This document outlines a sepsis education and prevention program created by Piedmont Healthcare. It describes the development of a sepsis collaborative to establish guidelines for early identification and treatment of sepsis. Key points include:
1) Piedmont formed a sepsis collaborative in 2007 with an expert to develop methods for earlier diagnosis and treatment protocols.
2) The collaborative established guidelines to evaluate, identify, and treat patients at risk for sepsis within 60 minutes of suspicion.
3) Following these guidelines, Piedmont saw a 30-40% reduction in mortality rates for patients admitted to the emergency department with sepsis.
This document discusses Sugar, an educational desktop environment created by Sugar Labs as a spin-off from the One Laptop Per Child (OLPC) project. It provides background on OLPC's goals of providing low-cost laptops to children worldwide, and how Sugar Labs was founded when OLPC shifted focus. Sugar is built using free and open source software, is designed for children's learning needs, and runs on older, slower hardware. It uses a Python-based architecture with components like activities (applications), a shell, journal, and datastore service. Sugar Labs now focuses on expanding Sugar to different platforms and involving more contributors and organizations.
Gordon Ramsay has a 10-point plan for improving restaurants that need help boosting sales and profits, which involves having clear objectives, strong leadership, the right décor and menu, disciplined kitchen and staff training, motivating employees, and delivering great customer service. Running a sales team is similar and requires clear objectives, skilled managers, a disciplined selling process, training, skilled employees, desirable products, understood processes, and great customer service. The author offers sales audits through their company that can deliver impressive results like Ramsay, by impartially observing businesses and focusing on improving results rather than day-to-day operations.
This speech provides guidance for a sales training presentation to inspire salespeople to succeed in selling Toastmasters membership. It outlines objectives to inform the audience about the buyer-seller relationship and use stories and examples. It recommends selling Toastmasters by finding prospects' needs, gaining their confidence, selling the solution, anticipating objections, and closing the sale. It also addresses common objections people may have and emphasizes that all members can help Toastmasters grow.
The document compares the front cover layouts of two music magazines, Kerrang and NME. Both magazines feature a masthead, main image, and cover lines, with Kerrang having a darker aesthetic focused on rock artists and NME having a brighter style focused on a variety of genres. The key differences are that only NME includes a pull quote and the magazines have very contrasting designs in terms of color and featured artists.
This newsletter provides information about upcoming events for the Performing Arts Patrons Association (PAPA) at Pebblebrook High School. It announces a dance performance by ComPAny 2010 from October 15-18. It also lists the calendar of additional upcoming performances, auditions, and visits through November. The newsletter highlights PAPA's annual Silent Auction and Faculty Performance on November 6th at the Strand Theatre as a fundraising event for the school's performing arts program.
This paper reviews the evolution of the definition of sepsis and the controversy surrounding the sepsis-3 definition and the sepsis screening tool, qSOFA.
This document discusses Sugar, an educational desktop environment created by Sugar Labs as a spin-off from the One Laptop Per Child (OLPC) project. It provides background on OLPC's goals of providing low-cost laptops to children worldwide, and how Sugar Labs was founded when OLPC shifted focus. Sugar is built using free and open source software, is designed for children's learning needs, and runs on older, slower hardware. It uses a Python-based architecture with components like activities (applications), a shell, journal, and datastore service. Sugar Labs now focuses on expanding Sugar to different platforms and involving more contributors and organizations.
Gordon Ramsay has a 10-point plan for improving restaurants that need help boosting sales and profits, which involves having clear objectives, strong leadership, the right décor and menu, disciplined kitchen and staff training, motivating employees, and delivering great customer service. Running a sales team is similar and requires clear objectives, skilled managers, a disciplined selling process, training, skilled employees, desirable products, understood processes, and great customer service. The author offers sales audits through their company that can deliver impressive results like Ramsay, by impartially observing businesses and focusing on improving results rather than day-to-day operations.
This speech provides guidance for a sales training presentation to inspire salespeople to succeed in selling Toastmasters membership. It outlines objectives to inform the audience about the buyer-seller relationship and use stories and examples. It recommends selling Toastmasters by finding prospects' needs, gaining their confidence, selling the solution, anticipating objections, and closing the sale. It also addresses common objections people may have and emphasizes that all members can help Toastmasters grow.
The document compares the front cover layouts of two music magazines, Kerrang and NME. Both magazines feature a masthead, main image, and cover lines, with Kerrang having a darker aesthetic focused on rock artists and NME having a brighter style focused on a variety of genres. The key differences are that only NME includes a pull quote and the magazines have very contrasting designs in terms of color and featured artists.
This newsletter provides information about upcoming events for the Performing Arts Patrons Association (PAPA) at Pebblebrook High School. It announces a dance performance by ComPAny 2010 from October 15-18. It also lists the calendar of additional upcoming performances, auditions, and visits through November. The newsletter highlights PAPA's annual Silent Auction and Faculty Performance on November 6th at the Strand Theatre as a fundraising event for the school's performing arts program.
