Dr Ian Sturgess: Optimising patient journeysNuffield Trust
In this slideshow Dr Ian Sturgess, Director at IMP Healthcare consultancy, explores how we can better understand admitted flow streams and optimise patient journeys.
Dr Sturgess spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September2014.
Dr David Maltz: The challenge of length of stayNuffield Trust
In this slideshow, Dr David Maltz, of The Oak Group, explores the challenge of length of stay and opportunities for improvement.
Dr Maltz spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September 2014.
Dr Derek Thompson: Building a caring futureNuffield Trust
In this slideshow, Dr Derek Thompson, GP and Medical Director at Northumbria Healthcare Foundation Trust, on reducing the length of hospital stay and building a caring future.
Dr Thompson spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September2014.
A service improvement focused on frailty using an R&D approach, pop up uni, 3...NHS 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
Associate Professor Ian Scott - Princess Alexandra Hospital; University of Qu...Informa Australia
Associate Professor Ian Scott
Director
Internal Medicine & Clinical Epidemiology; Associate Professor of Medicine
Princess Alexandra Hospital; University of Queensland
• A study of 20 million patients
• Examining mortality in relation to NEAT
• Tracking quality indicators
Speakers: Clair Sullivan Deputy Chair Medicine Princess Alexandra Hospital, QLD & Andrew Staib Deputy Director Emergency Princess Alexandra Hospital, QLD
• Implementing ACE in 100 aged care facilities
• Building relationships with aged care staff for improved patient outcomes
• Examining savings and delivering results
Speaker: Jacqueline Hewitt Clinical Nurse Consultant John Hunter Hospital, NSW
Dr Ian Sturgess: Optimising patient journeysNuffield Trust
In this slideshow Dr Ian Sturgess, Director at IMP Healthcare consultancy, explores how we can better understand admitted flow streams and optimise patient journeys.
Dr Sturgess spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September2014.
Dr David Maltz: The challenge of length of stayNuffield Trust
In this slideshow, Dr David Maltz, of The Oak Group, explores the challenge of length of stay and opportunities for improvement.
Dr Maltz spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September 2014.
Dr Derek Thompson: Building a caring futureNuffield Trust
In this slideshow, Dr Derek Thompson, GP and Medical Director at Northumbria Healthcare Foundation Trust, on reducing the length of hospital stay and building a caring future.
Dr Thompson spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September2014.
A service improvement focused on frailty using an R&D approach, pop up uni, 3...NHS 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
Associate Professor Ian Scott - Princess Alexandra Hospital; University of Qu...Informa Australia
Associate Professor Ian Scott
Director
Internal Medicine & Clinical Epidemiology; Associate Professor of Medicine
Princess Alexandra Hospital; University of Queensland
• A study of 20 million patients
• Examining mortality in relation to NEAT
• Tracking quality indicators
Speakers: Clair Sullivan Deputy Chair Medicine Princess Alexandra Hospital, QLD & Andrew Staib Deputy Director Emergency Princess Alexandra Hospital, QLD
• Implementing ACE in 100 aged care facilities
• Building relationships with aged care staff for improved patient outcomes
• Examining savings and delivering results
Speaker: Jacqueline Hewitt Clinical Nurse Consultant John Hunter Hospital, NSW
Ausmed Nursing Conference 2018 - Catherine HenryCatherine Henry
This presentation covers under-resourcing/work pressures and the impact on quality of care for patients. It also presents how the law deals with the supervision of junior doctors and health professionals – achieving adequate experience and training whilst not compromising patient care.
Although symptoms can vary widely, the first problem many people notice is forgetfulness severe enough to affect their ability to function at home or at work or to enjoy lifelong hobbies.
The award recognizes South Nassau’s commitment and success to ensuring that stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines.
NHS Improvement worked with clinical teams across health and social care to find examples of equality of treatment and outcome regardless of the day of the week.
This guide and case studies give examples ofservice delivery models that are being used across the NHS to deliver clinical services outside the standard working hours and across the weekend period, in many instances.
The service delivery models described respond to service, patient or carer demand and provide benefitsfor both patients,staff and carers. There are three emerging principlesthat could be used to categorise the models being adopted under the following headings:
1. Admission prevention
Servicesthat are designed to care for patientsin their usual place of residence during times of poor health or mental illness.
2. Early diagnosis and intervention
No delay sin assessment, diagnostics and treatment leading to an earlier diagnosis and intervention.
