Locality Registers pilot project reports by IPSOS Mori
End of Life Locality Registers evaluation - final report
29 June 2011 - Ipsos MORI
This report presents the findings from an evaluation of eight locality register pilot sites across England.
This incorporates the findings from the interim report, and includes a detailed case study report for each of the sites. They began operating in October 2009 and have been evaluated since September 2010 so that key learning points and good practice from the pilots can be shared.
This report expresses the views of those involved in the pilot programme and the evaluation team, but does not necessarily reflect DH and NHS policy.
Medical technologies and data protection issues - food for thoughtRenato Monteiro
Document prepared towards the modernization procedure of Council of Europe´s Convention 108 on the Protection of Personal Data. Available at: http://www.coe.int/t/dghl/standardsetting/dataprotection/TPD_documents/T-PD-BUR%282014%2904Rev%20-%20Medical%20Data%20%28By%20Renato%20Leite%29.pdf
Medical technologies and data protection issues - food for thoughtRenato Monteiro
Document prepared towards the modernization procedure of Council of Europe´s Convention 108 on the Protection of Personal Data. Available at: http://www.coe.int/t/dghl/standardsetting/dataprotection/TPD_documents/T-PD-BUR%282014%2904Rev%20-%20Medical%20Data%20%28By%20Renato%20Leite%29.pdf
An analytic document on the social impact of Aadhar Card. the paper particularly deals with how the society will avail the health benefits through Aadhar card
Poor bone health in Indians. The case for digitization in OrthopedicsRanjit Kovilinkal
Inspite of more than 60 years history of orthopedics in India we have not been able to define optimum and the current state of bone health in our population. We have not identified the factors responsible for poor bone health and evolve state and national level strategies to improve the bone health of the nation. The poor bone health affects the work potential and performance thereby reducing productivity and adds a tremendous musculoskeletal disease burden in late youth due to weak bones. It is not only a clinical burden needing treatment but also causes a huge loss of earnings/man-day. Surgeons in India want to improve the healing times in their patients while patients in turn are willing to spend money on technologies that work. Ultimately, identifying the optimal fracture healing technology for the Indian population is of significant interest to the health care community.
Monitoring and evaluation toolkit - Conférence de la 2e édition du Cours international « Atelier Paludisme » - TUSEO Luciano - World Health Organization / Roll Back Malaria - maloms@iris.mg
This report documents the collective output of research activities undertaken by the Institute for Employment Studies in response to a request from EU-OSHA to undertake a review of successful OSH benchmarking initiatives. The overarching aim was to review OSH benchmarking schemes that have been set up at sector, Member State or European level in order to assess the benefits that such schemes can deliver, as well as their limitations, and to identify the key factors of and main obstacles to their success.
The IDMP Challenge - Whitepaper on ISO IDMP by CunesoftV E R A
The updated whitepaper on ISO IDMP - learn what you need to know during this transition. And how Cunesoft's cune-IDMP can help your organization: https://cunesoft.com/en/products/idmp/
PharmaLedger – Healthcare industry digitization & engagement guidelines throu...PharmaLedger
The objective of this Report is to describe the 1st iteration of the Healthcare industry digitization & engagement guidelines through Collaboration Platform and the key elements and components which enable it to fulfil the brief as specified in Task 6.2. This is an iterative development process to ensure a goal-oriented development process aligned with users’ needs and requirements.
The requirements and activities related to this task are linked and aligned with WP2.5 deliverable D2.5 “Reference Domain Applications Use Cases Implementation, Validation and Piloting”. The work described within the report specifically related to the implementation of the GDPR is linked to WP5, delivery 5.1: PharmaLedger Ethical and Legal Inventory.
The results of this deliverable is a 1st iteration (or Alpha version) of the Collaboration Platform that includes the identification of User Types, the functional specification of the core elements of the platform, GDPR and Privacy arrangements, Training, Sandbox testing/development and Feedback mechanisms. The plan is to launch this version of the Collaboration Platform in M18 and engage stakeholders.
The tasks You are assumed to be one of the software consultants .docxsarah98765
The tasks
You are assumed to be one of the software consultants appointed to shoulder the system analysis responsibilities in, the project outlined in, the case study. You will plan and manage the project as well as investigate and document its system requirements. You will produce a report that discusses this project based on your understanding of it and the related investigation results through the tasks below.
Task 1:
Approaches to Systems Development • How would you go about developing Hospital Information System? Compare different Software Development approaches to consider the best suited for developing HIS. • Justify the choice of your selected approach to systems development.