This paper reviews the evolution of the definition of sepsis and the controversy surrounding the sepsis-3 definition and the sepsis screening tool, qSOFA.
This document discusses the evolution of understanding and treatment of HIV/AIDS over the past 30+ years from the perspective of a psychiatrist working in an HIV clinic. It summarizes that:
1) In the 1980s, HIV/AIDS was seen as a death sentence and highly stigmatized, but treatment advances have now made it a manageable condition.
2) However, stigma continues to be a problem and prevents people from getting tested, even though early treatment is key.
3) New issues have emerged like "chemsex" where psychoactive drugs are used during sex, hindering condom use and increasing transmission risk.
Indian medical professionals Association, 4th Telangana state conventionPARUL UNIVERSITY
1) Dr. S P Nayak presented on Covid-19 at the 4th Telangana State Convention of IMPA, an organization with the objective of completely eradicating inequality in the Brahminical social system.
2) Covid-19 is an infectious disease caused by the SARS-CoV-2 virus which was first identified in Wuhan, China in December 2019 and has resulted in an ongoing global pandemic. As of October 2020, over 37 million cases and 1.07 million deaths have been reported worldwide.
3) Patients with preexisting conditions like hypertension, obesity, diabetes, cardiovascular disease, chronic lung disease, and cancer have significantly higher risks of contracting the virus as well as higher mortality
A 29-year-old previously healthy man was referred to UCLA with a 8-month history of fever, fatigue, enlarged lymph nodes, and a 12.5 kg weight loss. He had a fever of 39.5°C, appeared physically wasted, and had swollen lymph nodes. Laboratory tests showed depressed lymphocytes. The patient suffered from simultaneous infections of Candida albicans in the upper gastrointestinal tract, Pneumocystis carinii in the lungs, and cytomegalovirus in the urinary tract, and was not responding to antibiotics with no known cause of immunosuppression. There were also 3 other previously healthy young men in the last 6 months reported with similar symptoms who all had Candida albic
This document discusses the relationship between periodontal disease and various systemic conditions. It begins by providing historical context on how the link between oral and systemic health has been understood over time. Key points discussed include: the era of focal infection theory in the 18th-19th centuries; associations found between periodontitis and coronary heart disease/atherosclerosis, diabetes, pregnancy outcomes, COPD, and acute respiratory infections; and how periodontal medicine knowledge can be applied in clinical practice through interprofessional collaboration and patient education.
Steve Jobs was diagnosed with pancreatic cancer at age 48 in 2003, with symptoms starting at age 24. He died from the disease at age 56 in 2011. Vitamin D from moderate sun exposure without sunscreen may help lower the risk of certain cancers like pancreatic, as it is nearly 50% less likely in those with higher vitamin D levels from sun exposure. While surgery, radiation, and chemotherapy have been standard cancer treatments for decades, they have shown little improvement in overall survival rates for all cancers in the last 55 years. Alternative non-toxic treatments exist but are suppressed.
The document argues that the Pfizer COVID-19 vaccine kills more people than it saves based on several calculations and studies. It claims the excess death to life ratio for the Pfizer vaccine in clinical trials and databases like VAERS is unacceptable. It also argues that reports of adverse events are much higher than baseline levels and reports of fraud in Pfizer's clinical trials have not been properly investigated. Alternative early treatment options are presented as safer alternatives.
Today we stand at a vital threshold. Within our grasp is the opportunity to end 30 years of suffering and death due to HIV/AIDS. Individuals and communities around the world have been mobilized toward prevention, and existing treatment can prolong life for many years. While we celebrate these successes, we reject any modicum of complacency. Now is the time to double down and finish the job. The world is fighting AIDS today just as it had previously fought to eliminate smallpox. For centuries, smallpox was a feared scourge that killed nearly half of those infected and maimed those that survived. A worldwide campaign to end the disease began in earnest in the late 1960s and by 1980 smallpox was officially eradicated.
Planet Aid anticipates the day when AIDS, too, will be stopped. To this end, we have been helping mobilize communities around the globe to increase HIV/AIDS prevention and care. With this special issue of the Planet Aid Post, we focus on the battle ahead. We also extend a warm welcome to those joining us on the forefront of this work,
This document discusses the use of homeopathic prophylaxis or nosodes to help prevent the spread of COVID-19. It provides several examples from the past where homeopathic prophylaxis was successfully used to reduce epidemics of diseases like influenza, cholera, smallpox, and leptospirosis. It notes that a pharmacy has created a nosode from a patient exhibiting COVID-19 symptoms to potentially be used preventatively by those interested in a homeopathic approach. Historical evidence is presented to support the use of homeopathic prophylaxis in epidemics while complying with social distancing guidelines.