3. Early supported discharge
Patients returning home once they are able to be supported in their own home by services.
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.
Ausmed Nursing Conference 2018 - Catherine HenryCatherine Henry
This presentation covers under-resourcing/work pressures and the impact on quality of care for patients. It also presents how the law deals with the supervision of junior doctors and health professionals – achieving adequate experience and training whilst not compromising patient care.
Although symptoms can vary widely, the first problem many people notice is forgetfulness severe enough to affect their ability to function at home or at work or to enjoy lifelong hobbies.
The award recognizes South Nassau’s commitment and success to ensuring that stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines.
NHS Improvement worked with clinical teams across health and social care to find examples of equality of treatment and outcome regardless of the day of the week.
This guide and case studies give examples ofservice delivery models that are being used across the NHS to deliver clinical services outside the standard working hours and across the weekend period, in many instances.
The service delivery models described respond to service, patient or carer demand and provide benefitsfor both patients,staff and carers. There are three emerging principlesthat could be used to categorise the models being adopted under the following headings:
1. Admission prevention
Servicesthat are designed to care for patientsin their usual place of residence during times of poor health or mental illness.
2. Early diagnosis and intervention
No delay sin assessment, diagnostics and treatment leading to an earlier diagnosis and intervention.
3. Early supported discharge
Patients returning home once they are able to be supported in their own home by services.
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.
Ciaran O'Neill on NHS reform - a Northern Irish perspectiveThe King's Fund
Professor Ciaran O'Neill, School of Business and Economics, NUI Galway, gives his perspective on the proposed NHS refoms and outlines the health care system in Northern Ireland.
Ludo Glimmerveen: integrated care for people with dementia in the NetherlandsThe King's Fund
Ludo Glimmerveen, Lecturer at the University of Amsterdam, explains how the Dutch organisation Geriant provides an integrated set of care services for people with dementia in the community.
Since 2000, Geriant has offered a community-based service to people diagnosed with dementia, 24 hours a day, 7 days a week.
The teams include case managers, social geriatricians, psychiatrists, clinical psychologists, dementia consultants, and specialised home care nurses. Case managers act as the focal point for the client and his or her informal caregivers, co-ordinating services from the team and from other network partners including GPs, hospitals, home care and welfare organisations.
Peter Littlejohns: Generating the right kind of clinical evidence and guidanceThe King's Fund
Peter Littlejohns, Clinical and Public Health Director, NICE, discusses how they are working to help patients and clinicians make choices about health care.
Jay Crosson on integrated care - lessons from the USThe King's Fund
Jay Crosson, Senior Adviser for The Permanente Medical Group, shares his experience of integrated health care systems in the US and looks at incentives to support integration between primary and secondary care.
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.
Dan Wellings: public perceptions on health and social care fundingThe King's Fund
Dan Wellings, Head of Public Health Research at Ipsos MORI, gives an interesting insight into what the public think about the funding of health and social care.
Mike Attwood at The King's Fund Annual Conference 2010The King's Fund
Mike Attwood, Programme Director, Total Place Coventry talks about whole area approaches to providing public services at The King's Fund Annual Conference 2010.
Ben Bridgewater: Measuring outcomes for surgeryThe King's Fund
Ben Bridgewater, Director of Clinical Audit, University Hospital of South Manchester NHS Foundation Trust, discusses how to measure outcomes for surgery, including the patient's perspective.
Linked Open Data for cities at SemTechBiz 2013 (San Francisco)AI4BD GmbH
Showing how to use open source tools to create linked open data. Provided a first view into the Linked Data Orchestration process that is easy to use and support the triplification process including the publishing of datasets as SPARQL endpoint.
Bdk fachforum (gpec) big data und intelligente datenanalyseAI4BD GmbH
Big Data udn intelligente Analyse. This motivational talk was given at the GPEC conference hosted and organised by BDK. In the talk I address topics of linked data, information extraction, rdf and sparql and provide a real world example from a Russian customer.
Ruth Poole, Group Clinical Director at Healthcare at Home, looks at why an engaged and supported workforce supports patient choice and control at home.
Hugh Reeve: How is the NHS in Cumbria adapting to lessons from the Alternativ...The King's Fund
Hugh Reeve draws on the lessons that can be learnt from the Alternative Quality Contract and shares how Cumbria Clinical Commissioning Group have started to put those lessons into practice.
