This document discusses the importance of electronic health records and clinical decision support systems for improving healthcare quality and reducing costs and errors. It notes that healthcare information is essential for providing and managing patient care. Clinical decision support systems can help ensure best practices are followed and reduce unnecessary tests and costs. However, the document also finds that healthcare practices still vary greatly between regions and clinicians due to complexity, uncertainty and lack of evidence. More high-quality data and decision support are needed to address these issues and improve consistent high-value care.
Big Data Analytics using in Healthcare Management Systemijtsrd
Big data is the new technology for healthcare management system. Present day's big data analytics are using in everywhere because of its good data management and its large storage capacity. In hospital managements the patients and doctors record keeping safe is the important role in healthcare system. In worldwide the big data method is extended use in the area of medicine and healthcare system. In this sector so many problems are there in implementing big data in healthcare system especially in relation to securities, privacy matters, standard records, good governance, managing of data, data storing and maintenance, etc. It is critical that these challenges to overcome before big data can be implemented successfully in healthcare. The amount of data being digitally collected and stored safely in big data Hadoop clusters. This paper introduces healthcare data, big data in healthcare systems, applications, advantages, issues of Big Data analytics in healthcare sector. Gagana H. S | Bhavani B. T | Gouthami H. S "Big Data Analytics using in Healthcare Management System" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-4 , June 2020, URL: https://www.ijtsrd.com/papers/ijtsrd31014.pdf Paper Url :https://www.ijtsrd.com/computer-science/other/31014/big-data-analytics-using-in-healthcare-management-system/gagana-h-s
Determinants Of Nurse-Midwives Related Factors On Computer Technology Utilization In Nursing Practice Among Nurse - Midwives In Kwale County, Kenya
DOI Number: 10.29322/IJSRP.10.04.2020.p10078
Personal Health Record Management SystemYogeshIJTSRD
Good health is one of the most valuable resources for a human being. Large scale technological advancements have significantly improved human health by a large margin. But there are still several diseases whose symptoms are highly painful and debilitating for a patient. The doctor is in charge of facilitating an effective diagnosis of the patients illness and providing relief to the patient through various medications. For this purpose, the doctor has at his disposal repository of information in the form of PHR or Public Health Records which can be utilized for querying the symptoms experienced by the patient. Sometimes the Medical Institute does not have the PHR with the exact parameters and symptoms described by the patient. Due to the deficiency in the PHR database, the doctor can employ the use of a data aggregator or vendor for fulfilling the requirement from other medical institutions. The problem in this approach is that there is a lack of trust between the medical Institutions and the data aggregators, as PHR can contain sensitive and personally identifiable information that cannot be shared easily. Therefore, this Publication details the implementation of an effective access control mechanism through the use of the distributed blockchain framework along with the introduction of K means clustering and entropy analysis catalyst by the artificial neural network to alleviate the trust issues. Extensive experimentation on the proposed methodology has confirmed its superiority in comparison to the conventional approaches. Chinmayee Y. Raut | Bushra R. Inamdar | Prof. R. G. Yelalwar "Personal Health Record Management System" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-3 , April 2021, URL: https://www.ijtsrd.com/papers/ijtsrd39900.pdf Paper URL: https://www.ijtsrd.com/engineering/computer-engineering/39900/personal-health-record-management-system/chinmayee-y-raut
Big Data Analytics using in Healthcare Management Systemijtsrd
Big data is the new technology for healthcare management system. Present day's big data analytics are using in everywhere because of its good data management and its large storage capacity. In hospital managements the patients and doctors record keeping safe is the important role in healthcare system. In worldwide the big data method is extended use in the area of medicine and healthcare system. In this sector so many problems are there in implementing big data in healthcare system especially in relation to securities, privacy matters, standard records, good governance, managing of data, data storing and maintenance, etc. It is critical that these challenges to overcome before big data can be implemented successfully in healthcare. The amount of data being digitally collected and stored safely in big data Hadoop clusters. This paper introduces healthcare data, big data in healthcare systems, applications, advantages, issues of Big Data analytics in healthcare sector. Gagana H. S | Bhavani B. T | Gouthami H. S "Big Data Analytics using in Healthcare Management System" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-4 , June 2020, URL: https://www.ijtsrd.com/papers/ijtsrd31014.pdf Paper Url :https://www.ijtsrd.com/computer-science/other/31014/big-data-analytics-using-in-healthcare-management-system/gagana-h-s