Bridgepoint Health Bulletin discusses the rising crisis of complex chronic illness. 60% of healthcare spending is for people with complex chronic illnesses. Modern medicine has improved treatment of deadly illnesses but not found cures, converting many to chronic illnesses. As lifespans increase, more people are living with multiple chronic conditions or complex chronic illness, which is the leading cause of death, disability, and rising healthcare costs. Bridgepoint Health specializes in patients with complex illnesses and sees addressing their care as the new frontier in healthcare.
Wanneer medicijnen en games samenkomen door Tom Aelbrecht (Zorgidee 2013)Michiel Stoffels
Het traditionele business model van de big pharma werkt allang niet meer. Janssen Pharmaceutica zoekt dan ook naar succesvolle formules om te innoveren. Eén van de innovatietrajecten dat alvast veelbelovend is, is Serious Gaming.
Tom Aelbrecht, directeur van het incubatiecentrum van het Venture & Incubationcenter van Janssen, neemt ons mee doorheen het innovatietraject en laat ons zien waarom zij misschien zelfs meer geloven in de toekomst van games dan die van pillen.
The document discusses strategies to reduce sepsis infections and mortality rates. It describes how North Shore-LIJ Health System in New York overhauled their approach to sepsis diagnosis and treatment, moving upstream to earlier identification. This included developing triage criteria to screen for sepsis in the emergency department and speeding antibiotic administration and other treatments. As a result, the health system reduced sepsis mortalities by 50% since 2009. The document also discusses the controversy over a new CMS core measure for sepsis bundles and efforts to standardize sepsis care nationally.
Dementia care world's great healthcare economic challenge for 21st cent ap...SDGWEP
Dementia is currently the fastest growing cause of death in America. How do you care for those suffering from Dementia and what are the typical signs of this mental disability
The document discusses various concepts in epidemiology including:
1) The epidemiologic triangle which includes the agent, host, and environment as factors that influence disease.
2) Observational study designs like cross-sectional studies which assess disease prevalence at a point in time, and cohort studies which follow groups over time to compare disease rates between exposed and unexposed individuals.
3) Key figures in the history of epidemiology like John Snow who conducted seminal investigations tracing cholera outbreaks to contaminated water sources in London in the 1850s.
4) The overall goal of epidemiology is to identify and quantify relationships between exposures and health outcomes in populations in order to control disease. Descriptive and analytical approaches are used.
JMW Bradford, V Di Nicola. The War Against Ukraine – A Social Psychiatry Perspective. Global Mental Health & Psychiatry Review, Spring-Summer 2022, 3(2): 9.
Guest Editorial – A Clarifying Moment: The War on Ukraine and the Unraveling ...Université de Montréal
The document discusses the mental health consequences of the COVID-19 pandemic and war in Ukraine on refugees, internally displaced persons, and other vulnerable populations in Africa. It notes that the pandemic exacerbated vulnerabilities by destroying livelihoods in the informal sector. Refugees and IDPs relied on social networks and mutual aid that were disrupted by lockdowns and gathering bans. They faced higher risks due to crowded living conditions and lack of services. The conflicts in places like Somalia brought back traumatic memories and increased mental health issues. Neglected groups like the elderly faced increased isolation and risk of infection due to lack of social supports.
The author learned a lot about their self concept, attitudes, and feelings by taking this psychology course. They discovered that they are a creative and compassionate person who enjoys activities that use their imagination. The author also realized they are a good listener, which helps them be understanding and supportive of others. Taking this course provided insight into social influence, relationships, and how the author views and describes themselves.
Coronavirus Unmasked - Biosecurity and Medical FascismAndrew Johnson
In this presentation, we will go through the evidence relating to the history and planning of the alleged COVID-19 Pandemic and how it fits in with a wider, more longstanding globalist agenda. We will look at how the UK Govt. has lied and committed crimes in relation to the measures it has implemented.
Slide 004 - Andrew’s Activities re COVID-19
https://cvpandemicinvestigation.com/
https://cvpandemicinvestigation.com/covid-19-investigation-report-challenging-the-narrative-pandemic/
https://cvpandemicinvestigation.com/2020/09/covid-19-evidence-of-fraud-medical-malpractice-acts-of-domestic-terrorism-and-breaches-of-human-rights/
Slide 006 - Swine Flu (2009) – Looking at Evidence
https://vimeo.com/25624580
Slide 018 - WHO Advisory Checklist - 1
https://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_4/en/
Slide 020 - Swine Flu – Retrospective Review
https://www.telegraph.co.uk/news/health/swine-flu/7865796/Swine-flu-killed-457-people-and-cost-1.24-billion-official-figures-show.html
Slide 021 - Swine Flu Vaccine?
https://www.bmj.com/content/362/bmj.k3948
Slide 024 - WHO Dunnit…
https://www.detroitnews.com/story/news/world/2020/03/11/declares-virus-crisis-now-pandemic/111415246/
https://www.bbc.co.uk/news/world-africa-51720184
https://www.opride.com/2017/05/11/case-director-general-candidate-tedros-adhanom/
https://www.theburningplatform.com/2020/04/04/the-crimes-of-tedros-adhanom/
Slide 025 - Who Planned it…??
