Dr Rustam Rea, Associate Clinical Director and Consultant in Diabetes, Derby Hospitals NHS Foundation Trust, talks about First Diabetes - an integrated diabetes service, delivering care in one place, closer to patients’ homes.
The health care professionals in the team are drawn from both the hospital and the community and include consultants, GPs, specialist nurses, health care assistants and dieticians. The team are able to communicate easily among themselves through a shared electronic patient record and work closely with the practices who are part of the First Diabetes service. As well as providing individual appointments for patients, team members also provide group education along the whole patient pathway, from prevention of diabetes to complex insulin regimes. They also go out to practices to see patients and provide professional training and advice.
CarDon's & Associates CIO shares his best-in-class strategies to consistently deliver high-quality care and reduce readmission rates without increasing cost.
Key takeaways include:
- Leverage real-time data to proactively and effectively staff employees.
- Reduce patient readmission rates through understanding behavior patterns and trends.
- Expertly manage the flow and care of patients to enhance the patient experience and improve outcomes.
CarDon's & Associates CIO shares his best-in-class strategies to consistently deliver high-quality care and reduce readmission rates without increasing cost.
Key takeaways include:
- Leverage real-time data to proactively and effectively staff employees.
- Reduce patient readmission rates through understanding behavior patterns and trends.
- Expertly manage the flow and care of patients to enhance the patient experience and improve outcomes.
CAHPO 2016. Workshop 4: Trudi Dunn and Nina FinlayNHS England
Chief Allied Health Professions Officer’s Conference 2016
Workshop 4: Supporting self-care and behaviour change – Chair Linda Hindle
Health Coaching. Trudi Dunn and Nina Finlay, Health Coaching Trainers/ Clinical Specialist Physiotherapists, West Suffolk NHS Foundation Trust
Comprehensive pharmacy services | Point of caredanielbrain10
Learn about our comprehensive pharmacy solutions at the point of care that allow physicians to improve clinical outcomes and increase patient satisfaction.
Are you still searching which among the possible drug and alcohol abuse treatment programs will be ideal for your loved ones addiction problem? People suffering from drug or alcohol addiction have at least two options to consider, the inpatient or outpatient treatment. Let me give you a quick tour on both treatment programs, including other issues like who can be a suitable candidate for inpatient or outpatient and what is the best option.
Tailoring programs and services to methamphetamine (Nov 15)Uniting ReGen
Presentation by Laurence Alvis & Rose McCrohan on ReGen's work developing a range of treatment responses to people seeking treatment for methamphetamine dependence.
Health Care Reform: Connecting the Present to the FutureDoeren Mayhew
Is grappling with health care reform making you want to lie down on a gurney? At CPA and advisory firm Doeren Mayhew's 2014 client conference, USI Executive Vice President Mike Turpin provided an insider’s view on the dark arts, hidden secrets and possible direction of health care today. CEOs and CFOs learned ways to impact cost, practices and dysfunctions that cause plans to be more expensive than they need to be, and ways to hold vendors and your own teams more accountable for low, single-digit medical trends.
CAHPO 2016. Workshop 4: Trudi Dunn and Nina FinlayNHS England
Chief Allied Health Professions Officer’s Conference 2016
Workshop 4: Supporting self-care and behaviour change – Chair Linda Hindle
Health Coaching. Trudi Dunn and Nina Finlay, Health Coaching Trainers/ Clinical Specialist Physiotherapists, West Suffolk NHS Foundation Trust
Comprehensive pharmacy services | Point of caredanielbrain10
Learn about our comprehensive pharmacy solutions at the point of care that allow physicians to improve clinical outcomes and increase patient satisfaction.
Are you still searching which among the possible drug and alcohol abuse treatment programs will be ideal for your loved ones addiction problem? People suffering from drug or alcohol addiction have at least two options to consider, the inpatient or outpatient treatment. Let me give you a quick tour on both treatment programs, including other issues like who can be a suitable candidate for inpatient or outpatient and what is the best option.
Tailoring programs and services to methamphetamine (Nov 15)Uniting ReGen
Presentation by Laurence Alvis & Rose McCrohan on ReGen's work developing a range of treatment responses to people seeking treatment for methamphetamine dependence.