Determinants Of Nurse-Midwives Related Factors On Computer Technology Utilization In Nursing Practice Among Nurse - Midwives In Kwale County, Kenya
DOI Number: 10.29322/IJSRP.10.04.2020.p10078
Personal Health Record Management SystemYogeshIJTSRD
Good health is one of the most valuable resources for a human being. Large scale technological advancements have significantly improved human health by a large margin. But there are still several diseases whose symptoms are highly painful and debilitating for a patient. The doctor is in charge of facilitating an effective diagnosis of the patients illness and providing relief to the patient through various medications. For this purpose, the doctor has at his disposal repository of information in the form of PHR or Public Health Records which can be utilized for querying the symptoms experienced by the patient. Sometimes the Medical Institute does not have the PHR with the exact parameters and symptoms described by the patient. Due to the deficiency in the PHR database, the doctor can employ the use of a data aggregator or vendor for fulfilling the requirement from other medical institutions. The problem in this approach is that there is a lack of trust between the medical Institutions and the data aggregators, as PHR can contain sensitive and personally identifiable information that cannot be shared easily. Therefore, this Publication details the implementation of an effective access control mechanism through the use of the distributed blockchain framework along with the introduction of K means clustering and entropy analysis catalyst by the artificial neural network to alleviate the trust issues. Extensive experimentation on the proposed methodology has confirmed its superiority in comparison to the conventional approaches. Chinmayee Y. Raut | Bushra R. Inamdar | Prof. R. G. Yelalwar "Personal Health Record Management System" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-3 , April 2021, URL: https://www.ijtsrd.com/papers/ijtsrd39900.pdf Paper URL: https://www.ijtsrd.com/engineering/computer-engineering/39900/personal-health-record-management-system/chinmayee-y-raut
The Paperless partograph – The new user-friendly and simpler tool for monitor...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
AN IMPROVED MODEL FOR CLINICAL DECISION SUPPORT SYSTEMijaia
Misguided information in health care has caused much havoc that have led to the death of millions of people as a result of misclassification, and inconsistent health care records; hence the objective of this paper is to develop an improved clinical decision support system. This system incorporated hybrid system
of non-knowledge based and knowledge based decision support system for the diagnosis of diseases and proper health care delivery records using prostate cancer and diabetes datasets to train and validate the model. The min-max method was adopted in normalizing the datasets, while genetic algorithm was
deployed in initiating the training weights of the MLP. The result obtained in this paper yielded a classification accuracy of 98%, sensitivity of 0.98 and specificity of 100 for prostate cancer and accuracy of 94%, sensitivity of 0.94 and specificity of 0.67 for diabetes.
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.There are a total of thirteen hospitals included in this review. These facilities have implemented vitals capture and the MEWS scoring system.
Data Science Deep Roots in Healthcare IndustryDinesh V
Data Science transforms the healthcare industry with impeccable solutions that can improve patient care through EHRs, medical imaging, drug discovery, predictive medicines and genetics and genomics.
“The phrase ‘Never Events’ now evokes strong feelings in both medical and consumer circles. The Picker Institute has seized the concept and stood it on its head to come up with the notion of ‘Always Events.’ Picker is looking to identify those elements of the health care experience that should always happen from a humanistic perspective.”
Dr. James is medical director of Humana’s National Network Operations and practices Pediatrics/Internal Medicine at Normton Community Medical Associates-Audubon West.
Precision Medicine: Opportunities and Challenges for Clinical TrialsMedpace
The momentum and muscle behind "finding the right drug for the right patient at the right dose" has further escalated with President Barack Obama’s announcement of a $215 million dollar Precision Medicine Initiative earlier this year. In this webinar, Dr. Frank Smith will explore advances in precision medicine and how it is affecting clinical research. As a pediatric hematologist/oncologist, he will use his extensive clinical and research background as a backdrop for the discussion.
Topics will include:
The evolution of "personalized medicine" to "precision medicine"
How state-of-the-art molecular biology is creating new diagnostic and prognostic strategies
How these new strategies are helping inform the design of clinical trials
Case study: How precision medicine is improving clinical trials in hematology and oncology
Societal Homophobia, EDCI 886, Fall 2010Joelyn K Foy
This is my second social problem paper for Perspectival Philosophy: Social Reconstruction, where education is seen as the method and pathway for social reconstruction as advocated by Harold Rugg, George Counts, and Theodore Brameld, among others.