https://hub.jhu.edu/2019/11/06/event-201-health-security/
https://www.youtube.com/watch?v=AoLw-Q8X174
http://www.centerforhealthsecurity.org/event201/about
https://www.bloomberg.com/features/2020-china-wuhan-pollution/
Slide 026 - Someone is worried about Dissent…
https://ec.europa.eu/info/live-work-travel-eu/health/coronavirus-response/fighting-disinformation/identifying-conspiracy-theories_en
Slide 028 - Dr Neil Ferguson’s “Scare” Model
https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-Europe-estimates-and-NPI-impact-30-03-2020.pdf
https://www.ecdc.europa.eu/en/covid-19/data-collection
https://www.washingtonexaminer.com/news/imperial-college-scientist-who-predicted-500k-coronavirus-deaths-in-uk-revises-to-20k-or-less
https://lockdownsceptics.org/code-review-of-fergusons-model/
https://twitter.com/neil_ferguson/status/1241835454707699713
https://www.vaccineimpact.org/resources/VIMC_orgchart_2017.pdf
https://www.mirror.co.uk/news/politics/professor-behind-coronavirus-lockdown-plan-21979710
Slide 030 - UK – COVID-19 is NOT an HCID…
https://cvpandemicinvestigation.com/wp-content/uploads/2020/08/Letter-JVT-March13th_Open_Government_Status-.pdf
Slide 031 - UK Government Posts Statement
https://www.gov.uk/guidance/high-consequence-infectious-diseases-hcid
Sorry - no more space!
The document discusses controversies surrounding cancer screening programs. It notes that while screening aims to detect diseases early, there are also risks of overdiagnosis, overtreatment, and false alarms. Screening programs for diseases like breast cancer and diabetes have faced criticism for potentially misleading women about the downsides of screening and not fully informing their choices. Proper informed consent is needed so that healthy individuals understand the benefits and harms at both individual and population levels before agreeing to screening.
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1) In the 1980s, HIV/AIDS was seen as a death sentence and highly stigmatized, but treatment advances have now made it a manageable condition.
2) However, stigma continues to be a problem and prevents people from getting tested, even though early treatment is key.
3) New issues have emerged like "chemsex" where psychoactive drugs are used during sex, hindering condom use and increasing transmission risk.
Indian medical professionals Association, 4th Telangana state conventionPARUL UNIVERSITY
1) Dr. S P Nayak presented on Covid-19 at the 4th Telangana State Convention of IMPA, an organization with the objective of completely eradicating inequality in the Brahminical social system.
2) Covid-19 is an infectious disease caused by the SARS-CoV-2 virus which was first identified in Wuhan, China in December 2019 and has resulted in an ongoing global pandemic. As of October 2020, over 37 million cases and 1.07 million deaths have been reported worldwide.
3) Patients with preexisting conditions like hypertension, obesity, diabetes, cardiovascular disease, chronic lung disease, and cancer have significantly higher risks of contracting the virus as well as higher mortality
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This document discusses the relationship between periodontal disease and various systemic conditions. It begins by providing historical context on how the link between oral and systemic health has been understood over time. Key points discussed include: the era of focal infection theory in the 18th-19th centuries; associations found between periodontitis and coronary heart disease/atherosclerosis, diabetes, pregnancy outcomes, COPD, and acute respiratory infections; and how periodontal medicine knowledge can be applied in clinical practice through interprofessional collaboration and patient education.
Steve Jobs was diagnosed with pancreatic cancer at age 48 in 2003, with symptoms starting at age 24. He died from the disease at age 56 in 2011. Vitamin D from moderate sun exposure without sunscreen may help lower the risk of certain cancers like pancreatic, as it is nearly 50% less likely in those with higher vitamin D levels from sun exposure. While surgery, radiation, and chemotherapy have been standard cancer treatments for decades, they have shown little improvement in overall survival rates for all cancers in the last 55 years. Alternative non-toxic treatments exist but are suppressed.
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Today we stand at a vital threshold. Within our grasp is the opportunity to end 30 years of suffering and death due to HIV/AIDS. Individuals and communities around the world have been mobilized toward prevention, and existing treatment can prolong life for many years. While we celebrate these successes, we reject any modicum of complacency. Now is the time to double down and finish the job. The world is fighting AIDS today just as it had previously fought to eliminate smallpox. For centuries, smallpox was a feared scourge that killed nearly half of those infected and maimed those that survived. A worldwide campaign to end the disease began in earnest in the late 1960s and by 1980 smallpox was officially eradicated.
Planet Aid anticipates the day when AIDS, too, will be stopped. To this end, we have been helping mobilize communities around the globe to increase HIV/AIDS prevention and care. With this special issue of the Planet Aid Post, we focus on the battle ahead. We also extend a warm welcome to those joining us on the forefront of this work,
This document discusses the use of homeopathic prophylaxis or nosodes to help prevent the spread of COVID-19. It provides several examples from the past where homeopathic prophylaxis was successfully used to reduce epidemics of diseases like influenza, cholera, smallpox, and leptospirosis. It notes that a pharmacy has created a nosode from a patient exhibiting COVID-19 symptoms to potentially be used preventatively by those interested in a homeopathic approach. Historical evidence is presented to support the use of homeopathic prophylaxis in epidemics while complying with social distancing guidelines.
