The document describes efforts to improve psychosis care through the Treatment and Recovery In PsycHosis (TRIumPH) program. The key points are:
1) A working group was established between Southern Health NHS Foundation Trust and Wessex Academic Health Science Network to improve assessment and treatment for people experiencing psychosis based on understanding gaps in existing care.
2) The program developed and implemented a standardized care pathway across four Early Intervention in Psychosis teams, improving access to assessment and treatment.
3) Feedback from service users, carers, and clinicians informed the work, which aimed to provide more compassionate, holistic, and recovery-focused care.
Presented by: David Cozadd, Director of Operations with the Burke Center
Thomas Kerss, Sheriff of Nacogdoches County; Current President of the Sheriff’s Association for Texas
Anne Bondesen, Project Director for the Rural East Texas Health Network (RETHN)
A Co-response Model Mental Health and Policingcitinfo
Presented by: Mary C. Pyche, MSW, RSW Health Service Manager
Mental Health Mobile Crisis Team (MHMCT)
Susan Hare, BScOT, Program Leader, Crisis Supports, Capital District Mental Health Program
Constable Angela Balcom, Halifax Regional
Police, MHMCT dedicated police officer
Presentation by Auditor General - Caroline Spencer, An audit of access to State-managed adult mental health services.
Presented at the Western Australian Mental Health Conference 2019.
Presented by: David Cozadd, Director of Operations with the Burke Center
Thomas Kerss, Sheriff of Nacogdoches County; Current President of the Sheriff’s Association for Texas
Anne Bondesen, Project Director for the Rural East Texas Health Network (RETHN)
A Co-response Model Mental Health and Policingcitinfo
Presented by: Mary C. Pyche, MSW, RSW Health Service Manager
Mental Health Mobile Crisis Team (MHMCT)
Susan Hare, BScOT, Program Leader, Crisis Supports, Capital District Mental Health Program
Constable Angela Balcom, Halifax Regional
Police, MHMCT dedicated police officer
Presentation by Auditor General - Caroline Spencer, An audit of access to State-managed adult mental health services.
Presented at the Western Australian Mental Health Conference 2019.
Guidance for commissioners of liaison mental health services to acute hospitalsJCP MH
This guide describes what ‘good looks like’ for a modern acute liaison service. It should be of value to Clinical Commissioning Groups (who will be commissioning secondary services, both specialist mental and acute).
Guidance for commissioners of mental health services for people from black an...JCP MH
This guide describes what ‘good’ mental health services for people from Black and Minority Ethnic (BME) communities look like.
While all of the JCP-MH commissioning guides apply to all communities, there are good reasons (see P9) why additional guidance is required on commissioning mental health services for people from BME communities.
This guide focuses on services for working age adults. However, it could also be interpreted for commissioning specialist mental health services, such as CAMHS, secure psychiatric care, and services for older adults.
Guidance for commissioners of older people’s mental health servicesJCP MH
This guide is about the commissioning of mental health services which can improve the mental health and wellbeing of older people.
This guide has been developed by a group of older people’s mental health professionals, people with mental health problems, and carers. The content is primarily evidence and literature-based, but ideas deemed to be best practice by expert consensus have also been included.
Guidance for commissioners of dementia servicesJCP MH
This guide describes what a good quality, modern dementia service looks like. It has primarily been written for Clinical Commissioning Groups, local authorities, and Health and Wellbeing Boards. It will also be of interest to patients, carers and voluntary sector and provider organisations.
Keynote presentation by Dr Sebastian Rosenberg, from the Centre for Mental Health Research ANU College of Health and Medicine. presented at the WA Mental Health Conference 2019.
Presentation by Antonella Segre, of Connect Groups - Social Prescribing: An old concept but a new way forward. Presented at the Western Australian Mental Health Conference 2019.
Guidance for commissioning public mental health servicesJCP MH
Public mental health services (updated August 2013)
This is the second version of the public mental health guide. It has been revised and updated to include new sources of data and information.