The Paperless partograph – The new user-friendly and simpler tool for monitor...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
AN IMPROVED MODEL FOR CLINICAL DECISION SUPPORT SYSTEMijaia
Misguided information in health care has caused much havoc that have led to the death of millions of people as a result of misclassification, and inconsistent health care records; hence the objective of this paper is to develop an improved clinical decision support system. This system incorporated hybrid system
of non-knowledge based and knowledge based decision support system for the diagnosis of diseases and proper health care delivery records using prostate cancer and diabetes datasets to train and validate the model. The min-max method was adopted in normalizing the datasets, while genetic algorithm was
deployed in initiating the training weights of the MLP. The result obtained in this paper yielded a classification accuracy of 98%, sensitivity of 0.98 and specificity of 100 for prostate cancer and accuracy of 94%, sensitivity of 0.94 and specificity of 0.67 for diabetes.
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.There are a total of thirteen hospitals included in this review. These facilities have implemented vitals capture and the MEWS scoring system.
Data Science Deep Roots in Healthcare IndustryDinesh V
Data Science transforms the healthcare industry with impeccable solutions that can improve patient care through EHRs, medical imaging, drug discovery, predictive medicines and genetics and genomics.
“The phrase ‘Never Events’ now evokes strong feelings in both medical and consumer circles. The Picker Institute has seized the concept and stood it on its head to come up with the notion of ‘Always Events.’ Picker is looking to identify those elements of the health care experience that should always happen from a humanistic perspective.”
Dr. James is medical director of Humana’s National Network Operations and practices Pediatrics/Internal Medicine at Normton Community Medical Associates-Audubon West.
Precision Medicine: Opportunities and Challenges for Clinical TrialsMedpace
The momentum and muscle behind "finding the right drug for the right patient at the right dose" has further escalated with President Barack Obama’s announcement of a $215 million dollar Precision Medicine Initiative earlier this year. In this webinar, Dr. Frank Smith will explore advances in precision medicine and how it is affecting clinical research. As a pediatric hematologist/oncologist, he will use his extensive clinical and research background as a backdrop for the discussion.
Topics will include:
The evolution of "personalized medicine" to "precision medicine"
How state-of-the-art molecular biology is creating new diagnostic and prognostic strategies
How these new strategies are helping inform the design of clinical trials
Case study: How precision medicine is improving clinical trials in hematology and oncology
Societal Homophobia, EDCI 886, Fall 2010Joelyn K Foy
This is my second social problem paper for Perspectival Philosophy: Social Reconstruction, where education is seen as the method and pathway for social reconstruction as advocated by Harold Rugg, George Counts, and Theodore Brameld, among others.
Dr Brent James: quality improvement techniques at the frontlineNuffield Trust
Dr Brent James, Intermountain Institute for Healthcare Delivery Research, presents to the Health Policy Summit 2015 on delivering quality improvement techniques at the frontline.
The Learning Health System: Thinking and Acting Across ScalesPhilip Payne
A Learning Health System (LHS) can be defined as an environment in which knowledge generation processes are embedded into daily clinical practice in order to continually improve the quality, safety, and outcomes of healthcare delivery. While still largely an aspirational goal, the promise of the LHS is a future in which every patient encounter is an opportunity to learn and improve that patient’s care, as well as the care their family and broader community receives. The foundation for building such an LHS can and should be the Electronic Health Record (EHR), which provides the basis for the comprehensive instrumentation and measurement of clinical phenotypes, as well as a means of delivering new evidence at the patient- and population levels. In this presentation, we will explore the ways in which such EHR-derived phenotypes can be combined with complementary data across a spectrum from biomolecules to population level trends, to both generate insights and deliver such knowledge in the right time, place, and format, ultimately improving clinical outcomes and value.
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
3. Some Definitions. Information is not a necessary adjunct to care, it is care , and effective patient management requires effective management of patients’ clinical data. Donald M. Berwick President and CEO, Institute for Healthcare Improvement There is no health without management, and there is no management without information. WHO-Gonzalo Vecina Neto, head of the Brazilian National Health Regulatory Agency Information is necessary to provide and manage health care at all levels , from individual patients to health care systems to national Ministries of Health (MOH). W.Tierney. Dir. Regenstrief Institute. So what is eHealth? The World Health Organization (WHO) definition: “ e-Health is the combined use of electronic communication and information technology in the health sector.”
