1. Clinical decision making (CDM) involves intuitive and analytical thinking styles that can be influenced by biases, knowledge, context and other factors.
2. CDM involves assessing patient severity, developing differential diagnoses, and determining appropriate treatment. Diagnostic errors are common and affect patient safety.
3. Improving CDM requires training clinicians in critical thinking, addressing cognitive biases, providing feedback, and using strategies to enhance logical decision making. Understanding how various individual and contextual factors influence the decision making process is also important.
This document provides an overview of clinical decision making (CDM) and discusses several related topics:
- It outlines the five domains of emergency care that involve CDM: assessment and stabilization; monitoring; assessing illness severity; making a differential diagnosis; and determining treatment.
- CDM can be influenced by many factors including knowledge, biases, context, and non-technical skills. Both intuitive and analytical thinking styles impact CDM.
- Improving CDM involves training to enhance critical thinking skills and address common cognitive errors and biases. Receiving timely feedback is also important to make better clinical judgments.
The document provides 3 case studies on different types of shock: hypovolemic shock from blood loss after surgery, cardiogenic shock following a heart attack, and septic shock from an untreated urinary tract infection. Each case study outlines the patient's presentation, relevant medical history, assessments, diagnostic findings, and shock management including fluid resuscitation and vasoactive medications. The goal is for students to apply their knowledge of shock pathophysiology and management using a case study approach.
Experts decision making schemes 2018 tababa ytb 2 ss1Imad Hassan
This document discusses expert clinical decision making and the use of diagnostic schemes. It begins by outlining the steps experts take: 1) gathering comprehensive information, 2) summarizing the case concisely using technical language, 3) proposing a diagnosis using pattern recognition and other schemes, 4) considering differential diagnoses, 5) rationally ordering tests using pre-test probability and test characteristics, 6) ordering therapeutic interventions, and 7) preparing for discharge. It then discusses specific schemes and heuristics experts employ at each step, such as the BESD scheme for diagnosis labeling and use of sensitivity, specificity, and likelihood ratios to guide test selection.
Structured Approach to Critically Ill and Injured Patientmetriccertain
CERTAIN (Checklist for Early Recognition and Treatment of Acute Illness and iNjury) is designed and developed to standardize the approach to the evaluation and treatment of acutely decompensating patients. The design and content was informed by the survey of clinicians from diverse international settings. Available in electronic (laptop/mobile) and paper formats, CERTAIN provides evidence based diagnostic checklists, clinical decision support, educational modules on performing critical procedures, and has the ability to time and document real-time interventions. CERTAIN prompting has been shown to improve performance of clinical providers faced with simulated emergencies.
Challenging clinical trials: Why doesn't early goal-directed therapy work? De...scanFOAM
A talk by Derek Angus at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
Based on the information provided, this item is testing the learner's ability to make a clinical decision by diagnosing the most likely cause of the patient's presentation based on the key laboratory findings provided in the stem. The stem provides sufficient relevant information to answer the question without being tricked or misled. The alternatives provided are plausible and independent diagnoses to consider. This item follows best practices for writing multiple choice questions that test clinical decision making abilities.
Back to the Bedside: Internal Medicine Bedside Ultrasound ProgramAllina Health
David Tierney, MD. How bedside ultrasound is changing the practice of medicine and how Abbott Northwestern Hospital has become a national leader in integrating bedside ultrasound in its Internal Medicine Residency Program. "As internal medicine physicians, we are finding that everything we do with our hands, eyes and stethoscopes can be done a little better with ultrasound. That means our physical exam, which we consider our bread and butter, has more sensitivity and specificity. This gives us better diagnostic ability and results in earlier and more appropriate treatment."
This document discusses multiple sclerosis (MS), including its epidemiology, etiology, pathophysiology, clinical course, diagnosis, prognosis, and treatment. MS is a chronic inflammatory demyelinating disease of the central nervous system that affects young adults and has a relapsing-remitting course. It has autoimmune origins and causes focal lesions in the brain, spinal cord and optic nerves. Physical therapy for MS aims to manage symptoms like sensory issues, pain, weakness, balance problems and fatigue through exercises, education and addressing psychosocial needs.
This document provides an overview of clinical decision making (CDM) and discusses several related topics:
- It outlines the five domains of emergency care that involve CDM: assessment and stabilization; monitoring; assessing illness severity; making a differential diagnosis; and determining treatment.
- CDM can be influenced by many factors including knowledge, biases, context, and non-technical skills. Both intuitive and analytical thinking styles impact CDM.
