Professor Sue Hill OBE, Chief Scientific Officer for Englandrightcare
We are excited to introduce the NHS Atlas of Variation in Diagnostic Services, the latest publication in the series of impressive NHS Atlases, which have highlighted variation in the provision of healthcare services.
Diagnostic services are of great importance in the NHS because, when used correctly, they support or rule out potential diagnoses, and underpin the effective and efficient management of patient pathways.
Unwarranted variation in the rates of diagnostic testing is of the utmost relevance to individual patients with the over-use, as well as under-use, of diagnostic tests being potentially serious issues. For example, effective capacity planning in imaging services should enable improved patient access balanced against the need to avoid over-use of interventions that have the potential to cause harm, such as ionising radiation.
Acute Kidney Injury (AKI)
Keeping kidneys healthy:
The national AKI programme
Dr Richard Fluck
richard.fluck@nhs.net,
National Clinical Director (Renal)
NHS England
Professor Sue Hill OBE, Chief Scientific Officer for Englandrightcare
We are excited to introduce the NHS Atlas of Variation in Diagnostic Services, the latest publication in the series of impressive NHS Atlases, which have highlighted variation in the provision of healthcare services.
Diagnostic services are of great importance in the NHS because, when used correctly, they support or rule out potential diagnoses, and underpin the effective and efficient management of patient pathways.
Unwarranted variation in the rates of diagnostic testing is of the utmost relevance to individual patients with the over-use, as well as under-use, of diagnostic tests being potentially serious issues. For example, effective capacity planning in imaging services should enable improved patient access balanced against the need to avoid over-use of interventions that have the potential to cause harm, such as ionising radiation.
Acute Kidney Injury (AKI)
Keeping kidneys healthy:
The national AKI programme
Dr Richard Fluck
richard.fluck@nhs.net,
National Clinical Director (Renal)
NHS England
Elizabeth Orton: Leicestershire’s Better Care Fund Nuffield Trust
Elizabeth Orton, Consultant in Public Health and Janine Dellar, Head of Public Health Intelligence at Leicestershire County Council present on evaluating Leicestershire's Better Care Fund programme.
Helen Southwell, Diabetes Commissioning Lead, South Worcestershire CCG,
Dr. Matthew Goodman, Chief Medical Officer, Mapmyhealth
Emma Innes, Matron Diabetes/Senior Lecturer, Worcestershire Acute Hospitals NHS Trust & University of Worcester
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This presentation was created for reporters looking for key facts, figures and views on health and social care in the run up to the general election in 2015 in the UK. It was compiled by Leonora Merry and references Nuffield Trust research and analysis throughout.
In Dr. Khan’s panel discussion, she discusses how population health management enables healthcare organizations to meet their operational, financial and clinical goals, by leveraging advanced analytics to identify critical gaps in care and streamline administrative costs. At the population-level, real-time analytics can assist hospitals, providers and ACOs to more effectively manage chronic conditions, reduce hospital admissions and readmissions, and ultimately may improve patient outcomes. She also discusses that by incorporating both real-time clinical information and claims data, providers can obtain a comprehensive view of their entire population data landscape, and thus are able to identify those with the greatest noncompliance risk and the most actionable clinical opportunities for improvement.
Elizabeth Orton: Leicestershire’s Better Care Fund Nuffield Trust
Elizabeth Orton, Consultant in Public Health and Janine Dellar, Head of Public Health Intelligence at Leicestershire County Council present on evaluating Leicestershire's Better Care Fund programme.
Helen Southwell, Diabetes Commissioning Lead, South Worcestershire CCG,
Dr. Matthew Goodman, Chief Medical Officer, Mapmyhealth
Emma Innes, Matron Diabetes/Senior Lecturer, Worcestershire Acute Hospitals NHS Trust & University of Worcester
ECO 11: Transfer of Care to Pharmacy - Hassan Argomandkhah, Chair of Pharmacy...Innovation Agency
Hassan introduces the concept and key objectives of transfer of care to pharmacy (TCP). The slides include a project outline, an overview of TCP in Cheshire and Merseyside, and the benefits and potential savings of Electronic Transfer of Care to Pharmacy.
