The document discusses the establishment of an integrated regional dialysis service and clinical networks in Northland, New Zealand using telehealth. It outlines the rural geography which results in long travel times and costs for patients receiving dialysis in the region. Telehealth equipment was installed in three dialysis units to facilitate multidisciplinary meetings, patient assessments, education sessions and clinical discussions with tertiary centers. Initial resistance from tertiary centers was overcome and telehealth is now used for collaborative planning of vascular and transplant care for Northland patients.
Fundación EPIC _ Tendencias actuales en TAVI y desafíos futuros.Fundacion EPIC
This document summarizes a presentation on current trends in transcatheter aortic valve implantation (TAVI) and future challenges. It discusses the use of TAVI in intermediate surgical risk patients, new generation valve devices, post-implant outcomes like paravalvular regurgitation and pacemaker rates, and several large clinical trials investigating the use of TAVI in lower risk patients. It also reviews temporal trends in TAVI procedures in France and research on reducing cerebral embolism during the procedure.
Stroke care seven days a week – improving outcomes for patients, co-ordinatin...NHS Improvement
Stroke care seven days a week – improving
outcomes for patients, co-ordinating the Stroke
imaging pathway - 365 day rapid-access one-stop TIA clinic - Dr David Eveson - presentation from the seven day services in diagnostics event held on 4 March 2013 #7dayDiagnostics
This document discusses the challenges in treating diabetic foot problems. It notes that neuropathy, deformity, trauma, ulceration, infection, ischemia and limb loss are common complications. A thorough assessment is needed to determine if the foot problem is neuropathic, ischemic, involves osteomyelitis, Charcot neuroarthropathy or a combination. Treatment depends on the underlying issues but may include offloading, antibiotics, debridement, revascularization procedures like angioplasty or bypass. Multidisciplinary care with specialists like vascular surgeons is important for managing the complex challenges of the diabetic foot.
Dialysis various modalities and indices usedAbhay Mange
Dialysis is a process used to remove waste and excess water from the blood of patients with kidney failure. There are various modalities of dialysis including intermittent hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. Hemodialysis uses diffusion and ultrafiltration across a semi-permeable membrane in a dialyzer to clean the blood. Proper vascular access and anticoagulation are also important aspects of hemodialysis treatment.
Surgeon Champion Call 2010 - Dr Peter Dorismart1971
This document summarizes the journey of Surrey Memorial Hospital in implementing the ACS-NSQIP program to track surgical outcomes and improve quality. It describes initial challenges with data quality including missing data, coding errors and inconsistencies that were addressed through staff education and updated processes. It provides examples of pneumonia and catheter-associated urinary tract infection prevention initiatives that were undertaken using a team-based approach including practice changes, education and audits to reduce infection rates. Graphics show outcomes data over time comparing the hospital to NSQIP benchmarks.
This document discusses the use of radial access for complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures based on findings from the RECHARGE registry and the presenter's experience. The key points are:
1) The RECHARGE registry found technical success rates of 85% for complete radial access and 86% for femoral access CTO PCI procedures, showing radial access can achieve similar results.
2) Complex radial CTO PCI requires mastery of both CTO and radial techniques, and attempting to learn both simultaneously is not recommended.
3) Emerging technologies continue to help simplify radial access for complex CTO cases, but such procedures still demand extensive operator skills.
Fundación EPIC _ Tendencias actuales en TAVI y desafíos futuros.Fundacion EPIC
This document summarizes a presentation on current trends in transcatheter aortic valve implantation (TAVI) and future challenges. It discusses the use of TAVI in intermediate surgical risk patients, new generation valve devices, post-implant outcomes like paravalvular regurgitation and pacemaker rates, and several large clinical trials investigating the use of TAVI in lower risk patients. It also reviews temporal trends in TAVI procedures in France and research on reducing cerebral embolism during the procedure.
Stroke care seven days a week – improving outcomes for patients, co-ordinatin...NHS Improvement
Stroke care seven days a week – improving
outcomes for patients, co-ordinating the Stroke
imaging pathway - 365 day rapid-access one-stop TIA clinic - Dr David Eveson - presentation from the seven day services in diagnostics event held on 4 March 2013 #7dayDiagnostics
This document discusses the challenges in treating diabetic foot problems. It notes that neuropathy, deformity, trauma, ulceration, infection, ischemia and limb loss are common complications. A thorough assessment is needed to determine if the foot problem is neuropathic, ischemic, involves osteomyelitis, Charcot neuroarthropathy or a combination. Treatment depends on the underlying issues but may include offloading, antibiotics, debridement, revascularization procedures like angioplasty or bypass. Multidisciplinary care with specialists like vascular surgeons is important for managing the complex challenges of the diabetic foot.
Dialysis various modalities and indices usedAbhay Mange
Dialysis is a process used to remove waste and excess water from the blood of patients with kidney failure. There are various modalities of dialysis including intermittent hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. Hemodialysis uses diffusion and ultrafiltration across a semi-permeable membrane in a dialyzer to clean the blood. Proper vascular access and anticoagulation are also important aspects of hemodialysis treatment.