- Improving CDM involves training to enhance critical thinking skills and address common cognitive errors and biases. Receiving timely feedback is also important to make better clinical judgments.
The document provides 3 case studies on different types of shock: hypovolemic shock from blood loss after surgery, cardiogenic shock following a heart attack, and septic shock from an untreated urinary tract infection. Each case study outlines the patient's presentation, relevant medical history, assessments, diagnostic findings, and shock management including fluid resuscitation and vasoactive medications. The goal is for students to apply their knowledge of shock pathophysiology and management using a case study approach.
Experts decision making schemes 2018 tababa ytb 2 ss1Imad Hassan
This document discusses expert clinical decision making and the use of diagnostic schemes. It begins by outlining the steps experts take: 1) gathering comprehensive information, 2) summarizing the case concisely using technical language, 3) proposing a diagnosis using pattern recognition and other schemes, 4) considering differential diagnoses, 5) rationally ordering tests using pre-test probability and test characteristics, 6) ordering therapeutic interventions, and 7) preparing for discharge. It then discusses specific schemes and heuristics experts employ at each step, such as the BESD scheme for diagnosis labeling and use of sensitivity, specificity, and likelihood ratios to guide test selection.
Structured Approach to Critically Ill and Injured Patientmetriccertain
CERTAIN (Checklist for Early Recognition and Treatment of Acute Illness and iNjury) is designed and developed to standardize the approach to the evaluation and treatment of acutely decompensating patients. The design and content was informed by the survey of clinicians from diverse international settings. Available in electronic (laptop/mobile) and paper formats, CERTAIN provides evidence based diagnostic checklists, clinical decision support, educational modules on performing critical procedures, and has the ability to time and document real-time interventions. CERTAIN prompting has been shown to improve performance of clinical providers faced with simulated emergencies.
Challenging clinical trials: Why doesn't early goal-directed therapy work? De...scanFOAM
A talk by Derek Angus at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
Based on the information provided, this item is testing the learner's ability to make a clinical decision by diagnosing the most likely cause of the patient's presentation based on the key laboratory findings provided in the stem. The stem provides sufficient relevant information to answer the question without being tricked or misled. The alternatives provided are plausible and independent diagnoses to consider. This item follows best practices for writing multiple choice questions that test clinical decision making abilities.
Back to the Bedside: Internal Medicine Bedside Ultrasound ProgramAllina Health
David Tierney, MD. How bedside ultrasound is changing the practice of medicine and how Abbott Northwestern Hospital has become a national leader in integrating bedside ultrasound in its Internal Medicine Residency Program. "As internal medicine physicians, we are finding that everything we do with our hands, eyes and stethoscopes can be done a little better with ultrasound. That means our physical exam, which we consider our bread and butter, has more sensitivity and specificity. This gives us better diagnostic ability and results in earlier and more appropriate treatment."
This document discusses multiple sclerosis (MS), including its epidemiology, etiology, pathophysiology, clinical course, diagnosis, prognosis, and treatment. MS is a chronic inflammatory demyelinating disease of the central nervous system that affects young adults and has a relapsing-remitting course. It has autoimmune origins and causes focal lesions in the brain, spinal cord and optic nerves. Physical therapy for MS aims to manage symptoms like sensory issues, pain, weakness, balance problems and fatigue through exercises, education and addressing psychosocial needs.
Evidence based decision making in periodonticsHardi Gandhi
INTRODUCTION TO EVIDENCE BASED DENTISTRY
EVIDENCE BASED PERIODONTOLOGY
NEED, PRINCIPLES, GOALS AND ADVANTAGES OF EBDM
SKILLS NEEDED FOR EBDM
ASSESING THE EVIDENCE
INCORPORATING INTO THE PRACTICE
1. The document discusses the approach and management of polytrauma patients. It outlines the concepts of trauma care including the ATLS philosophy and damage control surgery.
2. Polytrauma is defined as two or more body regions with signs of systemic inflammatory response syndrome (SIRS). The metabolic response to trauma occurs in two phases - the ebb phase which conserves energy and the flow phase which mobilizes resources.
3. Management principles include organized team approach, treatment before diagnosis, and frequent re-examination. The primary and secondary surveys follow the ATLS protocol to address airway, breathing, circulation, disability, and exposure.
The document provides guidance on performing an initial assessment of a trauma patient using the ABCDE approach and mnemonics to evaluate the patient's airway, breathing, circulation, disability, exposure, vital signs, comfort, history, and injuries. It emphasizes stabilizing life-threatening problems, providing ongoing monitoring, and evaluating multiple body systems.
