The document discusses advance care planning (ACP) and its importance in end-of-life care. It defines ACP as a voluntary process where patients discuss future medical treatment preferences with healthcare providers. Key points include:
- ACP allows patients to communicate their values and wishes should they become unable to make decisions later.
- Triggers for initiating ACP include prognosis from chronic illness or a "gut feeling" from clinicians. Sensitive conversations are important.
- Documents like Preferred Priorities of Care and Advance Decisions to Refuse Treatment can record a patient's wishes if properly completed.
- Valid advance decisions must be specific, signed/witnessed, and state they apply even if life is at
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Presented at Kansas City University of Osteopathic Medicine 10/27/15 in Lecture Series in Bioethics. See live presentation here: https://www.youtube.com/watch?v=Dr3g3PeVKeo
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Presented at Kansas City University of Osteopathic Medicine 10/27/15 in Lecture Series in Bioethics. See live presentation here: https://www.youtube.com/watch?v=Dr3g3PeVKeo
Do Not Resuscitate Orders : What They Mean ?SMSRAZA
Most doctors working in Acute areas know when and how to do CPR. However, most get stuck when it comes to ' When not to do CPR' due to cultural, social, ethical and legal issues attached.
Geriatric Population. Geriatric Palliative and End-of-Life Care.Michelle Peck
During your journey through this slide deck Geriatric Population. Geriatric Palliative and End-of-Life Care you will experience what it means to die badly.
After practicing as a Geriatric Clinician for over a decade what I know for sure is: Life is a tremendous gift. 100% of us are going to die. If you don't communicate your end-of-life plan, then you should plan on dying badly.
In The Cost of Dying: End-of-Life Care on CBS 60 minutes Steve Kroft interviews Doctor Ira R. Byock. “Families cannot imagine that there could be anything worse than their loved one dying, but in fact there are things worse, generally it’s having someone you love die badly.” ~Doctor Ira Byock
“Dr. Byock what do you mean dying badly?” ~Mr. Kroft
“Dying suffering, dying connected to machines, denial of death at some point becomes a delusion and we start acting in ways that make no sense whatsoever.” ~Doctor Ira Byock
A majority of Americans say they want to die at home. Why is this not happening?
Place of death should be regarded as an essential goal in end-of-life care.
Let’s explore how the end-of-life decision occurs?
For Doctors
Bernacki & Block (2014) found in their review and synthesis of best practices that physician attitudes, training, and perceptions of feeling inadequate in managing the emotional and behavioral reactions of patients all play a role. A majority of trainees were not taught how to communicate and they express strong desires to learn more. Physician barriers also include not addressing psychosocial concerns, placing focus on diagnoses, treatments, and procedures during discussions about the medical care at the end-of-life.
For Patients
Bernacki & Block (2014) found that patients who do bring up dying concerns with their physicians often meet barriers and often are not aware that they are at the end-of-life. Patients that have not set goals based on meaningful conversations about their desires may overuse life-prolonging treatment and underuse services that support quality of life.
Conclusion
Bernacki & Block (2014) found that there is a large body of evidence demonstrating that early discussions of serious illness care goals are associated with:
♛ beneficial outcomes for patients,
♛ no harmful adverse effects, and
♛ potential cost savings.
Apply & Do
To prevent dying badly start early conversations, enhance your knowledge and establish goals. Dreams are only dreams until you write them down. When you write dreams down then they become goals.
Do ♛ The Conversation Project a collaboration with the Institute for Healthcare Improvement. http://theconversationproject.org/starter-kit/intro/
Do your conversation kit now and make your loved ones aware of your wishes.
Wishing you the very best, Michelle
Bernacki RE, Block SD, for the American College of Physicians High Value Care Task Force. Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices. JAMA Intern Med. 2014;174(12):1994-2003.
DNAR (Do Not Attempt Resuscitation): Policy, Practice and Challenges (Present...Irish Hospice Foundation
DNAR (Do Not Attempt Resuscitation): Policy, Practice and Challenges (Presentation at Dublin Community Network Meeting / Residential Network Meeting, November 2016)
Improving the Family Experience at the End of Life in Organ DonationAndi Chatburn, DO, MA
Communication skills strategies for improving family experience at the end of life for patients who die in the ICU after determination of brain death or after removing mechanical life support. Audience: Organ Procurement Organization staff and hospital administration
Ethics at the End of Life and Introduction to Hospice and Palliative Care for Medical Students. Exploration of feeding tubes, code status, when to stop chemo. Discusses cases and the ethical principles and values that are the basis for disagreement in care and what to do when there is a conflict in ethical principles themselves. Also provides an introduction to decisions of last resort including physician aid in dying, palliative sedation and voluntary refusal of nutrition and hydration.