Health Care Reform: Connecting the Present to the FutureDoeren Mayhew
Is grappling with health care reform making you want to lie down on a gurney? At CPA and advisory firm Doeren Mayhew's 2014 client conference, USI Executive Vice President Mike Turpin provided an insider’s view on the dark arts, hidden secrets and possible direction of health care today. CEOs and CFOs learned ways to impact cost, practices and dysfunctions that cause plans to be more expensive than they need to be, and ways to hold vendors and your own teams more accountable for low, single-digit medical trends.
Bob Hudson: Public health lessons from home: The view from WalesThe King's Fund
Bob Hudson, Chief Executive of Public Health Wales, gives an overview of the Welsh public health system and how it fits within wider changes to the NHS in Wales.
Beverly Alimo-Metcalfe, Chief Executive, Real World Group, discusses the relationship between governance and leadership at The King's Fund's Leadership Summit 2012.
Chris Ham: capitated budgets - a flexible way to enable new models of careThe King's Fund
Chris Ham, Chief Executive at The King’s Fund, looks at how high performing integrated systems are using capitated budgets and shares examples of eight PCTs who are commissioning integrated care in an innovative way.
Clive Bowman: The future for residential care provisionThe King's Fund
Clive Bowman, Medical Director, Bupa Care Homes, gives a history of care homes in England and looks at the challenges facing residential care provision in the future.
Eventos Demo for SemTechBiz 2013 (San Francisco)AI4BD GmbH
Eventos allows to cluster, categories in real time web information (articles). Individuals can train the system and start to collect articles by topics. Those are automatically aggregated to events, super-topics and also show a history of a story evolution.
Katrina Percy: Working with partners to deliver high quality health and socia...The King's Fund
Katrina Percy, Chief Executive of Southern Health NHS Foundation Trust, talks about the health system in Hampshire and the key elements of Southern Health’s integrated care strategy.
Andre Tylee and Alan Cohen: Incorporating psychological therapies in the trea...The King's Fund
Dr Alan Cohen, Director of Primary Care at West London Mental Health Trust, and Professor Andre Tylee, Professor of Primary Care Mental Health at King’s College London, explain how the IAPT (Improving Access to Psychological Therapies) programme has been helping treat chronic conditions.
Sandie Keene: Whole systems approach to assessing the current and future need...The King's Fund
Sandie Keene, Director of Leeds Adult Social Services, gives an insight into the demography of Leeds and shares her experiences of establishing a Joint Strategic Needs Assessment (JSNA) for the needs of the local population.
Dick Sorabji: Providing the evidence base for integrated careThe King's Fund
Dick Sorabji, Corporate Director of Policy and Public Affairs, London Councils, shares examples of integrated care initiatives in London and looks at the future barriers to achieving integration.
Introduction of the NZ Health IT Plan enables better gout management - Reflections of an early adopter. Presented by Peter Gow, Counties Manukau DHB, at HINZ 2014, 12 November 2014, 11.37am, Plenary Room
National Diabetes Inpatient Audit (NaDIA) 2015Laura Fargher
A easy read summary report about the quality of diabetes care in hospitals in England and Wales. Based on findings from the National Diabetes Inpatient Audit (2015).
Role of pharmacist in managing diabetes mellitusSomnath Das
As a healthcare professional like a pharmacist we can deliver a very good quality of healthcare services to the common people. Here I have spoke to you about the possibilities of a pharmacist in controlling a chronic disease like diabetes mellitus. I have clearly mentioned the process of controlling such disease through simple slides. I hope all of you will get some help from it. Thank you.
Preventing type 2 diabetes in england, pop up uni, 2pm, 2 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
The learning outcome for this activity: Participants will have increased knowledge of using the Age-Friendly 4Ms Framework while caring for an older adult patient with Diabetes Mellitus in a convenient care setting.
Understanding NHS financial pressures: visual resourcesThe King's Fund
This slideset contains key visual elements from our report, Understanding NHS financial pressures: how are they affecting patient care? Please feel free to share and re-use these graphics with credit to The King's Fund.
Nine characteristics of good-quality care in district nursing taken from interviews with patients, carers and staff.
We hope this framework and these slides will be a useful resource for you – please feel free to use them in your work, in documents and presentations.
As part of a joint learning network on integrated housing, care and health, The King's Fund and the National Housing Federation have produced a set of slides illustrating the connections between housing, social care, health and wellbeing.
We hope they will be a useful resource for you – please feel free to use them in your office, in documents or presentations.