The document discusses the management of polytrauma patients. It begins with definitions of polytrauma and terms like SIRS, sepsis, and MODS. It then covers the metabolic response to trauma, which occurs in two phases - the ebb phase and the flow phase. The rest of the document details the principles and philosophy of trauma management based on the ATLS approach. This includes concepts like the golden hour, damage control surgery, and the primary and secondary surveys.
This document outlines an agenda and content for a cupping therapy training session. The session will discuss moving the practice of cupping therapy towards a more standardized, evidence-based, and professionally regulated approach. Speakers will address the current inconsistent practices in cupping therapy and the need to establish standardized protocols for patient safety. They will introduce the British Cupping Society's approach, which focuses on practitioners obtaining proper clinical knowledge and skills, managing treatments appropriately, and engaging in ongoing professional development. The document provides example cases and questions to illustrate key discussion points around professionalization, treatment management, and developing cupping therapy as a safe, effective treatment approach.
1) The document discusses the importance of recognizing and responding to deteriorating patients using a systematic approach called the COAT & Review approach.
2) It emphasizes the importance of monitoring vital signs and their trends to detect deterioration in patients, as over 60% of code blue calls are for patients whose vitals had been abnormal for over 8 hours.
3) The COAT & Review approach involves confirming and optimizing life-threatening problems, assessing and treating underlying causes, and reviewing the patient through reassessment of vital signs and organs. It provides structure to rapidly identify, prioritize and treat deteriorating patients.
Presentation slides from our first meeting, held on Tuesday 10th September 2013 at the Royal College of Surgeons.
Find us on
Twitter @STARSurgUK
Facebook.com/STARSurgUK
Email: STARSurgUK@gmail.com
The document provides guidance on how to critique scientific articles. It discusses evaluating the study design, methodology, population, interventions, outcomes, and statistics. Key aspects to examine include the randomization and blinding methods, comparison groups, sample sizes, narrowness of focus, and appropriate application of statistical tests. The goal is to determine if the evidence presented is sufficient to accept the study's conclusions by considering factors like biases, generalizability, and clinical significance of any findings.
The document discusses the management of multiple injured road traffic accident victims. It begins with definitions of road traffic accidents and their common causes like distraction, drunk driving, and speeding. It then outlines the effects of road traffic accidents like fractures, soft tissue damage, and traumatic brain injuries. The management section covers triage protocols using color codes to prioritize patients. It also details the primary and secondary survey process, including the ABCDE approach to initially stabilize patients and treat life-threatening injuries followed by a full head-to-toe examination. Prevention strategies mentioned include following road rules and regular vehicle maintenance to reduce accident risks.
Workshop — The Art of Writing Good Multiple-Choice Questions for High-Stakes ...MedCouncilCan
The document provides guidance on writing effective multiple choice questions for high-stakes medical exams, outlining key concepts like defining the purpose and concept being tested in each question, ensuring the stem provides sufficient relevant information to answer the question, and avoiding technical flaws like negative wording, logical cues, or word repeats that could inadvertently provide clues to the correct answer.
Initial management of polytrauma patients requires a systematic approach with airway, breathing, and circulation as top priorities. The primary survey assesses these areas to identify life-threatening injuries, while the secondary survey provides a full head-to-toe examination to identify all injuries and guide further treatment. Trauma mortality follows a trimodal distribution with immediate deaths from major vascular or brain injuries within an hour, early deaths from hemorrhage or respiratory failure within hours, and late deaths after 3 days often from sepsis or organ failure.
Design and Conduct of Clinical Trials 2016Meguid Nahas
This document provides an overview of how to design, conduct, and report a clinical trial based on a presentation from Prof Meguid El Nahas at the Sheffield Kidney Institute. It discusses ethical considerations like the Declaration of Helsinki, trial design elements like objectives and endpoints, conducting trials according to good clinical practice, statistical analysis, interpreting and reporting results, and how to appraise clinical trials based on factors like validity of results and risk-benefit analysis. The overall document offers guidance on the end-to-end process for clinical research.
Trauma management in ER and primary survegAnnaya Khan
The document outlines the initial assessment and management of trauma patients. It describes performing a primary survey to address life threats like airway, breathing, circulation, disability and exposure. This is followed by resuscitation efforts and reassessment. A secondary survey then involves a full history, head-to-toe exam, and diagnostic tests to identify and treat all injuries. Special considerations are given to minimizing missed injuries and determining when transfer to a higher level of care is necessary.