Surgeon Champion Call 2010 - Dr Peter Dorismart1971
This document summarizes the journey of Surrey Memorial Hospital in implementing the ACS-NSQIP program to track surgical outcomes and improve quality. It describes initial challenges with data quality including missing data, coding errors and inconsistencies that were addressed through staff education and updated processes. It provides examples of pneumonia and catheter-associated urinary tract infection prevention initiatives that were undertaken using a team-based approach including practice changes, education and audits to reduce infection rates. Graphics show outcomes data over time comparing the hospital to NSQIP benchmarks.
This document discusses the use of radial access for complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures based on findings from the RECHARGE registry and the presenter's experience. The key points are:
1) The RECHARGE registry found technical success rates of 85% for complete radial access and 86% for femoral access CTO PCI procedures, showing radial access can achieve similar results.
2) Complex radial CTO PCI requires mastery of both CTO and radial techniques, and attempting to learn both simultaneously is not recommended.
3) Emerging technologies continue to help simplify radial access for complex CTO cases, but such procedures still demand extensive operator skills.
Future of Non Thermal Ablation: Is the Future of Endovenous AblationVein Global
By: Steve Elias, MD, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Critical Care Research: Connection to PracticeAllina Health
1) The document discusses a critical care research program at Abbott Northwestern Hospital with the goals of conducting studies to improve patient outcomes, enhance quality of care, and reduce costs.
2) The program involves intensivists, hospitalists, and other clinical specialties conducting studies and presenting findings to improve practice.
3) Several ongoing studies are summarized that examine issues like postoperative monitoring, pulmonary ultrasound scoring, infection risks, and outcomes after procedures.
The document discusses opportunities for investment in China's healthcare sector. It notes that China ranks 26th in healthcare efficiency globally but has seen a 17.5% rise in healthcare costs relative to income. Potential areas of investment mentioned include medical equipment, clinical research organizations, digital health technologies, elderly care, pharmaceuticals, high-end private hospitals catering to wealthy urban residents, specialized private hospitals, general private hospitals, transforming and acquiring public hospitals, expanding into related healthcare areas like elderly care facilities or pediatric hospitals, and consolidating hospitals into healthcare groups. Property developers are also entering the medical sector in China.
This document provides guidance on starting a successful transradial cardiac catheterization program. It discusses how the author started their program during fellowship by attending courses and enrolling patients in clinical trials. It highlights advantages of transradial access such as reduced access complications, earlier ambulation, and improved patient comfort. The document also reviews data demonstrating reduced bleeding and improved outcomes with transradial compared to transfemoral access. Overall, it presents a case for transradial access and provides tips for establishing a successful transradial program.
The document provides information about the University of Michigan StrokeNet Regional Coordinating Center #17 (RCC-17). It discusses the origins and growth of StrokeNet and RCC-17 over time. Currently, RCC-17 coordinates clinical trials across 17 counties in Michigan and Kentucky, enrolling over 270 sites on average. RCC-17 runs both prevention and treatment trials, enrolling nearly 500 subjects total. It aims to improve enrollment diversity and provides fellowships for training in stroke research. RCC-17 also develops new clinical trial proposals and represents the region in national StrokeNet committees.
Cost Effectiveness Procedures in cathlab: Tips and TricksIsman Firdaus
1) The document discusses strategies for improving cost effectiveness in cardiac catheterization labs in Indonesia under the country's universal health coverage program. It analyzes costs based on procedures, devices, hospitalization, and remuneration.
2) Several strategies are proposed, including standardizing devices and implants for UHC patients, clinical pathways to standardize length of stays, and using national formularies. Teamwork, physician champions, and data-driven management are emphasized.
3) Metrics like door-to-balloon times for STEMI patients are discussed as important for monitoring performance and outcomes. Overall the document focuses on balancing clinical needs with budget constraints of Indonesia's universal health coverage.
BC Kidney Days 2015 - Foot Care Nursing Breakout SessionDaniel Schwartz
This document summarizes a foot care pilot project for dialysis patients at Abbotsford Regional Hospital. The project was initiated to improve foot health and reduce complications through regular foot screenings, education on proper foot care, and access to podiatry services. Initial results found reductions in lower limb amputations and hospital days compared to previous rates. Case studies demonstrated improved outcomes with regular debridement. The goals of the project are to continue improving patient outcomes and quality of life through a proactive, patient-centered approach to foot care.
Stephen Radley Consultant Obstetrician & Gynaecologist3GDR
This document discusses the benefits and practicalities of setting up and running virtual clinics. It provides an overview of virtual clinics and how they can utilize different communication methods like the internet to provide remote medical care. It then describes how the presenter has set up virtual urogynaecology clinics using an electronic pelvic floor questionnaire (ePAQ) to collect patient data before appointments. Patients found the virtual approach eased disclosure of sensitive issues and clinicians saw benefits like embedded outcomes tracking. The presentation concludes by discussing lessons learned and the practical steps involved in implementing a virtual clinic.
This document provides a technology status evaluation report on echoendoscopes. It summarizes that echoendoscopes combine endoscopy with ultrasound imaging to examine internal structures. The report describes the technical components and designs of current echoendoscope models, including imaging capabilities. It outlines the clinical applications of echoendoscopy such as evaluating cancers of the esophagus, stomach, and pancreas, as well as guiding interventional procedures like biopsy sampling.