Developing and implementing clinical standards for seven day servicesNHS Improving Quality
Celia Ingham Clark National Director: Reducing Premature Mortality. Slides from Celia's presentation from the 7 Day Services events West Midlands 11th June and East Midlands 12th June 2014
Risk profiling, multiple long term conditions & complex patients, integrated ...Dr Bruce Pollington
Dr Bruce Pollington web-ex presentation to LTC QIPP programme
Utilising risk profiling, and risk stratification to identify patients with multiple long term conditions requiring complex care through integrated care teams.
Transforming End of Life Care in Acute Hospitals AM Workshop 2: AMBER Care Bu...NHS Improving Quality
Transforming End of Life Care in Acute Hospitals AM Workshop 2: AMBER Care Bundle by Dr Irene Carey, Susanna Shouls, Guy’s and St Thomas’ NHS Foundation Trust
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Dr Eileen Pepler, Academic, Researcher and Consultant in the Canadian Healthcare will discuss how NHS England work in chronic disease is being translated into a Canadian context.
Presentation made by Celia Ingham Clark National Director for Reducing Premature Mortality, at Improving access to seven day services. Southampton 25 March 2015
By Marc Newell, MD. A discussion about the rapidly evolving TeleHealth program at Minneapolis Heart Institute that promises to increase access to and timeliness of specialty care in communities across the region. “This is an innovative strategy that allows more patients to be seen closer to home, and have more access to subspecialty care. We need to transform how and where we deliver care so we can focus on prevention and chronic disease management.”
Can we solve the adult primary care shortage without more physicians? CHC Connecticut
Tom Bodenheimer,of the Center for Excellence in Primary Care at UCSF Dep’t of Family and Community Medicine talks about addressing the primary care shortage at the 2014 Weitzman Symposium
Phil McCarvill, Head of Policy and Public Affairs at Marie Curie Cancer Care spoke at Commissioning Live on 26 March 2014 on 'End of life: using evidence'.
Using evidence that is currently available such as the Marie Curie Atlas; independent evaluations (e.g. Nuffield Trust); user, patient and carer feedback and social media, we are continuing to increase our understanding of experiences of end of life care.
Marie Curie is using this evidence and responding to feedback when we work with commissioners around the country to redesign end services.
For more information on commissioning, have a look at our website mariecurie.org.uk/commissioning or get in touch at servicedevelopment@mariecurie.org.uk
NHSE South 7DS Webinar - How 7 day therapy services can become business as us...NHS England
This webinar gives an example of how the role of Allied Health Professionals is improving care and flow across seven days a week.
Caroline Poole from NHS Improvement gives a brief update on the AHP ‘Flow Collaborative’ and Vicki Sheen from Torbay and South Devon NHS Foundation Trust describes the impact of therapy teams providing a seven day service and how this has become business as usual.
Clinical standards - Celia Ingham Clark
NHS England
Presentation from the 'NHS services open seven days a week: every day counts' event on Saturday 16 November at The Metropole Hotel, Birmingham.
This event was hosted by NHS Improving Quality and NHS England to share the views and ideas of public, patients, carers, NHS England and health and social care staff on how to improve access to services for patients across the seven day week.
More information at http://www.nhsiq.nhs.uk/improvement-programmes/acute-care/seven-day-services.aspx or #7DayServices
Home Hospital: hospital level care at home for acutely ill adultsJeffrey Lortz
Dr. David Levine, MD of Brigham & Women's Hospital presents how his home hospital pilot program resulted in a 52% cost savings by admitting emergency patients to a home-based acute care program vs. inpatient 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.
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
2 Case Reports of Gastric Ultrasound
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/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
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.
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.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
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).
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.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
3. Hospitals struggling to cope…
• Feedback from patients, RCP fellows and members
• Francis inquiry
‘insufficient care for patients’ dignity’ … ‘degrading conditions’… ‘horrific experiences’
‘a consultant body that disassociated itself from management and often adopted a fatalistic
approach to management issues and plans.’
• NCEPOD reports
‘Routine daily input from medicine for the care of older people should be available to
elderly patients undergoing surgery and is integral to inpatient care pathways in this
population.’
• Temple report on impact of EWTD
‘Despite significant consultant expansion, trainees are still responsible for initiating and
frequently delivering the majority of out of hours service, often with limited supervision.’
• The King's Fund report continuity of care
‘Continuity of care cannot be achieved without fundamental change in the way that the NHS
as a whole thinks about the role and priorities of the Acute General Hospital and how it is
run.’
