The document discusses support for living an ordinary life and using the Reach standards to evaluate supported living services. Reach involves facilitated conversations using "It's My Life" to gather people's experiences and focus groups to review the service. The results inform an action plan to improve support for choice, control and an ordinary lifestyle. Key points include focusing on human rights, considering all resources available to a person, and moving from a service model to truly supported living.
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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
9. We often hear….
Support for living
an ordinary life
‘Yep, we’ve done
supported living’
‘Yep, we’ve done
supported living’
‘We’ve de-registered’‘We’ve de-registered’
‘Supported living is
only for the most
able’
‘Supported living is
only for the most
able’
‘Supported living
means living on your
own’
‘Supported living
means living on your
own’
‘Supported living
creates loneliness’
‘Supported living
creates loneliness’
And it’s alright
we’ve got…..
‘PCPs’
‘DPs’
‘OPPs’
‘IBs’
‘PBs’
‘SDSs’
10. But what we often see and hear is……
Support for living
an ordinary life
No I didn’t
choose who I
live with.
No I didn’t
choose who I
live with.
I can’t move
can I?
I can’t move
can I?
No I didn’t
choose who
supports me.
No I didn’t
choose who
supports me.
I’m lonely.I’m lonely.
11. We think.
Supported living has developed rapidly in the UK
but not always in the way it should.
It has, in many organisations, become a service
type rather than a way of supporting people to
have real choice and control over their lives.
We think that this needs to change.
Support for living
an ordinary life
12. Some things that are in the
way
• Confusion about what supported living really is ie.
‘it = tenancy based services’
• Quality assurance systems that do not relate
inputs to outcomes in peoples lives (even if this is
the intention)
• Interpreting regulations in a way that avoids any
risk & ordinary experiences in peoples lives
• Believing that only more money can make
services better, more person centred etc.
Support for living
an ordinary life
13. We reviewed Reach with with Quality
Checkers from Choice Support Support for living
an ordinary life
15. Supported Living to Support for Living.
We want Reach: Support for living an ordinary life to achieve the
following:
•To clarify the standards of support for living to ensure that
‘supported living’ doesn’t become a model that people can simply
tick as ‘achieved’.
•To ensure that in the current climate of dwindling financial resources
and tightening budgets, we remain committed to quality support
that values the range of resources available to people, for example
the community, family, skills exchanges and friends.
•To show how Reach can be useful to people with direct payments
or personal budgets.
•To ensure that as we work to drive up quality in relation to care and
support, we focus on supporting ordinary lives based on Human
Rights.
Support for living
an ordinary life
16. Who is Reach designed for?
People use Reach for a number of reasons.
Reach can be used by:
• anyone who receives support
• families and friends
• supporters
•people living in a residential care home
•organisations that support people
• people who fund support
• organisations that are responsible for
monitoring the support people receive
Support for living
an ordinary life
19. WE MUST always consider
all the resources available to a person.
Support for living
an ordinary life
20. A set of standards relating to 3 key
questions:
1. Is each person receiving quality support for living?
2. How are the people or organisation offering
support doing in relation to Supported for Living?
3. Are the right conditions in place to help develop
good Supported for Living an ORDINARY LIFE?
The core of REACH
Support for living
an ordinary life
21. • How you live (your lifestyle)
• Who you live with (if anyone)
• Where you live
• Who supports you
• How you are supported
Supported for living is
essentially choosing Support for living
an ordinary life
22. • Learn to think outside of services and be creative in problem
solving
• Make sure that you use Person Centred Planning and/or
Individual Service Design to find out how people want to live
• Think about a wide range of housing options
• Use your own (and others’) connections, networks and
resources in thinking through support – your own friends and
acquaintances can be important
• Learn to understand the specific nature of relationships which
individual people want – we are all different
TRUE Supported for Living
23. Reach is a resource and set of standards to
encourage people to explore what support
for living an ordinary life looks like for a
person.
If changes are needed in a person’s life
Reach helps you agree the desired
changes, plan and take action together.
for living an ordinary life
Reach: Support for living an ordinary life is
NOT an assessment tool.
Support for living
an ordinary life
24. The Reach Pack (two main parts)
Support for living an ordinary life
Support for living
an ordinary life
It’s My Life can be used on it’s own
25. Support for living
an ordinary life
CQC are moving away from a compliance based
model of regulation. To get to the heart of people’s
experience of care and support they are going to ask a
new set of 5 questions. These questions are about the
quality of services, based on the things that matter to
people. They will ask the following five questions of every
service:
• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?
26.
27. The Social Care Commitment is a
voluntary agreement about
workforce quality between all
parts of the adult social care
sector in England that has been
developed by Skills for Care as
part of the response to
Winterbourne View Joint
Improvement Programme. Its
primary purpose is to ensure that
the general public are confident
that they/their families will always
be supported by skilled people
who treat them with dignity and
respect.
Employers and employees will be
asked to sign-up to 7 statements
that describe their commitments
to ensuring workforce quality.
Both employers and employees make the commitment.
The employer commitment is a promise to:
•Recruit staff who care.
•Provide thorough induction training.
•Help staff develop their skills.
•Make sure staff understand safety and quality standards.
•Take responsibility for how staff work.
•Supervise staff properly.
•Support staff to put their commitment into practice
everyday.
The employee commitment is a promise to:
•Work responsibly.
•Uphold dignity.
•Work co-operatively.
•Communicate effectively.
•Protect privacy.
