This presentation is the update of key findings from the second National Diabetes Registry (NDR) report since the establishment of the registry in Malaysia. It is intended to share the data contained within the NDR for clinicians, public
health specialists and researchers and all those who are interested in the clinical management of diabetes
Non-Communicable Diseases: Malaysia in Global Public HealthFeisul Mustapha
Paper presented at a CME Session, held in conjunction with the NIH Research Week 2014, 26 November 2014 at the Institute for Health Management, Bangsar
Non-Communicable Diseases: Malaysia in Global Public HealthFeisul Mustapha
Paper presented at a CME Session, held in conjunction with the NIH Research Week 2014, 26 November 2014 at the Institute for Health Management, Bangsar
Clinical practice guidelines are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.”They are intended to offer concise instructions on how to provide healthcare services.The most important benefit of clinical practice guidelines is their potential to improve both the quality or process of care and patient outcomes. Increasingly, clinicians and clinical managers must choose from numerous, sometimes differing, and occasionally contradictory, guidelines.
Healthcare is a major part of every country's development platform. By healthcare we are in fact protecting the most important driver of development. Healthcare systems are primarily safe guarding the development core engine and are the best means of sustainable development.
AHIMA ICD-10 ICD-11 switch to ICD-10-CM in the USA; Bedirhan Ustun
Switching to ICD-10-CM and ICD revision in the USA. This presentation was made at AHIMA conference in 2011. Now ICD 11 is scheduled in 2017 and ICD-10-CM can be made as a National Linearization.
Menyusun indikator mutu rumah sakit adalah tugas yang gampang-gampang susah. Gampang karena bentuknya pecahan sederhana. Susah karena konsekuensinya besar. Berikut saya menyumbangkan pemikiran untuk menyusun indikator mutu dengan bekal latihan selama kuliah dan pengamatan selama proses akreditasi. Tulisan ini pernah dimuat di Web Mutu Pelayanan Kesehatan dengan tautan: http://www.mutupelayanankesehatan.net/index.php/component/content/article/1986
Semoga bermanfaat, salam!
National Diabetes Audit (NDA) Care Processes and Treatment Targets 2013-15 Laura Fargher
The National Diabetes Audit (NDA) continues to provide a comprehensive view of Diabetes Care in England and Wales and measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards, in England and Wales.
This national report presents the key findings and recommendations on care processes and treatment target achievement rates from 2013-2015 in all age groups in England and Wales along with information on offers and attendance for structured education places.
Clinical practice guidelines are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.”They are intended to offer concise instructions on how to provide healthcare services.The most important benefit of clinical practice guidelines is their potential to improve both the quality or process of care and patient outcomes. Increasingly, clinicians and clinical managers must choose from numerous, sometimes differing, and occasionally contradictory, guidelines.
Healthcare is a major part of every country's development platform. By healthcare we are in fact protecting the most important driver of development. Healthcare systems are primarily safe guarding the development core engine and are the best means of sustainable development.
AHIMA ICD-10 ICD-11 switch to ICD-10-CM in the USA; Bedirhan Ustun
Switching to ICD-10-CM and ICD revision in the USA. This presentation was made at AHIMA conference in 2011. Now ICD 11 is scheduled in 2017 and ICD-10-CM can be made as a National Linearization.
Menyusun indikator mutu rumah sakit adalah tugas yang gampang-gampang susah. Gampang karena bentuknya pecahan sederhana. Susah karena konsekuensinya besar. Berikut saya menyumbangkan pemikiran untuk menyusun indikator mutu dengan bekal latihan selama kuliah dan pengamatan selama proses akreditasi. Tulisan ini pernah dimuat di Web Mutu Pelayanan Kesehatan dengan tautan: http://www.mutupelayanankesehatan.net/index.php/component/content/article/1986
Semoga bermanfaat, salam!
National Diabetes Audit (NDA) Care Processes and Treatment Targets 2013-15 Laura Fargher
The National Diabetes Audit (NDA) continues to provide a comprehensive view of Diabetes Care in England and Wales and measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards, in England and Wales.
This national report presents the key findings and recommendations on care processes and treatment target achievement rates from 2013-2015 in all age groups in England and Wales along with information on offers and attendance for structured education places.