4. What patients tell us they want
• Dignity and privacy
• Kindness
• Not to be moved around “like a parcel”
• Joined up care
• Someone in charge who knows what is going
on
• (Safe effective care )
5. What RCP fellows and members say:
Rate your hospital’s ability to deliver:
• continuity of care as norm – 24% (poor or very poor)
• stable medical teams for care and education – 23%
• discharge arrangements that realistically allocate
responsibility for further action – 17%
• high-quality care, 24/7 – 13%
• balance of care between specialists and generalists – 13%
• effective relationships between medical & other teams – 10%
(RCP survey, January 2012)
6. What RCP fellows and members say:
One in ten doctors would not recommend their
hospital to a family member or friend as a high-quality
place to receive treatment and care, and nearly one in
four were not sure.
(RCP survey, August 2012)
8. Five key challenges
• Increasing clinical demand
• Changing patients, changing needs
• Fractured care
• Out-of-hours care breakdown
• Looming medical workforce crisis
9. Increasing clinical demand
• Third fewer acute beds than 25 years ago
• Third more emergency admissions over last decade
• Fall in length of stay flattening, even increasing for over
85s
• 59% of consultants report working more hours than
three years ago, and three quarters report being under
more pressure
• ‘Consultants felt that the supervision that they can offer
to trainees is inadequate due to pressure of clinical work
and a fragmented team structure.’
• The hospital door is always open…
10. Changing patients, changing needs
• Two thirds of people admitted are over 65
• Quarter have diagnosis of dementia
• People over 85 account for 25% of beds days – an
increase of 22% over the past ten years
• Yet the system continues to treat older patients as
a surprise, at best, or unwelcome, at worse
• ‘A significant percentage of patients seen are over
80 yet those caring from them often have no
geriatric training.’ (Regional conversation)
12. Fractured care
A quarter of hospital doctors rate their hospital’s ability to
deliver continuity of care as poor.
Conversations with doctors
• It is ‘common for patients to move four or five times during their
stay’, ‘particularly afflicting elderly patients moved to outlying wards
during the night’
• Decisions are often ‘made by bed managers’
• Patient care is ‘often transferred to a new consultant without any
formal handover’
• Patients who do not fall neatly into an organ-based specialty remit
may become ‘lost’ in the system or ‘neglected’
Every ward move puts one day on length of stay
13. Continuity of care for older people
12 patients with ‘complex medical
problems’
Average transfers between medical
teams = three per patient
10 out of 12 moved after 8pm
(The King's Fund 2012) 14
14. “Out-of-hours” care breakdown
At weekends:
• Patients do not get diagnostic tests as quickly
• Number of procedures, including emergency procedures, falls
• Fewer people are discharged
• Studies suggest 10% increase in mortality
• Access to primary care is fragmented and patchy
Conversations with doctors
• ‘All present were concerned that the trust does not function well at
night.’
• ‘Often feel relieved on Monday that nothing catastrophic has happened
over the weekend.’
• ‘Would like to see a 7 day week but believe that this would require more
consultant cover and support services.’
15. Gastrointestinal bleeding in Wales
24,291 admissions 1999-2007
30 day deaths
Admissions on:
Weekday: 18,285 9.8% fatality
Sat/Sun: 5,686 10.6% (OR 1.13)
Public holidays: 450 12.9% (OR 1.41)
Fewer endoscopies Fri/Sat
Button et al. World J Gastroenterol 2010;16:431-8.
16. Looming workforce crisis
• Difficulty recruiting to emergency and general medicine
posts
• Application rates to training schemes with a general
medicine commitment are declining
• Over a quarter of medical registrars are concerned their
workload is unmanageable*
• 5.3% of FT2s and CMTs thought medical registrars had an
‘excellent’ work-life balance, compared to 88.5% for GP
registrars*
We risk losing the pool of general medical skills essential to
the provision of holistic care
*RCP (forthcoming) ‘The Future of the Registrar’ study,
2011/2
20. What is the Commission?
• Set up by the RCP
• Reports to RCP president and Council
• Chaired by Professor Sir Michael Rawlins
• Multi-professional steering group
• Range of additional stakeholders
• Due to report in March 2013
• Set longer-term programme of work for RCP (focusing
on implementation of recommendations, including use of pilot sites)
21. Purpose and scope
Identify a system in which safe, effective and compassionate medical care
can be delivered to all who need it as hospital inpatients.