The guide is about the commissioning of public mental health interventions to reduce the burden of mental disorder, enhance mental wellbeing, and support the delivery of a broad range of outcomes relating to health, education and employment.
Guidance for commissioners of child and adolescent mental health servicesJCP MH
This guide describes what ‘good looks like’ for a modern child and adolescent mental health service (CAMHS). It should be of value to Clinical Commissioning Groups (CCGs) and NHS England.
By the end of this guide, readers should be more familiar with the concept of CAMHS and better equipped to understand:
what a good quality, modern, service looks like
why a good CAMHS delivers the mental health strategy and the Quality Innovation Productivity and Prevention initiative – not only in itself but also by enabling changes in other parts of the system
the benefits of CAMHS to children, young people, their families and carers, and
why CAMHS are important for commissioners.
Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning
Tuesday 24 June 2014: 15 Hatfields, Chadwick Court, London
Guidance for commissioners of acute care – inpatient and crisis home treatmentJCP MH
This guide is about commissioning services for people with acute mental health needs. It explains the purpose, characteristics and components of acute care so that commissioners can commission good quality services that are therapeutic, safe and support recovery.
Guidance for commissioners of services for people with medically unexplained ...JCP MH
This guide is about the commissioning of comprehensive MUS services across the healthcare system. In developing this guide, we recognise that ‘medically unexplained symptoms’ is an unsatisfactory term for a complex range of conditions.
MUS refers to persistent bodily complaints for which adequate examination does not reveal suf ciently explanatory structural or other specified pathology. The term MUS is commonly used to describe people presenting with pain, discomfort, fatigue and a variety of other symptoms in general practice and specialist care. Whilst recognising that the phrase ‘medically unexplained symptoms’ can be problematic, it is nonetheless widely used, and an appropriate term to use in this guide.
This guide aims to: describe MUS and the associated outcomes: outline current service provision for MUS and detail the components of a high quality comprehensive MUS service, and highlight the importance of commissioning comprehensive MUS services.
Guidance for commissioners of rehabilitation servicesJCP MH
This guide is about the commissioning of good quality mental health interventions and services for people with complex and longer term problems to support them in their recovery.
Guidance for commissioners of primary mental health servicesJCP MH
This guide describes what good quality, modern, primary mental health care services look like. It has been written by a group of primary mental health care experts, in consultation with patients and carers. The content is primarily evidence-based but ideas deemed to be best practice by expert consensus have also been included.
Guidance for commissioners of drug and alcohol servicesJCP MH
This guide has been written to provide practical advice on developing and delivering local plans and strategies to commission the most effective and efficient drug and alcohol services for adults.
Based upon clinical best practice guidance and drawing upon the range of available evidence, it describes what should be expected of a modern drug and alcohol service in terms of effectiveness, outcomes and value for money.
Guidance for commissioners of liaison mental health services to acute hospitalsJCP MH
This guide describes what ‘good looks like’ for a modern acute liaison service. It should be of value to Clinical Commissioning Groups (who will be commissioning secondary services, both specialist mental and acute).
Guidance for commissioners of mental health services for people from black an...JCP MH
This guide describes what ‘good’ mental health services for people from Black and Minority Ethnic (BME) communities look like.
While all of the JCP-MH commissioning guides apply to all communities, there are good reasons (see P9) why additional guidance is required on commissioning mental health services for people from BME communities.
This guide focuses on services for working age adults. However, it could also be interpreted for commissioning specialist mental health services, such as CAMHS, secure psychiatric care, and services for older adults.
Guidance for commissioners of older people’s mental health servicesJCP MH
This guide is about the commissioning of mental health services which can improve the mental health and wellbeing of older people.
This guide has been developed by a group of older people’s mental health professionals, people with mental health problems, and carers. The content is primarily evidence and literature-based, but ideas deemed to be best practice by expert consensus have also been included.