Comprehensive approach to managing heart Failure Patientdrucsamal
The document discusses Korea's comprehensive approach to managing heart failure (HF) patients through a multidisciplinary team approach. Some key points:
1) HF prevalence in Korea is increasing, while device therapies like ICD, CRT, ECMO, and LVAD as well as heart transplants have also increased in recent years.
2) The comprehensive HF management program in Severance Hospital utilizes an integrated, interdisciplinary, and patient-centered approach including drug optimization, education, monitoring, management of comorbidities, and transitions of care.
3) A multidisciplinary heart failure team consisting of specialists, nurses, dietitians and more conduct monthly meetings and provide programs like cardiac rehabilitation and a nurse-
How to manage delays in stroke treatment Jacek StaszewskiJacek Staszewski
This document discusses strategies to manage delays in stroke treatment. It notes that while thrombolysis and thrombectomy have improved outcomes, time is still critical factor. Various factors can contribute to delays including pre-hospital times, hospital workflows, and patient factors. Studies demonstrate improved outcomes with shorter onset-to-treatment and door-to-needle times. Initiatives like pre-notification, standardized protocols, telemedicine, and programs like Target: Stroke that focus on key strategies have been shown to reduce times and increase treatment rates. While challenges remain, an emphasis on collaboration, continuous quality improvement and learning from initiatives can help further reduce delays to improve patient outcomes.
1) The document summarizes evidence from multiple studies comparing radial versus femoral access for ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
2) The RIVAL trial found no difference in major clinical outcomes between radial and femoral access but found significantly lower rates of major bleeding and vascular complications with radial access. Subgroup analysis found radial access was associated with lower rates of death and bleeding in STEMI patients.
3) The RIFLE STEACS and STEMI-RADIAL trials both found significantly lower rates of bleeding, with RIFLE STEACS also finding lower mortality, with radial versus femoral access in STEMI patients undergoing primary PCI.
The document discusses implementing early vascular access planning for inpatients starting hemodialysis to improve outcomes during the first year of outpatient hemodialysis. It notes that over 85% of incident hemodialysis patients started dialysis as inpatients and over 90% initiated with a dialysis catheter. The highest mortality risk for hemodialysis patients is in the first 120 days and is largely due to use of dialysis catheters. Converting from catheters to arteriovenous fistulas or grafts can reduce mortality by 15-50%. The document proposes predicting which inpatients will require long-term dialysis to target for early vascular access planning, including fistula placement before discharge. This "Early V
Untether Your Data with EndoGear: Wireless Volumetric Blood Flow and Pressure...InsideScientific
Join Cole McLarty and Dr. Danielle Senador for an introduction to the newest biotelemetry system in the life science field, EndoGear.”
Tethered Transonic flow probes have been instrumental in life science protocols for the past 40 years. They have delivered absolute blood volume with a high level of accuracy, durability, and biocompatibility. However, tethered monitoring is complex and does not allow for the synchronized assessment of blood pressure. EndoGear allows for continuous assessment of high-fidelity, solid-state pressure, and volumetric blood flow. Using EndoGear to collect cardiac output and systemic pressure recordings, Cole and Danielle review the new platform and the research opportunities that it brings.
Key Topics Include:
What sets this equipment apart from other telemetry systems on the market
How EndoGear fits into various fields of study including physiology, safety pharmacology, and behavioral science
How EndoGear can fit into your protocols today, including data acquisition, flow probe customization, and power supply options
What strategies can be employed for analyzing months’ worth of continuous blood flow, pressure, temperature, and activity
Utility of primary care based TIA electronic decision support: A cluster randomised controlled trial. Presented by Anna Ranta, Department of Neurology, MidCentral DHB, at HINZ 2014, 12 November 2014, 12pm, Plenary Room
This document discusses telemedicine and reducing healthcare costs through innovative programs. It provides data on the breakdown of healthcare costs by category for a pilot population, showing that hospital care accounts for the largest share. The document also summarizes results from several telemedicine programs that led to reductions in ICU and hospital days, readmission rates, and overall healthcare costs compared to national averages. It concludes that preliminary data suggests healthcare costs were reduced by around 50% through telemedicine interventions but that more investigation is still needed.
Dr. Paul Schmidt presented on using simulation to manage unscheduled care at Portsmouth Hospitals NHS Trust. The current system had functional divides between the emergency department and acute medicine unit that led to operational inefficiencies. Simulation was used to test an integrated model that aligned demand with focused services to simplify patient flow. The new model reduced transfers, wait times and ambulance turnaround times. It showed potential staffing and bed capacity savings that require further testing and organizational change.
This document discusses coordinating an extracorporeal membrane oxygenation (ECMO) service with patient retrieval. It compares the ECMO models in Australia and New Zealand, with New Zealand having a single national ECMO service based in Auckland that provides retrieval services across the country. Maintaining adequate caseload volume is important for outcomes, and a national/regional centralized model can help with this by concentrating experience. Successfully managing competing demands and indication creep is also discussed.
The Diabetes Discovery Project at Austin Health aimed to use their Cerner EMR system to routinely test HbA1c levels on inpatients over 54 to identify undiagnosed and poorly controlled diabetes. Testing of over 5,000 patients found 5% had undiagnosed diabetes and 29% had known diabetes. Higher HbA1c levels were associated with increased hospital admissions and longer lengths of stay for surgical patients. The project demonstrated using health IT to identify diabetes management opportunities. Ongoing work includes refining protocols and expanding to other patient populations.