Bridgepoint Health Bulletin discusses the rising crisis of complex chronic illness. 60% of healthcare spending is for people with complex chronic illnesses. Modern medicine has improved treatment of deadly illnesses but not found cures, converting many to chronic illnesses. As lifespans increase, more people are living with multiple chronic conditions or complex chronic illness, which is the leading cause of death, disability, and rising healthcare costs. Bridgepoint Health specializes in patients with complex illnesses and sees addressing their care as the new frontier in healthcare.
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2) Observational study designs like cross-sectional studies which assess disease prevalence at a point in time, and cohort studies which follow groups over time to compare disease rates between exposed and unexposed individuals.
3) Key figures in the history of epidemiology like John Snow who conducted seminal investigations tracing cholera outbreaks to contaminated water sources in London in the 1850s.
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Slide 004 - Andrew’s Activities re COVID-19
https://cvpandemicinvestigation.com/
https://cvpandemicinvestigation.com/covid-19-investigation-report-challenging-the-narrative-pandemic/
https://cvpandemicinvestigation.com/2020/09/covid-19-evidence-of-fraud-medical-malpractice-acts-of-domestic-terrorism-and-breaches-of-human-rights/
Slide 006 - Swine Flu (2009) – Looking at Evidence
https://vimeo.com/25624580
Slide 018 - WHO Advisory Checklist - 1
https://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_4/en/
Slide 020 - Swine Flu – Retrospective Review
https://www.telegraph.co.uk/news/health/swine-flu/7865796/Swine-flu-killed-457-people-and-cost-1.24-billion-official-figures-show.html
Slide 021 - Swine Flu Vaccine?
https://www.bmj.com/content/362/bmj.k3948
Slide 024 - WHO Dunnit…
https://www.detroitnews.com/story/news/world/2020/03/11/declares-virus-crisis-now-pandemic/111415246/
https://www.bbc.co.uk/news/world-africa-51720184
https://www.opride.com/2017/05/11/case-director-general-candidate-tedros-adhanom/
https://www.theburningplatform.com/2020/04/04/the-crimes-of-tedros-adhanom/
Slide 025 - Who Planned it…??
https://hub.jhu.edu/2019/11/06/event-201-health-security/
https://www.youtube.com/watch?v=AoLw-Q8X174
http://www.centerforhealthsecurity.org/event201/about
https://www.bloomberg.com/features/2020-china-wuhan-pollution/
Slide 026 - Someone is worried about Dissent…
https://ec.europa.eu/info/live-work-travel-eu/health/coronavirus-response/fighting-disinformation/identifying-conspiracy-theories_en
Slide 028 - Dr Neil Ferguson’s “Scare” Model
https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-Europe-estimates-and-NPI-impact-30-03-2020.pdf
https://www.ecdc.europa.eu/en/covid-19/data-collection
https://www.washingtonexaminer.com/news/imperial-college-scientist-who-predicted-500k-coronavirus-deaths-in-uk-revises-to-20k-or-less
https://lockdownsceptics.org/code-review-of-fergusons-model/
https://twitter.com/neil_ferguson/status/1241835454707699713
https://www.vaccineimpact.org/resources/VIMC_orgchart_2017.pdf
https://www.mirror.co.uk/news/politics/professor-behind-coronavirus-lockdown-plan-21979710
Slide 030 - UK – COVID-19 is NOT an HCID…
https://cvpandemicinvestigation.com/wp-content/uploads/2020/08/Letter-JVT-March13th_Open_Government_Status-.pdf
Slide 031 - UK Government Posts Statement
https://www.gov.uk/guidance/high-consequence-infectious-diseases-hcid
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The document discusses controversies surrounding cancer screening programs. It notes that while screening aims to detect diseases early, there are also risks of overdiagnosis, overtreatment, and false alarms. Screening programs for diseases like breast cancer and diabetes have faced criticism for potentially misleading women about the downsides of screening and not fully informing their choices. Proper informed consent is needed so that healthy individuals understand the benefits and harms at both individual and population levels before agreeing to screening.
Similar to Sepsis Education And Prevention Video Final Working Draft 6 29 09 (20)
Sepsis Education And Prevention Video Final Working Draft 6 29 09
1. Sepsis Education and Prevention
For Piedmont Healthcare
Final WORKING Draft
June 29, 2009
Submitted by:
Michele Glazer
Page 1 of 11
2. Sepsis Education and Prevention
Audio Video
GRAPHIC TITLE:
MUSIC UP:
Narrator: (V.O.) Piedmont Healthcare’s Sepsis
Collaborative Presents…Severe Sepsis
Prevention. The McLean-Piedmont Method for
Arresting Sepsis.