Disability and Mental Health: The Ties that BindEsserHealth
Depression and Disability: The Ties That Bind. See how Disability and Depression work hand in hand. Learn the most recent statistics in disability science and how essential it is to tackle the whole picture to help the whole patient.
Considerations when deciding about withholding or withdrawing life-sustaining...Dr. Liza Manalo, MSc.
Towards the end of life, physicians face dilemmas of discontinuing life-sustaining treatments or interventions. In some circumstances, these treatments are no longer of benefit, while in others the patient or family no longer want them. The physician plays an essential role in clarifying the goals of medical treatment, defining the care plan, initiating discussions about life-sustaining therapy, educating patients and families, helping them deliberate, making recommendations, and implementing the treatment plan. Communication is key. It should be clarified that when inevitable death is imminent, it is legitimate to refuse or limit forms of treatment that would only secure a precarious and burdensome prolongation of life, for as long as basic humane, compassionate care is not interrupted. Agreement to DNR status does not preclude supportive measures that keep patients free from pain and suffering as possible. Acceptable clinical practice on withdrawing or withholding treatment is based on an understanding of the medical, ethical, cultural, and religious issues. There is a need to individualize care option discussions to illness status, and patient and family preferences, beliefs, values, and cultures. The process of shared decision making between the patient, the family, and the clinicians should continue as goals evolve and change over time.
Palliative Care What Is Palliative MedicineIndranil Khan
What is Palliative Care Who needs Palliative Care Components of Palliative Care Doctors in Kolkata West Bengal India Pain Treatment Yoga Morphine Buprenorphine
Ethics presentation given at Providence Health Care on 2/19/16 as a part of a day-long nursing oncology conference. Discusses the fundamental clinical ethics consultation approach and discusses in narrative the relevant ethics cases that are common to oncology practice
Do Not Resuscitate Orders : What They Mean ?SMSRAZA
Most doctors working in Acute areas know when and how to do CPR. However, most get stuck when it comes to ' When not to do CPR' due to cultural, social, ethical and legal issues attached.
Geriatric Population. Geriatric Palliative and End-of-Life Care.Michelle Peck
During your journey through this slide deck Geriatric Population. Geriatric Palliative and End-of-Life Care you will experience what it means to die badly.
After practicing as a Geriatric Clinician for over a decade what I know for sure is: Life is a tremendous gift. 100% of us are going to die. If you don't communicate your end-of-life plan, then you should plan on dying badly.
In The Cost of Dying: End-of-Life Care on CBS 60 minutes Steve Kroft interviews Doctor Ira R. Byock. “Families cannot imagine that there could be anything worse than their loved one dying, but in fact there are things worse, generally it’s having someone you love die badly.” ~Doctor Ira Byock
“Dr. Byock what do you mean dying badly?” ~Mr. Kroft
“Dying suffering, dying connected to machines, denial of death at some point becomes a delusion and we start acting in ways that make no sense whatsoever.” ~Doctor Ira Byock
A majority of Americans say they want to die at home. Why is this not happening?
Place of death should be regarded as an essential goal in end-of-life care.
Let’s explore how the end-of-life decision occurs?
For Doctors
Bernacki & Block (2014) found in their review and synthesis of best practices that physician attitudes, training, and perceptions of feeling inadequate in managing the emotional and behavioral reactions of patients all play a role. A majority of trainees were not taught how to communicate and they express strong desires to learn more. Physician barriers also include not addressing psychosocial concerns, placing focus on diagnoses, treatments, and procedures during discussions about the medical care at the end-of-life.
For Patients
Bernacki & Block (2014) found that patients who do bring up dying concerns with their physicians often meet barriers and often are not aware that they are at the end-of-life. Patients that have not set goals based on meaningful conversations about their desires may overuse life-prolonging treatment and underuse services that support quality of life.
Conclusion
Bernacki & Block (2014) found that there is a large body of evidence demonstrating that early discussions of serious illness care goals are associated with:
♛ beneficial outcomes for patients,
♛ no harmful adverse effects, and
♛ potential cost savings.
Apply & Do
To prevent dying badly start early conversations, enhance your knowledge and establish goals. Dreams are only dreams until you write them down. When you write dreams down then they become goals.
