1) The document discusses the responsibilities of family doctors in regards to justification and optimization of medical imaging according to the European BSS 2013 guidelines. It describes how family doctors can contribute to ensuring imaging examinations are justified based on clinical need and protocols are optimized to reduce radiation exposure.
2) The document outlines various ways family doctors can help with risk assessment, communication, and management including sharing guidelines, communicating with specialists, collecting patient exposure histories, and involving patients in decision making.
3) WONCA commits to cooperation across stakeholders to promote radiation protection culture through education and establish clear justification processes and clinical imaging guidelines.
Ref: References & Teaching Materials:
• Green, M. A. and Bowie, M. J. (2005). Essentials of Health Information
Management, Principles and Practices. Clifton Park, NY: Delmar Learning.
ISBN: 9780766845022.
Objectives
At the end of this chapter, the student should be able to:
List and define hospital categories
Identify types of hospital patients
Differentiate among freestanding, hospital-based, and hospital-owned ambulatory care settings
Distinguish among various types of behavioral health care facilities
Detail services provided by a home care agency
Describe the goal of hospice care
Explain the various types of long-term care
Differentiate between the various managed care models
Name and describe of governmental health care facilities
Compare the responsibilities of agencies within the Public Health Services
The Patient Record: Hospital, Physician Office, and Alternate Care Settings
Reference: Michelle Green and Mary Jo BOWIE
At the end of this chapter,
the student should be able to:
Differentiate among various types of patient records
Summarize the purpose of the patient record
Provide examples of administrative and clinical data
Delineate provider documentation responsibilities
Summarize the development of the patient record
Explain the correct method for correcting documentation
Distinguish between manual and automated record formats
Discuss the importance of authentication of records
Compare alternative storage methods
Summarize patient record completion responsibilities
Resource Nurse Program.A Nurse-Initiated, Evidence-Based Program to Eliminate...GNEAUPP.
✔ El programa Enfermera de Recursos alienta al personal de enfermería a explorar los factores causales relacionados con el desarrollo de la PU.
✔ enseñanza / aprendizaje de igual a igual es una estrategia efectiva para llegar a las enfermeras de cabecera.
✔ Las enfermeras de recursos tienen el poder de cambiar la práctica.
✔ El programa de la enfermera de recursos es una manera rentable de reducir Hapus.
Ref: References & Teaching Materials:
• Green, M. A. and Bowie, M. J. (2005). Essentials of Health Information
Management, Principles and Practices. Clifton Park, NY: Delmar Learning.
ISBN: 9780766845022.
Objectives
At the end of this chapter, the student should be able to:
List and define hospital categories
Identify types of hospital patients
Differentiate among freestanding, hospital-based, and hospital-owned ambulatory care settings
Distinguish among various types of behavioral health care facilities
Detail services provided by a home care agency
Describe the goal of hospice care
Explain the various types of long-term care
Differentiate between the various managed care models
Name and describe of governmental health care facilities
Compare the responsibilities of agencies within the Public Health Services
The Patient Record: Hospital, Physician Office, and Alternate Care Settings
Reference: Michelle Green and Mary Jo BOWIE
At the end of this chapter,
the student should be able to:
Differentiate among various types of patient records
Summarize the purpose of the patient record
Provide examples of administrative and clinical data
Delineate provider documentation responsibilities
Summarize the development of the patient record
Explain the correct method for correcting documentation
Distinguish between manual and automated record formats
Discuss the importance of authentication of records
Compare alternative storage methods
Summarize patient record completion responsibilities
Resource Nurse Program.A Nurse-Initiated, Evidence-Based Program to Eliminate...GNEAUPP.
✔ El programa Enfermera de Recursos alienta al personal de enfermería a explorar los factores causales relacionados con el desarrollo de la PU.
✔ enseñanza / aprendizaje de igual a igual es una estrategia efectiva para llegar a las enfermeras de cabecera.
✔ Las enfermeras de recursos tienen el poder de cambiar la práctica.
✔ El programa de la enfermera de recursos es una manera rentable de reducir Hapus.
Knowledge and Practice of Documentation among Nurses in Ahmadu Bello Universi...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
The ESMO-ECPC Cancer Survivorship Guide and Cancer Survivorship Plan is a unique care and cancer advocacy tool.