This document summarizes a presentation on using data and informatics to improve allied health services. It discusses the history of allied health and challenges with data collection. Examples are provided of projects in New Zealand that used data to enhance patient and clinician experiences, reduce hospital-acquired infections, and inform staffing needs. The presentation emphasizes standardizing data to facilitate benchmarking and applying knowledge gained from data analysis to drive improvements in allied health.
Future of Non Thermal Ablation: Is the Future of Endovenous AblationVein Global
By: Steve Elias, MD, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Critical Care Research: Connection to PracticeAllina Health
1) The document discusses a critical care research program at Abbott Northwestern Hospital with the goals of conducting studies to improve patient outcomes, enhance quality of care, and reduce costs.
2) The program involves intensivists, hospitalists, and other clinical specialties conducting studies and presenting findings to improve practice.
3) Several ongoing studies are summarized that examine issues like postoperative monitoring, pulmonary ultrasound scoring, infection risks, and outcomes after procedures.
The document discusses opportunities for investment in China's healthcare sector. It notes that China ranks 26th in healthcare efficiency globally but has seen a 17.5% rise in healthcare costs relative to income. Potential areas of investment mentioned include medical equipment, clinical research organizations, digital health technologies, elderly care, pharmaceuticals, high-end private hospitals catering to wealthy urban residents, specialized private hospitals, general private hospitals, transforming and acquiring public hospitals, expanding into related healthcare areas like elderly care facilities or pediatric hospitals, and consolidating hospitals into healthcare groups. Property developers are also entering the medical sector in China.
This document provides guidance on starting a successful transradial cardiac catheterization program. It discusses how the author started their program during fellowship by attending courses and enrolling patients in clinical trials. It highlights advantages of transradial access such as reduced access complications, earlier ambulation, and improved patient comfort. The document also reviews data demonstrating reduced bleeding and improved outcomes with transradial compared to transfemoral access. Overall, it presents a case for transradial access and provides tips for establishing a successful transradial program.
The document provides information about the University of Michigan StrokeNet Regional Coordinating Center #17 (RCC-17). It discusses the origins and growth of StrokeNet and RCC-17 over time. Currently, RCC-17 coordinates clinical trials across 17 counties in Michigan and Kentucky, enrolling over 270 sites on average. RCC-17 runs both prevention and treatment trials, enrolling nearly 500 subjects total. It aims to improve enrollment diversity and provides fellowships for training in stroke research. RCC-17 also develops new clinical trial proposals and represents the region in national StrokeNet committees.
Cost Effectiveness Procedures in cathlab: Tips and TricksIsman Firdaus
1) The document discusses strategies for improving cost effectiveness in cardiac catheterization labs in Indonesia under the country's universal health coverage program. It analyzes costs based on procedures, devices, hospitalization, and remuneration.
2) Several strategies are proposed, including standardizing devices and implants for UHC patients, clinical pathways to standardize length of stays, and using national formularies. Teamwork, physician champions, and data-driven management are emphasized.
3) Metrics like door-to-balloon times for STEMI patients are discussed as important for monitoring performance and outcomes. Overall the document focuses on balancing clinical needs with budget constraints of Indonesia's universal health coverage.
BC Kidney Days 2015 - Foot Care Nursing Breakout SessionDaniel Schwartz
This document summarizes a foot care pilot project for dialysis patients at Abbotsford Regional Hospital. The project was initiated to improve foot health and reduce complications through regular foot screenings, education on proper foot care, and access to podiatry services. Initial results found reductions in lower limb amputations and hospital days compared to previous rates. Case studies demonstrated improved outcomes with regular debridement. The goals of the project are to continue improving patient outcomes and quality of life through a proactive, patient-centered approach to foot care.
Stephen Radley Consultant Obstetrician & Gynaecologist3GDR
This document discusses the benefits and practicalities of setting up and running virtual clinics. It provides an overview of virtual clinics and how they can utilize different communication methods like the internet to provide remote medical care. It then describes how the presenter has set up virtual urogynaecology clinics using an electronic pelvic floor questionnaire (ePAQ) to collect patient data before appointments. Patients found the virtual approach eased disclosure of sensitive issues and clinicians saw benefits like embedded outcomes tracking. The presentation concludes by discussing lessons learned and the practical steps involved in implementing a virtual clinic.
This document provides a technology status evaluation report on echoendoscopes. It summarizes that echoendoscopes combine endoscopy with ultrasound imaging to examine internal structures. The report describes the technical components and designs of current echoendoscope models, including imaging capabilities. It outlines the clinical applications of echoendoscopy such as evaluating cancers of the esophagus, stomach, and pancreas, as well as guiding interventional procedures like biopsy sampling.
Comprehensive approach to managing heart Failure Patientdrucsamal
The document discusses Korea's comprehensive approach to managing heart failure (HF) patients through a multidisciplinary team approach. Some key points:
1) HF prevalence in Korea is increasing, while device therapies like ICD, CRT, ECMO, and LVAD as well as heart transplants have also increased in recent years.