Task 2: Systems Requirements • What are the primary functional requirements for the system in the case study? List and discuss
Length: 2000 words
these requirements. • What are the non-functional requirements for the system in the case study? List and discuss these non-functional requirements. Justify the choice of your non-functional requirements
Task 3: Project Cost Benefit Analysis • Discuss your project Cost Benefit Analysis (CBA). CBA should focus the following two main points: a. To determine if an investment (or decision) is sound, ascertaining if – and by how much – its benefits outweigh its costs; and b. To provide a basis for comparing investments (or decisions), comparing the total expected cost of each option with its total expected benefits. • Provide an excel spread sheet with details in a Project Cost Benefit Analysis.
Task 4:) Project Schedule • Show a work breakdown structure and a project schedule as a Gantt Chart. Explain both of them and discuss how they relate to each other.
• Given the system goals, requirements, and scope as they are currently understood, is the project schedule reasonable? Why or why not?
Task 5: System Information Requirement Investigation Techniques • Who are the stakeholders involved? • Explain your choice of the 3 most useful investigation techniques. • Justify the usefulness of these 3 investigation techniques.
Information Systems Analysis and Design
Assessment - Systems Development
Lecturer: Lecturer Name
Tutor: Tutor Name
Prepared by:
Student Name
Student Number
Table of Contents (TOC)
Insert a word generated table of contents here
How to create a table of contents in Microsoft Word
1. Apply the built-in Heading styles to the headings in your text.
2. In Word 2007 and Word 2010: References > Table of Contents > choose an option from the menu.
1. Introduction
Add your contents here.
Note: In this section, you provide a clear definition of the aims of this report. You also identify the project objectives. Explain all findings in the reporting document.
2. Approach to Systems Development
Please add your contents here. There are many approaches to Systems development such as Water fall SDLC, Agile, RAD JAD. etc. You need to clearly explain which .
Evaluating and Improving A Compliance Program EncloseBetseyCalderon89
Evaluating and Improving A Compliance Program
Enclosed for reference is a sample compliance document developed in
2003 by a Task Force assigned by the Health Care Compliance Association.
It was developed as a resource for evaluating and improving a compliance
program for Health Care Executives and Compliance Officers.
The Society of Corporate Compliance & Ethics
HEALTH CARE
COMPLIANCE
ASSOCIATION
5780 Lincoln Drive · Suite 120 · Minneapolis, MN 55436 · 888/580-8373 · www.hcca-info.org
January 24, 2003
Dear HCCA Colleagues:
On behalf of the HCCA Board of Directors and the many volunteers from across the country who served on the
HCCA Compliance Performance Measurement Initiative Task Force and its Steering and Drafting Committees,
we are pleased to announce the release of the following document, “Evaluating and Improving a Compliance
Program, A Resource for Health care Board Members, Health care Executives and Compliance Officers.”
This resource is now available to all HCCA members and other interested parties on the public section of the
HCCA website at www.hcca-info.org.
This document is the product of an extensive collaborative process and reflects hundreds of volunteer hours of
research, meetings, drafting, collaborative discussions, decades of collective professional experience, as well as
the important feedback received from the HCCA membership through surveys, interactions at meetings and
finally, through comments received during a 45-day review and comment period.
We trust that this document will provide added value by identifying and sharing information and best practices
regarding the operation and evaluation of compliance programs. While principally developed for the benefit of
HCCA members, this reference is intended to be a useful guide to all health care compliance professionals.
Nevertheless, it is important to note that this document is not intended nor should it be used as a “cookbook” or
“list of standards.” One size certainly does not fit all. As a reference, you should use and tailor this information
to meet the specific needs of your organization and to better inform your board members, senior management and
executives.
This document will also serve as the foundation for the next steps in HCCA’s continued efforts to provide
practical tools to you, our members, to assess the performance of compliance programs within health care
organizations. Recognizing the complexity and variety of compliance issues within different health care industry
sectors, the HCCA Board has assigned the task of developing specific performance measurement tools for
different health care industry sectors to the HCCA Compliance Focus Groups (CFG’s), e.g., Health Systems CFG,
Home Health CFG, Pharmaceutical CFG, etc. The CFG’s will provide an appropriate and useful forum to attract
volunteers and their ideas to tailor and customize these tools to fit specific industry secto ...
An analytic document on the social impact of Aadhar Card. the paper particularly deals with how the society will avail the health benefits through Aadhar card
Poor bone health in Indians. The case for digitization in OrthopedicsRanjit Kovilinkal
Inspite of more than 60 years history of orthopedics in India we have not been able to define optimum and the current state of bone health in our population. We have not identified the factors responsible for poor bone health and evolve state and national level strategies to improve the bone health of the nation. The poor bone health affects the work potential and performance thereby reducing productivity and adds a tremendous musculoskeletal disease burden in late youth due to weak bones. It is not only a clinical burden needing treatment but also causes a huge loss of earnings/man-day. Surgeons in India want to improve the healing times in their patients while patients in turn are willing to spend money on technologies that work. Ultimately, identifying the optimal fracture healing technology for the Indian population is of significant interest to the health care community.