Music Transition into Video Montage
Insert: Video Montage of Interviews – 8-10 second
effect transition with sound bites from interviews
DISSOLVE TO:
Dr. Hamby: By definition, sepsis is a term used INT. ICU Nursing Station: Dr. Hamby (O.C.)
to define a continuum of problems. In general, Title: Dr. Leigh Hamby, M.D., EVP/Chief Medical
it means infection of the blood stream Officer/Chief Quality Officer
accompanied with a profound inflammatory
response. And while that sounds like a relatively
non-serious explanation, complications from
exacerbated sepsis or severe sepsis, can be life
threatening.
Severe sepsis is an expression of multi-organ
dysfunction created by both an un-contested
pro-inflammatory and hyper coagulation
syndrome. Those clots block small vessels,
impacting normal flood flow to vital organs.
Both inflammatory organ attacks as well as
ischemia from lack of blood flow affect many
organs and may cause them to operate in a
dysfunctional manner, even to completely fail.
Early diagnosis is crucial, since one third of the
patients diagnosed with sepsis die from the
complications associated with it.
MUSIC TRANSITION
GRAPHIC:
NARRATOR (V.O.): So exactly how common is 750,000 Cases of Severe Sepsis Annually in the U.S.
sepsis? (Angus, Crit Care Med 2001)
Page 2 of 11
3. More than 750,000 cases of severe sepsis occur
each year in the United States, with a mortality
rate at around 30%.
GRAPHIC Slide #2 on
A sepsis death occurs every 2 ½ minutes. In the
United States, approximately 1,400 people die
every day from severe sepsis, making it the 10th
most common cause of death. Annual death
rates from sepsis rank higher than other Major
Diseases such as heart attack or stroke. In fact,
10% of all patients admitted to the ICU are
diagnosed with sepsis.
CD
And the issue is not limited to human cost. The
GRAPHIC:
economic cost to the country is roughly $17
Sepsis Healthcare Cost: $17,000,000,000 annually
billion each year.
DISSOLVE TO:
Music Transition
Slide #3 – Erin Flatley
Narrator (V.O.) - Erin Flatley from Dunedin,
Florida was 23 years old when she underwent a
simple hemorrhoidectomy procedure in 2002.
Her father, Dr. Carl Flatley, said he had no idea
what to watch for when Erin developed sepsis.
Erin went into the hospital for a minor
hemorrhoid operation and five days later was
dead from sepsis.
Slide #4 – Mariana Bridi de Costa
NARRATOR: Brazilian model Mariana Bridi da
Costa was a healthy 20-year-old when doctors
told her she had a urinary tract infection, her
family says. The infection spread, and after
amputating her feet, then her hands, doctors
thought they had the situation under control.
Four days later, da Costa was dead.
Mariana Bridi da Costa, Brazilian model
Page 3 of 11
4. Slide #5
NARRATOR: And what began as a case of
pneumonia in 1990 for Muppets creator Jim
Henson, resulted in his death from sepsis at the
age of 53.
Jim Henson, Muppets creator
CUT TO:
Music Transition
GRAPHIC – Slide #6
NARRATOR: So how CAN we reduce sepsis
mortality?
Slide #7 – Sepsis Team
Narrator: Well, Piedmont accomplished just
that. By creating a joint effort among multiple
organizations that share resources and
information. By creating a collaborative
between all of Piedmont’s hospitals, along with
Chief Quality Officer Dr. Leigh Hamby, and the
sepsis expert, Barbara McLean. And by
establishing a procedure for early recognition
and treatment, which in turn, has resulted in a
significant impact on the reduction of sepsis
mortality.
Animate pic – separate into quadrants then recover
Page 4 of 11
5. Graphic: - Slide #8
MUSIC TRANSITION
NARRATOR: Beginning in February 2004
Piedmont Healthcare initiated methods to
detect severe sepsis, and implement the
evidence-based guidelines proposed by the
surviving sepsis campaign. Eventually,
Piedmont formed The Sepsis Collaborative in
January 2007. An international sepsis expert,
Barbara McLean came on board to assist with
developing methods for an earlier diagnosis and Cut To:
treatment protocol.
Interview with Barbara McLean (see specific segment
[INSERT BARBARA MCLEAN SOUND BITE] – “…It in audio)
seemed to be a simple extension that if we
could identify those patients at risk for sepsis,
via a vigilant analysis, that we could treat with
volume and BSA while diagnosing and do both
within 60 minutes of initial identification. The DISSOLVE TO:
strategy was to prevent sepsis from evolving…”
GRAPHIC:
NARRATOR: Now we had a new goal: Reducing Guidelines:
morality by early recognition and treatment. Evaluate and Identify
Treatment
The team established guidelines to evaluate Understanding Pathophysiology
and identify patients at risk for severe sepsis.