2) The comprehensive HF management program in Severance Hospital utilizes an integrated, interdisciplinary, and patient-centered approach including drug optimization, education, monitoring, management of comorbidities, and transitions of care.
3) A multidisciplinary heart failure team consisting of specialists, nurses, dietitians and more conduct monthly meetings and provide programs like cardiac rehabilitation and a nurse-
How to manage delays in stroke treatment Jacek StaszewskiJacek Staszewski
This document discusses strategies to manage delays in stroke treatment. It notes that while thrombolysis and thrombectomy have improved outcomes, time is still critical factor. Various factors can contribute to delays including pre-hospital times, hospital workflows, and patient factors. Studies demonstrate improved outcomes with shorter onset-to-treatment and door-to-needle times. Initiatives like pre-notification, standardized protocols, telemedicine, and programs like Target: Stroke that focus on key strategies have been shown to reduce times and increase treatment rates. While challenges remain, an emphasis on collaboration, continuous quality improvement and learning from initiatives can help further reduce delays to improve patient outcomes.
1) The document summarizes evidence from multiple studies comparing radial versus femoral access for ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
2) The RIVAL trial found no difference in major clinical outcomes between radial and femoral access but found significantly lower rates of major bleeding and vascular complications with radial access. Subgroup analysis found radial access was associated with lower rates of death and bleeding in STEMI patients.
3) The RIFLE STEACS and STEMI-RADIAL trials both found significantly lower rates of bleeding, with RIFLE STEACS also finding lower mortality, with radial versus femoral access in STEMI patients undergoing primary PCI.
The document discusses implementing early vascular access planning for inpatients starting hemodialysis to improve outcomes during the first year of outpatient hemodialysis. It notes that over 85% of incident hemodialysis patients started dialysis as inpatients and over 90% initiated with a dialysis catheter. The highest mortality risk for hemodialysis patients is in the first 120 days and is largely due to use of dialysis catheters. Converting from catheters to arteriovenous fistulas or grafts can reduce mortality by 15-50%. The document proposes predicting which inpatients will require long-term dialysis to target for early vascular access planning, including fistula placement before discharge. This "Early V
Untether Your Data with EndoGear: Wireless Volumetric Blood Flow and Pressure...InsideScientific
Join Cole McLarty and Dr. Danielle Senador for an introduction to the newest biotelemetry system in the life science field, EndoGear.”
Tethered Transonic flow probes have been instrumental in life science protocols for the past 40 years. They have delivered absolute blood volume with a high level of accuracy, durability, and biocompatibility. However, tethered monitoring is complex and does not allow for the synchronized assessment of blood pressure. EndoGear allows for continuous assessment of high-fidelity, solid-state pressure, and volumetric blood flow. Using EndoGear to collect cardiac output and systemic pressure recordings, Cole and Danielle review the new platform and the research opportunities that it brings.
Key Topics Include:
What sets this equipment apart from other telemetry systems on the market
How EndoGear fits into various fields of study including physiology, safety pharmacology, and behavioral science
How EndoGear can fit into your protocols today, including data acquisition, flow probe customization, and power supply options
What strategies can be employed for analyzing months’ worth of continuous blood flow, pressure, temperature, and activity
Utility of primary care based TIA electronic decision support: A cluster randomised controlled trial. Presented by Anna Ranta, Department of Neurology, MidCentral DHB, at HINZ 2014, 12 November 2014, 12pm, Plenary Room
This document discusses telemedicine and reducing healthcare costs through innovative programs. It provides data on the breakdown of healthcare costs by category for a pilot population, showing that hospital care accounts for the largest share. The document also summarizes results from several telemedicine programs that led to reductions in ICU and hospital days, readmission rates, and overall healthcare costs compared to national averages. It concludes that preliminary data suggests healthcare costs were reduced by around 50% through telemedicine interventions but that more investigation is still needed.
Dr. Paul Schmidt presented on using simulation to manage unscheduled care at Portsmouth Hospitals NHS Trust. The current system had functional divides between the emergency department and acute medicine unit that led to operational inefficiencies. Simulation was used to test an integrated model that aligned demand with focused services to simplify patient flow. The new model reduced transfers, wait times and ambulance turnaround times. It showed potential staffing and bed capacity savings that require further testing and organizational change.
This document discusses coordinating an extracorporeal membrane oxygenation (ECMO) service with patient retrieval. It compares the ECMO models in Australia and New Zealand, with New Zealand having a single national ECMO service based in Auckland that provides retrieval services across the country. Maintaining adequate caseload volume is important for outcomes, and a national/regional centralized model can help with this by concentrating experience. Successfully managing competing demands and indication creep is also discussed.
The Diabetes Discovery Project at Austin Health aimed to use their Cerner EMR system to routinely test HbA1c levels on inpatients over 54 to identify undiagnosed and poorly controlled diabetes. Testing of over 5,000 patients found 5% had undiagnosed diabetes and 29% had known diabetes. Higher HbA1c levels were associated with increased hospital admissions and longer lengths of stay for surgical patients. The project demonstrated using health IT to identify diabetes management opportunities. Ongoing work includes refining protocols and expanding to other patient populations.