Monitoring and evaluation toolkit - Conférence de la 2e édition du Cours international « Atelier Paludisme » - TUSEO Luciano - World Health Organization / Roll Back Malaria - maloms@iris.mg
This report documents the collective output of research activities undertaken by the Institute for Employment Studies in response to a request from EU-OSHA to undertake a review of successful OSH benchmarking initiatives. The overarching aim was to review OSH benchmarking schemes that have been set up at sector, Member State or European level in order to assess the benefits that such schemes can deliver, as well as their limitations, and to identify the key factors of and main obstacles to their success.
The IDMP Challenge - Whitepaper on ISO IDMP by CunesoftV E R A
The updated whitepaper on ISO IDMP - learn what you need to know during this transition. And how Cunesoft's cune-IDMP can help your organization: https://cunesoft.com/en/products/idmp/
PharmaLedger – Healthcare industry digitization & engagement guidelines throu...PharmaLedger
The objective of this Report is to describe the 1st iteration of the Healthcare industry digitization & engagement guidelines through Collaboration Platform and the key elements and components which enable it to fulfil the brief as specified in Task 6.2. This is an iterative development process to ensure a goal-oriented development process aligned with users’ needs and requirements.
The requirements and activities related to this task are linked and aligned with WP2.5 deliverable D2.5 “Reference Domain Applications Use Cases Implementation, Validation and Piloting”. The work described within the report specifically related to the implementation of the GDPR is linked to WP5, delivery 5.1: PharmaLedger Ethical and Legal Inventory.
The results of this deliverable is a 1st iteration (or Alpha version) of the Collaboration Platform that includes the identification of User Types, the functional specification of the core elements of the platform, GDPR and Privacy arrangements, Training, Sandbox testing/development and Feedback mechanisms. The plan is to launch this version of the Collaboration Platform in M18 and engage stakeholders.
The tasks You are assumed to be one of the software consultants .docxsarah98765
The tasks
You are assumed to be one of the software consultants appointed to shoulder the system analysis responsibilities in, the project outlined in, the case study. You will plan and manage the project as well as investigate and document its system requirements. You will produce a report that discusses this project based on your understanding of it and the related investigation results through the tasks below.
Task 1:
Approaches to Systems Development • How would you go about developing Hospital Information System? Compare different Software Development approaches to consider the best suited for developing HIS. • Justify the choice of your selected approach to systems development.
Task 2: Systems Requirements • What are the primary functional requirements for the system in the case study? List and discuss
Length: 2000 words
these requirements. • What are the non-functional requirements for the system in the case study? List and discuss these non-functional requirements. Justify the choice of your non-functional requirements
Task 3: Project Cost Benefit Analysis • Discuss your project Cost Benefit Analysis (CBA). CBA should focus the following two main points: a. To determine if an investment (or decision) is sound, ascertaining if – and by how much – its benefits outweigh its costs; and b. To provide a basis for comparing investments (or decisions), comparing the total expected cost of each option with its total expected benefits. • Provide an excel spread sheet with details in a Project Cost Benefit Analysis.
Task 4:) Project Schedule • Show a work breakdown structure and a project schedule as a Gantt Chart. Explain both of them and discuss how they relate to each other.
• Given the system goals, requirements, and scope as they are currently understood, is the project schedule reasonable? Why or why not?
Task 5: System Information Requirement Investigation Techniques • Who are the stakeholders involved? • Explain your choice of the 3 most useful investigation techniques. • Justify the usefulness of these 3 investigation techniques.
Information Systems Analysis and Design
Assessment - Systems Development
Lecturer: Lecturer Name
Tutor: Tutor Name
Prepared by:
Student Name
Student Number
Table of Contents (TOC)
Insert a word generated table of contents here
How to create a table of contents in Microsoft Word
1. Apply the built-in Heading styles to the headings in your text.
2. In Word 2007 and Word 2010: References > Table of Contents > choose an option from the menu.
1. Introduction
Add your contents here.
Note: In this section, you provide a clear definition of the aims of this report. You also identify the project objectives. Explain all findings in the reporting document.
2. Approach to Systems Development
Please add your contents here. There are many approaches to Systems development such as Water fall SDLC, Agile, RAD JAD. etc. You need to clearly explain which .
Evaluating and Improving A Compliance Program EncloseBetseyCalderon89
Evaluating and Improving A Compliance Program
Enclosed for reference is a sample compliance document developed in
2003 by a Task Force assigned by the Health Care Compliance Association.
It was developed as a resource for evaluating and improving a compliance
program for Health Care Executives and Compliance Officers.