31. After Hours Resource Utilisation - 1998/99 (PRH0s-UK.) 87% Unnecessary out-of-hours tests 80% Diagnostic uncertainty 79% Medico-legal protection 66% Avoid leaving work for colleagues 71% Prevent criticism from staff (especially Consultants) 76% Lessen anxiety and reduce stress levels 71% Agreed attempts should be made to reduce unnecessary testing McConnell AA , Bowie P . Health Bull (Edinb). 2002 Jan;60(1):40-3. Unnecessary out-of-hours biochemistry investigations--a subjective view of necessity.
32. THE VARIATION PHENOMENON “ The variation phenomenon in modern medicine -the observation of differences in the way apparently similar patients are treated from one health care setting to another.” D. Blumenthal. Editorial NEJM 331:1994;1017-8
33.
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35. IHC TURP QUE Study-Grams excised vs. Time variation
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39. Better Health Worse Health Less state spending Less state spending Individual US States
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41. Variation 2008 The wide variation in medical prices within U.S. markets that creates an opportunity for transparency to reduce spending. This variation exists even for relatively common procedures. New Hampshire-2008 Average payment for arthroscopic knee surgery - $2,406 with a standard deviation of $1,203 in hospital settings and $2,120 with a standard deviation of $1,358 in nonhospital settings. Tu HA, Lauer JR. Impact of health care price transparency on price variation: the New Hampshire experience. Issue brief no. 128. Washington, DC: Center for Studying Health System Change, 2009. Massachusetts- Median hospital cost in 2006 and 2007 for magnetic resonance imaging (MRI) of the lumbar spine, performed without contrast material, ranged from $450 to $1,675.2 Massachusetts Division of Healthcare Finance and Policy. Measuring healthcare quality and cost in Massachusetts. ( http://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/09/measuring_hc_quality_cost_mass_nov-09.pdf .)
42.
43. USING PHYSICIAN INPATIENT ORDER WRITING ON MICROCOMPUTER WORKSTATIONS. REDUCTION IN HEALTH CARE RESOURCE UTILISATION Physician inpatient order writing on microcomputer workstations-effects on resource utilisation. WM Tierney and others. JAMA 1993;269:379-383
44. USING PHYSICIAN INPATIENT ORDER WRITING ON MICROCOMPUTER WORKSTATIONS. REDUCTION IN HEALTH CARE RESOURCE UTILISATION Physician inpatient order writing on microcomputer workstations-effects on resource utilisation. WM Tierney and others. JAMA 1993;269:379-383 $3 million per year savings- (USA $65b)
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47. Nurse Physician Pharmacist Physician Pharmacy Nurse/Clerk Physician Pharmacist Patient Physician Dietician ADE Rate Route Nurse Dose Dilution Time Wrong drug Spelling Scheduling Transcribing Dosage Route Order missed Psychic Compliance Neural Age Gender Electrolyte Hepatic Race Weight Renal Past Allergic Reaction Absorption Drug/Drug Unforeseen Drug/Food Drug/Lab Expected Hemal Brand name vs.. Generic Drug Administration Errors Ordering Errors Patient Physiologic Factors Pharmacological Factors Cause and effect of potential causes of ADEs. (From L.Grandia. IHC,Utah-with permission)
48. Nurse Physician Pharmacist Physician Pharmacy Nurse/Clerk Physician Pharmacist Patient Physician Dietician ADE Rate Route Nurse Dose Dilution Time Wrong drug Spelling Scheduling Transcribing Dosage Route Order missed Psychic Compliance Neural Age Gender Electrolyte Hepatic Race Weight Renal Past Allergic Reaction Absorption Drug/Drug Unforeseen Drug/Food Drug/Lab Expected Hemal Brand name vs.. Generic Drug Administration Errors Ordering Errors Patient Physiologic Factors Pharmacological Factors Cause and effect of potential causes of ADEs. (From L.Grandia. IHC,Utah-with permission) 60% Administration errors Occur between written orders and nurse administration
49. Computerized surveillance of adverse drug events in hospital patients Classen DC, Pestotnik SL, Evans RS, Burke JP. JAMA 1991;266:2847-2851.