Do ♛ The Conversation Project a collaboration with the Institute for Healthcare Improvement. http://theconversationproject.org/starter-kit/intro/
Do your conversation kit now and make your loved ones aware of your wishes.
Wishing you the very best, Michelle
Bernacki RE, Block SD, for the American College of Physicians High Value Care Task Force. Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices. JAMA Intern Med. 2014;174(12):1994-2003.
DNAR (Do Not Attempt Resuscitation): Policy, Practice and Challenges (Present...Irish Hospice Foundation
DNAR (Do Not Attempt Resuscitation): Policy, Practice and Challenges (Presentation at Dublin Community Network Meeting / Residential Network Meeting, November 2016)
Improving the Family Experience at the End of Life in Organ DonationAndi Chatburn, DO, MA
Communication skills strategies for improving family experience at the end of life for patients who die in the ICU after determination of brain death or after removing mechanical life support. Audience: Organ Procurement Organization staff and hospital administration
Ethics at the End of Life and Introduction to Hospice and Palliative Care for Medical Students. Exploration of feeding tubes, code status, when to stop chemo. Discusses cases and the ethical principles and values that are the basis for disagreement in care and what to do when there is a conflict in ethical principles themselves. Also provides an introduction to decisions of last resort including physician aid in dying, palliative sedation and voluntary refusal of nutrition and hydration.
Disability and Mental Health: The Ties that BindEsserHealth
Depression and Disability: The Ties That Bind. See how Disability and Depression work hand in hand. Learn the most recent statistics in disability science and how essential it is to tackle the whole picture to help the whole patient.
Considerations when deciding about withholding or withdrawing life-sustaining...Dr. Liza Manalo, MSc.
Towards the end of life, physicians face dilemmas of discontinuing life-sustaining treatments or interventions. In some circumstances, these treatments are no longer of benefit, while in others the patient or family no longer want them. The physician plays an essential role in clarifying the goals of medical treatment, defining the care plan, initiating discussions about life-sustaining therapy, educating patients and families, helping them deliberate, making recommendations, and implementing the treatment plan. Communication is key. It should be clarified that when inevitable death is imminent, it is legitimate to refuse or limit forms of treatment that would only secure a precarious and burdensome prolongation of life, for as long as basic humane, compassionate care is not interrupted. Agreement to DNR status does not preclude supportive measures that keep patients free from pain and suffering as possible. Acceptable clinical practice on withdrawing or withholding treatment is based on an understanding of the medical, ethical, cultural, and religious issues. There is a need to individualize care option discussions to illness status, and patient and family preferences, beliefs, values, and cultures. The process of shared decision making between the patient, the family, and the clinicians should continue as goals evolve and change over time.
Palliative Care What Is Palliative MedicineIndranil Khan
What is Palliative Care Who needs Palliative Care Components of Palliative Care Doctors in Kolkata West Bengal India Pain Treatment Yoga Morphine Buprenorphine
Ethics presentation given at Providence Health Care on 2/19/16 as a part of a day-long nursing oncology conference. Discusses the fundamental clinical ethics consultation approach and discusses in narrative the relevant ethics cases that are common to oncology practice
A presentation designed to inform health care workers about the components and importance of advance directives, with specific information for Massachusetts residents.
Explores palliative and end of life care. Outlines advance care planning and provides information about planning ahead to include using advance healthcare directives
SHARE Presentation: Palliative Care for Womenbkling
Dr. Michael Pearl discusses supportive palliative care for women with cancer, how it differs from hospice care, and the New York Palliative Care Information Act. Dr. Michael Pearl is Professor and Director of the Division of Gynecologic Oncology in the Department of Obstetrics, Gynecology and Reproductive Medicine at Stony Brook University Hospital.
Ethical issues of Care of elderly patients:-
Decision making capacity.
Informed consent.
Refusal of treatment.
Advance directive.
Major ethical principles.
Psycho-social aspects of aging.