The Society of Corporate Compliance & Ethics
HEALTH CARE
COMPLIANCE
ASSOCIATION
5780 Lincoln Drive · Suite 120 · Minneapolis, MN 55436 · 888/580-8373 · www.hcca-info.org
January 24, 2003
Dear HCCA Colleagues:
On behalf of the HCCA Board of Directors and the many volunteers from across the country who served on the
HCCA Compliance Performance Measurement Initiative Task Force and its Steering and Drafting Committees,
we are pleased to announce the release of the following document, “Evaluating and Improving a Compliance
Program, A Resource for Health care Board Members, Health care Executives and Compliance Officers.”
This resource is now available to all HCCA members and other interested parties on the public section of the
HCCA website at www.hcca-info.org.
This document is the product of an extensive collaborative process and reflects hundreds of volunteer hours of
research, meetings, drafting, collaborative discussions, decades of collective professional experience, as well as
the important feedback received from the HCCA membership through surveys, interactions at meetings and
finally, through comments received during a 45-day review and comment period.
We trust that this document will provide added value by identifying and sharing information and best practices
regarding the operation and evaluation of compliance programs. While principally developed for the benefit of
HCCA members, this reference is intended to be a useful guide to all health care compliance professionals.
Nevertheless, it is important to note that this document is not intended nor should it be used as a “cookbook” or
“list of standards.” One size certainly does not fit all. As a reference, you should use and tailor this information
to meet the specific needs of your organization and to better inform your board members, senior management and
executives.
This document will also serve as the foundation for the next steps in HCCA’s continued efforts to provide
practical tools to you, our members, to assess the performance of compliance programs within health care
organizations. Recognizing the complexity and variety of compliance issues within different health care industry
sectors, the HCCA Board has assigned the task of developing specific performance measurement tools for
different health care industry sectors to the HCCA Compliance Focus Groups (CFG’s), e.g., Health Systems CFG,
Home Health CFG, Pharmaceutical CFG, etc. The CFG’s will provide an appropriate and useful forum to attract
volunteers and their ideas to tailor and customize these tools to fit specific industry secto ...
Developing evaluation framework for clinical information systems and incorpor...inderjyot singh
The report summarizes activities performed during the internship period under the Business Intelligence team at NSHA. It comparizes topics such as Evaluation frameworks for clinical information systems, change management required to implement organizational changes and data validation work done to improve the administrative data presented on business intelligence reports.
The author has uploaded this document to share the work done and highlight informatics based skills the author used in their job. This document can serve as the starting point for collaboration and mutual learnings for folks involved in healthcare analytics/ informatics arena. The author encourages the readers to connect through LinkedIn to discuss and facilitate co-learning/ career development opportunities.
Happy reading! :)
This Guide for Executives is aimed at senior healthcare leaders. It provides 31 practical tips for leaders
who want to contribute positively to the culture for innovation in their organisations and systems.
A more in-depth practitioners guide, Creating the Culture for Innovation, provides much more
detailed advice and guidance, a host of additional examples, and information about an online staff
survey that can be used to assess, benchmark and understand the culture for innovation.
The Sustainability Model is a diagnostic tool that will identify strengths and
weaknesses in your implementation plan and predict the likelihood of sustainability
for your improvement initiative.
The Sustainability Guide provides practical advice on how you might increase the
likelihood of sustainability for your improvement initiative.
Pathways to Success: a self-improvement toolkit Focus on normal birth and reducing Caesarean section rates
Caesarean section (CS) has an important role in ensuring safe maternity care. How can we make
sure that every Caesarean is appropriate, effective and efficient?
The NHS Institute for Innovation and Improvement is working with NHS clinical staff to promote best practice in achieving low CS rates while maintaining safe outcomes for mothers and babies.
This toolkit is designed to help maternity services review and assess their current practice in promoting normal birth and reducing CS rates. The toolkit also provides practical techniques to support sustainable changes in maternity services.
A practical, introductory guide to thinking differently. It is not a comprehensive blueprint nor is it designed to make you an expert in thinking. But it will get you started on
a journey of thinking differently, and therefore doing things differently, that we hope continues well into
your future.
We have selected concepts and thinking tools that have proven their value, ease, and applicability in a
variety of industries and in over five years of experience with front line teams in various NHS organisations.
We’ll provide you with just enough background theory to help you see why the various thinking tools ask
you to do certain things that might seem a bit odd at first. But the emphasis here is not on dry theory or
abstract concepts. Rather, it is on developing new thinking that leads to new ways of doing.
If you are involved in treating patients, managing and/or improving health services or
managing or training those that do, you will understand the importance of providing the
best care possible for all our patients.
Great progress has been made in improving service standards and access and in reducing
waiting times, but there is still some way to go to ensure consistently high standards of
patient care across the NHS.
It is clear that we need to ensure we are getting it right first time, which means better care
and better value through the reduction of waste and errors and the prioritisation of effective
treatments. Quality, innovation, productivity and prevention (QIPP) is the mechanism through
which we can achieve this.