The lecture explains the steps of thinking while applying the principles of evidence based medicine on radiology.An example from real life is given and how to apply this type of thinking in order to achieve the best results.
Dr Ian Sturgess: Optimising patient journeysNuffield Trust
This document discusses optimizing patient flow through emergency care by segmenting patients into categories based on length of stay and clinical needs. It advocates using expected date of discharge and clinical criteria for discharge as goals to coordinate care and discharge planning. Key steps include allocating patients early to specialty teams, standardizing care pathways, minimizing handovers, and conducting daily board rounds to focus on constraints and moving patients smoothly through their care. The overall aim is to get patients home safely and faster while improving outcomes.
This document provides guidance on preoperative preparation for general surgery patients. It discusses defining the preoperative period, objectives of preoperative assessment, types of patients, principles of history taking and medical examination, common investigations, optimizing medical conditions, obtaining consent, and organizing the operating theatre list. The key aspects of preoperative preparation covered include gathering relevant patient information, assessing and optimizing the patient's medical status, anticipating and planning for risks, and informing all parties involved in the patient's care.
This document provides an introduction to internal medicine and its various specialties such as cardiology, pulmonology, gastroenterology, and neurology. It discusses the medical process including diagnosis, treatment, and medical ethics. Key aspects of diagnosis are outlined including medical history, physical examination, differential diagnosis, and investigations. Diagnostic testing concepts like sensitivity, specificity, and predictive values are defined. Medical ethics principles like non-maleficence, beneficence, autonomy, and confidentiality are introduced.
This document provides an orientation to family medicine. It discusses the key principles of family medicine including providing comprehensive, continuous, and personal primary care. It outlines the core competencies of a family physician including managing acute/chronic health problems, providing health promotion/preventative services, counseling, emergency care, and more. The document also discusses specific skills like communication, collaboration, management, and advocacy. It provides examples of common clinical presentations family physicians encounter and guidelines for evaluating and managing conditions like hypertension, diabetes, chest pain, fever, and more.
A Value-Based Approach to Clinical Pathology and InformaticsCirdan
A presentation delivered by Dr. Glenn Edwards, SA Pathology at the Pathology Horizons 2017 conference in Cairns, Australia.
Pathology Horizons is an annual CPD conference organised by Cirdan on the future of pathology. More information on Pathology Horizons can be accessed at www.pathologyhorizons.com
Evidence based decision making in periodonticsHardi Gandhi
INTRODUCTION TO EVIDENCE BASED DENTISTRY
EVIDENCE BASED PERIODONTOLOGY
NEED, PRINCIPLES, GOALS AND ADVANTAGES OF EBDM
SKILLS NEEDED FOR EBDM
ASSESING THE EVIDENCE
INCORPORATING INTO THE PRACTICE
1. The document discusses the approach and management of polytrauma patients. It outlines the concepts of trauma care including the ATLS philosophy and damage control surgery.
2. Polytrauma is defined as two or more body regions with signs of systemic inflammatory response syndrome (SIRS). The metabolic response to trauma occurs in two phases - the ebb phase which conserves energy and the flow phase which mobilizes resources.
3. Management principles include organized team approach, treatment before diagnosis, and frequent re-examination. The primary and secondary surveys follow the ATLS protocol to address airway, breathing, circulation, disability, and exposure.
The document provides guidance on performing an initial assessment of a trauma patient using the ABCDE approach and mnemonics to evaluate the patient's airway, breathing, circulation, disability, exposure, vital signs, comfort, history, and injuries. It emphasizes stabilizing life-threatening problems, providing ongoing monitoring, and evaluating multiple body systems.
The document discusses the management of polytrauma patients. It begins with definitions of polytrauma and terms like SIRS, sepsis, and MODS. It then covers the metabolic response to trauma, which occurs in two phases - the ebb phase and the flow phase. The rest of the document details the principles and philosophy of trauma management based on the ATLS approach. This includes concepts like the golden hour, damage control surgery, and the primary and secondary surveys.
This document outlines an agenda and content for a cupping therapy training session. The session will discuss moving the practice of cupping therapy towards a more standardized, evidence-based, and professionally regulated approach. Speakers will address the current inconsistent practices in cupping therapy and the need to establish standardized protocols for patient safety. They will introduce the British Cupping Society's approach, which focuses on practitioners obtaining proper clinical knowledge and skills, managing treatments appropriately, and engaging in ongoing professional development. The document provides example cases and questions to illustrate key discussion points around professionalization, treatment management, and developing cupping therapy as a safe, effective treatment approach.