DQ 1 Response 1 As health care is advancing, there have been man.docxelinoraudley582231
DQ 1 Response 1
As health care is advancing, there have been many essential right concerning patients. The process of dying is very complex and it consequences are complicated. If one dies, the individual will not come back again. Therefore, individual with living will may promote care providers’ guideline to their destiny. It will prevent any litigation that may affect the care provider and the organization. Healthcare industry has now got involved or it is now involving spiritual treatment. Spiritual health care may have close relationship with end of life. The essential aspect to spiritual health care may include emotions, feelings, and assumptions of an individual. Therefore, it is very important to guide such essential concerning patient desire to have evidence. Sometimes patient do not want their family members to witness such desire because of the emotional consequences. Every patient knows the kind of pain their feeling and if this individual desire to end this suffering, others may not understand. Hence parent and family of a patient should not interfere in such situation. I can imagine a patient with a serious accident and is subjected to life support machine based on the patient’s unresponsive reaction. This patient has gone through treatment day and night for more than years. Such situation worsens the patient pain and suffering but who else can feel what the patient is feeling? Parent should decide on what they would do to their child regardless. In my opinion, the child will depend on the parent to survive living healthy. It would be very painful if the parent income -wise is poor. Which will lead the child to go through painful life. Therefore, parent knows their situation at hand and they need to make their own decision regardless.
Reference
Balk, E. D: Closing the gaps on efforts to improve healthcare quality at the end-of-life.
Russell, D: Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life by the Committee on Approaching Death: Addressing Key End of Life Issues. Washington, DC: National Academies Press, 2014. 638 pages.
Response 2
Assess the ethical issues surrounding end-of-life decisions. How has the living will affected medical response and why is this important for guiding end-of-life decisions? Should families be able to impact how and if a person's living will is carried out? Should parents have the right to choose to end the life of their child if the child has Down Syndrome?
Living wills are very important. They are legal documents that lay out decisions that the patient has made for their health care in the event that they are unable to make decisions anymore. Decisions that are made could include if the patient wants to be resuscitated or kept on life support. Furthermore, a living will can have the patients in regards to pain management or organ donation. (Mayo Clinic Staff, 2017) This is way if the patient’s family or friends do not agree it goes back to the patient’s .
Art Of Dying In The English Spiritual TraditionHospiscare
The Rt Revd Gordon Mursell Bishop Gordon is a well-known preacher, author and tutor in spirituality. The art of dying in the English Spiritual Tradition was presented at Hospiscare's Holy Living, Holy Dying held in Exeter 2 November 2009.
The Rt Revd Gordon Mursell Bishop Gordon is a well-known preacher, author and tutor in spirituality. The art of dying in the English Spiritual Tradition was presented at Hospiscare's Holy Living, Holy Dying held in Exeter 2 November 2009.
A psychological perspective on the inevitability of pain and sufferingHospiscare
Revd David Nicholson A psychological perspective on the inevitability of pain and suffering, presented at the Holy Living, Holy Dying conference held in Exeter on 2 November 2009
The pastoral challenge of people dying at homeHospiscare
Revd Ian Ainsworth-Smith The pastoral challenge of people dying at home, presented at the Holy Living, Holy Dying conference held in Exeter on 2 November 2009
Dr Tim Harlow, Hospiscare Consultant
Spiritual causes of physical pain, presented at the Holy Living, Holy Dying conference held in Exeter on 2 November 2009
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
"This is how i want to die" DPT Study Day 16th September 2011
1.
2. “ This is how I want to die” Politically correct but ethically sound? How do we, and should we, discuss dying with people who have mental and physical illness?
17. Unlike other conditions, most people with dementia, including Alzheimer ’s, die in care homes. Of those who died with one of these conditions recorded as the main underlying cause of death, some 59% died in a nursing or residential home compared to 32% in hospital. The report also shows that people who die from cardiovascular disease, cancer or respiratory illness are significantly more likely to die in a care home if dementia including Alzheimer ’s is a contributory factor in their death.
28. Taken from GSF Prognostic Indicator guide 2008 High Low Function Time Cancer High Low Function Time Fraility/Dementia High Low Function Time Organ Failure GP ’s Workload Ave 20 Deaths per GP per year
46. Valid ADRTs I wish to refuse the following specific treatments:- In these circumstances:- Artificial (mechanical) breathing machine If I have had a severe stroke with little chance of recovering consciousness Antibiotics If my dementia means that I cannot not make the decision, in the event that I have a severe chest infection that might threaten my life. Artificial feeding (via a tube or drip) When my dementia has deteriorated to the point that I cannot swallow safely, even with the help of others
- LARGE NUMBER OF DEATHS EACH YEAR 2/3RDS OVER 75 YRS TOO MANY DEATHS OCCUR IN Hospital TOO FEW in other settings
Over the last 10 yrs health policy has sought to redress this & reduce hospital deaths. The public in the main want to die at home Many receive E oL good care but many do not and do not die where they would wish.