50. ADVERSE EVENTS -IDENTIFICATION AND PREVENTION Potential identifiability and preventability of adverse events using information systems. D Bates et.al J Am Med Informatics Assoc. 1994;1:404-411 “ Most hospitals rely on spontaneous voluntary reporting to identify adverse events, but this method overlooks more than 90% of adverse events detected by other methods............... Retrospective chart review improves the rate of adverse event detection but is expensive and does not facilitate prevention .”
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53. Intermountain Health Care, Salt Lake City, Utah, USA Overall antibiotic use: d ecreased 22.8% Mortality rates: decreased from 3.65% to 2.65% Antibiotic-associated ADE: decreased 30% Antibiotic resistance: remained STABLE Appropriately timed preoperative a/biotics: 40% to 99.1% Antibiotic costs per treated patient: decreased $122.66 to $51.90 Acquisition costs for antibiotics: fell 24.8% to 12.9% ($987,547) to ($612,500) Our case-mix index which measures patient acuity levels INCREASED during this period, meaning we were treating sicker and sicker patients while better utilizing the delivery of antibiotics. Pestotnik, S. L. Classen, D. C. Evans, R. S. Burke, J. P. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes.Ann Intern Med 1996 May 15
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55. Not all HIT are beneficial. There were also some instances in which relationships in the opposite direction were found; for example, electronic documentation was associated with a 35% increase in the risk of complications in patients with heart failure, though this may have been present because it was easier to find these events since better documentation was present. 1. Bates DW. ARCH INTERN MED/VOL 169 (NO. 2), JAN 26, 2009 Editorial 2. Amarasingham R, Plantinga L, Diener-West M, Gaskin DJ, Powe NR. Clinical information technologies and inpatient outcomes: a multiple hospital study. Arch Intern Med . 2009;169(2):108-114.
56. Questions. 1. Are the technologies—computer order entry, decision support, and clinical documentation—sufficiently mature that hospitals should be adopting them now? Bates: the answer is a clear yes for large hospitals. For smaller hospitals, which use a different set of vendors, the answer is less clear, but studies are currently under way that should provide additional information regarding this. 2. For clinical documentation, the benefits are still only beginning to be determined and are likely to be spread across a wide range of areas, but this will likely prove to be beneficial as well. Bates DW. REPRINTED) ARCH INTERN MED/VOL 169 (NO. 2), JAN 26, 2009 WWW.ARCHINTERNMED.COM Amarasingham R, Plantinga L, Diener-West M, Gaskin DJ, Powe NR. Clinical information technologies and inpatient outcomes: a multiple hospital study. Arch Intern Med . 2009;169(2):108-114.
57. Do the negative consequences of implementing HIT in hospitals overwhelm or wash out the positive ones? Current evidence is that they do not overall. EVALUATION is critical with technology after implementation and making multiple changes to it—points that are all too often ignored. Bates DW. ARCH INTERN MED/VOL 169 (NO. 2), JAN 26, 2009
69. WHO/Evelyn Hockstein At every monthly check-up patients are given their charts and hand-carry them to the nurse, clinical officer and other providers they are seeing that day. Updates to the chart are made at each station. WHO/Evelyn Hockstein Clinical officers like Lillian Boit provide most patient care and maintain charts. "The electronic record-keeping system allows us to provide care to more people and take better care of patients", she says. http://www.who.int/features/africaworking/en/index.html
70. WHO/Evelyn Hockstein Outreach workers download completed forms into Mosoriot clinic's data management system daily. Automated alerts flag any alarming new symptoms to the attention of the responsible clinical officer, or when a patient has missed an appointment so that outreach workers can find out what is wrong. An innovative home-care programme using hand-held computers is also being piloted in the region. Monica Korir, who is living with HIV and is trained as an outreach worker, interviews Paul Ekorok, 52, at his home in Captarit village and records his answers.