Guidance for commissioners of dementia servicesJCP MH
This guide describes what a good quality, modern dementia service looks like. It has primarily been written for Clinical Commissioning Groups, local authorities, and Health and Wellbeing Boards. It will also be of interest to patients, carers and voluntary sector and provider organisations.
Keynote presentation by Dr Sebastian Rosenberg, from the Centre for Mental Health Research ANU College of Health and Medicine. presented at the WA Mental Health Conference 2019.
Presentation by Antonella Segre, of Connect Groups - Social Prescribing: An old concept but a new way forward. Presented at the Western Australian Mental Health Conference 2019.
Guidance for commissioning public mental health servicesJCP MH
Public mental health services (updated August 2013)
This is the second version of the public mental health guide. It has been revised and updated to include new sources of data and information.
The guide is about the commissioning of public mental health interventions to reduce the burden of mental disorder, enhance mental wellbeing, and support the delivery of a broad range of outcomes relating to health, education and employment.
Guidance for commissioners of child and adolescent mental health servicesJCP MH
This guide describes what ‘good looks like’ for a modern child and adolescent mental health service (CAMHS). It should be of value to Clinical Commissioning Groups (CCGs) and NHS England.
By the end of this guide, readers should be more familiar with the concept of CAMHS and better equipped to understand:
what a good quality, modern, service looks like
why a good CAMHS delivers the mental health strategy and the Quality Innovation Productivity and Prevention initiative – not only in itself but also by enabling changes in other parts of the system
the benefits of CAMHS to children, young people, their families and carers, and
why CAMHS are important for commissioners.
Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning
Tuesday 24 June 2014: 15 Hatfields, Chadwick Court, London
Guidance for commissioners of acute care – inpatient and crisis home treatmentJCP MH
This guide is about commissioning services for people with acute mental health needs. It explains the purpose, characteristics and components of acute care so that commissioners can commission good quality services that are therapeutic, safe and support recovery.
Guidance for commissioners of services for people with medically unexplained ...JCP MH
This guide is about the commissioning of comprehensive MUS services across the healthcare system. In developing this guide, we recognise that ‘medically unexplained symptoms’ is an unsatisfactory term for a complex range of conditions.
MUS refers to persistent bodily complaints for which adequate examination does not reveal suf ciently explanatory structural or other specified pathology. The term MUS is commonly used to describe people presenting with pain, discomfort, fatigue and a variety of other symptoms in general practice and specialist care. Whilst recognising that the phrase ‘medically unexplained symptoms’ can be problematic, it is nonetheless widely used, and an appropriate term to use in this guide.
This guide aims to: describe MUS and the associated outcomes: outline current service provision for MUS and detail the components of a high quality comprehensive MUS service, and highlight the importance of commissioning comprehensive MUS services.
Guidance for commissioners of rehabilitation servicesJCP MH
This guide is about the commissioning of good quality mental health interventions and services for people with complex and longer term problems to support them in their recovery.
Guidance for commissioners of primary mental health servicesJCP MH
This guide describes what good quality, modern, primary mental health care services look like. It has been written by a group of primary mental health care experts, in consultation with patients and carers. The content is primarily evidence-based but ideas deemed to be best practice by expert consensus have also been included.
Guidance for commissioners of drug and alcohol servicesJCP MH
This guide has been written to provide practical advice on developing and delivering local plans and strategies to commission the most effective and efficient drug and alcohol services for adults.
Based upon clinical best practice guidance and drawing upon the range of available evidence, it describes what should be expected of a modern drug and alcohol service in terms of effectiveness, outcomes and value for money.
Early Intervention: Improving Access to Mental Health by 2020 [Presentations]Sarah Amani
Most mental illnesses begin in adolescence or early adulthood – the vital time in life when we establish our independence. Mental illness can derail this process with long-lasting effects. We know that the earlier we can engage a young person in treatment the better their outcomes – but young people are the least likely to seek help from mental health services. This is not helped by the separation of services at age 18.