Taken from National EoL care intellegence network Underlying' cause of death is defined as: (i) the disease or injury that initiated the train of events directly linked to death; or (ii) the cirumstances of the accident or violence that produced the fatal injury. 'Contributory' cause of death is defined as part of the causal sequence of events leading to death, or contributing to the death but not part of the causal sequence.
That contrasts sharply with the figure for deaths overall: nationally 58% of us die in hospital and only 16% in care homes.
What is covered? Any aspect of future health and social care, such as where the individual wants to be cared for now and in the future, and where they want to die. ( Always be aware of considering if there are the resources to support choices a person may make, and being aware that their circumstances may change,). Who do they want told when their condition deteriorates? Do they want to be told when death is near? Who do they want to be involved in making decisions regarding their care? Are there things they want to avoid happening such as admission to hospital? Who completes it? It is written by the individual who has the capacity to make the statement. It may be written with the support from professionals, and relatives or carers. What does it provide? It covers an individuals preferences, wishes, beliefs and values about future care to guide best interest decisions in the event an individual has lost capacity to make decisions. Is it legally binding? No – but it must be taken into account when acting in the individuals best interests How does it help? It makes the MDT aware of an individuals wishes and preferences in the event the individual looses capacity. Does it need to be signed and witnessed? A signature is not required but its presence makes it clear whose views are documented. Who should see it? The patient is supported in its distribution, but has the final say on who sees it. PPC What is this document? A non- legally binding document which represents a persons hopes and wishes, completing it is entirely voluntary, it can be verbal or written informally, and can form part of an advanced care plan. Who completes it? The document is completed by people who want to discuss their wishes, future care and treatment, the focus is on what is important for the individual, also for those with progressive life limiting disease. The focus is on comfort and QOL. The purpose of the document is to facilitate provision of care for the person consistent with their wishes. As well as aiming to establish the patients wishes regarding current and future care it should also act as a trigger for appropriate referral to other services. Thereby enabling anticipatory planning of future care and instigate communication with other HCP ’s . It can facilitate decisions taken in the best interests of a person who lacks capacity to make decisions themselves. What are the triggers? Being eligible for the DS1500, the AA or DLA under special rules. ( expect to live no longer than 6 months). Being on the GSF register. Potentially curative treatment no longer possible or declined. An individual expressing a wish to discuss an advance decision. What is done with it? It is the individuals personal responsibility to inform professionals of the PPC ’s existence, a copy should stay with the patient, one to the GP one to other key involved professionals, other services likely to be involved with the persons care should be alerted such as the out of hours service. If after completing the document the person becomes unable to make decisions, the ppc will be taken in to account Is this document used to refuse treatment? Gives the ability to state what treatment you may or may not want but does not give the right to those treatments. To refuse treatment is a separate document ADRT Ensure the ppc is reviewed regularly, feelings needs and wishes change, the document needs to reflect these changes.
FOR SOME PATIENT GROUPS IT IS OBVIOUS THAT THEY ARE DECLINING Other Groups it is much more difficult to judge. GSF prognostic indicator guidance on each of the main chronic disease groups.
LOOKING AT THE GRAPH TAKEN FROM THE GUIDANCE & COMPARING THE DISEASE TRAJECTORIES 1 – CANCER – PATIENTS ARE STABLE FOR A WHILE AND THEN TEND TO DECLINE FAIRLY DRAMATICALLY 2 – ORGAN FAILURE such as HEART FAILURE, COPD , RENAL FAILURE ARE MUCH MORE DIFFICULT TO PREDICT, THEY CAN DETERIORATE & THEN STABILISE AGAIN 3 – FRAILTY & DEMENTIA DECLINE DRAMATICALLY OVER TIME WITH VERY POOR PERFAORMANCE STATUS .. THEY BOB ALONG AT A VERY FRAIL LEVEL BEFORE ULTIMATE DEATH.
SELF EXPLAINATORY.. BUT SOME OF THE FOLLOWING TRIGGORS ARE USEFUL TO THINK ABOUT...
