences between the nurse and the patient, while meeting the needs of the patient.
We have chosen to deliberate on the Amish culture because due to their beliefs, lifestyle and isolation from the modern world, much mystery surrounds their culture and many nurses are unable to relate to their culture, understand it, or practice culturally competent care (Jirwe, Gerrish, & Emami, 2006, ).
Amish families have purposely separated themselves from the advancing modern society that surrounds them and refuse to depend on outside help in order to survive (Baker, 2007). This seems such a rebellious and alternative way of life that is hard for many people to understand (Baker).
The Centers for Disease Control and Prevention (CDC) defines bioterrorism as "the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants” (Centers for Disease Control and Prevention [CDC], 2007, p. 1).
This presentation will cover the initiation, process and roles of agencies in Multnomah County, Oregon and their relationships with international, national and state agencies. The role of the public health department in relation to bioterrorism will also be explored.
Injury is the leading cause of death among children and adults up to age 44 and is the leading cause of potential life lost before age 65 (Healthy States, 2007, p. 3). In 200, more than 120,000 Americans of all ages died from injuries from motor vehicle crashes, suicide, falls, poisoning, drug overdoses, drowning, fires and other causes (Centers for Disease Control and Prevention [CDC], 2006) while more than 20,000 persons in the United States die from drug overdose.
Because of its impact on the health of all Americans--young and old--preventing injury is a serious public health challenge. As recent tragedies shine the spotlight on accidental drug overdoses, it’s becoming increasingly clear that prescription drugs are playing an increasing role in accidental deaths (Kelley, 2009, p. 24).
Healthy Communities: Multnomah county is one of the 36 counties in the state of Oregon, located with Portland as its county seat. Portland is the second largest city in Oregon and the most populous metropolitan area in the state (U.S. Census Bureau [USCB], 2008, p. 1). As of 2007, Multnomah County's population is 681,454 people (Sperling, 2008). For the purpose of this study, the community focus will be primarily on the sector of Multnomah County in the 97212 area code, which will be called the Rose Sector.
Implementing an electronic charting system in a healthcare facility, barriers to change, and organizational plan for change. speaker notes are indepth.
Today we will be discussing legal considerations dealing with professional boundaries and sexual misconduct in the workplace. We will examine in depth what sexual misconduct is, and how to prevent this from happening in our nursing practice. This presentation will also review the nurse practice act and its view on sexual misconduct. If you have any questions, please don’t hesitate to ask.
Delegation in healthcare and nursing. Delegating a task does not mean that you have absolved yourself of the responsibility of that task. You are still the principal person in charge of the task and how well the job is done ultimately rests on you. This is why a delegation model is essential in the workplace.
This presentation will identify the key phases of a delegation model, and use that model in a case study based in the healthcare setting.
Today’s presentation focuses on Jean Watson's Theory of Human Caring. During this presentation we will analyze the theoretical framework, review the critical components of the Theory of Caring, and discuss how the theory is utilized in nursing practice. This presentation will also detail application of Watson’s Theory of Caring into the peri-operative environment by instituting a “sacred space” and explain the process of implementing the sacred space. Enjoy!
Healthcare in the United States has become very fragmented, expensive and disjointed. Over the course of a hospitalization, a patient may be transferred from one unit to another, sometimes spending as much as 5 different units in a 3 day stay. This has led to many hand-off reports, and increased the potential for mistakes, improper communication, and patient deaths.
Partnership in this context is defined as a relationship between individuals or groups that is characterized by mutual cooperation and responsibility, as for the achievement of a specified goal (The American Heritage Dictionary, 2006). Partnership ensures that each member is equal and brings something important to the table. The Partnership Care Delivery Model (PCDM) ensures that the patient is an integral part of the healthcare team, and their experiences, contributions, advice, and influence is needed and valued.
Self assessment presentation that crafts ones strengths and weaknesses into a perfect position. Hello everyone. I would like to take this opportunity to determine the perfect position for me within the new organization post-expansion. In creating the ideal leadership position, I will identify my leadership style, the strengths, weaknesses and capabilities; as well as contrast different leadership theories and how they apply to my personal style.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
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.
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.
NVBDCP.pptx Nation vector borne disease control program
Overcoming Stigma in Sickle Cell Disease
1. Overcoming Stigma in Sickle Cell Disease Presented by: Tosin Ola-Weissmann, BSN, RN
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Editor's Notes
Hello everyone, My name is Tosin Ola-Weissmann, and I’m a registered nurse practicing at Oregon Health Sciences University. A little of my background in sickle cell: For starters, I have sickle cell. In 1999 I moved to the US to attend nursing school, and have been practicing as a nurse very since graduation from Oakwood University in 2001. In 2005, I had a really bad sickle cell crises, which left me in the hospital for over 2 weeks. When I got home, I was so overwhelmed with having sickle cell, and I searched online for someone else who…blah blah blah So I started my own blog. This eventually developed into the Sickle Cell Warriors website and Facebook community, which serves as an online support group for over 2300 members. I was featured in an issue of Minority Nursing (Where Darling found me). Having interaction with over 2300 members on a daily basis has given me more insight into sickle cell than I could ever have possibly imagined. I have learned so much from the group, but the one recurring theme that seems to be a sore spot for everyone is the way sickle cell warriors are treated in the hospital setting. That will be the focus of our discussion today.