This document summarizes a presentation on using data and informatics to improve allied health services. It discusses the history of allied health and challenges with data collection. Examples are provided of projects in New Zealand that used data to enhance patient and clinician experiences, reduce hospital-acquired infections, and inform staffing needs. The presentation emphasizes standardizing data to facilitate benchmarking and applying knowledge gained from data analysis to drive improvements in allied health.
This document presents a proof of concept for using Twitter data to conduct syndromic surveillance for public health monitoring. It analyzed tweets containing the keyword "measles" between 2014-2015 and found 1,408 relevant tweets. The number of tweets mentioning measles was compared to confirmed measles cases from a national surveillance system, showing potential for Twitter data as an early warning system. However, limitations include using a single keyword and the free Twitter API. Future work proposed improving data collection, applying machine learning techniques, and validating tweets with other health data sources.
The document discusses using surface modelling and mapping techniques to analyze healthcare data. It provides three scenarios as examples: 1) Mapping KPIs regionally to identify opportunities for improvement, 2) Mapping data around a specific pharmacy to examine market penetration, and 3) Comparing the market penetration of two smoking cessation medications. Surface mapping allows easy visualization and comparison of multiple data layers, helps protect patient privacy, and can provide insights into how to optimize outcomes.
The document summarizes how providing laptop computers to clinicians in a community allied health service has enhanced clinical care. Each of the 20 clinicians was provided a laptop with mobile data and remote desktop access to complete administrative and electronic tasks in the community rather than returning to the office. This has increased efficiency by allowing timely and collaborative work, which has decreased stress on clinicians and allowed for more timely information sharing with children and families. Some challenges remain around the weight of laptops and continuing reliance on paper records. Future plans include providing iPads and moving to more paperless systems.
This document describes the development of an electronic workflow system called scope to improve surgical practice at a District Health Board (DHB) hospital. The goals were to seamlessly map the patient journey, accurately collect coded data, and leverage trusted data to inform clinicians. The system streamlines waiting lists, captures accurate operating notes, and facilitates morbidity and mortality meetings. Implementation across surgical specialties has achieved good compliance and uptake. Preliminary results found increased quality of notes, discussion of complications, and potential to change practice through advanced data analysis. In conclusion, scope has replaced a disconnected paper system with a seamless electronic solution that fully captures standardized data to improve surgical outcomes.
1. The document discusses how healthcare has progressed beyond just electronic medical records (EMRs) and is now focused on areas like mobile computing, health collaboration, cloud-based back office systems, health intelligence, and clinical grade communications.
2. It provides examples of how technology is enabling cross-campus collaboration, telehealth, clinical collaboration using medical devices and teleradiology, and clinical communications.
3. The document advocates for sustainable eHealth innovation beyond just EMRs and discusses how areas like health analytics, mobility for care, patient-centered care, and emerging technologies can further improve healthcare.
The document discusses empowering healthcare through technology that is safe, works for everyone, and leaves no one behind. It describes how digital technologies are disrupting traditional healthcare models and outlines opportunities to enhance patient and provider experiences through virtual care, remote monitoring, and analytics. Key goals are mentioned like reducing readmissions, increasing effectiveness, and improving clinical productivity. The future of healthcare is envisioned as personalized, connected, data-driven, and empowering every person and organization to achieve more through technology.
The document discusses using analytics and care coordination to reduce hospitalizations and arrests of mental health patients. It notes that around 10% of patients are readmitted to psychiatric hospitals within 30 days of discharge. Care coordination aims to break this cycle through improved outcomes, treatment adherence, continuity of care, and identifying high-risk patients. Analytics tools can provide predictive modeling, population clustering, and care quality analysis to develop insights. The goal is to engage all stakeholders to deliver an integrated care plan through data-driven insights and coordination between providers.
Dr Nic Woods discusses tools for early recognition and management of sepsis using the electronic medical record (EMR). Sepsis poses a major global health challenge and burden. Tools discussed include a sepsis predictive model built into the EMR that can detect signs of sepsis with sensitivities of 68-91% and specificities of 91-97.6%. Clinical decision support and workflows in the EMR are also used to alert clinicians and guide treatment. Evaluations found these tools helped reduce mortality from sepsis by 4.2-17% and lower length of hospital stays. Key points emphasized that predictive models integrated into clinical workflows can positively impact outcomes, but more progress is still needed.
This document discusses allied health professionals and their role in the healthcare system. It lists various allied health roles and describes how they rehabilitate and enable patients by taking a collaborative and holistic approach focused on patient needs. The document emphasizes that allied health professionals help reduce health service needs by facilitating patients' independence and ability to remain in their communities. It argues that capturing allied health data can help provide visibility into their services, allow for quality improvement, and ultimately benefit patients through a more coordinated system where the "right intervention" is delivered at the "right time". The challenges of engaging stakeholders and integrating passive data extraction are also addressed.
This document discusses changes in clinical data collection and the role of clinical coders. It notes that data now comes from many sources through various mediums and is used for many purposes. Clinical coding translates medical descriptions into codes. While technology has improved coding efficiency, the role of clinical coders may change further as technology advances. In particular, widespread electronic health records could significantly impact current clinical coding practices and roles. The document urges clinical coders and organizations to consider how to prepare for and adapt to technological changes to ensure accurate and consistent health data collection into the future.