72. Besides antiretroviral drugs (which are provided by USAID), care by AMPATH cost only $175/patient/year in 2007 and is now less than $100/patient/year in 2009. P. Park, et al., Case Report: The Academic Model for the Prevention and Treatment of HIV/AIDS . Harvard Business School, Boston, 2008. In addition to the monthly, quarterly, and annual reports required by funding and agencies and the MOH, the AMRS also provides data to a robust multidisciplinary research program: Researchers from more than a dozen North American universities and Moi University currently have more than 30 ongoing studies in East Africa, supported by >$26 million in grants from U.S. federal granting agencies and various foundations.
81. OpenMRS sites – Spring 2010 http://openmrs.org/wiki/Summary_of_OpenMRS_Implementation_Sites
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83. Implementation Time Frames and support. It took us about 6 weeks … to configure our ER and Surgery modules in OpenMRS. … Thanks again to Andy at MVP and James at HAS among others for considerable guidance and support … There are only a couple of us working on this project at MSF with limited resources, and without the help of the implementers group we would have been stopped in our tracks. On June 1 we went live with the production database in Port au Prince. … the system is run by local staff with limited technical training . … Overall we have been impressed with the stability of OpenMRS on Linux; server reboots are sometimes necessary once or twice a day because of Tomcat memory errors. With three months of data in the system now and stability and output tried and true … Thanks. John John Brooks. Médecins Sans Frontières (MSF)/Doctors Without Borders
87. Features This is an incomplete list of OpenMRS features “out of the box”. Our many add-on modules make it easy to infinitely expand and extend the system. Central concept dictionary: Definitions of all data (both questions and answers) are defined in a centralized dictionary, allowing for robust, coded data Currently, the AMRS (Kenya) contains 50 million observations from 2 million visits to 23 AMPATH clinics by >100,000 HIV-infected patients. (Oct 2010) Google Workshop-OpenMRS® - Is a community-developed, open-source, enterprise electronic medical record system platform and the most widely used EMR in the developing world.
88. Features of OpenMRS Security: User authentication Privilege-based access: User roles and permission system Patient repository: Creation and maintenance of all patient data, Multiple identifiers per patient: A single patient may have multiple medical record numbers Data entry: With the FormEntry module, clients with InfoPath (included in Microsoft Office 2003 and later) can design and enter data using flexible, electronic forms. With the HTML FormEntry module, forms can be created with customized HTML and run directly within the web application. Data export: Data can be exported into a spreadsheet format for use in other tools (Excel, Access, etc.) Standards support: HL7 engine for data import Modular architecture: An OpenMRS Module can extend and add any type of functionality to the existing API and web app.
89. Patient workflows: An embedded patient workflow service allows patient to be put into programs (studies, treatment programs, etc.) and tracked through various states. Cohort management: The cohort builder allows you to create groups of patients for data exports, reporting, etc. Relationships: Relationships between any two people (patients, relatives, caretakers, etc.) Patient merging: Merging duplicate patients Localization / internationalization: Multiple language support and the possibility to extend to other languages with full UTF-8 support. Support for complex data: Radiology images, sound files, etc. can be stored as “complex” observations Reporting tools : Flexible reporting tools Person attributes: The attributes of a person can be extended to meet local needs
90. Not all smooth sailing! A number of unintended adverse consequences that have followed CPOE implementation. Unfavourable workflow issues, Continuous demands for system change, Untoward changes in communications patterns and practices Generation of new kinds of medical errors, Negative emotional responses to the system by clinicians. Physician resistance can derail costly, complex CPOE projects . Campbell EM, Sittig, DF, Ash JS, et al. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2006 Sept-Oct;13(5):547-556.
91. One of the answers to these questions are to be found in the CULTURE OF MEDICINE Deeply rooted customs and training High standards of autonomous individual performance A commitment to progress through research-lead to advances in biomedical science and cures to millions. However ……. These advances have created challenges to safety not faced by other hazardous industries. Five Years After To Err Is Human. What Have We Learned? JAMA. 2005;293:2384-2390
92. “ It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than the creation of a new system. For the initiator has the enmity of all who would profit by the preservation of an old institution and merely lukewarm defenders in those who would gain by the new ones,” Machiavelli., Niccolo 1532.
These are defined goals required for any EMR system and are taken from the review if effective EMR developments that have occurred during the last 25-30 years,in Volume 54 of the IJMI in 1999.
Compliments previous slide.
In a 1999 review of the major EMR systems in the world that are the models for future EMRs, these were the data/information and performance values for the Regenstrief system in Indian. They emphasize that technology is not the problem for EMRs and information retrieval must function at these levels of recall time.