Facts, figures and views on health and social care: A pack prepared for repor...Nuffield Trust
This presentation was created for reporters looking for key facts, figures and views on health and social care in the run up to the general election in 2015 in the UK. It was compiled by Leonora Merry and references Nuffield Trust research and analysis throughout.
In Dr. Khan’s panel discussion, she discusses how population health management enables healthcare organizations to meet their operational, financial and clinical goals, by leveraging advanced analytics to identify critical gaps in care and streamline administrative costs. At the population-level, real-time analytics can assist hospitals, providers and ACOs to more effectively manage chronic conditions, reduce hospital admissions and readmissions, and ultimately may improve patient outcomes. She also discusses that by incorporating both real-time clinical information and claims data, providers can obtain a comprehensive view of their entire population data landscape, and thus are able to identify those with the greatest noncompliance risk and the most actionable clinical opportunities for improvement.
‘Think Kidneys': Improving the management of acute kidney injury in the NHS Renal Association
‘Think Kidneys': Improving the management of acute kidney injury in the NHS
Presented by Dr Richard Fluck, National Clinical Director (Renal) – NHS England
Presentation by Terry Whalley, Director of Delivery, Cheshire & Merseyside Health & Care Partnership at ECO 19: Care closer to home on Tuesday 9 July at Deepdale Stadium.
Dr Richard Fluck - Chair of Think Kidneys spoke at HPE Live yesterday. The slides from his talk:Think(ing) Kidneys
Reducing the impact of AKI in secondary care can be found here.
Measurement for Improvement - Management of Acute Kidney Injury in primary c...Renal Association
Charlie Tomson, Consultant Nephrologist at theFreeman Hospital Newcastle upon Tyne and Chair of the Intervention Workstream, NHS England/UKRR Think Kidneys Programme
presented at a Measurement for Improvement event on 16th March.
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Tricia Cable, Year of Care Lead
Alison Phiri, Business Intelligence Manager
Mohini Chauhan, Year of Care Commissioning Manager
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NHS England ‘Think Kidneys’ programme gave a presentation:
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Similar to Patient First Conference AKI Outcomes Dan Lasserson (20)
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On 6th June, Louise Wells, Co-chair of KQuIP - the Kidney Quality Improvement Partnership presented at the Yorks and Humber Network KQuIP UK Renal Registry Support day. You can see her slides here.
At UK Kidney Week, Graham Lipkin from the Kidney Quality Improvement Partnership (KQuIP) gave a presentation on
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On Thursday 4 May, Julie Slevin, Think Kidneys Programme Development Officer spoke at the NACC conference at Haberdashers Hall in London:Raising awareness of hydration and ways to avoid Acute Kidney Injury in the care home environment
Paul Bristow, BKPA, and Karen Thomas, UKRR gave a presentation at BRS2017: Embedding patient reported experience into future QI - 1st National PREM Pilot Survey 2016
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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:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Patient First Conference AKI Outcomes Dan Lasserson
1. Workshop: acute kidney injury
commissioning and primary care
Daniel Lasserson MA MD FRCP Edin MRCGP
Co-chair Measurement Workstream, Think Kidneys
Senior Interface Physician in Acute and Complex Medicine, Oxford University Hospitals NHS
Foundation Trust
Clinical Lead, Out of Hospital Care Network, Oxford Academic Health Science Network
12 November 2015
2. Who are we?
Importance of AKI
Overview of the Think Kidneys Programme
Measurement Workstream
Outcomes commissioning
Over to you……
| 2
Plan for the Workshop
3. | 3
What is acute kidney injury?
Acute kidney injury (AKI) is a rapid deterioration of renal function,
resulting in inability to maintain fluid, electrolyte and acid-base
balance. It normally occurs in the context of other serious illness
(e.g. sepsis) on a background of risk.