This document provides background information on New Zealand's national maternity system called BadgerNet. It discusses the existing national programs and governance structure in place. BadgerNet is being rolled out nationally as an end-to-end maternity information system to record information from conception to six weeks postnatal. It will be used across District Health Boards and in the community. The financial model and implementation process are also outlined.
This document summarizes a presentation given by Dr. Shaun Costello on oncology treatment patterns in the South Island of New Zealand. The presentation discusses the creation of the South Island Cancer Clinical Information System (SICCIS) to capture patient-level oncology data across multiple hospitals in the region. This includes implementation of the MOSAIQ electronic medical record system and a shared data repository called METRIQ. The goal is to analyze the treatment patterns and outcomes of cancer patients in order to improve the quality of care in the South Island. Examples of preliminary analyses of the data are shown, including cancer stages, treatments, and radiation doses for lung cancer patients.
The evaluation identified several unintended consequences of the electronic prescribing pilot including new types of errors related to prescribing workflows and system defaults. Key lessons learned were that ongoing training and engagement are needed as workflows change over time. Regular monitoring is required to identify errors and develop strategies to address them, such as simplifying multi-step processes and minimizing alert fatigue. Overall the evaluation found that electronic prescribing has benefits but also risks, and a focus on how systems are implemented and used is as important as the technology itself.
This document discusses emerging technologies in the pharmacy sector. It begins with an overview of the evolution of pharmacy and a discussion of disruptive technologies. It then examines specific emerging capabilities like online healthcare access in Switzerland, remote patient monitoring in Spain, and ingestible sensors. Exciting retail trends are also explored, such as using customer data to predict behaviors, billboards responding to airplane flights, and the potential of Li-Fi wireless networks. The document suggests several technologies may disrupt pharmacies or remain niche capabilities. Overall, it analyzes new digital innovations and how they could impact pharmacy services and the customer experience.
This document discusses the development of a smartphone app to help patients better manage their rheumatoid arthritis. Interviews with rheumatoid arthritis patients and healthcare professionals revealed key themes. Patients were enthusiastic about an app's potential to record symptoms and communicate with their care team. However, healthcare professionals were apprehensive about increased workloads. Both groups saw value in collecting patient-reported outcomes but acknowledged limitations. Next steps include piloting a new "RAconnect" app and conducting a clinical trial to evaluate its impact on disease management compared to standard care.
This document discusses various self-tracking tools and applications for health, fitness, and well-being. It mentions several companies and products including 23andMe for DNA sequencing, UBiome for microbiome sequencing, Dexcom for continuous blood glucose monitoring, and Jawbone UP and Fitbit for activity tracking. It also discusses ideas around open data, genomic APIs, geo-tracking health data, and future technologies like ingestible sensors. Overall, the document explores the growing field of self-quantification and personalized data collection for improving individual health and wellness.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
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The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
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Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Telerenal Services in Northland
1. Telerenal Services in
Northland
Establishing an integrated
regional dialysis service and
clinical networks
Dr Walaa Saweirs (2012),
Whangarei Hospital,
New Zealand
2. Outline
Background
Regional service
Rurality/travel times
Cost of travel
Tertiary referral
Current use of telehealth
Within the region
Links with other centres
Lessons learned
Future plans
5. Population Density (2008)
< 1 person/ km2
1-5 persons/ km2
5-10 persons/ km2
Kaitaia 10-50 persons/ km2
Kawakawa
500-750 persons/ km2
Whangarei
750-2000 persons/ km2
250-500 persons/ km2
7. Kaitaia to Whangarei – 2¼ hrs
Kawakawa to Whangarei – 1hr
Whangarei to Auckland – 2¼ hrs
8. Travel Costs
Ambulance transfer to Whangarei Base Hospital
From Kaitaia costs NDHB roughly $350
From Bay of Islands costs NDHB roughly $150
Patient transfer by taxi to Whangarei Base Hospital
From Kaitaia costs NDHB roughly $200
From Bay of Islands costs NDHB roughly $100
NTA allowance of 28c/km
From Kaitaia to Whangarei (155km) - $43.40
From Bay of Islands to Whangarei (71km) - $19.90
Hidden costs
Social eg support person travelling, child care, isolation from
whanau
Staffing eg need for nurse escort
13. Issues:
Opening of new satellite dialysis unit at Kaitaia
hospital in November 2010
Lack of permanent Clinical Nurse Manager
Contingency for BOI CNM to oversee KTA satellite
No on-site specialist physician
Planned for 2 visits per month for clinics
Travel times for both patients and staff movement
Weekly multidisciplinary team meetings would prove
challenging
Staff isolation and training issues
Support for existing satellite unit at BOI
…etc
14. ..other options?
Don’t open the Kaitaia unit…
Health pressures
Community pressure etc
Increased staffing…
Financially and logistically not viable
Skype-based system initially discussed...