An ongoing education program included GRAPHIC – Slide #9
definition, recognition, treatment and
explaining the pathophysiology of sepsis, severe Recognize Sepsis
sepsis and septic shock.
S evere S epsis
This collaborative has helped establish a Prevention P ackage =
procedure for early recognition and treatment,
In 60 minutes:
which in turn, has had the biggest impact on
20 ml/kg IV Fluid,
the reduction of sepsis mortality.
Blood Culture and
IV Antibiotics
The goal of the collaborative consisted of a
simple directive: Fluid, Culture and Antibiotics
in 60 Minutes.
CUT TO:
Page 5 of 11
6. Dr. Hamby (O.C.): Early recognition and INT. ICU Nursing Station – Dr. Hamby O.C.
aggressive resuscitation initiated within the first Cut to:
hour has reduced mortality in our system by as (Split screen: Dr. Hamby with following graphic?)
much as 34%. Graphic: Slide #10
Sepsis Mortality:
[PAUSE]
PIEDMONT HEALTHCARE
18.00%
16.00%
14.00%
12.00%
12.98%
10.00%
8.00%
8.93%
6.00%
4.00%
2.00%
0.00%
FY2007 (n=2271) FY2008 (n=3247)
Dr. Hamby: If we can improve our methods of
how we treat sepsis, we can improve our
outcomes. We can save lives. ISO on Dr. Hamby for final line
CUT TO: CUT TO:
Narrator: Several healthcare providers share Open on Freeze of Dr. Core interview
their experiences as they followed the McLean-
Piedmont collaborative.
MUSIC TRANSITION:
INSERT :
PHYSICAN/STAFF INTERVIEWS PHYSICIAN/STAFF INTERVIEWS
DISSOLVE:
MUSIC TRANSITION:
GRAPHIC: Slide #11
NARRATOR: Piedmont’s Sepsis Evaluation
Process relies heavily on an algorithm -- the
McLean-Piedmont Method – which aids the
clinician in evaluating patients that are at high
risk for sepsis. It helps to identify the patient at
risk for sepsis and assists with monitoring those
patients in the continuum of the disease
process should it progress from Uncontrolled
Inflammation… to sepsis… to severe sepsis, and
escalating into septic shock.
Page 6 of 11
7. Evaluation Process
NARRATOR: Referring to Category A in the
Evaluation Process - once there is a suspicion of
infection and/or exposure to infection, the
patient receives one point for each item
checked in his or her Clinical Suspicion such as
lung infection; trauma, exposure to illness,
chemotherapy, altered mental status, recent
abortion, recent antibiotic therapy, chills or
fever and any indwelling catheters.
Evaluation Process
NARRATOR: And the patient receives one point
for exposures in the hospital such as surgery; all GRAPHIC: (create on Avid)
indwelling catheters such as a central line, a Patient has history of, but not limited to:
pulmonary artery catheter, a vas-cath and a Lung Infection
femoral sheath; any urinary catheters; Trauma
ventilation procedures; open wounds and Exposure to Illness
antibiotic therapy. Chemotherapy
Altered Mental Status
Recent Abortion
Recent Antibiotic Therapy
Chills / Rigor / Fever
Indwelling Catheters
NARRATOR: So in looking at the Category A
block, the Clinical Suspicion area…a patient GRAPHIC: (create on Avid)
suspected of sepsis would receive one point for Exposures in Hospital
each Clinical Suspicion checked in this category. Surgery
A strong clinical suspicion of the involved Indwelling Catheters
practioners is also considered as a qualifier of
Urinary Catheter
suspicion. Largely, since Sepsis sources are vast
Ventilated Patients
and sometimes impossible to recognize early.
Open Wounds
Currently on Antibiotics
GRAPHIC: Slide
Page 7 of 11
8. Evaluation Process
NARRATOR: For example… let’s say the patient
under your care, we’ll call her Mrs. Smith, has
an upper respiratory infection and a Triple
Lumen catheter. Mrs. Smith would receive two
points in Category A.
NARRATOR: Let’s look at the second level of our
algorithm, the SIRS portion - Systemic
#12
Inflammatory Response Syndrome, or
Uncontrolled Inflammation throughout the
INT. PATIENT ROOM – Nurse and Patient
entire body…
Patient in bed. Nurse providing care; checking vitals
NARRATOR: Clinical signs of SIRS consist of a
central temperature greater than 101° F or less
than 96.8 °F. A sustained heart rate of greater
GRAPHIC: Create on Avid
than 90 beats per minute. A sustained
respiratory rate of greater than 20 breaths per S – Systemic
minute. The heart rate and respiratory rate I – Inflammatory
must be measured at least two different times, R – Response
at least five and no more than 15 minutes
apart.
S – Syndrome
NARRATOR: Again, utilizing the point system, GRAPHIC: Slide #13
your patient receives one point from the B
category for each of the clinical signs of SIRS. Evaluation Process
Mrs. Smith has fever of 101.7° and a persistent
heart rate of 100 - 104. You would assign her
two points from Category B – temperature and
heart rate.