Lifespan: People with severe SCD are now living into adulthood but can experience a life expectancy that is 30 years shorter than those without disease. (CDC) I know most of you probably know the basics of what sickle cell disease is, so I’m going to talk about some stuff that you might not know. First discovered blood disorder Nwiiwii (Faute), Nuidudui (Ewe), Ogbanjes (Ibo) Dr Herrick (attending), Dr Irons (did the work). Walter C. Noel from Grenada, Dental student Trait, S, C, E, S-beta thallasemia According to U.S. News & World Report, some 120,000 infants are born with SCD every year worldwide and 90% of the people with sickle cell worldwide are born outside of the USA. Estimates purport that in the United States, there are over 80,000 people with the disease, and 2 million people are carriers of sickle cell trait. Nigeria is the most populous country in Africa and also has the highest incidence of sickle cell. There are over 4 million people with sickle cell disease in Nigeria and due to the fact that 3 out of every 10 children are born with sickle cell trait, this number is growing astronomically. In India, it is estimated that 20% of the population have sickle cell trait and over 20 million people have the disease (it is just being discovered over there). These numbers mean that it is possible that the number of people with sickle cell disease will grow instead of decline in the next few decades unless proper education is disseminated to the general public to stop the proliferation of sickle cell. Throw in globalization, and the fact that University of Oregon is such an awesome school, this means that in your clinical or educational career, you will come across several sickle cell patients.
By now you’ve heard of several athletes with sickle cell trait or disease going into respiratory or cardiac arrests after excessive sports. It is such a huge problem that the National College Athletic Association (NCAA) has started screening on all athletes to test for the trait. The reason behind this is that with rigorous physical activity, the body requires a higher metabolic and oxygen demand. Since sickle cells do not cooperate with that scenario in any way, the rest of the body has to overcompensate to make up for those queens. As a result, the lungs pump out more oxygen, the blood pressure and heart rate increases, and your body is in overdrive trying to keep up with the demand. When you run in overdrive for a long time, eventually, the heart and lungs can’t keep up and basically crap out on you. This is what has led to all those deaths. To avoid this trigger, sickle cell patients need to really pace themselves when exercising. Pain is your body reminding you to slow down and take a break. Listen to the warning, take a break, catch your breath and drink some water.
A person with chronic pain might not have the same posturing that you expect with a 10/10 pain. Remember, we have been having this pain since childhood…for me, that is 3 decades of chronic pain. With my 10/10 pain, I can’t do anything, I don’t even want to talk, I just want to cry, curl into a fetal position and pray for a quick, merciful death. However, a friend of mine at a 10, watches TV to distract herself and keep her mind off the pain. At a 9 she can even talk on the phone. And when my parents or family call me on the phone, at a 9/10, I talk and act as ‘normal’ as possible because I don’t want them to be worried. How one deals with pain is should not be the yardstick for the pain scale or your decision to administer or with-hold meds. Under-treatment of pain can lead to pseudo-addiction and seriously undermine a patient's quality of life. Patients report that in the ED, low doses of pain meds are often given leading to lack of pain relief. A recent study showed that there was a 70-120 minute delay in the ED from admission to administration of analgesic to patients with SC. This could be due to high workload, difficulty establishing IV, or low prioritization of SCD patients. Pseudo-addictive behaviors include: Fear of being in severe pain Clock watching Calling ahead of time Ranking pain higher
A common thread among the members in my SC community is that they are afraid of getting addicted to narcotics. Many use their pain meds sparingly, to the point that they remain ‘in pain’ even when they have enough medication to completely knock out their pain. In addition, there are so many side effects that come with using narcotics, and many sickle cell patients want to enjoy life, and not let it pass them by in a groggy haze
I detest going to the emergency room or getting admitted to the hospital for my disease. I will manage it at home as much as I can, but if I need to go to the hospital, it is because the pain is uncontrollable, and nothing in my arsenal works. I do go to my doctor’s visits, and have a healthy grasp of my disease process, but I still have to go to the emergency room when in an acute pain crises. Most of the time, even if I go to my doctor’s office, it is just a waste of time, because he will tell me to go to the ER. So coming to the ER because one has a chronic condition is not a misuse of the medical facility. If a diabetic came in with a blood sugar of 45 or 545, would he be misusing the ER? After all, he understands his disease process and diabetes is a chronic condition, is it not? In my esteem, SCD patient coming to the ER with an acute flare-up of a chronic condition should get the same compassionate care as a diabetic coming to the ER with an out of wack blood sugar.