QIPP is about creating an environment in which change and improvement can flourish; it
is about leading differently and in a way that fosters a culture of innovation; and it is
about providing staff with the tools, techniques and support that will enable them to take
ownership of improving quality of care.
The Handbook of Quality and Service Improvement Tools from the NHS Institute brings
together a collection of proven tools, theories and techniques to help NHS staff design and
implement quality improvement projects that do not compromise on the quality and safety of
patient care but rather enhance the patient experience.
The ebd approach (experience based design) is a method of designing better experiences for patients, carers and staff. The approach captures the experiences of those involved in healthcare services. It involves looking at the care journey
and in addition the emotional journey people
experience when they come into contact with a particular pathway or part of the service. Staff work together with patients and carers to firstly understand these experiences and then to improve them.
This guide is an introduction to the ebd approach (experience based design).
This guide and toolkit has been produced as
a result of work that the NHS Institute for
Innovation and Improvement has undertaken in collaboration with NHS organisations and external agencies, using the experience of patients, carers and staff to design better
healthcare services.
This document is one of a series of documents that was produced by the NHS Institute for Innovation and Improvement as part of the High Volume Care programme.
Produced by the Delivering Quality and Value Team, the aim of the Focus on series was to help local health communities and organisations improve the quality
and value of the care they deliver
Support Sheet 18: PPC
This support sheet provides a description of Preferred Priorities for Care, a tool for the discussion and recording of end of life care wishes and preferences.
Support Sheet 15: Enhancing the Healing Environment
This support sheet outlines key design principles for end of life care environments and provides tips for managing an environmental improvement project
Support Sheet 14: Using the NHS Continuing Health Care Fast Track Pathway Tool
This support sheet provides answers to frequently asked questions about the NHS Continuing Health Care Fast Track Pathway Tool.
Support Sheet 13: Decisions made in a person's 'Best Interests'
This support sheet outlines the process for making decisions on behalf of someone who lacks capacity.
Support Sheet 12: Mental Capacity Act (2005)
This support sheet outlines the main provisions of the Mental Capacity Act the four tests essential for assessing capacity
Support Sheet 11: Quality Markers for Acute Hospitals
This support sheet outlines the quality markers by which acute hospitals can measure the standard of end of life care they provide.
Support Sheet 7: Models/Tools of Delivery
This support sheet outlines the key elements of
Advance Care Planning (ACP)
Gold Standards Framework (GSF)
Liverpool Care Pathway (LCP)
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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:
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Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
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Supertasters:
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Increased number of fungiform papillae
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
3. Contents
Executive summary......................................................................... 4
1. Introduction ................................................................................. 2
1.1 Background and context ...................................................................... 2
1.2 Aims and objectives of the evaluation .................................................. 5
1.3 Methodology......................................................................................... 6
1.4 This report ............................................................................................ 7
1.5 Presentation and interpretation of data ................................................ 7
1.6 Acknowledgements .............................................................................. 8
1.7 Publication of data................................................................................ 8
2. Technical delivery ..................................................................... 10
2.1 Involving stakeholders right from the start .......................................... 10
2.2 Selecting the platform ........................................................................ 12
2.3 Working with commercial providers .................................................... 17
2.4 Developing the data set ..................................................................... 20
3. Implementation .......................................................................... 26
3.1 Maintaining buy-in from stakeholders ................................................. 26
3.2 Administration rights ........................................................................... 27
3.3 Obtaining patient consent................................................................... 30
3.4 The Summary Care Record (SCR) and consent ................................ 35
3.5 Leadership ......................................................................................... 37
3.6 Additional support .............................................................................. 37
4. Inter-agency partnership and working .................................... 41
4.1 How can registers improve partnership working?............................... 41
4.2 Cost benefits ...................................................................................... 43
5. Service users, carers and families .......................................... 46
5.1 Measuring the benefits ....................................................................... 46
5.2 Concerns about the register ............................................................... 46
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4. 6. Conclusions and recommendations ....................................... 50
7. Pilot site case studies ............................................................... 54
7a) NHS Brighton & Hove ........................................................................ 55
7b) Camden PCT Provider Services ........................................................ 65
7c) Leeds Teaching Hospitals NHS Trust ................................................ 79
7d) NHS Mid Essex .................................................................................. 94
7e) Royal Marsden NHS Foundation Trust ............................................ 108
7f) Salford PCT with Salford Royal NHS Foundation Trust .................... 121
7g) Sandwell PCT .................................................................................. 132
7h) Weston Area Health Trust and NHS South West ............................. 138
Appendix 1: Palliative care templates ....................................... 150
Appendix 2: Core data set .......................................................... 153
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6. Executive summary
Background and methodology
The Department of Health (DH) and the National End of Life Care Programme (NEoLCP)
recently backed a pilot programme to support and encourage the local development of End
of Life Care registers in England. The programme comprised eight pilot sites, each following
different approaches to the development and implementation of registers. The pilot
programme ran from October 2009 to March 2011, though a number of the sites are
continuing with the development and implementation beyond this cutoff. The sites are:
NHS Brighton and Hove
Camden PCT Provider Services
Leeds Teaching Hospitals NHS Trust
NHS Mid Essex
Royal Marsden NHS Foundation Trust
Salford PCT with Salford Royal NHS Foundation Trust
Sandwell PCT
Weston Area Health Trust and NHS South West
Ipsos MORI were commissioned to undertake an independent evaluation of the pilots. The
evaluation deployed a variety of methodologies to gather information on the views and
experiences of pilot stakeholders – desk research, in-depth telephone interviews, and a selfcompletion survey.