•Continue to learn.
•Treat people fairly.
30. The Reach review team
Support for living an ordinary life
Support for living
an ordinary life
Family People
supported
Support
workers
Human
Resources
and
Finance
colleagues
Trustees
Managers
31. Evidence is important
Support for living an ordinary life
Support for living
an ordinary life
When doing a Reach review, you continually need to ask yourselves ‘what is
the evidence for this?’.
Most of the evidence comes from what the people you support and their
families say about how they are living their lives. Some of the evidence will
come from how you run your organisation and the values and policies you
have in place.
The starting place
is the people you
support!
The starting place
is the people you
support!
32. Evidence is important
Support for living an ordinary life
Support for living
an ordinary life
‘No two people have the same desires, expectations,
wants or needs. Each and every person is a unique
human being.
What we share is our humanity, our desire to be loved
and to belong.’
(Sally Warren, Reach)
36.
What does this standard mean? What kind of things would you see in a person’s life if
the standard being met – i.e. how would you know?
What kinds of things would you definitely not see? What kinds of things might you see in a service if it
wanted to present as though it was meeting the
standard but it was not?
In your groups discuss the standard you have been
given and think how it might be further defined.
Use the following questions to build your definition:
37. Time for action! …..
A plan is not an
outcome!
Agree action
and act.
40. Having a go
Group work
• In pairs, one person think about
someone they support/know well. The
other person work through one of the
standards with them.
• What works well and what doesn't’t –
what are the ‘top tips’ for making it
work?
41. Over to you……..
Support for living an ordinary life
Support for living
an ordinary life
How would you do against ‘this means’?
How might you best use ‘It’s My Life’?
What do you need to ensure is in place to ensure time for
real conversations?
What support might facilitators need?
How will you gather the information?
1
2
3
4
5
42. Support for living an ordinary life
Support for living
an ordinary life
E
43. Support for living an ordinary life
Support for living
an ordinary life
E
45. Talk to & look at ….
Support for living an ordinary life
Support for living
an ordinary life
46. Ten top tips for focus groups:
There’s no doubt that great focus groups require meticulous planning.
Our Top Ten Tips below can’t guarantee great groups on their own, but
they will go a long way to address common pitfalls….so:
1.Understand the questions we have provided to ensure a focus.
2.Be specific about who you need to talk with and why.
3.Ensure you invite the right people, a mixed group representing a range
of people, families and staff.
4.Agree the finish time and don’t save the most important topics until the
end.
5.Try it out with a friend or colleague.
6.Create a relaxed, positive atmosphere.
7.Be in charge of the ‘virtual’ microphone.
8.Never ask leading questions.
9.Ask open-ended questions.
10.Never assume you understand what participants mean – check it out!
47. Table 1….
What does support for living
look like?
Support for living an ordinary life
Support for living
an ordinary life
Focus groups –
a min of 2
days over a
month
Focus groups –
a min of 2
days over a
month
A group
discussion to
ensure what
good support for
living looks like
A group
discussion to
ensure what
good support for
living looks like
48. Example
Support for living
an ordinary life
It’s essential to
develop
people’s belief
in and
knowledge of
what’s possible.
49. Practice that needs to change
Support for living an ordinary life
Support for living
an ordinary life
Getting it right means Support for living
an ordinary life
51. Table 2….How are you doing?
Support for living an ordinary life
Support for living
an ordinary life
Be honest.
How are you
doing now?
Be honest.
How are you
doing now?
How can you
move from a
service to an
ordinary life?
How can you
move from a
service to an
ordinary life? How do these
questions relate
to different parts
of your
organisation?
How do these
questions relate
to different parts
of your
organisation?
53. Having a go
Group work
• In pairs work through one of the
standards.
• Can you share some examples of
where and how you are meeting some
of the ‘from a service to an ordinary
life’ ideas?
58. When ‘It’s My Life’ conversations have been
facilitated with people supported and focus
groups have been facilitated for the Service
Review, the stories and information gathered will
lead to the creation an action plan. A plna for
improvement and provide evidence for internal
and externals reporting.
When ‘It’s My Life’ conversations have been
facilitated with people supported and focus
groups have been facilitated for the Service
Review, the stories and information gathered will
lead to the creation an action plan. A plna for
improvement and provide evidence for internal
and externals reporting.
Support for living
an ordinary life
59. Support for living
an ordinary life
Top 10 Tips for success…
1. Know why you’re using it
2. Plan realistic timescales accordingly
3. Promote it as a positive tool rather
than ‘Big Brother’
4. Involve a diverse range of people, it
helps with staying honest
5. Think about how you’ll investigate –
conversations rather than questions
6. Know how you will respond to issues
60. Top 10 Tips for success…
7. Remember to celebrate success
8. Think about how you make it
meaningful to the people you
support
9. Look at it as a way to influence
change in the ‘helpful conditions’
that are not yet there
10. Believe that people have a right to
quality supported living services…
not just your definition of it
Support for living
an ordinary life
63. Choice Support are part of an exciting current development for
Quality Checkers in creating an Association of Quality Checkers .
The AQC will be a :
Membership organisation for individuals and organisations that provide
quality checking services.
The Association of Quality Checkers will :
raise the profile of Quality Checking in health and social care services
showcase best practice, themes and trends in health and social care
campaign for employment, rights and citizenship for people with disabilities
For more Information about the AQC contact SARAH MAGUIRE
Sarah.maguire@choicesupport.org.uk