Cancer patient advocates can include it in their work.
A global challenge to reduce harm and save livesProqualis
Apresentação de Itziar Larizgoitia Jauregui durante o
Itziar Larizgoitia Jauregui é médica, nascida na Espanha, com atuação em Saúde Pública, com mestrado nessa área e Doutorado em Políticas e Gestão da Saúde. Nos últimos 13 anos, tem atuado como membro da Organização Mundial da Saúde (OMS) em Genebra, Suíça. No total, são mais de 20 anos de experiência nas áreas de Qualidade e Segurança do Paciente, Organização e Reforma de sistemas de saúde.
A physician led bedside wound care program in post acute care reduces wound related hospitalizations, infections, and amputations over 85% and saves Medicare over $19,000 per patient.
Knowledge and Practice of Documentation among Nurses in Ahmadu Bello Universi...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
The ESMO-ECPC Cancer Survivorship Guide and Cancer Survivorship Plan is a unique care and cancer advocacy tool.
Cancer patient advocates can include it in their work.
A global challenge to reduce harm and save livesProqualis
Apresentação de Itziar Larizgoitia Jauregui durante o
Itziar Larizgoitia Jauregui é médica, nascida na Espanha, com atuação em Saúde Pública, com mestrado nessa área e Doutorado em Políticas e Gestão da Saúde. Nos últimos 13 anos, tem atuado como membro da Organização Mundial da Saúde (OMS) em Genebra, Suíça. No total, são mais de 20 anos de experiência nas áreas de Qualidade e Segurança do Paciente, Organização e Reforma de sistemas de saúde.
A physician led bedside wound care program in post acute care reduces wound related hospitalizations, infections, and amputations over 85% and saves Medicare over $19,000 per patient.
My talk at the Scientific Research Day of Medical colleges, UQU
5 March 2019
where I presented my publication (Patient-Centered Pharmacovigilance: A review)
Geneva Pharma Forum on Pharmacovigilance: Partnering for
Patient Safety (Geneva, 20 November 2012), Jeremiah Mwangi, Director, Policy and External Affairs, IAPO
Real world Evidence and Precision medicine bridging the gapClinosolIndia
Real-world evidence and precision medicine represent complementary forces reshaping the healthcare landscape. The synergy between these realms offers a pathway to more personalized, effective, and patient-centered care. As technology, data analytics, and collaborative initiatives advance, the integration of real-world evidence into precision medicine practices holds the promise of revolutionizing how healthcare is delivered, ensuring that treatments are not only scientifically sound but also tailored to the unique characteristics and experiences of individual patients.
Pharmacovigilance (PV) is defined as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem. WHO established its Programme for International Drug Monitoring in response to the thalidomide disaster detected in 1961. Together with the WHO Collaborating Centre for International Drug Monitoring, Uppsala, WHO promotes PV at the country level. At the end of 2010, 134 countries were part of the WHO PV Programme. The aims of PV are to enhance patient care and patient safety in relation to the use of medicines; and to support public health programmes by providing reliable, balanced information for the effective assessment of the risk-benefit profile of medicines.
1. Hospital or Healthcare System Data:
o Internal Data: Reviewing your own hospital or healthcare system's data can provide insights into the average length of stay for patients with fractured hips. This data can be analyzed based on different factors such as age groups, severity of fracture, surgical procedures performed, and complications.
Information and support for patients on MKI treatmentMarika Porrey
Information and support for patients on MKI treatment - guidance for physicians and patient organizations by Dr Fabian Pitoia
Encargado de la Sección Tiroides
División Endocrinología - Hospital de Clínicas
Universidad de Buenos Aires
Similar to Rischio Radiologico (Ernesto Mola e Giorgio Visentin) (20)
Seminario di Primavera CSeRMEG 8 aprile 2017
IL CENTRO STUDI e LA MEDICINA GENERALE DEL FUTURO: progetti in corso, analisi, aspettative e proposte
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La Scuola di Ricerca CseRMEG – Bicocca (Marina Bosisio)csermeg
Seminario di Primavera CSeRMEG 8 aprile 2017
IL CENTRO STUDI e LA MEDICINA GENERALE DEL FUTURO: progetti in corso, analisi, aspettative e proposte
www.csermeg.it
Seminario di Primavera CSeRMEG 8 aprile 2017
IL CENTRO STUDI e LA MEDICINA GENERALE DEL FUTURO: progetti in corso, analisi, aspettative e proposte
www.csermeg.it
Seminario di Primavera CSeRMEG 8 aprile 2017
IL CENTRO STUDI e LA MEDICINA GENERALE DEL FUTURO: progetti in corso, analisi, aspettative e proposte
www.csermeg.it
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
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Equity: High costs could limit access to this potentially life-saving technology.
