Improving the prevention, recognition and management of AKI: the ‘Think Kidne...Renal Association
NHS England ‘Think Kidneys’ programme gave a presentation:
Improving the prevention, recognition and management of AKI: the ‘Think Kidneys’ initiative at the RCPSG meeting on 18.03.2016
Dr Richard Fluck - Chair of Think Kidneys spoke at HPE Live yesterday. The slides from his talk:Think(ing) Kidneys
Reducing the impact of AKI in secondary care can be found here.
The TP-CKD Team held Cohort 2 Learning and Sharing Event - Valuing Individuals – Transforming Participation in Chronic Kidney Disease
Here are the slides from the event.
Improving the prevention, recognition and management of AKI: the ‘Think Kidne...Renal Association
NHS England ‘Think Kidneys’ programme gave a presentation:
Improving the prevention, recognition and management of AKI: the ‘Think Kidneys’ initiative at the RCPSG meeting on 18.03.2016
Dr Richard Fluck - Chair of Think Kidneys spoke at HPE Live yesterday. The slides from his talk:Think(ing) Kidneys
Reducing the impact of AKI in secondary care can be found here.
The TP-CKD Team held Cohort 2 Learning and Sharing Event - Valuing Individuals – Transforming Participation in Chronic Kidney Disease
Here are the slides from the event.
Presentation made by Celia Ingham Clark National Director for Reducing Premature Mortality, at Improving access to seven day services. Southampton 25 March 2015
Graham Lipkin, Co-chair of KQuIP and Clinical VP Renal Association, together with Ron Cullen, CEO UKRR
Presented at the Scottish Renal Association 27th - 28th October 2016
The topic was:
Kidney Quality Improvement Partnership (KQuIP) Improving care for patients with kidney disease in Scotland?
Opening Keynote"From Patient to Population: Providing Optimal Care - The Role for Technology"
Ronald Paulus, MD, MBA
President & CEO
Mission Health System
Pathology Optimisation in Chronic Blood Disease MonitoringAndrew O'Hara
Richard Croker shows how an innovative approach to service redesign can improve patient outcomes at pace and scale through the safe and effective use of testing at NHS Northern, Eastern and Western Devon CCG.
Paul Bristow, BKPA, and Karen Thomas, UKRR gave a presentation at BRS2017: Embedding patient reported experience into future QI - 1st National PREM Pilot Survey 2016
Aiming for a Higher Performing Health Care System: Learning from Cross-Nation...The Commonwealth Fund
Robin Osborn, Vice President and Director, International Program in Health Policy and Innovation at The Commonwealth Fund, discusses international health care systems. These slides were presented at the Queen’s Health Policy Change Conference, May 6, 2015 in Toronto, Canada.
Kidney Quality Improvement Partnership (KQuIP): Launch
A dynamic & inclusive and professionally-led partnership supporting improved quality of care for patients with kidney disease. Slides presented at the event by Graham Lipkin & Louise Wells, Co-chairs of KQuIP
Presentation made by Celia Ingham Clark National Director for Reducing Premature Mortality, at Improving access to seven day services. Southampton 25 March 2015
Graham Lipkin, Co-chair of KQuIP and Clinical VP Renal Association, together with Ron Cullen, CEO UKRR
Presented at the Scottish Renal Association 27th - 28th October 2016
The topic was:
Kidney Quality Improvement Partnership (KQuIP) Improving care for patients with kidney disease in Scotland?
Opening Keynote"From Patient to Population: Providing Optimal Care - The Role for Technology"
Ronald Paulus, MD, MBA
President & CEO
Mission Health System
Pathology Optimisation in Chronic Blood Disease MonitoringAndrew O'Hara
Richard Croker shows how an innovative approach to service redesign can improve patient outcomes at pace and scale through the safe and effective use of testing at NHS Northern, Eastern and Western Devon CCG.
Paul Bristow, BKPA, and Karen Thomas, UKRR gave a presentation at BRS2017: Embedding patient reported experience into future QI - 1st National PREM Pilot Survey 2016
Aiming for a Higher Performing Health Care System: Learning from Cross-Nation...The Commonwealth Fund
Robin Osborn, Vice President and Director, International Program in Health Policy and Innovation at The Commonwealth Fund, discusses international health care systems. These slides were presented at the Queen’s Health Policy Change Conference, May 6, 2015 in Toronto, Canada.