The first stage of the research involved gathering all the available documentation and data
from each of the pilot sites. The data was then analysed and fed into a framework model in
order to develop a picture of how each pilot was progressing against each of the framework
objectives.
The next stage was to have semi-structured discussions with pilot leads, to interview them in
detail about their experiences of the pilot, what has gone well, what could have gone better,
and lessons learned so far. Pilot leads were each asked to provide a list of key stakeholders
involved in the pilot in their area. Questionnaires were sent to them to complete and return.
4
7. This report covers findings from the undertakings of all sites. Individual sites are considered
in case studies which can be found as Chapter 7 of the main body of the report.
This report expresses the views of those involved in the pilot programme and the evaluation
team, but does not necessarily reflect DH and NHS policy.
Implementing an End of Life Care Register: Overview
The report details key lessons at each stage of development and implementation that other
NHS organisations considering developing their own register should consider. The flow chart
below brings together these lessons to illustrate what the process of developing and
implementing the register looks like, drawn from the experiences of the pilot sites, and what
needs to be considered at each stage.
Key findings
Developing the register
The first stage of register development is necessarily IT-focused. A key finding was that both
clinicians and IT specialists need to work together from the outset to ensure the system
meets the requirements of clinical staff in terms of data and process. Ideally, the clinical lead
needs to be sufficiently senior to drive the register forward and secure high-level buy-in
from stakeholders.
A respected clinician may also be more persuasive when
communicating the clinical benefits of the register lending credibility to the project when
‘marketing’ the register.
It is also important to ensure that stakeholders are identified and involved early in the
development process, with representatives from all of the service groups with an interest in
the register. These may include GPs, out-of-hours providers, ambulance services, acute
providers, end-users, patients and families, technical delivery and commissioners, although
stakeholders will vary locally. Establishing a stakeholder group which meets regularly
was helpful in smoothing the process of the development and ensuring that the finished
product is fit for purpose.
5
8. Implementing an EoLC register: key stages and issues to
consider
Map stakeholders at the outset: Who is likely to be affected by, or have an interest in, the
creation of a register?. These stakeholders should be engaged as soon as possible to ensure
they share the same vision of the register’’s purpose.
Obtain dedicated IT and clinical input: There should be a member of staff from each
background who can devote time to register development.
Register or care plan?: Although capable of holding more complex information, care planning
tools require more complex functionality, consent processes and administration rights.
Map the systems that are already in use: Most areas will have a wide range of IT platforms
already in use in GP surgeries and out of hours services, with separate networks for acute care,
community services and the local ambulance service.
Select IT platform and approach: A key challenge is to select a platform which can be used
across all different services, whilst retaining as much clinical functionality as possible. Having
mapped the pre existing systems in the area, an approach can be decided upon based on the
functionality, equality of access, compatibility and ease of used offered by each system.
Establish the data requirements: Capturing a minimum level of data is necessary in order to
fulfil the objectives of a register. The intention is to establish through the Information Standards
Board a national data set which will be available to any other areas developing a register in the
future. Once these basics are agreed, more targeted discussions can be had locally about any
additional information it would be useful to collect.
Determine administration rights: Consider who is best placed to edit the record. Healthcare
staff other than GPs, such as district nurses, hospice workers or community workers may be in a
good position to recognise when a patient is ready to be added to the register and to update it.
Specify clearly who the data controller is and who has responsibility for maintaining the record
and ensuring its accuracy.
Design the consent process: Consider the training requirements of staff around obtaining
consent. Gaining consent involves some potentially difficult and sensitive conversations with
patients. Consider carefully at which points patients should be asked to join the register. Many
pilots identified twelve months as the appropriate length of time for patients to be on the
register. Anticipate patient’’s objections to giving consent. Produce some literature for patients
detailing exactly how their information will be safeguarded and used.