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Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
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How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Rischio Radiologico (Ernesto Mola e Giorgio Visentin)
1. Justification principle & Family Doctors
Ernesto Mola (MD)
World Organization of National Colleges,
Academies and Academic Associations
of General Practitioners/Family Physicians
(WONCA)
Wien 10° March 2016
HERCA - Justification and
optimisation in the medical field
1
2. Objectives
Starting from the content of Euratom BSS 2013
• To describe the responsibilities of Family Doctors (FDs)
concerning Justification, as implied in the characteristics of
General Practice
• To define the role of FDs in the strategic approach to
appropriateness and radiation risks prevention
• To illustrate the commitments of WONCA aimed to increase
radiation protection culture among doctors and patients
2
3. World Organization of Family Doctors
“The Mission of WONCA is
to improve the quality of life
of the peoples of the world
through defining and
promoting its values,
including respect for
universal human rights and
including gender equity, and
by fostering high standards
of care in general
practice/family medicine”
118 Member Organizations
In 131 countries
500,000 family doctors
90 per cent of the world’s
population.
3
4. Euratom BSS: definition of Justification
“Medical exposure shall show a sufficient net benefit, weighing
the total potential diagnostic or therapeutic benefits it
produces, including the direct benefits to health of an
individual and the benefits to society, against the individual
detriment that the exposure might cause, taking into account
the efficacy, benefits and risks of available alternative
techniques having the same objective but involving no or less
exposure to ionising radiation.”
“Member states shall ensure that:
all individual medical exposures are justified in
advance”
4
5. European BSS
Article 57
Responsibilities
….
(c) the referrer and the practitioner are involved, as specified
by Member States, in the justification process of individual
medical exposures;
(d) wherever practicable and prior to the exposure taking
place, the practitioner or the referrer, as specified by
Member States, ensures that the patient or their
representative is provided with adequate information relating
to the benefits and risks associated with the radiation dose
from the medical exposure. .... 5
6. European BSS
Article 58
Procedures
Member States shall ensure that:
(a) written protocols for every type of standard medical
radiological procedure are established for each
equipment for relevant categories of patients;
(b) information relating to patient exposure forms part of the
report of the medical radiological procedure;
(c) referral guidelines for medical imaging, taking into
account the radiation doses, are available to the
referrers;....
6
7. European BSS: Justification
• Relies on professional evaluation of comprehensive patient
information, including previous relevant clinical, imaging,
laboratory, and treatment data. The final decision usually
requires a clinical assessment and a physical examination,
taking into account patient expectations and the psycho-social
context
• Provides for a cooperation between referrers and practitioner
• Takes into account the benefits to the community
• Should be based on referral guidelines available to the referrers
which should support the decision for individual patient, by
providing generic evidence-based criteria.
7
8. What the referrer should
answer
Main causes of unnecessary use of radiology
Has it been done already?Repeating investigations that have been already
done
Do I need it?Undertaking investigations when results are
unlikely to affect patient management
Do I need it now?Investigating too early
Is this the best investigation?Doing the wrong investigation
Have I explained the
problem?
Failing to provide appropriate clinical
information and questions that the imaging
investigation should answer
Are they all needed?
From Maria Perez del Rosario – WHO
Over-investigating
8
9. A x-ray examination process
Patient with
a Health
problem Family doctor
Specialist
X-ray
referral
Practitioner
Physicist
Radiographer
X-ray examination
X-ray
referral
J U S T I F I C A T I O N
O
P
T
I
M
I
Z
A
T
I
O
N
9
10. Characteristics of General Practice
General Practice:
• is normally the first point of medical contact..
• makes efficient use of health care resources
through coordinating care ….
• develops a person-centred approach…..