Kidney Quality Improvement Partnership (KQuIP): Launch
A dynamic & inclusive and professionally-led partnership supporting improved quality of care for patients with kidney disease. Slides presented at the event by Graham Lipkin & Louise Wells, Co-chairs of KQuIP
Developing and Implementing a Patient Reported Experience MeasureRenal Association
Rachel Gair, Person Centred Care Facilitator on the Transforming Participation in CKD programme gave a talk at the Home Therapies conference in Manchester:
Developing and Implementing a Patient Reported Experience Measure
Think Kidneys Chair, Richard Fluck presented at the Home Dialysis conference in Manchester: A proposal for a improvement project for home dialysis
Read his presentation here.
Measurement for Improvement - Management of Acute Kidney Injury in primary c...Renal Association
Charlie Tomson, Consultant Nephrologist at theFreeman Hospital Newcastle upon Tyne and Chair of the Intervention Workstream, NHS England/UKRR Think Kidneys Programme
presented at a Measurement for Improvement event on 16th March.
a precise presentation over CKD made for house officers/medical interns . It focuses over signs and symptoms and in-hospital management of resulting problems , material taken majorly from medscape, CMDT and oxford hand book
Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning
Tuesday 24 June 2014: 15 Hatfields, Chadwick Court, London
Patient activation: New insights into the role of patients in self-managementMS Trust
This presentation by Helen Gilburt, Fellow at The King's Fund, looks at why some people are active at managing their health while others are quite passive, and how levels of patient activation impact on health outcomes.
It was presented at the MS Trust Annual Conference in November 2014.
Team as Treatment: Driving Improvement in DiabetesCHC Connecticut
NCA Clinical Workforce Development, Team-Based Care 2019 Webinar Series
Webinar broadcast on: June 11, 2019 | 3 p.m. EST
This webinar will share evidence-based models that will provide a framework for health centers to optimize the team in primary care. Experts will describe how utilization of extended team members and technology can reduce gaps in care for prediabetics and diabetics. With a focus on lifestyle and community based projects, this webinar will highlight the strategies and resources to improve the health and behaviors of patients at risk for diabetes and manage uncontrolled diabetes. Through early detection and providing diabetes management through a team-based care, health centers can help patients’ live long, healthy lives.
2.2 Develop the team - nursing - Louise BradyNHS England
Develop the team - nursing. Developing nursing roles in primary care. Reviewing a wide range of initiatives including from Manchester, Gateshead and Hanwell. Louise Brady, Clinical & Strategic Development Lead Practice Nursing , Manchester CCGs.
Apresentação realizada no I Seminário Internacional de Atenção às Condições Crônicas, pela diretora do Programa da Gestão de Doenças Crônica dos Serviços Sanitários De Alberta/Canadá, Sandra Delon.
Belo Horizonte, 11 de novembro de 2014
How can front-line professionals incorporate the emerging brain health ...SharpBrains
(Session held at the 2014 SharpBrains Virtual Summit; October 28-30th, 2014)
12:30-2pm. How can front-line professionals incorporate the emerging brain health toolkit to their practices?
- Elizabeth Frates, Director of Medical Student Education at the Institute of Lifestyle Medicine
- Dr. Catherine Madison, Director of the Ray Dolby Brain Health Center at California Pacific Medical Center
- Barbara Van Amburg, Chief Nursing Officer at Kaiser Permanente Redwood City
- Dr. Wendy Law, Clinical Neuropsychologist at Walter Reed National Military Medical Center
- Chair: Dr. Michael O’Donnell, Editor-In-Chief of the American Journal of Health Promotion
Learn more here:
http://sharpbrains.com/summit-2014/agenda/
Michelle Pilling, Lay Member Patient and Public Involvement and Deputy Chair with Dave Rogers, Head of Communications & Engagement at East Lancashire CCG
Benefits of NHS Choices for those wanting to lose weight or get fitterNHSChoices
Report of the findings of an web survey amongst those coming to the NHS Choices site to find information to help them lose weight or get fitter. The report uses the Di Clemente behaviour change model to identify the extent to which the site influences behaviour
Enhancing the quality of life for people living with long term conditions.
https://mhealthinsight.com/2016/06/27/join-us-at-the-kings-funds-digital-health-care-congress/
KQuIP presentation Yorks & Humber regional day 060717Renal Association
On 6th June, Louise Wells, Co-chair of KQuIP - the Kidney Quality Improvement Partnership presented at the Yorks and Humber Network KQuIP UK Renal Registry Support day. You can see her slides here.