Training: It is vital that end users are trained in both the IT and the clinical skills required to use
the register. Users need to be able to add patients and record their preferences, but they also
need the confidence and skills to approach the EoLC conversation with their patients. Feeling
unable to have or uncomfortable with having this conversation may result in it not happening.
6
9. This initial engagement needs to be maintained throughout the project. This requires a
sustained effort until stakeholders can see the benefits of a successfully implemented
register. GPs have been noted by pilot sites as a key stakeholder group to engage. They
play an important role in early input to the register, and need reassurance about the workload
involved from their perspective. Peer to peer support helping to increase understanding of
the potential value of the system is also felt to be very important for GPs.
At later stages of register development, hard-to-engage stakeholders should be able to see
an improvement in the efficiency and effectiveness of the register. This requires a critical
mass of patients on the register and regular feedback on the register’s benefits.
A suitable technology platform is likely to be constrained by the local context and the existing
IT infrastructure. A key challenge is to find a platform which can be used across the different
local services, such as GPs, acute care and community services. None of the pilot sites
developed a platform from scratch, with all choosing to ‘piggyback’ onto pre-existing local
or national platforms. The following platforms were used across the pilot sites:
Advanced Health & Care, formerly Adastra (Royal Marsden; Camden; Mid Essex;
South West)
EMIS, SystmOne and Acute Trust (Leeds)
SystmOne (Sandwell)
Summary Care Record (SCR) (Brighton and Hove)
Local pre-existing bespoke integrated patient record (Salford)
No platform emerged as a perfect solution. Instead it is important to ensure that the selected
platform has the functionality, access, reporting, compatibility and ease of use that will
be required from the register. Other reasons for selecting particular IT platforms include:
Choosing a platform with which staff are familiar, in order to decrease the training
burden and fit in well with current clinical processes; and
Using a commercial provider already contracted to provide a service in the area, such
as that providing out-of-hours care, although termination of contracts or change in
providers can result in unexpected difficulties.
7
10. Key learning points
Identify and engage stakeholders as early as possible and before you start
developing the data specification and collection protocol.
Maintaining buy-in, once stakeholders have been engaged, depends largely on
being able to demonstrate improvements in efficiency as the system ‘beds in’.
It is often most efficient to build on existing systems rather than develop a new
platform from scratch.
Think about the functionality that is required – what do you want the register to be
able to do? What type of reporting do you and other stakeholders want?
Is the register a detailed clinical care record or is it a palliative care summary?
Which different stakeholders need to access the register and what systems do
they have in place already? Will users have to switch between different systems?
N3 connectivity may need to be arranged for some services that need access to
the register.
Be aware of the potential effect of contractual changes. It can be time-saving to
use the same provider to host the register that is already hosting other systems
e.g. out-of-hours services. However, if the provider loses that pre-existing contract
it can be very disruptive to implementation of the register.
How will you ensure that different platforms can share data, especially given some
commercial providers may be reluctant to fully support this?
Prepare for unexpected hitches. Build time into the schedule to deal with
unforeseen technical problems.
Implementing the register
The commonly agreed core minimum dataset used by all pilot sites incorporates a
number of items, some of which are set out below:
Record creation and review dates
Patient name and address
Demographic information (date of birth, gender, ethnicity)
Consent to share/add details to register
8
11. Name of usual GP and details of practice
Key worker details
Carer details
Hospice details (if applicable)
Diagnosis and complications
Secondary diagnoses (if applicable)
Resuscitation status
Preferred place of death
Following the pilot it is intended to put this to the Information Standards Board for approval
as a national data set, which will provide a basis for the development of other registers.
Once the basics are agreed, more targeted discussions can be had about any additional
information it may be useful to collect. These additional items may contain information for
particular groups of patients or within particular localities.
The original intention of the EoLC register was to provide more comprehensive information
than that already available on databases such as GP practice palliative care registers, which
simply provide a list of names. Whilst there are some care planning elements in the
current minimum dataset, many pilots have gone beyond this and adapted their dataset to
include more substantial care planning elements.
Given this care planning element to the register, who has access to editing and inputting
patient data, as well as who has ‘ownership’ of the record, are very important issues to
resolve. Most pilots have opted for allowing GPs to control the data with rights to edit and
the responsibility to ensure accuracy. The GP would therefore also have ultimate say as to
whether the patient was added to the register. Allowing palliative care consultants the same
rights has also been a common approach as this is another key point where patients are
likely to be identified.
Information governance processes need to be clearly thought through.
Sharing
information needs to be done in such a way that it ensures the accuracy, accessibility,
consistency, and completeness of the information stored about patients. Information needs to
be managed in a way that ensures the attribution of authorship and changes is possible.