Make sure hospitals in future are based around the needs of patients and
can deliver:
• high quality care 24 hours per day, seven days a week
• continuity of care for patients
• stable medical teams for patient care and education
• effective relationships between medical and other teams
• appropriate balance between specialist and general care
• discharge/ transfer arrangements that realistically allocate responsibility
for further action.
22. Emerging themes: Patients and
compassion
These themes are intended to generate discussion, they are not
recommendations and have not been approved by Commissioners at this
stage – we need your views!
23. Overall approach
• Patient experience matters as much as clinical outcomes
• Is it good for patients ?
• Have we listened to what patients are telling us?
• Have we tried to find put what they think?
• If we take this seriously, then we will change how we do
things
24. Key issues to patients
• Continuity of care
• ‘Wrong patient on wrong ward’ means lower standard of care
• Communication
• Involvement of families and carers
• Joined up care
• Dignity, compassion and respect –treated as a human being
(Human Rights agenda)
25. 12 principles of care
1. Good communication is essential between medical and ward
teams if a patient moves, and must be improved.
2. Once a patient has reached a ward after assessment in the acute
medical unit, they should not move again, unless there are
exceptional circumstances.
3. More beds should be designated as general/older people’s beds
and less as speciality beds.
4. A named consultant should be designated on each ward to liaise
with the ward manager on basic standards of care for all patients
on that ward.
5. The hospital environment needs to be designed for the needs of
the frail older patient with dementia, whilst considering the needs
of other specific groups such as young people.
26. 12 principles of care
6. Patients and their families should be involved in discharge planning.
7. Medical staff need more training in motivational interviewing
techniques (to support self care) and in recognition of the dying
patient.
8. Advanced care planning for people with end stage disease needs to be
done before hospital admission.
9. Values should be incorporated into appraisals and staff survey results
recognised. Appraisals should be less punitive and more supportive.
10. Time for staff support, development and reflective practice should be
built into working patterns.
11. Recruitment of staff should take attitudes and values into account.
12. Doctors and nurses in all specialties need to have basic training in
cognitive impairment, acute confusional state and dementia.
27. Moving beds: Our commitment to patients
1. We will only move you on the basis of your needs.
2. We will explain to you where you are moving to and
why. Where possible, we will tell you how long you
are moving for.
3. We will not move you at night unless your needs
immediately and urgently require it.
4. We will make sure you know who to speak to about
your needs, treatment and care.
5. We will make sure your family know where you are
and, where appropriate, why you are there.
28. Principles: continuity of care
Care for patients admitted as an emergency should be
organised so:
• the consultant team involved in care on the day of
admission delivers care the following day
• (as far as possible) the same consultant team provides care
throughout admission
Applicable patients on specialty pathways
29. Continuity of care at the front door (1)
• Transfers out of AMU: currently, AMU size
mandates ward transfer of short stay
patients (24–72 hrs) not requiring
specialty pathway
• Transfers associated with added risk, need
for handover, distress for patient
• Lose momentum towards discharge: adds
one to two days to length of stay
30. Acute care directorate?
Co-locate with:
• Ambulatory care: patients discharged from AMU follow up
with same consultant on ambulatory care unit
• Augmented care area: level 1–2 beds, located on AMU
with staff competencies to provide care acutely ill
• ITU, HDU – close working – benefit from proximity
• Emergency department
Benefits of single acute care hub: unity of purpose staffing
‘esprit de corps’, clinical, administrative, accounting
32. What is the right balance?
• Specialists who also do GIM on intake
and look after those patients on the
wards
• Acute Physicians –intake and ? 24-48
hours post admission
• Geriatricians –specialists who are
expert in care of older people
• Specialists
• (probably not hospitalists as in USA)
33. Balance between geriatricians and general
physicians
‘We’re not worried about the patients you’re looking after, we’re concerned
about the ones you’re not’ – Quotation from FHC participant
Workforce being pulled in all directions:
• Geriatricians at the hospital ‘front door’
• In-reach to Acute Medical Units
• Liaison with surgical wards, etc
• Community, post-discharge and prevention
What’s the answer?
• More geriatricians (and doing what)?
• More geriatric medicine beds?
• More training and skills (eg dementia and delirium) across medical
workforce?
34. Get involved
Get engaged in the debate:
• Suggestions, comments, evidence and examples of good
and innovative practice to:
futurehospital@rcplondon.ac.uk.
Find out more: www.rcplondon.ac.uk/futurehospital