District councils’ contribution to public healthThe King's Fund
Our health is primarily determined by factors beyond just
health care. These slides illustrate the ways in which district
councils influence the health of local people through their key
functions and in their wider role supporting communities and
influencing other bodies.
The King’s Fund Events organise more than 20 health and social care events each year. Our highly-regarded conferences attract leading speakers from the government, the NHS, local authorities and the independent and voluntary sectors.
Jos de Blok set up Buurtzorg – which means ‘neighbourhood care’ in Dutch – with a team of four nurses. Today there are nearly 8,000 Buurtzorg nurses in 630 independent teams, caring for 60,000 patients a year. Nurses in Sweden, Norway, Japan and the United States are adopting the Buurtzorg model.
Our infographics highlight some key facts and figures around leadership vacancies in the NHS and some of the difficulties NHS organisations face in recruiting and retaining people for executive positions.
Sharing leadership with patients and users: a roundtable discussionThe King's Fund
‘What more is possible when patients, service users and those delivering services share the leadership task in health and social care?’
We held a roundtable discussion with patient leaders and organisational leads to discuss this question. Our slidepack summaries the conversations, including the opportunities and challenges for patient leaders, and where and how to start shared leadership working.
Making the case for public health interventionsThe King's Fund
In partnership with the Local Government Association, we have produced a set of infographics that describe key facts about the public health system and the return on investment for some public health interventions.
We hope they will be a useful resource for you – please feel free to use them in your office, in documents or presentations.
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Rustam Rea: integrating diabetes care in Derbyshire
1. Integrating diabetes care in Derbyshire
Dr Rustam Rea
Consultant Diabetologist, Royal Derby Hospital
Co-Chair First Diabetes
www.firstdiabetes.co.uk
2. Person centered integration
BOB
AGE 60
Practice Nurse for
regular check-ups
GP for regular BP and
medication checks
Foot calluses
Podiatry Clinic at Village
St Health Centre
Referred by GP
for New patient
education
classes
DAY course at Coleman St
Health Centre delivered by
Nurse Consultant, Dietician and
Podiatrist
Referred by GP for
retinopathy screen
Retinopathy screening at
the London Road
Community Hospital
Referred by GP
for Podiatry
Bob has obesity
issues
Referred by GP to
dietician
Dietician
appointments at
the Walk-in
Centre
Bob confesses he
has erectile
dysfunction
Referred by GP to
Erectile Dysfunction
Clinic
Diabetic Specialist
Nurse at the erectile
dysfunction clinic at
RDH
Podiatrist at
Village St finds
foot neuropathy
Podiatrist refers to
Diabetic foot clinic
Diabetic Foot Clinic seen
by Diabetic Specialist
Nurse, Podiatrist, and
Consultant at RDH
Nurse Specialist at the
Osmaston Surgery has
recommended exenatide
Referred by GP to
RDH
Consultant Diabetologist
initiates exenatide
GP
eventually
thinks Bob
requires
insulin
Referred
by GP to
LES2
insulin
initiation
service
Nurse Specialist at the
Osmaston Surgery decides
exenatide is a better option
so refers patient back to GP
for referral to Consultant
Foot neuropathy
discovered
3.
4. Integration across a community
„Bringing together clinicians across the
system with legal and financial autonomy to
be responsible for the health outcomes of the
community‟
5.