9
12. An opt-in approach for patients to be registered on the EoLC register has been universally
adopted by the pilot sites. Gaining consent involves sensitive conversations around patient
wishes, often best carried out by the healthcare professional who is most familiar with the
patient. It has been found that there is a need for a variety of healthcare professionals to
have permission to add patients to the register, although some sites have caveated this with
the need for GPs to then sanction all additions.
Conversations need to be broached at an appropriate time for the patient. Twelve months
has been identified as a suitable time period for patients to be on the register, with a useful
guideline for this being the question of whether the healthcare professional would be
surprised of the patient were to die within the next twelve months.
Those pilot sites where the register is live have reported a good uptake from patients when
seeking consent to add them to the register. Any concerns or uncertainties that patients
have had about consenting focus on data sharing and data security issues. Those who
choose not to consent should be flagged in some way on their medical records to prevent
being asked to consent repeatedly. At the time of the evaluation, no pilot sites reported that
any patients had refused to consent.
Training requirements for staff to use the register have been identified as straightforward for
the IT side of the project. In many cases staff are using a system with which they are already
familiar. The key training element identified is to support clinicians in the development of
communication and care planning skills.
Allowing healthcare professionals to feel
comfortable having these conversations is vital in order to get them to engage with the
project and in order to get a critical mass of patients consented to the register.
10
13. Key learning points
An end of life care dataset is likely to be available nationally.
Think about what specific local issues and problems there are and what other
information might it therefore be useful to collect.
Will the system hold extensive care planning information? Increasing the
complexity has implications for ease of use and the type of training required for
users.
Consider who is best placed to edit the record. This may not always be the GP or
consultant.
Consider developing a data sharing agreement to promote a consistent approach
to the sharing of information. Such an agreement can benefit individuals and
services whilst protecting the people that information is about. An example of such
a data sharing agreement can be found here http://www.protectinginfo.nhs.uk/.
Specify clearly who the data controller is and who has responsibility for updating
the record and ensuring its accuracy. Resolve any conflicts and ensure the register
can always be updated promptly.
Clinical data should be input by the GP as the data controller, or another clinical
lead for the patient, and not devolved to an administrative member of staff in the
surgery.
An ‘opt-in’ approach to obtaining consent should be adopted.
Ensuring relevant health and social care staff are trained and confident in how to
have sensitive consent conversations is important in increasing the uptake of the
register.
Consider carefully at what point patients should be asked to join the register. Many
pilots identified twelve months as the appropriate length of time for patients to be
on the register, which offers a guide for clinicians on when to ask patients if they
want to join.
Consider religious and ethnic diversity.
11
14. Interagency and partnership working
Another benefit of the register is to increase interagency and partnership working among
services. Increasing interagency working will therefore create a more seamless and patientcentred experience for the patient. In order to encourage successful partnership working,
being involved in the register needs to be a positive experience for stakeholders. Public
health bodies can also have a role to play here, by focussing public demand for better EoLC
from providers. In order to ensure interagency and partnership working, all services must
have equity of access to the register. This may mean establishing N3 connectivity for
those services that do not currently have this.
It is too early in the life of the pilots to know for certain what the cost benefits will be; however
a number of savings and efficiencies are anticipated by pilot sites. Most sites estimate that
they will see cost saving as a result of a reduction in unscheduled care, with better
communication of patients wishes and more patients dying in their preferred place of care,
which is known in many cases to be at home. Early data and anecdotal findings from two of
the pilot sites indicates that this is a realistic anticipatory benefit.
Key learning points
Ensuring benefits to partnership working are communicated to stakeholders can
help secure their buy-in.
Ensuring successful partnership working and entrenching the benefits depends on
positive experiences for stakeholders.
Equity of access to the register (via NHS connectivity) can help agencies
involved in a patient’s care to view each other as being equal partners in that care.
Public health bodies can have a role in uniting EoLC providers by focusing public
demand for better EoLC care from providers.
12
15. Service users, carers and families
None of the pilot sites are at the point where they have hard evidence that their EoLC
registers are improving patient care. Anecdotal findings and early data from the more
advanced pilot sites, however, suggest that registers support the delivery of patient choice.
The registers’ existence and the activity and conversations that they drive have prompted a
positive response from patients who feel reassured that their wishes are being considered.
One register was instrumental in ensuring that a patient’s end of life care preferences were
met when neither the patient’s family nor GP knew what the patient’s wishes were. As time
progresses register sites will seek to measure these outcomes more formally. Some of the
things they will be looking to measure include:
more patients dying in their preferred place
more seamless care
fewer hospitals admissions
fewer hospital bed days
less family distress
Concerns from patients and families may focus on:
Data protection
Sensitivities around the topic of end of life care
Whether the register is ‘binding’
Procedure for updating wishes and preferences
Patient and family conflicts of wishes
Key learning points
The two most likely key benefits to patients are:
More patients dying in their place of choice.
More seamless end of life care.
13