1) The document discusses the importance of recognizing and responding to deteriorating patients using a systematic approach called the COAT & Review approach.
2) It emphasizes the importance of monitoring vital signs and their trends to detect deterioration in patients, as over 60% of code blue calls are for patients whose vitals had been abnormal for over 8 hours.
3) The COAT & Review approach involves confirming and optimizing life-threatening problems, assessing and treating underlying causes, and reviewing the patient through reassessment of vital signs and organs. It provides structure to rapidly identify, prioritize and treat deteriorating patients.
Presentation slides from our first meeting, held on Tuesday 10th September 2013 at the Royal College of Surgeons.
Find us on
Twitter @STARSurgUK
Facebook.com/STARSurgUK
Email: STARSurgUK@gmail.com
The document provides guidance on how to critique scientific articles. It discusses evaluating the study design, methodology, population, interventions, outcomes, and statistics. Key aspects to examine include the randomization and blinding methods, comparison groups, sample sizes, narrowness of focus, and appropriate application of statistical tests. The goal is to determine if the evidence presented is sufficient to accept the study's conclusions by considering factors like biases, generalizability, and clinical significance of any findings.
The document discusses the management of multiple injured road traffic accident victims. It begins with definitions of road traffic accidents and their common causes like distraction, drunk driving, and speeding. It then outlines the effects of road traffic accidents like fractures, soft tissue damage, and traumatic brain injuries. The management section covers triage protocols using color codes to prioritize patients. It also details the primary and secondary survey process, including the ABCDE approach to initially stabilize patients and treat life-threatening injuries followed by a full head-to-toe examination. Prevention strategies mentioned include following road rules and regular vehicle maintenance to reduce accident risks.
Workshop — The Art of Writing Good Multiple-Choice Questions for High-Stakes ...MedCouncilCan
The document provides guidance on writing effective multiple choice questions for high-stakes medical exams, outlining key concepts like defining the purpose and concept being tested in each question, ensuring the stem provides sufficient relevant information to answer the question, and avoiding technical flaws like negative wording, logical cues, or word repeats that could inadvertently provide clues to the correct answer.
Initial management of polytrauma patients requires a systematic approach with airway, breathing, and circulation as top priorities. The primary survey assesses these areas to identify life-threatening injuries, while the secondary survey provides a full head-to-toe examination to identify all injuries and guide further treatment. Trauma mortality follows a trimodal distribution with immediate deaths from major vascular or brain injuries within an hour, early deaths from hemorrhage or respiratory failure within hours, and late deaths after 3 days often from sepsis or organ failure.
Design and Conduct of Clinical Trials 2016Meguid Nahas
This document provides an overview of how to design, conduct, and report a clinical trial based on a presentation from Prof Meguid El Nahas at the Sheffield Kidney Institute. It discusses ethical considerations like the Declaration of Helsinki, trial design elements like objectives and endpoints, conducting trials according to good clinical practice, statistical analysis, interpreting and reporting results, and how to appraise clinical trials based on factors like validity of results and risk-benefit analysis. The overall document offers guidance on the end-to-end process for clinical research.
Trauma management in ER and primary survegAnnaya Khan
The document outlines the initial assessment and management of trauma patients. It describes performing a primary survey to address life threats like airway, breathing, circulation, disability and exposure. This is followed by resuscitation efforts and reassessment. A secondary survey then involves a full history, head-to-toe exam, and diagnostic tests to identify and treat all injuries. Special considerations are given to minimizing missed injuries and determining when transfer to a higher level of care is necessary.
The lecture explains the steps of thinking while applying the principles of evidence based medicine on radiology.An example from real life is given and how to apply this type of thinking in order to achieve the best results.
Dr Ian Sturgess: Optimising patient journeysNuffield Trust
This document discusses optimizing patient flow through emergency care by segmenting patients into categories based on length of stay and clinical needs. It advocates using expected date of discharge and clinical criteria for discharge as goals to coordinate care and discharge planning. Key steps include allocating patients early to specialty teams, standardizing care pathways, minimizing handovers, and conducting daily board rounds to focus on constraints and moving patients smoothly through their care. The overall aim is to get patients home safely and faster while improving outcomes.
This document provides guidance on preoperative preparation for general surgery patients. It discusses defining the preoperative period, objectives of preoperative assessment, types of patients, principles of history taking and medical examination, common investigations, optimizing medical conditions, obtaining consent, and organizing the operating theatre list. The key aspects of preoperative preparation covered include gathering relevant patient information, assessing and optimizing the patient's medical status, anticipating and planning for risks, and informing all parties involved in the patient's care.