6. Whole system integration
1 care 2 careIntermediate care
Specialist podiatrists
Diabetes service
Specialist dietitians
Specialist doctorsSpecialist DSNs
Practice nurses
GPs
7. First Diabetes – a very new model
Partnership
Shares held 50% by GPs
and 50% by acute trust
Single budget, not-for-profit
Comprehensive
Outcome focused, not
process driven
A network including primary
care, community and
hospital staff
No one directly employed –
staff either seconded or
sessional
Facilities rented
8. Pillars of integration in First Diabetes
IT
Financial
Patient participation
Clinical engagement
Clinical governance
9. SystmOne - the IT solution
Single real-time clinical record
Rapid access to decision making and referrals
Consent and confidentiality
Rolled out into tertiary hospital clinics
Patient access
10. Programme budgeting – the
financial solution
Single budget for diabetes, jointly owned by GPs and
hospital
Set by PCT based on previous years spend, scope of
specification and efficiency savings
Not-for-profit organisation
Re-invest surplus back into the service
11. Care planning – the patient
engagement solution
Care planning philosophy
Patients informed and educated before clinic appointment
Patient shadow clinical board
Diabetes prevention workshops
Education throughout the patient journey
12. Clinical engagement
Keeping colleagues engaged – primary care and hospital
New style of leadership – collaborative, shared
responsibility, acknowledging historical differences
MSc diabetes module for upskilling primary care
Practice visits, discussing difficult patients – 4 groups
Reporting outcomes and comparing practices
13. Clinical governance
Underpinned by a legal partnership
– Company limited by shares
– Equally owned by hospital and GPs
– Provides stability and confidence in long term future
Move from silo working to joint ownership
– Board of directors
– Clinical management board
– Wider team working – in hospital, in general practice
14. Cost of integration
50% lower DNA rate compared to non-integrated service
Cost per patient
Year First Diabetes
£
National tariff
£
2009/10 109 112
2010/11 124 118
2011/12 121 122
15. Reduction in prescribing costs
£0.00
£500.00
£1,000.00
£1,500.00
£2,000.00
£2,500.00
£3,000.00
CostperPU
Total diabetes costs
First Diabetes Act Cost Per
standard pu
Derbyshire Act Cost Per
standard pu
National Act Cost Per
standard pu
£200M savings if
figures were
extrapolated nationally
16. Biochemical outcomes
Sustained QoF improvements for diabetes
Reduction in HbA1c (1-2%) and weight (5-10kg) in
patients starting new diabetes drugs
75% reduction in insulin doses and 1.25kg weight loss in
patients on complex insulin regimes
17. Admission with primary code of diabetes
0
20
40
60
80
100
120
140
160
180
2009/10 2010/11 2011/12 2012/13
County Practices
First Diabetes
18. Admission with a secondary
code of diabetes
0
500
1000
1500
2000
2500
2009/10 2010/11 2011/12 2012/13
County Practices
First Diabetes
21% reduction in admissions in First Diabetes
9% reduction in surrounding county practices
19. Patient and professional satisfaction
“The FD service from Stoneleigh House is excellent. They
give excellent care and advise to any patients I have sent
there and have always improved the diabetic measures of
control as well as helping the patient with understanding
their condition. The patient satisfaction is very high.
They have also helped with my own understanding of
diabetes as well as being a considerable support to our
nursing team”
20. Recognition
Winner of Quality in Care Awards 2012 for Best Cross
Boundary Working and Best Primary and Community
Initiative
Finalist in HSJ Awards 2012 in Managing Long Term
Conditions category
Finalist in HSJ / Nursing Times Care Integration Awards 2012
in Diabetes Care
Finalist in Health Enterprise East Innovations Awards 2012
21. Challenges ahead
Providing diabetes care for Southern Derbyshire
Integrating with other long-term conditions
Integrating with social services and mental health
Ongoing clinical engagement
22. Acknowledgements
Dr Garry Tan
Dr Kyran Farrell
Staff and patients at First Diabetes
GPs, hospital management
PCT / CCG
The prevalence of type 2 diabetes mellitus (T2DM) and its rate of rise has been a source of concern in the UK.There is also much evidence of gaps and challenges in the care of people with diabetes. Areas that stand out in particular include the lack of access to and uptake of structured education, the high level of variability of care in both primary and secondary care and feedback from people with diabetes that the care they receive appears fragmented. For people with type 1 diabetes mellitus (T1DM), the present evidence suggests high levels of poor glycaemic control and a low rate of care process achievement increases the likelihood of future complications that can be avoided with good care.The need for integrated care is present at every stage of the patient journey. It is particularly important for those individual whose needs are becoming more complex. This group of people includes the elderly and infirm, those with longer duration of diabetes and those with multiple morbidities and a plethora of medications. Integrated care is pivotal for this group as their care is provided by multiple groups of professionals, who may have conflicting priorities. This can result in fragmentation of care, poorer outcomes and complications as well as hospital admissions that may have been avoidable with better integrated care.Best practice for commissioning diabetes services - An integrated care framework was developed in response to the needs of new commissioners and of health professionals involved in diabetes care. The overarching goal of this framework is to provide practical guidance and key principles for these professional groups to better commission and provide integrated care for people with diabetes. It aims to ensure that people with diabetes have access to a joined up service from the time of diagnosis, through more complex management, complications, inpatient care to end-of-life care.