Diabetes mellitus is a major global public health problem. The rise in global prevalence is expected to reach 5.4% or 300 million worldwide by 2025, with developed countries carrying a larger burden (1). Malaysia is not spared from this phenomena, with an alarming rise in prevalence of Type 2 diabetes mellitus (T2DM) over the past fifteen years, from 8.3% (NHMS 1, 1996) to 20.8% (NHMS IV, 2011) (2). What is most worrying is the figure for undiagnosed diabetics, which recorded almost a ten-fold increase (from 1.8% to 10.1%) within the same period. The national economic burden for provision of ambulatory or outpatient care for diabetes patients alone was estimated to cost the Ministry of Health RM 836 million, which took up 2.2% of the nation’s total health expenditure for 2009 (3). The average provider cost per outpatient visit for diabetes treatment at primary care was RM393.24, compared to RM 2707.44 at Specialist diabetic clinics. Treatment at primary care health centres was also highly cost effective compared to Specialist diabetic clinics (4). Due to the chronic nature of the disease, its many related complications and the progress in medical expertise, the costs to provide health care for the this group can only be expected to escalate in years to come. Strategies to effectively treat the chronic diseases (i.e. NCDs and T2DM) have been in place since the 1990s, however, the National Strategic Planning for Non-Communicable Diseases, (NSPNCD)(5) recommends that efforts should be channeled towards primary prevention, early NCD risk factor identification and NCD risk factor intervention or “clinical preventive services”. The clinical preventive services however, need to be emphasised, as early preventive measures can reduce long-term complications and morbidity related to diabetes. The risk factors which should trigger clinicians to provide clinical preventive measures include: obesity, sedentary lifestyles, dietary indiscretions, elderly (for late onset diabetes, pancreas insufficiency), family history of diabetes (risk in offspring of one diabetic parent: 30%, both parents: 60%). The 10th Malaysian Plan : Country Health Plan aims to restructure the national healthcare financing and healthcare delivery system to ensure universal health coverage of healthcare services to be provided at minimal cost using the existing infrastructure in delivering continuity of care across programmes, across healthcare settings and across healthcare providers (6). To reduce the fragmentation of care which commonly occurs in most NCD programmes, there is a need to involve healthcare providers within the healthcare service to be orientated in their roles and contribution in providing a seamless long-term care programme. It is hoped that this effort will benefit not only the patients but also provide relevant feedback on quality of healthcare service provision by the stakeholders. The current public health centre set up which combines Outpatient Primary Care
Effectiveness of Telenursing on Diabetic Patients with Glucose Self Monitorin...ijtsrd
BACKGROUND Diabetes is one of the most common debilitating diseases in the elderly requiring reasonable blood sugar control to prevent complications. Telenursing has been presented as a cost effective method to control blood glucose levels. AIM The present study aims to assess the effect on telenurisng on self glucose control among clients with type to diabetes mellitus at Saveetha medical college and hospital. METHODS AND MATERIALS A quantitative research design was used for the present study. A total 100 samples were collected using quota sampling technique. The demographic variable pretest and posttest level of complaints on self glucose monitoring was assessed using structured questionnaire, telenursing on glucose self monitoring and mangement was given among diabetes mellitus followed by that data was gathered and analyzed. RESULTS The results the study revealed that there is a significant association between the selected demographic variables and posttest level of diabetes mellitus at the level of p 0.01. CONCLUSION Thus, the present despites that factors associated with posttest level of diabetes mellitus among demographic variable. Mrs. Sindhupriya. R | Kanimozhi. N "Effectiveness of Telenursing on Diabetic Patients with Glucose Self-Monitoring among with General Population at Arakkonam GH" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-5 , October 2023, URL: https://www.ijtsrd.com/papers/ijtsrd60034.pdf Paper Url: https://www.ijtsrd.com/biological-science/other/60034/effectiveness-of-telenursing-on-diabetic-patients-with-glucose-selfmonitoring-among-with-general-population-at-arakkonam-gh/mrs-sindhupriya-r
Results of an impact evaluation on professional competences accreditation of general practitioners in primary care