At UK Kidney Week, Graham Lipkin from the Kidney Quality Improvement Partnership (KQuIP) gave a presentation on
Working in partnership with ARI to Improve Quality & Safety through eLearning
On Thursday 4 May, Julie Slevin, Think Kidneys Programme Development Officer spoke at the NACC conference at Haberdashers Hall in London:Raising awareness of hydration and ways to avoid Acute Kidney Injury in the care home environment
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
2. The Passive Patient
Chronic Kidney Disease National Programme | Rachel Gair | 2
• Healthcare can be
profoundly disempowering
• But most patients want to be
treated as active participants
– as co-producers of health.
3. To a person centred approach…
| 3Chronic Kidney Disease National Programme | Rachel Gair
5. Doctors’ and Patients’ Priorities
| 5
Sepucha et al. (2008). Pt Education and Counseling. 73:504-10
Chronic Kidney Disease National Programme | Rachel Gair
6. Patients’ Goals may be Different from Clinicians’ Goals
| 6
To better manage my pain relief so I don’t wake up at night
To stay in my own home as long as possible
To stop taking anti-depressants because I don’t like the side-effects
To learn how to cook healthy meals that the whole family will enjoy
To have the same person caring for me from 9am to 3pm so my parents can go
to work
To receive end-of-life care at the hospice close to where my sister lives
Source: Coalition for Collaborative Care. Personalised care and support planning handbook. NHS England 2015
Chronic Kidney Disease National Programme | Rachel Gair
7. Day to day decision making: self management
| 7
Hours with NHS / social care
professional = 5-10 in a year
Self management
= 8750-55 in a year
Chronic Kidney Disease National Programme | Rachel Gair
8. So…
| 8
The system should work in partnership with people with LTCs in
order to support them to develop the knowledge, skills and
confidence to manage their own health and healthcare
Chronic Kidney Disease National Programme | Rachel Gair
9. Background
| 9Chronic Kidney Disease National Programme | Rachel Gair
NHS England is required by the NHS Mandate
‘to ensure the NHS becomes dramatically better at involving patients
and their carers, and empowering them to manage and make
decisions about their own care and treatment’.
10. Five Year Forward View - NHSE
| 10Chronic Kidney Disease National Programme | Rachel Gair
To achieve this, the NHS Five Year Forward View sets out how the
health services needs to place emphasis on:
•a more engaged relationship with patients and communities
•promoting well-being and preventing ill-health
•supporting people to manage their own health and care
One way of doing this is to try different approaches and find which
work best. This is why the TP-CKD programme has been set up by NHS
England and the UK Renal Registry.
11. What are the questions the TP – CKD programme is asking?
| 11Chronic Kidney Disease National Programme | Rachel Gair
• Can PAM/CS-PAM/PROM/PREM measures be collected routinely
within renal units?
• Is the PAM related to PROM/PREM/Clinical Measure results?
• Can we introduce interventions that will increase a patient’s and
teams activation?
Co-production as a core value
12. Patient Activation Measure
| 12Chronic Kidney Disease National Programme | Rachel Gair
Unidimensional (ie measures a single concept)
Developmental (ie appropriate interventions can
support people to progress on a journey of activation)
Knowledge, skills and confidence to self manage
13 items, 4 levels
Score out of 100
13. Patient Activation Measure
| 13Chronic Kidney Disease National Programme | Rachel Gair
1 When all is said and done, I am the person who is responsible for taking care of my health
2 Taking an active role in my own health care is the most important thing that affects my health
3 I am confident I can help prevent or reduce problems associated with my health
4 I know what each of my prescribe medications do
5 I am confident that I can tell whether I need to go to the doctor or whether I can take care of a
health problem myself
6 I am confident that I can tell a doctor concerns I have even when he or she does not ask
7 I am confident that I can follow through on medical treatments I may need to do at home
8 I understand my health problems and what causes them
9 I know what treatments are available for my health problems
10 I have been able to maintain (keep up with) lifestyle changes, like eating right or exercising
11 I know how to prevent problems with my health
12 I am confident that I can figure out solutions when new problems arise with my health
13 I am confident that I can maintain lifestyle changes, like eating right and exercising, even during
times of stress
16. People at low levels of activation tend to:
| 16Chronic Kidney Disease National Programme | Rachel Gair
Feel overwhelmed with the task of managing their health
Have low confidence in their ability to have a positive impact on their
health
Not understand their role in care processes
Have limited problem solving skills
Have had a great deal of experience with failure in trying to manage,
and have become passive with regard to their health
Say they would rather not think about their health
17. People at higher levels of activation tend to:
| 17Chronic Kidney Disease National Programme | Rachel Gair
‘Be engaged’
Come prepared
Ask questions
Make decisions
Have less unmet needs (nb inequalities)
Have improved clinical outcomes (including mental health)
Enjoy an improved quality of life
Use less healthcare resource
Feel satisfied at work
Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related
Outcomes. Jessica Greene and Judith H. Hibbard Journal of General Internal Medicine, published online Nov. 30, 2011