This document provides an introduction to internal medicine and its various specialties such as cardiology, pulmonology, gastroenterology, and neurology. It discusses the medical process including diagnosis, treatment, and medical ethics. Key aspects of diagnosis are outlined including medical history, physical examination, differential diagnosis, and investigations. Diagnostic testing concepts like sensitivity, specificity, and predictive values are defined. Medical ethics principles like non-maleficence, beneficence, autonomy, and confidentiality are introduced.
This document provides an orientation to family medicine. It discusses the key principles of family medicine including providing comprehensive, continuous, and personal primary care. It outlines the core competencies of a family physician including managing acute/chronic health problems, providing health promotion/preventative services, counseling, emergency care, and more. The document also discusses specific skills like communication, collaboration, management, and advocacy. It provides examples of common clinical presentations family physicians encounter and guidelines for evaluating and managing conditions like hypertension, diabetes, chest pain, fever, and more.
A Value-Based Approach to Clinical Pathology and InformaticsCirdan
A presentation delivered by Dr. Glenn Edwards, SA Pathology at the Pathology Horizons 2017 conference in Cairns, Australia.
Pathology Horizons is an annual CPD conference organised by Cirdan on the future of pathology. More information on Pathology Horizons can be accessed at www.pathologyhorizons.com
Similar to Introduction Clinical Decision Making.ppt (20)
This document discusses various aspects of promotion in the pharmaceutical industry, including the objectives, mix, and techniques of promotion. It provides details on advertising, detailing, direct mail, sales promotion, and publicity/public relations as components of the promotional mix. The document also discusses factors to consider in designing a promotional strategy, such as market nature, product nature, product lifecycle stage, and available funds. Promotion at the retail level and use of packaging as a promotional tool are also summarized.
This document discusses the role of detailers or pharmaceutical sales representatives in promoting drug products. It provides details on the detailing process, which involves identifying and qualifying prospective customers, presenting sales messages and product samples, and following up. It describes the duties of detailers, which include providing information to healthcare professionals, distributing drug samples, and maintaining relationships with retailers and wholesalers. Key qualities of effective detailers are also outlined, such as knowledge, communication skills, and the ability to convince customers. The document also discusses how sales forces are managed through elements like territory assignment, performance evaluation, and compensation.
This document discusses the key aspects of staffing and human resource management (HRM) in a pharmaceutical organization. It covers the following main points:
1. The main activities of HRM include recruiting, selecting, training, evaluating and compensating employees to help achieve organizational goals.
2. Staffing involves finding and attracting potential candidates for open positions through both internal and external recruitment. Selection methods include interviews, tests and simulations to evaluate candidate fit.
3. Development and training of employees is important for enhancing skills and abilities. Different types of training like orientation, skills and on-the-job training are used. Performance is also regularly appraised.
4. Compensation includes wages, bonuses and
1. Dr. Ali Akhtar is a pharmacist with multiple advanced degrees in clinical pharmacy and pharmacology.
2. The document discusses the purposes and types of pharmaceutical advertising, including informing physicians and consumers, introducing new products, and building brand loyalty.
3. Advertising media options for pharmaceutical companies include print, television, radio, specialized films and electronic materials depending on the target audience and budget.
The document outlines the basic functions of marketing, including exchange functions like buying and selling. It describes the buying process, noting that buying involves assessing needs, finding suppliers, placing orders, receiving and inspecting goods. It also describes the selling process, noting that selling aims to bring buyers and sellers together and is how firms generate income. The document further outlines physical supply functions like storage and transportation, and ancillary functions like standardization, branding, financing, risk bearing, and feedback information.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
Communicating effectively and consistently with students can help them feel at ease during their learning experience and provide the instructor with a communication trail to track the course's progress. This workshop will take you through constructing an engaging course container to facilitate effective communication.
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
2. Overview
• Intro to clinical decision making (CDM)
• The five second rule: a case based CDM
challenge
• How do we think and make decisions?
• What affects our CDM?
• How can we improve CDM and enhance
patient safety?
• Next?
3. CDM and non-technical skills
• Team working
• Decision making
• Situation awareness
• Task management
• Diagnosis
• Prognosis
4. CDM exercise 1
• Think about your choice of speciality,
profession, job
• What influenced you in that decision
making?
5. CDM exercise 2
Look at the next slide and ask yourself:
• “Which beach would I rather be on?”
9. CDM in the acutely ill
• In the ward
• Assessment and management
• Looks….
• Obs….