• has a specific decision making process determined
by the prevalence and incidence of illness in the
community
• manages comprehensive care….
World Organization of National Colleges, Academies and Academic Associations
of General Practitioners/Family Physicians
10
11. FDs play an advocacy role "protecting
patients from the harm which may ensue
through unnecessary screening, testing, and
treatment"
and have a specific responsibility for the
health of the community.
Besides, in many countries, FDs are the gate
keepers of the National Health Service, and
request most clinical tests for outpatients.
Characteristics of General Practice
11
12. Appropriate Use of Radiation in Medical Imaging
Gate keeper
Booking
Registration
Preparation
Examination
Report
Transcription
Validation
Delivery
QA / Error reduction
Justification Optimization
Patient journey
(adapted from Dr. L. Lau IRQN)
Family doctors can contribute
to both … How? 12
13. How GPs can contribute to both?
• Communication between the family doctor and the
imaging specialist affords opportunities for more
rational use of imaging (justification)
• Communicating in the request, the clinical question
that the imaging procedure is expected to answer,
allows the imaging specialists to tailor the protocol
and reduce doses to the level of acceptable noise
for the given clinical condition (optimization)
13
14. FDs and the strategic approach
Risk assessment
Risk communication
Risk management
Assessing risks and
potential impacts
Implementing
policies, health
interventions
Engaging and communicating with stakeholders
Risk sharing
Involving patients in decision-making process
14
15. What GPs can do
Risk management
• sharing international and local guidelines with
specialists, radioligists and health authorities
• communicating with the specialists
(cardiologist, orthopaedist, etc.) and the imaging
professionals (practitioner, nuclear medicine
physician) for a more rational use of imaging
15
16. What GPs can do
Risk assessment
• collecting and recording the exposure
history of their patients
• assessing the individual benefit / risk
balance
16
17. What GPs can do
Risk communication
•informing patient about his/her individual risk / benefit
balance
• explaining risks and benefits to the patient in a way that
it is informative and understandable for them (including
radiation risks as well as the risk of not performing the
examination)
•listening, answering questions, and addressing concerns
about radiation risks
17
18. What FDs can do
Risk sharing
• explaining to the patient the reasons motivating the
examination (i.e. the clinical question expected to be
answered and the consequences on the treatment)
• rather than just collecting an informed patient’s
consent, involving the patient in the decision-making
process
18
19. Communication is a crucial crossing of the
modern health systems
Patient
Radiol.
Practitioner
Specialist
FD
19
20. WONCA Resolution
Justification and appropriateness
in radiological diagnostics
to stimulate medical colleges and
networks of general practice to develop
initiatives in their countries to increase
Radiological Protection Culture in
Medicine
20
21. Doctors’ Education for RPCM
• Promoting radiological protection culture through education
on radiation safety among all healthcare professionals, in the
basic medical education, specialty training and Continuing
Medical Education (CME)
• Education should:
include knowledge on ionizing radiation sources and related
risks, and use of clinical imaging guidelines
develop communication skills and competences to inform
patients in an understandable way about risks and advantages
of performing an x-ray procedure, and to give suitable
information to radiology practitioners.
21
22. WONCA commitments
• To cooperate with other stakeholders to encourage national
health authority to establish regulations, which define
responsibilities and procedures to make the justification
process clear and traceable
• To cooperate with radiology associations, and take part in
interdisciplinary panels, to set or adapt Clinical Imaging
Guidelines (CIG) at international and local level
• To cooperate with other stakeholders for an effective
strategy to spread CIG, implement them in Clinical Decision
Support systems (CDS) and include CDS in the databases
used by family doctors
22
23. WONCA commitments
• To incorporate in regulations the need to include in the
reports of procedures that require IR, the administered dose
• To include into the discharge letters from hospital the
overall dose of IR administered
• To include data concerning previous examinations and IR
exposure of each patient in the Patient’s File of the Health
Services, where available
• To include into the FDs’ databases the expected
administered dose of each examination and an automatic
computation of the exposure of the patient in the last years,
to help the doctor in applying the justification principle
23
24. WONCA commitments
WONCA intends to continue the
collaboration with international
organizations and institutions to
increase appropriateness and
pursue justification in radiological
procedures
24
Thanks for your attention