The next two slides document the results of the studies (I & II) into negligence by the Harvard group and reflect outcomes of the clinical decision making process. Clinical decision making is not the sole element here but can be seen as a major factor.
Slide taken from the keynote address by Larry Grandia (IHC, Utah) demonstrating the relationship of health care costs to the remainder of the economy. In Western economies the effect of health costs on the economy are virtually the same and are not dependent upon the health funding mechanisms whether public, private or both.
Another manifestation of the information overload problem is variation in health care. Brent James from IHC in Utah (based on the HELP computer-based record) defines random variation and inappropriate variation and the reasons why this occurs and possible solutions.
The variation found in average hospital costs for UNCOMPLICATED TURP. All patients had the same co-morbidities.
Same TURP group with LOS variation.
Same group demonstrating the variation in surgeons relating the time taken to remove a specific mass of prostate tissue. The study demonstrated that there was variation within the individual surgeons activities. All surgeons considered they were performing the same prior to the study.
Brent James summary of the the reasons for practice variation. All these factors involve complex decision making in an information rich environment.
This study in 1973 looked a the variation in health care across 20 health care locations in Vermont where it was considered care was of similar standards. The authors found a wide variation in the use of clinical resources for items that cost less than $20 each-refer to study by Johns and Blum. We see here the continuing link between decisions-resource utilization-costs.
Core decision support tools for all E.H.Rs regardless of the complexity of the decision support required.
Tierney’s study into the use of of a longitudinal CBPR to reduce resource utilization. (Refer to the Johns and Blum study on costs, resource utilization, and clinical decision making)
Tierney’s study into the use of of a longitudinal CBPR to reduce resource utilization. (Refer to the Johns and Blum study on costs, resource utilization, and clinical decision making)
Title change to match next slide.
This is a flow diagram of all the elements that are potentially involved in the production of and Adverse Drug Event. It demonstrates all the points where decision making can fail.
This is a study of 38,000+ patients over an 18 month period comparing ADE detection between the paper record and the EMR which is able to integrate most of the data and information contributing to ADE. Column 1-traditional paper record. Column 2-nurse enhanced reporting from the paper record. Column 3- Computer surveillance-columns 2 & 3 (610) are life-threatening events. Column 1.-traditional record 9 ADE Column 2. – Nurse scrtutinization of the record 21 ADE Column 3 – EMR integration of ALL elements contributing to the ADE. 731 ADE of which 703 were considered life-threatening!
Conclusions drawn from a similar study to the previous slide by Bates from Brigham's & Women's Hospital in Boston. It is self-explanatory and confirms the inadequacy of the paper chart and its ability to support clinical decision making and is costly.
Slides 114-122 display the results of the above study. It is important to look at this study from many aspects. The size of the study (not possible with a paper-based record-time, costs, data accuracy), the alteration of process, the measurements of outcome, the definition of patient cohorts. This is the only institution that has shown the stabilization of antibiotic resistance – a major problem with antibiotic usage. The study also demonstrates that the rewards from CBPR systems are the result of an INCREMENTAL process with verification of benefits and or failures along the way.
At the time, there was a lot of work to be done.
OpenMRS was created in response to HIV/AIDS. Indiana University School of Medicine had been collaborating with Moi University Faculty of Health Sciences (Eldoret, Kenya) for over a decade when their focus, by necessity, turned toward the HIV pandemic.
But patients like Musa, who you’ve already met, showed that HIV was a treatable disease. The problem wasn’t how to treat HIV, but how to scale that up to 100,000 and millions of patients. That kind of scale could only be obtained through effective information management.
So, OpenMRS is an EMR, a data model (some folks have chosen to simply use our data model and build their own system), an API, an HIV system, a TB system, a Primary Care system, a strong developer community, and a vibrant implementer community. We’re all in this together.
And we’ve already seen evidence of the flexibility of a platform approach. Folks in Maryland have wired a different primary care system atop the OpenMRS API, so docs work within another system, but all data are stored within an instance of OpenMRS. Shaun Grannis developed a disease surveillance system using OpenMRS. In Skid Row of Los Angeles, OpenMRS is being used to manage data for homeless patients with TB. And Paul’s pediatric decision support system has been rebuilt and now runs within OpenMRS.