4. 65% of AKI starts in the community
One in five emergency admissions to hospital will have AKI
Around 20% of AKI cases are preventable
Cost of AKI to the NHS is between £434m and £620m per annum
AKI is a global challenge – the NHS is the first health system to attempt to
tackle it
| 4
The size and scale of the problem
6. Think Kidneys objectives
Develop and implement tools and interventions for
prevention, detection, treatment and enhanced recovery
Promote effective management of AKI
Provide evidence-based education and training
programmes
Highlight importance of AKI to commissioners, health
care professionals and managers
| 6
8. The UKRR applied for National Information Governance Board’s approval to collect
patient identifiable data for AKI patients in England
Developed final specification for the master patient index (MPI) enabling the UKRR
to identify core information about the extent of AKI in England
Ensured data transfer between Trusts and UKRR was feasible; tested data and refined
format; ensured alert and creatinine files were received by UKRR
Analysis in 3 phases –
1. Reporting of data completeness,
2. Adding of date of admission to core data set and establishing link with HES,
3. Reporting data at patient level, CCG level, Trust level including incidence, progression of AKI and
other outcomes
| 8
Measurement workstream….work to date
9. Discuss with HSCIC future linkage to obtain other core data items
Link UKRR AKI dataset of RRT requirement in UK to obtain data
regarding need for RRT and non-recovery of AKI
Link with National Diabetes and CKD audit during 2016
Identify which Trusts compliant with the Patient Safety Alert, then work
with Detection to check variability and reliability of data collected
Analyse demographic information demonstrating size of at risk group
by linking with other registries/networks
Identify whether interventions have had an impact
Consider downstream consequences for AKI
| 9
Measurement workstream….next steps
10. Five domains of NHS Outcomes Framework
Preventing people from dying prematurely
Enhancing quality of life for people with LTCs
Helping people to recover from episodes of ill health
Ensuring that people have a positive experience of care
Treatment in a safe environment and protection from
harm
| 10
NHS England CCG Outcomes Indicator set 2015/6
13. | 13
NHS England CCG Outcomes Indicator set 2015/6
No AKI outcomes in Public Health Indicator outcome set
14. For each patient with AKI
• Where were they managed?
– Acute trust
– Community
• Which CCG were they in?
• Which acute hospital (if admitted)?
• Mortality
• Did their creatinine return to baseline?
– If so, when?
| 14
What can the Measurement Workstream deliver?
15. For each acute hospital trust
• Mortality
– Age, AKI stage, measures of clinical complexity
• Return of creatinine to baseline level
– Time to return
| 15
What can the Measurement Workstream deliver?
16. For each CCG
• Proportion of patients with AKI who are admitted
• Mortality
– Age, AKI stage, measures of clinical complexity
• Return of creatinine to baseline level
– Time to return
| 16
What can the Measurement Workstream deliver?
18. Can we select outcomes for commissioning?
• None of these are patient reported outcomes – is there one?
If so should they be….
–Monitored?
–Incentivised?
| 18
Commissioning for Outcomes after AKI
19. • Uses and abuses of performance data
• Dr Foster Ethics Committee Report
– Data quality is as important as ‘hitting the target’
– Measure the context and the indicator
– Avoid thresholds
– Be open
| 19
Outcomes contracts
20. Dan Lasserson
Co-chair, Measurement Workstream
Senior Interface Physician in Acute and Complex
Medicine
Oxford University Hospitals NHS Foundation Trust
Daniel.Lasserson@ouh.nhs.uk
| 20
Thank you
www.linkedin.com/company/think-kidneys
www.twitter.com/ThinkKidneys
www.facebook.com/thinkkidneys
www.youtube.com/user/thinkkidneys
www.slideshare.net/ThinkKidneys
www.thinkkidneys.nhs.uk
Editor's Notes
Focused on:
Who: who is at risk, vulnerable population, important triggers
When: when do people sustain AKI, how is early diagnosis supported
How: how should AKI be managed, prevention+treatment+recovery
What: what do people need to know, public patients/carers, professionals