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Importance of Medical Audit
Don't let COVID - 19 impact your practice. Get Free Practice Analysis and be financially healthy. Call Now - 888-357-3226
Click Here For More Information: https://bit.ly/3kw4rka
Get a Free Quote: https://bit.ly/30DFr2z
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2 Faculty of Nursing Sciences, Université Laval, Québec, Canada.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
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After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
2. Background
• Primary healthcare
agency to provide
public health
services for
– over 4.5 million
people
– the State of
Queensland (1.8
million km2),
Australia
3. HTA Program Structure
QPACT
Health
Economics
Clinical
Knowledge
MNCQACT NQACT SQACT GCACT PaedACT
4. Submission of applications by clinicians (EOIs)
Prioritisation of applications according to pre-defined criteria
HTA Process
HTA team conducts due diligence on shortlisted submissions
QPACT makes evidence-based decision on the technologies
• Staged approach
– Stage I
Policy recommendation
• Evaluation
• Decision-making
– Stage II
Piloting Field evaluation if
uncertainty remains • Local data collection
• System-wide policy
Clinical audit data on:
Clinical
Trial data collection on:
Clinical
development
Organisational Patient-related
Economic Organisational
Economic
Policy decision on system-wide
diffusion of the technology
5. Process – stage I
Submission of applications by clinicians
(EOIs)
• Pre-implementation
– Evaluation through Prioritisation of applications according to pre-
defined criteria
due diligence
process HTA team conducts due diligence on
– Evidence-based shortlisted submissions
decision-making
QPACT makes evidence-based decision on
the technologies
Policy
recommendation
6. Process – stage II
• Post-implementation
QPACT makes evidence-based decision on the technologies
– Local data collection Policy recommendation
• Piloting
Piloting Field evaluation
• Field evaluation
– Policy decision on
system-wide Clinical audit Trial data
data collection
diffusion Clinical Clinical
Organisational Patient-related
Economic Organisational
Economic
Policy decision on
system-wide diffusion
of the technology
7. Outcomes
• Assisted health administrators in prioritising their
health technology agendas (QPACT)
– 72 EOIs for new technologies received for evaluation
– 23 were short-listed and went through due diligence process
– 15 were funded for piloting
– 3 undergoing field evaluation
– 2 were evaluated through full HTA
• Multiple rapid evidence scans for district committees
to assist decision making
• Gained trust and wide support from policy makers
and clinicians
• Increasingly used to support funding allocations
8. Conclusion
• Evidence-based policy decision making
requires a comprehensive approach
• HTA is a valuable process to assist
such policy development
9. Thank you!
Any questions?
HTA: secretariat_hta@health.qld.gov.au
Editor's Notes
Faced with rapidly escalating healthcare costs worldwide due to limited available resources and increased demands, health policy makers have increasingly relied on evidence-based policy-making for better resource allocation. QH is not exempted from the challenge. Here we report our experience using HTA in supporting policy decision-making in introducing new technologies.
Queensland Health is the primary healthcare agency which provides public health services for over 4.5 million people spaning an area of almost 2 million km 2 in the State of Queensland, Australia, more than 3 times the size of Spain (505,992 km 2 ). Prior to 2009, there was no systematic and consistent approach in introducing new technologies in QH. Faced with rapidly escalating costs for healthcare with new health technologies being a significant contributor, a new model to introduce innovative health technologies into public healthcare system through a HTA program was established in 2009.
The Queensland Policy and Advisory Committee for New Technology was established in 2009 to oversee the state-wide HTA program and provide advice to QLD government and Health Ministers. The committee is made up of clinicians from various disciplines, health administrators, and representatives from research division and national medical technology assessment agencies. In addition to QPACT, a number of sub-committees at health service district level were set up to monitor the uptake of technologies which are new to that district. The committees are supported by a multidisciplinary secretariat comprising personnel with key HTA skills listed here. During the assessment, a wide range of stakeholders are consulted including, but not limited to, capital Build, planning & Financing, clinical engineering and IT departments.
The HTA process has been informed by the experience of similar assessment agencies both nationally and internationally; The flow chart demonstrates the sequence of events during the process which I’ll introduce separately in the following slides; A 2-staged approach was used in the process with the first stage focusing on evaluation of evidence to support decision-making (green part), and the second stage being local primary data collection in order to inform system-wide policy development later on (red part).
The HTA process starts with technology funding applications in the form of EOIs, which will be short-listed according to a set of pre-defined inclusion criteria, eg meeting one of the government priorities of equitable access to services, improving patient flow, decreasing surgery waiting lists etc. Short-listed EOIs then proceed to full applications, on which the HTA team will conduct the evaluation through due diligence process adopting a rapid evidence assessment approach, covering areas including the burden of the disease and the clinical need, the clinical benefits, the economic evaluation, the feasibility of adoption, and the societal and ethical consideration of adopting the technology. During the due diligence process, relevant literature is critically assessed, a range of stakeholders are consulted to examine the feasibility issues of adopting the technology. Based on the due diligence, the committee makes evidence-based recommendations employing a deliberative decision-making approach, consistent with the five areas covered in the due diligence. Depending on the underlying evidence, the recommendations are generally classified into three categories: 1) do not fund, 2) fund for piloting if the evidence is generally positive; 3) fund for field evaluation if there is insufficient evidence on effectiveness, cost-effectiveness or feasibility issues for a promising technology. Positive recommendations will then be used to seek funding approval.
Upon final funding approval, the technology is generally implemented into 1 or 2 site(s) to start the local data collection phase, which will cover the clinical, organisational, economic and patient-relevant outcomes in the “real-world” to allow future policy decision-making through Piloting for a period of time. Field evaluation The results from local setting will be feedback to the committee, and if positive outcomes are generated through the program, policy decision on the system-wide diffusion and appropriate funding of the technology can be made.
Over the 2 years since the program has been running, it has assisted health administrators in prioritising health technology agendas both at the state and district levels, resulting in a more efficient use of the limited resources; State level (QPACT), 72 EOIs received, among them 15 funded for piloting and 3 undergoing filed evaluation. In addition, a wider impact of the HTA program has been realised including increased awareness of and confidence in the evaluation process from both clinicians and policy makers increasing use of HTA to support funding allocations, and greater collaboration from various stakeholders to fully understand the system impact of adopting new technologies.
In conclusion, evidence-based policy decision on the uptake of innovative health technologies requires a comprehensive approach. The HTA program continues to evolve in Queensland Health, however our experience indicates that it is a valuable process to assist such policy development.