26th International Conference. The International Society for Quality in Health Care
Dublin 11th - 14th October 2009
County perspectives 2018 health workforce dr. nelson muriu. director, depar...Emmanuel Mosoti Machani
Dr. Nelson Muriu. Director, Nyeri County Department of Health. Presentation on the county Health Workforce in 2018 and teh task ahead for new county governments.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
National Diabetes Registry Report 2013-2019: Update of Key Findings
1. National Diabetes Registry Report
2013-2019
Update of Key Findings
Arunah Chandran
Public Health Medicine Specialist
Disease Control Division,
Ministry of Health Malaysia
12 November 2020
2. 1 of 5 adult Malaysians have Diabetes
Source: National Health and
Morbidity Survey 2019
Slides Prepared by Arunah Chandran, Disease Control Division,
MOH Malaysia
3. National Diabetes Registry
Contains information on patients with diabetes
managed at participating MOH health clinics
and consists of:
Web-Based Application
Patient Registry
Clinical Outcomes
Slides Prepared by Arunah Chandran, Disease Control Division,
MOH Malaysia
4. National Diabetes Registry Objectives
To enable tracking of
glycaemic control and clinical
outcomes of patients with
diabetes managed at MOH
health clinics
To enable comparisons
over time and across
geographical locations
Enable research to
improve the quality of
care provided to patients
in MOH facilities
Slides Prepared by Arunah Chandran, Disease Control Division,
MOH Malaysia
5. National Diabetes Registry
At the end of 2019, 830
KKs throughout Malaysia
have provided data to the
NDR
Socio-
demographic
Diabetes
Complications
Types of
Diabetes
Date of
Diagnosis
The following data is collected for all
Diabetes patients registered in the NDR
The Diabetes Clinical Audit is conducted annually on randomly
sampled active T2DM patients on follow-up at MOH health
clinics whereby a more detailed clinical data is collected.
Slides Prepared by Arunah Chandran, Disease Control Division,
MOH Malaysia
6. Socio-Demographics Characteristics
At the end of the
reporting year for
2019, there were a
total of 1,614,363
patients ever enrolled
in the registry.
At the end of the
reporting year for
2019, there were a
total of 894,000
active patients
enrolled in the
registry.
Nearly all the
patients enrolled
in the NDR were
diagnosed with
T2DM.
T1DM or other
forms of DM
comprised only
0.62% and 0.09%
repectively.
42.1% 57.9%
Malay
59.15%
Chinese
19.62%
Indian
13.17%
Others
8.05%
Slides Prepared by Arunah Chandran, Disease Control Division,
MOH Malaysia
17. Proportion of Diabetes patients
reaching clinical targets for HbA1c
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
2013 2014 2015 2016 2017 2018 2019
*Only includes patients who were tested for HbA1c
Slides Prepared by Arunah Chandran, Disease Control Division,
MOH Malaysia
20. Coverage and Quality of
Registration in National Diabetes
Registry
• Only 57% of known diabetes patients who claim to see treatment at
MOH primary care facilities are registered in the NDR.
• NHMS 2019: There are 1,999,450 known diabetes patients, of
whom 74.3% (1,485,591) seek care at MOH primary care facilities
• NDR in 2019: 849,691 active diabetes patients
• The accuracy of data, for example, diabetes-related complications, in
the NDR has improved from the previous report
• proportion of ‘unknown’ complications have reduced
• In 2019, the proportion of unknown for each of the conditions
only ranged between 1.6 to 2.3%.
Slides Prepared by Arunah Chandran, Disease Control Division,
MOH Malaysia
21. Limitations of National Diabetes
Registry Clinical Audit Data
• Heavily dependent on quality of documentations of the
patient’s case notes
• More emphasis should be placed on continuously improving
documentation of all health providers, regardless of level of
care
• Dataset does not contain information about hospital
admissions
• Standalone registry that requires primary data entry
• Limitation addressed by sampling a representative
population for annual clinical audit
Slides Prepared by Arunah Chandran, Disease Control Division,
MOH Malaysia
22. National Diabetes Registry:
Conclusions
• Despite some limitations in the dataset, the NDR dataset is a
useful tool for monitoring quality of care for people living with
Diabetes in MOH health clinics.
• Quality of reporting for the NDR has improved over the years
with relatively lower with ‘unknown’ variables. The rate of
screening for complications has also improved over the years.
• However, the data shows the outcomes of care, such as
glycaemic control and proportions of patients with
complications has not improved much.
• It is hoped that with the publication of this information, further
exploration into these questions can be pursued.
Slides Prepared by Arunah Chandran, Disease Control Division,
MOH Malaysia
