Parent guidelines one_slice
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The PARENT Guidelines have undergone a rigorous development process informed by literature and stakeholder consultation. While still in the early stages of adoption, they have medium levels of trustworthiness as they are supported by scientific societies and plans are in place for long-term maintenance. They have high levels of semantic interoperability by being based on standard terminologies and specifications. Future updates and incident resolution are expected though not on a regular scheduled basis.
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• Data that supports a change is needed
It is important that program and agency leaders first examine the current organizational and
political climate to assess readiness to both begin and sustain implementation and scaling up (or
expansion) of new practices or an innovation. It is important to recognize that, planning and
engaging in the implementation of any new innovation, evidence-based practice, or cluster of
practices takes time, energy and resources. The change process can be understood and organized
using defined steps and subsequent activities that are needed to move a concept into reality.
These steps and activities are outlined in the following document, \"A Guide to the
Implementation Process: Stages, Steps and Activities\".
Stage 1: Exploration
The State Leadership Team (SLT) should include cross- sector representation of agencies and
programs impacted by the proposed initiative. The composition, vision and mission of this initial
team may change over time as they go through the stages and steps.
The SLT ensures that the perspectives of key stakeholders from every level of the service system
are included as a part of a needs assessment of the current service delivery system. All available
data describing current challenges and need for change should be gathered and shared with
stakeholders. Stakeholders help build a common understanding of the current status and the
desired changes in practices and outcomes.During the exploration stage, an important
consideration for the State Leadership Team is whether they can commit to a multi-year
implementation process.
example of Exploration
• A State Leadership Team has been established to oversee the initiative.
• A stakeholder group has explored the need for change and the fit of potential new practices or
innovation.
• An innovation or set of practices was selected which addresses the need and is likely to result
in desired example.
• The service system and current practices were analyzed to determine necessary changes in
infrastructure, and training, technical assistance and coaching.
• The decision was made to proceed with the implementation initiative and move into
installation.
• Necessary agency or cross agency leadership has committed to supporting the implementation
of selected practices over multiple years.
Stage 2: Installation
The goal of the installation stage is to build system capacity which will support the
implemen.
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1) A five-stage scale to measure the maturity of six HIS components, from emerging to optimized.
2) An assessment tool that maps the current and desired future stages to guide improvement planning. It is administered through key informant interviews and a stakeholder workshop.
3) The goal is to help countries strengthen their HIS through a collaborative, participatory process focused on setting priorities and tracking progress over time.
Km Presentation
Knowledge management programs aim to identify, accumulate, and apply knowledge across an organization. This involves capturing both tacit knowledge within people's minds and explicit knowledge in documented form. When employees attrite, knowledge management strategies like knowledge sharing, transfer, repositories, and expert systems can help retain critical knowledge. Effective knowledge transfer requires identifying critical resources and knowledge, creating checklists, conducting training, collecting feedback, and storing knowledge in repositories for future use. Long-term success requires a culture that values knowledge sharing and a common approach to collaborative knowledge capture and reuse.
Km Presentation
Knowledge management programs aim to identify, accumulate, and apply knowledge across an organization. This involves capturing both tacit knowledge within people's minds and explicit knowledge in documented form. When employees attrite, it is important to retain critical knowledge through knowledge sharing and transfer. Effective knowledge transfer requires identifying critical resources, creating checklists of important information, conducting knowledge transfer sessions, and storing documentation in knowledge repositories for future use. Long term success requires establishing a culture that values knowledge sharing and a collaborative approach to knowledge capture and reuse.
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The document discusses various topics related to evaluating and managing innovation and risk, including:
- Effectiveness evaluation involves measuring how well targets are being met and identifying factors that help or hinder their achievement.
- Integrating different departments allows organizations to analyze risks at an early stage by combining expertise from areas like R&D, purchasing, and marketing.
- Post-implementation reviews analyze completed innovation projects to determine if goals were met, identify lessons learned, and suggest improvements for future projects.
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- The Team, Program, Value Stream, and Portfolio levels which describe the structure for agile teams, programs, large solutions, and organization-wide alignment.
- The Foundation which establishes principles, mindsets, and roles to support SAFe implementation.
- The Spanning Palette which contains roles, artifacts, and practices that can be used across levels.
- An overview of roles, activities, and practices at the Team and Program levels such as iterations, program increments, and continuous delivery.
Project management
This document provides an overview of modern project management. It defines a project, lists common project characteristics, and gives examples. It also outlines the key stages of the project life cycle: defining, planning, executing, and delivering. Additionally, it discusses the importance of project management, current trends in the field, and covers topics like feasibility studies, project selection, and software/consultancy projects. The document provides definitions and steps for conducting a feasibility study to assess the viability of a proposed project.
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Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
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7. Explain the role of peripheral chemoreceptors in regulation of respiration
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The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
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Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Parameters-It is used to describe the properties of an entire population.
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Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
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Parent guidelines one_slice
- 1. PARENT Guidelines Development process Good level. Literature review and meta-analysis (design or content has been informed by published evidence, in the literature). A wide multi- organisation and multi-stakeholder consultation process was adopted. It was carried out an external quality control process Maturity Low level. Full coverage of multiple domains. Expected to be deployed Multiple countries for cross border care. Not adopted yet by commercial solutions Trustworthiness: Medium level. Supported by European scientific or international scientific society. The asset is being held by a temporary body, and plans are in place for it to be transferred to a long-term source. The original development group, or the present asset holder, is available to provide support and guidance Support & skills: is required specialised background associated with the asset field and there are available tools able to support the definition of this class of assets Sustainability An outline business model has been developed for this asset, giving some confidence of its viability. Designed to be extended by others including feedback from open consultation into review cycles Semantic Interoperability: Maximum level. Based on standard specification. All of the nodes defined in the clinical information models and terms have been mapped to international terminologies Cost & effort: The validation and certification program is based on third party organization. The selected asset is free of charge for any purpose. It is recommended that adopters assign resources to implement new releases regularly that could be automatised to be incorporated in their system Maintainance: Change management process based on priorisation according to team leader and open consultation for evaluating complexity, gravity and feasibility of change. The update process has not planed regular updates but new releases are foreseen in the future. There are enough resources to address incidents and problems in a reasonable time