OFTEN AT REFERRAL TO A SPC TEAM DISCUSSIONS HAVE TAKEN PLACE ALREADY AT REFERRAL TO SUGGEST THEIR CONDITION IS UNTREATABLE & WILL ULTIMATELY LEAD TO THEIR GRADUAL DECLINE A DS1500 ALLOWS AN APPLICATION FOR HIGHER RATE ATTENDANCE ALLOWANCE/DISABILITY LIVING ALLOWANCE IF UNDER 65YRS IT IS A MEDICAL REPORT THAT HAS TO BE COMPLETED BY THE GP & GOOD PRACTICE WOULD BE TO DISCUSS WITH AN INDIVIDUAL WHY IT IS BEING COMPLETED AND WHAT THE IMPLICATION OF IT IS ...ie, PROGNOSIS < 6 MONTHS. OFTEN AT ASSESSMENT OF CARE NEEDS DISCUSSIONS LEAD TO THE FUTURE & WHAT AN INDIVIDUAL WOULD WANT/NOT WANT TO HAPPEN
THINKING ABOUT INIATING DISCUSSIONS....WE FEEL TROUBLED BY THIS IF WE ARE ALL HONEST!! I AM NOT INTENDING TO DISCUSS COMMUNICATION IN ANY DEPTH TODAY BUT THERE ARE SOME SIMPLE STRATEGIES THAT CAN BE REALLY HELPFUL TO THINK ABOUT..... TIMING SETTING ....RIGHT TIME, RIGHT PLACE, RIGHT PEOPLE PRESENT & PRIVACY!! Avoid interruptions/distractions GREEt appropriately....SHOWS MUTUAL RESPECT NON – VERBAL COMMUNICATION IS REALLY IMPORTANT ... MAINTAIN EYE CONTACT, POSTURE, FACIAL EXPRESSIONS,SHOWS ACTIVE LISTENING, ALLOW PERSONAL SPACE THE PACE & TONE/PITCH OF YOUR VOICE IS IMPORTANT An open dialogue ......QUESTIONS WHICH CANNOT BE ANSWERED BY A ‘YES’ OR ‘NO’ ALLOWS EXTRA INFORMATION, FEELINGS UNDERSTANDING TO BE CONVEYED.
THINKING ABOUT AN INDIVIDUALS FAMILY & FRIENDS THE SAME PRINCIPLES APPLY Outside pressures .. From family/organisation ....RESPOND TO CUES BE SENSITIVE
SELF EXPLAINATORY ...READ Positive communication can be very therapeutic for individuals because it gives them an opportunity for their beliefs/feelings to be expressed.
A lot of people get a bit scared at the thought of being asked to be involved with a legally binding document but I hope after today you feel more comfortable with your role. ACP in realise its not something to be afraid of. To understand the legalities behind ACP it is important to have some understanding of capacity and the mental capacity act. Brought into existence to help patients but also helps us as clinicians to act in a patients best interests
So, why do we need the MCA? Before the MCA came into existence there was evidence that: People ’s autonomy not always respected People written off as incapable of making a decision because of diagnosis No clear legal authority for people who act on behalf of a person lacking mental capacity Limited options for people who wanted to plan ahead for a time when they might lack capacity Mental capacity issues potentially affect everyone Over two million people lack the capacity to make some decisions for themselves, for example:
We must allow people to make unwise or eccentric decisions if they have the capacity to do so….. This is where we get into terrible ethical dilemmas – and sometimes these cases reach the papers. Referring back to the core competency slide ….. Its about getting the right person to address the issue. Most of us will be working in the bottom two tiers: we need an understanding of and awareness of the risks and benefits of ACP and the related guidance; and we need to be able to facilitate AcP discussions/advance statements. If the person doesn ’t have capacity is there a proxy to make the decision?
If you are unsure re capacity ask a senior colleague, get a second opinion. In cases where there are concerns about capacity it may be necessary that the courts decide. Court appointed deputies more likely to be for financial than welfare decisions An IMCA is a new statutory advocate. Section 36 of the Mental Capacity Act enables the Secretary of State and Welsh Ministers to make regulations as to the functions of IMCAs. The purpose of the IMCA is to represent vulnerable people who lack capacity to make important decisions about serious medical treatment and change of accommodation where they have no family and friends available for consultation about those decisions. There is a duty to instruct an IMCA where a person who lacks capacity has nobody to represent them in the following prescribed circumstances:providing, withholding or stopping serious medical treatment;moving a person into long-term care in a hospital or care home;moving the person to a different hospital or care home.The only exception to this rule can be where an urgent decision is needed.
Joy Tomkins, 81, grandmother from Norfolk Jan 2011 tatoo
Teach in an even-handed way, encouraging critical thinking rather than persuading towards a particular change in practice • Recognise that “assess at time” is not only valid but may often be desirable • Make sure that choice is seen accurately, as; “would you like this documented?” rather than “would you like this or that intervention?” • Recognise when our discussions are intrusive rather than welcomed • Be prepared to be more transparent about the extent to which our efforts are about saving resources