The good news is that we know that early intervention makes a difference in getting young people well and keeping them well. Early intervention teams have been established for psychosis in England for the last 12 years. Psychosis is a serious mental illness affecting 1-2% of the population, with about 500 new cases every year in the Oxford AHSN area.
Early intervention in psychosis is a specialist, community-based service providing medical, psychological and family-based treatments. It helps get young people back to work or education and keeps an eye out for any early signs of relapse so that they can be prevented. Early intervention teams are highly valued by young people and their families. They also save the health service money by keeping people well and getting them back to work.
The Early intervention in mental health network will make sure that this best practice is in place across the Oxford AHSN region with the highest standard of care provided everywhere. We also aim to spread this early intervention model across other conditions (such as eating disorders, personality disorder, autistic spectrum conditions) to help more young people.
World class research is being undertaken in Oxford AHSN and across England into early psychosis – both into the causes and to trial new treatments. We aim to make this research available to every patient being seen by our early intervention teams. We will also look to develop new innovations and technologies that could improve the experience of young people receiving mental healthcare.
Geraldine Strathdee and Jen Hyatt: Technology innovation for supporting patie...Nuffield Trust
Geraldine Strathdee, Oxleas NHS Foundation Trust,and Jen Hyatt, Big White Wall, present in a breakout session on using technology to support people with mental health issues at home.
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing opioid prescribing, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Pharmacist Interventions and Medication Reviews at Care Homes - Improving Med...Health Innovation Wessex
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Pharmacist Interventions and Medication Reviews at Care Homes - Improving Medication Safety and Patient Outcomes, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, SBAR Patient Engagement Tool, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing medication related falls risk in patients with severe frailty, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Assessing the outcomes of structured medication reviews, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Polypharmacy SMR reviews in outpatient bone health clinics, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Polypharmacy reviews of asthma and COPD patients over 65 and 10 or more medic...Health Innovation Wessex
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Polypharmacy reviews of asthma and COPD patients over 65 and 10 or more medicines, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Evaluating the impact of a specialist frailty multidisciplinary team pathway ...Health Innovation Wessex
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Evaluating the impact of a specialist frailty multidisciplinary team pathway with clinical pharmacist involvement, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Genome UK – State of the nation by Professor Dame Sue Hill, Chief Scientific Officer for England and NHS Genomics Programme Senior Responsible Officer.
Pharmacogenomics into practice - stroke services and a systems approach by Dr Richard Marigold, Consultant Stroke Physician and NIHR Hyperacute Stroke Research Centre Lead, University Hospital Southampton NHS Foundation Trust
To evaluate the benefits of Structured Medication Reviews in elderly Chinese ...Health Innovation Wessex
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, To evaluate the benefits of Structured Medication Reviews in elderly Chinese patients, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary,
Review of patients on high dose opioids at Living Well PCN, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Re-establishing autonomy in elderly frail patients, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Improving Medication Reviews using the NO TEARS Tool, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Improving care in County Durham under the STOMP agenda - A 5 year review.pdfHealth Innovation Wessex
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Improving care in County Durham under the STOMP agenda - A 5 year review, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Impact of an EMIS search to prioritise care home residents for a pharmacist l...Health Innovation Wessex
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Impact of an EMIS search to prioritise care home residents for a pharmacist led medication review, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Identifying Orthostatic Hypotension caused by Medication, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
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
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Couples presenting to the infertility clinic- Do they really have infertility...
Wessex AHSN Early Intervention in Psychosis report
1. Treatment and
Recovery In PsycHosis
(TRIumPH)
Improving psychosis care through faster access
to assessment and treatment
@WessexAHSN
wessexahsn.org.uk
2. 2 @WessexAHSN
Wessex Academic Health Science Network
(AHSN) connects NHS and academic
organisations, local authorities, the third sector
and industry.
We help create the right conditions to facilitate change across whole health and social care economies, with
a clear and consistent focus on citizens, service users and patients. Our twenty-five members work with each
other, and with a broad range of stakeholders, to support the creation of wellbeing and wealth in Wessex
through making innovation happen at speed and scale.