NARRATOR: The final category of the
algorithm, Category C, focuses on the patient’s
blood pressure. Is the systolic blood pressure
less than 90 mm Hg or has it decreased by 20
mm Hg from the previously measured systolic CUT TO:
blood pressure? For example, if the blood INT. PATIENT ROOM – Nurse and Patient
pressure is 89/60, then the patient would Nurse taking patient’s temp.
receive two points automatically for having
systolic hypotension.
CUT TO:
NARRATOR: So what do we do with this
information?
Graphic – Slide #14
Page 8 of 11
9. To meet the clinical criteria, Category A must
have at least one item checked in order to
suspect sepsis. And at least two different
categories must have check marks in them. To
diagnose Sepsis, we must have at least one item
in Category A checked and any combination of
items from the other two categories, so that
the evaluation totals three points.
To proclaim a sepsis judgment, three total
points must be measured in at least two
categories and one of those must be Category CUT TO:
A.
We add up the total from all 3 categories. For INT. PATIENT ROOM – NURSE and PATIENT
example, our patient Mrs. Smith, with a Nurse taking blood pressure, marking logarithm chart,
diagnosis of pneumonia… a temp of 101.7°… monitoring clock.
and a heart rate of 100 - 104. She has an
evaluation total of three points. CU – Evaluation Process chart in Nurse’s hands –
Nurse marking chart (?) Totaling chart – 3 points.
We suspect sepsis.
SFX: Ticking Clock… GRAPHIC: Create on Avid
SUSPECT SEPSIS!
NARRATOR:
And now the time clock starts ticking… GRAPHIC – Clock Slide #15
NARRATOR: With haste the caregiver should
proceed with fluid resuscitation, collect blood Graphic – Slide 16
cultures, lactic acid and other labs, and begin
antibiotic administration. Every 15 minutes,
vital signs should be checked until stable. Every
hour, organ dysfunction should be evaluated.
MUSIC TRANSITION
Page 9 of 11
10. DR. HAMBY: The Severe Sepsis Prevention CUT TO:
procedure is a relatively low cost operative with
little chance of negative patient outcome. And
the evidence-based medicine supports the
theory. INT. ICU Nursing Station - DR. Hamby (O.C)
Initiating this protocol within a 60 minute CUT TO:
timeframe has been widely successful at
Piedmont Hospital in reducing sepsis mortality GRAPHIC: - Slide 17
rates in ICU admits. Mortality Rate for ED Admits with ICU stay (Angus Codes +)
0.3
0.25
0.2
Proportion Dying
0.15
0.1
In fact, since 2007, Piedmont Hospital, 0.05
Piedmont Fayette Hospital and Piedmont
Mountainside have reduced the mortality rate 0
Dec- Jan- Feb- Mar- Apr- May- Jun-
05 06 06 06 06 06 06
Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun-
06 06 06 06 06 06 07 07 07 07 07 07
Jul-
07
Aug- Sep- Oct- Nov-
07 07 07 07
of patients coming to the Emergency GRAPHIC – Slide 18
Department with Sepsis by 30-40%. PIEDMONT HEALTHCARE: Sepsis Collaborative
Sepsis Patients - Calculated # Lives Saved
700
611
600
500
400
300
227 214
Part of this is better recognition of Sepsis, 200
170
however not all of the improvement appears to 100
be due to categorizing more patients as having 0
FY07 FY 08 FY09 (Jun - Dec) GRAND TOTAL
sepsis. One patient speaks for himself… LIVES SAVED
CUT TO:
INT. ICU NURSING STATION – Dr. Hamby on camera
[Interview with Gordon Perry]
NARRATOR: After a misdiagnosis at another CUT TO:
area hospital without a sepsis protocol, Mr.
Gordon Perry was admitted to Piedmont in full GRAPHIC – Slide #19
septic shock and perhaps moments away from
multi-system organ failure. He was immediately
treated following the sepsis protocol, the
McLean-Piedmont method. This life-saving
measure resulted in Mr. Perry’s complete
recovery from septic shock.
[Insert sound bite – “…I just can’t say
enough…”+
CUT TO:
Page 10 of 11
11. NARRATOR: But the change in sepsis protocols
on paper is easy… encouraging the change in Interview with Gordon Perry – final paragraph
personal practice takes more time and effort.
Dr. Hamby: *Insert ad lib: “We recognize that
it’s not a formula, not cookbook medicine, and
the collaborative doesn’t override a physician’s
critical thinking skills in determining the best
course for a patient…”+ The Sepsis INT. ICU Station – Dr. Hamby (O.C) – Medium shot
Collaborative at Piedmont Healthcare has
established a procedure for defining Severe
Sepsis as well as initiating a process to disrupt
the pathophysiology of Severe Sepsis.
(Pause)
We’ve come a long way in increasing positive
patient outcomes. And by continuing with these
measures, we look forward to more stories of FADE OUT:
success.
Credits
MUSIC OUT
Page 11 of 11