• Actions
System 1 thinking: (intuitive)
Cognitive style Heuristic
Cognitive awareness Low
Cost Low
Automaticity High
Rate Fast
Reliability Low
Errors Usually
Effort Low
Predictive power Low
Emotional component High
Scientific rigour Low
10. Importance of CDM in
managing sick patients
• Patients still die from ‘simple’ things either
missed, delayed or done sub-optimally
• Decisions including diagnosis
• Approx 80% of clinical time spent in the
cognitive domain
12. 1. Advanced First Aid
ASSESSMENT
• Hello, how are you ?
• Response
• Airway: patent ?
• Breathing
ACTION
• Look: obstruction
• Listen: ? noise
• Clear or secure:
headtilt/chin lift or jaw
thrust? Airway: oral or
nasal?
• High concn oxygen:
mask type? Flow?
13. 1. Advanced First Aid
ASSESSMENT
• Sounds ?
• Common 3 are ?
• Causes are ?
ACTION
• Clear and keep open
• Get help 2222?
• Advanced airway
management required?
Tracheal tube? Size? Cut
to what length? Are drugs
needed for anaesthesia
and intubation? If yes,
which?
14. 1. Advanced First Aid
ASSESSMENT
Sounds
• Nil: complete obstruction
or not breathing
• Snoring/gurgling: reduced
GCS, foreign material
• Stridor: anaphylaxis,
burns/thermal; tumour;
abscess/infection
For each ask ‘what is the
diagnosis?’
ACTION
• Clear and keep open
• Get help 2222
• Positioning
• Advanced airway
management required
15. 1. Advanced First Aid plus 2.
OBSERVE
• Rate
• Volume
• Symmetry
• Character
• Work of breathing
• Compromise
Ix & MONITOR
• CXR, PEFR, ABGs
• Repeat observations
• Pulse oximetry
• TREAT
• Oxygen
• Nebulisers
16. 1. Advanced First Aid
ASSESS
• Pulse: which pulse?
• Skin: cap refill time,
temperature
• BP: where? Which
method?
PHYSIOLOGY
• MAP = CO x SVR
• CO = HR x SV
• Low BP =
decompensation
17. 1. Advanced First Aid
iv access
• Site
• Size
• Blood sampling
iv access
• Upper limb
Femoral
• High flow: short and
thick
• Fluids
• Drugs
19. 1. Advanced First Aid
• Disability ?
• Conscious level, focal neurology
• DEFG
• Difficult bit
20. IMMEDIATE
INVESTIGATIONS
• Arterial blood gases: O2, CO2, acid-base
• Potassium
• Glucose can all be done on a
• Haemoglobin blood gas sample
• 12 lead ECG
• CXR
• Targeted investigations
• What should we do having analysed this information?
21. 1. Advanced First Aid
• Evidence
• Environment: context
• Targeted secondary Examination
• Explanation
• Everything else…
22. Advanced First Aid=Phase 1:abcde
• abcde, treating as you go
• Repeated assessment and continuous
monitoring: patient better or worse ?
• Do we need enhanced abcde ?
• Targeted secondary examination
23. 1.
Acute
assessment +
stabilisation &
immediate
investigations
and support.
Targeted
secondary
exam
2.
Monitors:
reassess
Surface
Invasive
Real time or
Delayed
Illness
severity
4.
Differential
diagnosis/
definitive
diagnosis
Immediate,
medium term
and long
term
treatment
3.
CDM
Team work
Task Mx
Situation
Awareness
Critical
Thinking
THE FOUR KEY DOMAINS OF
EMERGENCY CARE
24. Illness Severity Assessment
• Speed of action needed
• Level & type of expertise: resuscitation;
diagnostic; therapeutic
• Where should the patient be ? Nursing
intensity, monitoring, medical input?
• Definitive treatment: speed ?
25. SEVERITY SCORING 1:CLINICAL
ABNORMAL PHYSIOLOGY
• Airway compromised
• Resp rate
• Pulse rate
• SBP
• GCS
OBSERVATIONS
• Bad
• <10 or >30
• <45 or >120
• <100 (110) or >200
• Fall of 2 points, <15
26. SEVERITY SCORING 2: INVESTIGATIONS
ABNORMAL INVESTIGATIONS
• Hypoxaemia
• Hypercarbia
• Potassium
• Glucose
• H+
• Base excess
• Lactate
RESULTS
• <3 or >6 (ECG)
• <3 or >20
• >50 or <30
• < -5 or > +10
• Diagnosis ?