Anemia: Sickle cells only live for about 10 to 20 days, while normal hemoglobin can live up to 120 days (Strickland et al., 2001, p. 37). Due to the decreased number of hemoglobin cells circulating in the body, a person with sickle cell disease is chronically anemic (Strickland et al., p. 37). Anemia can be evidenced by coldness in hands/feet, fatigue, pallor, headache, chest pain, dizziness, syncope & SOB (NHLBI) Infections: Because of its narrow vessels and function in clearing defective red blood cells, the spleen of SCD patients is damaged early on leading to a decreased ability in filtering out infections (OHSU). SCD patients are susceptible to multiple bacterial infections including salmonella and pneumococcal sepsis which can easily become life-threatening (Tanabe & Myers, 2006). Assess the patient for cold and flu symptoms, diarrhea, elevated temperature or sore throat (American Academy of Pediatrics [AAP], 2002, p. 429). Pain: This is the most common complaint of sickle cell patients (OHSU). A vaso-occlusive crisis is caused by sickle-shaped red blood cells that obstruct capillaries and restrict blood flow to an organ, resulting in ischemia, pain, and organ damage (NHLBI, 2007). However, a thorough physical assessment should be done to check for other problems (Tanabe & Myers, 2006). Jaundice: Sickle cells do not live as long as normal red blood cells and, therefore they are dying more rapidly than the liver can filter them out (OHSU). Bilirubin (which causes the yellow color) from these broken down cells builds up in the system causing jaundice (OHSU). Respiratory distress: Due to their shape, sickled cells are unable to carry oxygen (OHSU). A high incidence of sickled cells leads to decreased oxygenation throughout the body (Tanabe & Myers, 2006) which triggers shortness of breath. In addition, pain in the body can cause the patient to start taking shallow breaths (AAP, p. 430).
Any and all major organs are affected by sickle cell disease (OHSU, 2008). SCD patients usually die from the complications, and not the disease itself (NHLBI, 2007). Splenic sequestration is a result of sickle cells pooling in the spleen (OHSU). The spleen can become enlarged and painful from the increase in blood volume and this can be life-threatening. Stroke can result from a progressive vascular narrowing of blood vessels, preventing oxygen from reaching the brain (OHSU). Cerebral infarction occurs in children, and cerebral hemorrhage in adults (NHLBI). Gallstones may result from excessive bilirubin production and precipitation due to prolonged hemolysis (Strickland et al., 2001, p. 40). Avascular necrosis of the hip may occur as a result of ischemia leading to severe pain when walking (OHSU). This ischemia can also lead to leg ulcers and improper wound healing. Priapism is caused by blood trapped in the penis due to infarction of the vessels (NHLBI). Untreated, recurrent priapism may lead to impotence (Strickland, et al). Renal failure is due to acute papillary necrosis in the kidneys, manifests itself with hypertension, proteinuria and worsened anemia (NHLBI). If it progresses to end-stage renal failure it carries a poor prognosis (OHSU). Acute chest syndrome is a life-threatening condition similar to pneumonia caused by an infection or sickle cells trapped in the lungs (NHLBI). Symptoms can include fever, pain, and a violent cough (NHLBI). Multiple episodes of acute chest syndrome can cause permanent lung damage (OHSU). Pulmonary hypertension: Damage to the small blood vessels in the lungs makes it hard for the heart to pump blood through the lungs which leads to increased pulmonary arterial pressure (NHLBI). Shortness of breath and problems with breathing are the main symptoms of PAH and can be fatal. Retinal damage: Sickle cells also can clog the small blood vessels in the eyes leading to damage of the retina which can cause blindness if untreated (NHLBI). Opioid tolerance or opiate-induced hyperalgesia can occur as a normal, physiologic response to the therapeutic use of opiates (Weissmann & Haddox, 1999). Pseudo-addiction is defined as an iatrogenic syndrome caused by the wrong treatment of pain with the inadequate prescription of analgesics to meet the primary pain stimulus (Lusher, Elander, Bevan, Telfer, & Burton, 2006, p. 316). Research suggests that drug addiction is no greater among people with sickle cell disease than it is in the general population (AAP, 2002, p. 530).
The medical management of sickle cell is an aspect that many sickle cell warriors are familiar with. Hospital routines and management become as natural to us as breathing, and by the time we hit our 20s, we already know the system. Unfortunately, with this knowledge comes a layer of cynicism and lack of trust with the hospital system. Some medical professionals, have no clue of the complexities with sickle cell disease. Many think that it’s just about pain management, but there is more to managing sickle cell than pain. The pain is a symptom of the disease, but unfortunately, this symptom is so agonizingly painful that it often gets the front seat.
In conclusion, Sickle cell is one of the least understood blood diseases in the world. It affects many people, and only through education and increased awareness can this disease be eradicated. Collaboration with sickle cell warriors and the healthcare team is important to ensure quality care. Sickle cell patients are by far the strongest people I have ever met and once you get to know them, I’m sure you will see that too. Thank you. Any questions?