18. Self care behaviours and activation 2
| 18Chronic Kidney Disease National Programme | Rachel Gair
20. Patients can be supported on a ‘journey of activation’ by offering tailored interventions: 1:1 or group coaching
| 20Chronic Kidney Disease National Programme | Rachel Gair
Thus tailored interventions improve all other ‘downstream’ indicators
21. Patient Reported Outcome Measure – PROM?
| 21Chronic Kidney Disease National Programme | Rachel Gair
• An additional 22 questions about your symptoms, how you are
feeling and how you manage your everyday life.
• We want to find out about YOU as a whole person and your
health and wellbeing - more than just your kidneys
• These questions will act as a prompt for you and the
doctor/nurse to highlight what is important and what needs
addressing – short & long term
22. Patient Reported Experience Measures – PREM?
| 22Chronic Kidney Disease National Programme | Rachel Gair
• Questions and themes about your care, the service,
the environment, transport etc.
• These will be anonymous and won’t be seen by the
clinical team
• They will be fed back to the team to inform service
improvement
23. Clinical Support – Patient Activation CS-PAM
| 23Chronic Kidney Disease National Programme | Rachel Gair
• Do the renal teams and individuals support patient activation?
• Do they have the knowledge, skills and confidence to move to
equal partners in care?
• Potential risk of conflict – activated patients but not clinical
teams
• The results of the CS-PAM fed back to individuals but also
provides a ‘heat map’ of the culture of the unit and what is
required to gain a shift
• This is not about judgement but about Quality Improvement
24. Knowledge, Skills and Confidence Cube
| 24Chronic Kidney Disease National Programme | Rachel Gair
26. Challenges
| 26Chronic Kidney Disease National Programme | Rachel Gair
• Time
• Resource
• Work force
• Skills
• Other initiatives
• Not a priority
• We are already doing it
• Engagement and leadership – whole team approach
27. Achievements
| 27Chronic Kidney Disease National Programme | Rachel Gair
10 renal units in cohort 1
Co-production – working groups of MDT and patients
CS-PAM completed across all units
Health Surveys coming back to UKRR and back again via PV and
Sonar
PREM – co-designed and produced – BKPA sponsored & available
for all patients
Interventions – next up
Cohort 2 – April onwards ( 13 renal units)
28. Visit our website:
www.thinkkidneys.nhs.uk/ckd
Rachel Gair
Person Centred Care Facilitator
UK Renal Registry
07933 016 037
rachel.gair@renalregistry.nhs.uk
THANK YOU!
Chronic Kidney Disease National Programme | Rachel Gair | 28
Editor's Notes
… but not so far to the extreme as to make the arrival at a decision unlikely! Many patients now have access to a lot of information on the internet – not all of it reliable or balanced. The challenge is to ensure we are working with patients as partners but ensuring they have good information on which to base their decisions.
This is a key diagram (always has high face validity for patients and everyone else in the audience - helps them really see what the issues of living with a LTC are really about). It
Demonstrates the need visually from the person’ point of view
Identifies the problems with the current approach
Provides a visual framework to hang the Delivery System on. The DS addresses all the aspects across the ‘whole System’
NB Drawn by people with LTCs on a paper table cloth at a World Café workshop.
Points to note:
People with LTCs are self managing all the time (8757 hours) – it is not something that can be ‘given to them’ or ‘allowed’ by the NHS
The contacts with NHS usually appear regularly – uncoordinated with the ups and downs of everyday life
Surveys show that less than half the time allotted to the orange bars is devoted to discussing living with the condition or self management along the green wavy line.
This is an innovative programme – not been done before. We know we can collect clinical outcomes.