Security
Logistics
Ease of use
Future adaptability
15. Equipment
Polycom HDX7000 with 32" LCD TV screen
on a mobile cart in each of the 3 units
Panasonic SD50 handheld videocamera in
each of the 3 units
QD700 Document Camera in each of 2
satellite units
HP Elitebook Pro tablet in base unit
Total set-up cost - $70k
Monthly cost (of 3 renal units) - $1000
17. Multidisciplinary Meeting
Weekly meeting with all units involved
Medical handover
Review of:
Difficult/problematic cases within each unit
Dialysis access issues
New patients
Forward planning
Patient transfers/logistics between units over the coming
week for eg planned procedures
Patient transfers/logistics to Auckland over the coming
week for eg vascular procedures
19. “Paper round” - Summary
Monthly review of individual haemodialysis
patient results with primary nurse/nursing team
leader by patient’s primary renal physician
Adjust dialysis prescription as needed
Adjust medication as needed and advise GP
Review any vascular access issues
Review any on-going concerns
20. “Paper round” - Logistics
Individual patient electronic folders:
Excel spreadsheet of cumulative monthly labs
Excel spreadsheet of dialysis BPs & weights
Word document with current medication record
Above prepared by nurses in advance of round
ECGs and individual dialysis session notes can be transmitted
using the document camera
Brief round note dictated to GP
Medication/dialysis record changes updated, signed & dated
using Tablet PC
Potential room for further efficiency:
Electronic renal IT system collating patient lab results, BPs,
weights
Electronic medication record linked to GP and Pharmacy
26. Patient Assessment
As needed basis
Medical assessment
Acute review of issues arising on dialysis eg vascular
access, skin lesions
Use of handheld digital camera
Allows collegial support of non-specialists at satellite unit
Allows streamlined transfer to tertiary centre without detour
via base hospital
Reduces unnecessary travel for patients and family
Discussion of complex management plans with patient &
carers
End of life discussions
Dietetic assessment
Social work review
Psychiatric review
27.
28. Other uses (within the region)
Family meetings – for those about to start or
on dialysis
Weekly nurse in-service training sessions
Staff performance appraisal
Collegial support of satellite team
29. Tertiary Links – “BVC”
Vascular & vascular radiology
Vascular access nurse-led paper referral sent to VA team
at ADHB
Outcome of discussions relayed back to Northland team
without direct discussion with Northland team
More crisis management than planned
Renal transplant
Monthly telephone discussion with Auckland transplant
team of Northland patients on transplant waiting list
Regional meetings
Ad hoc – inconsistent attendance due to travel time issues
and impact on clinical load
30. “Asymmetry of need - the incentive for telehealth is greater for those who receive
it than those who provide it”
31. …Perceived barriers by tertiary centre…
Time
Meeting times stretched already
“Current system works fine” (Tertiary team)
Money
Stretched resources
Who would fund?...
“Northland - as its for their patients” (Tertiary team)
Effort
Set-up of system
IT Support
“We don’t need it” (Tertiary team)
Impact on Auckland patients
“Aucklanders have the lowest intervention rate” (Tertiary team)
..implying they are usurped by regional centres it serves..
34. Tertiary Links – “AVC”
Vascular & vascular radiology
Weekly meeting with vascular surgery, radiology, vascular
access team (ADHB and NDHB)
Real-time two-way patient discussions with review of
radiological investigations and previous intervention
Collaborative planned approach
Renal transplant
Monthly meeting which now feels as though one is talking
with the whole team
Regional meetings
Improved ability to attend eg weekly transplant meetings
Potential for larger group discussion encompassing eg
Waitemata, Middlemore, Waikato etc
37. Benefits
Quantifiable:
Reduced staff and patient travel costs
Increased productivity
Estimated $8700 per month of additional revenue (on paper anyway!)
Additional 30 patients per month can be seen in clinic
Travel cost savings low, but productivity gain from time released is
large
Non-quantifiable:
Far greater value than quantifiable benefits
Include:
Team cohesion
Enhanced communication
Improved staff morale
Enhanced education and training
Improved ability and speed to adapt to new priorities and demands
Anticipated reduction in error rate
Safe and supported working environment for staff
38. Issues - Local
Location
Ideally need a dedicated consulting room which is
soundproof
Patient areas also need to be private
Security of units
Lockable, yet useable
Ease of use
Units initially appeared to reset themselves
Slow start-up
Bandwidth KEYS TO LOCAL ISSUES:
Initial Telecom issues Medical and nursing champion
Power issues Dedicated IS support
Team engagement and enthusiasm
Surge protector
Communication
39. Issues – Tertiary Link
?KEYS TO ISSUES:
Medical and nursing champion
Dedicated IS support
Team engagement and enthusiasm
Communication
Incorporate into service plan as part of
tertiary provision
Recognise cost through purchaser/provider
codes
Recognise the benefit and potential
41. Patient hand-over
Satellite transfer
Vascular access
Acute patient assessment
Dialysis equipment troubleshooting
Use of hand-held camera – “live” and “store &
forward”
Importance of camera stability +/- lighting
Link to renal pathology review meetings in
Auckland?
Regional and national meetings???
42. Acknowledgements:
Cheryle Kiwi – Northland Renal Service Nurse Manager
Roy Davidson – Telehealth Programme Leader
Sue Wyeth – GM Mental Health and District Hospitals
Neta Smith – Kaitaia Operations Manager
Philip Jarvis – CNM Bay of Islands dialysis unit
Laurie Francis – Previous acting CNM Kaitaia dialysis unit
Jill Rengatch – CNM Kaitaia dialysis unit
The nursing and medical staff of the Northland Renal Team
Simon Hayden and the team at Vivid Solutions