27. ICM 2001;27:74-83
Base Excess and Mortality Red = Dead Green = survivor
Relationship between base excess and mortality in ICU
28. SEVERITY SCORING 3: organ failures
• Clinical: cardiovascular (shock)
• CNS reduced conscious level
• Urea and creatinine: renal
• ABGs: respiratory (oxygenation+/or CO2
clearance)
• Clotting: coagulation
• WBC: bone marrow
• Gut/liver: glucose; lactate; clinical
29. 4. Differential Diagnosis, ultimate
diagnosis and definitive treatment
• Get more history
• Trachea
• Chest
• JVP and heart
• Abdomen
• Skin, CNS
• GP, family, SAS
• Deviation
• Lateralising signs,
wheeze, crackles
• HS III or IV, murmurs
• Swelling, pulsation
• Rashes, neck
stiffness, lateralising
signs
31. Decision making
• Diagnosis (and treatment)
• Is the diagnosis correct (complete) ?
• Prognosis
• Admit ?
• Discharge ?
• Stop ?
• Distributed
32. Diagnostic Error
• Ranked 2nd cause of adverse events
(Harvard study, 1991)
• Diagnostic failure highest in EM, GP, Gen
Med
• Passing on to specialists in wards, ICU
• 2/3 of claims against UK GPs are for
diagnostic failure
33. Type 2 thinking (analytical)
Cognitive style Systematic
Cognitive awareness High
Cost High
Automaticity Low
Rate Low
Reliability High
Errors Few
Effort High
Predictive power High
Emotional component Low
Scientific rigour High
Diagnosis
• History: full
• Examination:
complete
• Investigations
• Differential Dx
• Treatment
• Refine
diagnosis
35. Traditional cognitive taxonomy
or
“how you think it”
• Problem solving
• Pattern recognition
• Decision analysis theory
• Hypothetico-deductive reasoning
36. CDM: a universal model of
diagnostic reasoning
Intuitive
• Experiential-inductive
• Bounded rationality
• Heuristic
• Pattern recognition
• Hard wired response
• Thin slicing
• Unconscious thinking
theory
Analytical
• Hypothetico-deductive
• Unbounded rationality
• Normative reasoning
• Robust CDM
• Acquired, critical, logical
thought
• Multiple
branching/arborisation
• Deliberate, purposeful
thinking
38. CDM
What affects clinical decision making ?
• Knowledge and skills
• Behaviours: attitude (multiple selves),
emotions (affect: self, family, patients,
relatives, colleagues), values.
39. What affects clinical decision making ?
• Context
• Values
• Affect
• Knowledge
• Critical thinking
• Interruptions
• Clinical reasoning
• Words
• Non-technical Skills
• Physical factors
• Stress and Fatigue
• Ergonomics
• Experience
• What we hear
• What we think
• Cognitive biases
• Heuristics
• Epiphanies
• Geography
40. 30 Cognitive Errors after Croskerry
Aggregate bias Gender bias Psych-Out Errors
Anchoring Hindsight bias Representativeness
Ascertainment bias Multip.Alternatives Search satisficing
Availability Omission bias Sutton’s Slip
Base rate neglect Order effects Triage-Cueing
Commission bias Outcome bias Unpacking principle
Confirmation bias Overconfidence Vertical line failure
Diagnostic creep Playing the odds Visceral bias
Attribution error Posterior prob. Ying-Yang Out
Gambler’s Fallacy Premature closure Zebra retreat
41. Hard wiring
Heuristics and Biases
Ambient
conditions/Context
Task characteristics
Age and Experience
Affective state
Gender
Personality
Intellectual ability
Education
Training
Critical thinking
Logical competence
Rationality
Feedback
Pattern
Recognition
Repetition
Rational
override
Dysrationalia
override
Calibration Diagnosis
Patient
Presentation
Pattern
Processor
RECOGNIZED
TYPE
1
processes
TYPE
2
processes
NOT
RECOGNIZED
42. 1.
Acute
assessment +
stabilisation &
immediate
investigations
and support.
Targetted
secondary
exam
2.
Mons: reassess
Surface
Invasive
Real time or
Delayed
Tissue
hypoxia
4.
Differential
diagnosis/
definitive
diagnosis
Immediate,
medium term
and long
term
treatment
3.
CDM
Team work
Task Mx
Situation
Awareness
Critical
Thinking
THE FOUR KEY DOMAINS OF
EMERGENCY CARE
44. Solutions
• Training in critical thinking
• Training in major cognitive and affective
biases
• Training in logical thought
• Awareness of self and metacognition
• Timely feedback
• Training in cognitive forcing strategies