Our Mental Health Programme has been working in partnership with Southern Health NHS Foundation Trust to
improve access and treatment for people experiencing psychosis. The write up that follows details their journey.
Acknowledgements
We would like to acknowledge the contribution of all service users, family members, carers,
clinicians, commissioners and partner organisations who came together to support this work.
Foreword
3. 3wessexahsn.org.uk
Southern Health NHS Foundation Trust and
Wessex Academic Health Science Network
(AHSN) have been working together to
improve the care and outcomes for people
experiencing psychosis.
National and local data demonstrated that access to services and current treatment provision was not meeting the
needs of this group, their families and of the staff supporting them.
What was delivered?
• The development and implementation of a co-produced care pathway within four Early Intervention in Psychosis (EIP)
teams across Hampshire, covering a population of approx. 1.3 million: over 900 people have entered the pathway to date
• Improving access: since implementation of the pathway 60% of people have been assessed within seven days
of referral and 82% people have been assessed within 14 days of referral, supporting earlier engagement and
recovery (compared with baseline where 36% were assessed within seven days and 59% within 14 days)
• Implementation of a standardised assessment procedure across all teams
• Co-production and roll out of a carers’ pack, providing support and information for this important group
• Development and roll out of a comprehensive physical health assessment, supporting teams to reduce the 15 – 20 year
mortality gap for those experiencing severe mental illness
• Increasing numbers of staff have been trained in evidenced based interventions: CBT (Cognitive Behavioural Therapy),
family therapy, employment support and physical health
• Engagement and investment from commissioners
• The programme was highly commended at the national Positive Practice in Mental Health Awards in October 2016
• The evaluation protocol was published in the British Medical Journal (BMJ) Open in December 2016
Executive summary
As a result of the work, a one page visual
road map has been developed to outline the
process for supporting or leading organisational
change. This report follows the stages of the road
map. You can download it for free right here
3
2
1
4. 4 @WessexAHSN
Contents
Phase 1: Planning, preparation initiation
The big picture
5
Understanding the problem6
Developing a shared purpose7
Establishing a working group8
Stakeholder engagement9
Priority setting10
Timeframes10
Phase 2: Implementation
Putting plans in to practice
11
Measure, evaluate and learn12
Communication with stakeholders12
Phase 3: Keeping momentum
time for reflection
Sustainability and spread
13
Click on the numbers
opposite to view the
corresponding page
5. 5wessexahsn.org.uk
What is psychosis?
Psychosis represents a cluster of psychiatric disorders including schizophrenia, in which a person’s perception,
thoughts, mood and behaviour are significantly altered. Psychosis can occur at times of high stress when there
might be heightened worry, anxiety, fear and depression. Symptoms might include hearing voices, seeing, feeling or
tasting things that others cannot, holding unshared beliefs or experiences, difficulty concentrating and losing touch
with reality. Sometimes these experiences are accompanied by feelings of low mood, lack of motivation and apathy.
In England, at least 32 in 100,000 people develop psychosis each year 1
. Factors such as age, gender, ethnicity, population
density and social deprivation are determinants. First episode psychosis occurs more often in young people especially in
men from their teens to twenties. Black and minority ethnic groups have an elevated risk of developing psychosis even after
adjustment for socio-economic status 2
. Whilst people do recover from a first episode of psychosis it is estimated only 10-20%
will not experience a further episode 3
.
Evidence-based treatments are available which make a substantial difference in reducing relapse and promoting recovery, but
gaps remain in service delivery 4, 5
. Data has highlighted that spending is skewed towards expensive inpatient services rather than
community support 4
. Delays in access to services and treatment are apparent, which impedes recovery. Evidence demonstrates
the longer the time between onset of symptoms and the start of treatment (known as the Duration of Untreated Psychosis – DUP)
the more significant the impairment in function and social outcomes, resulting in increased distress and disability 6
.
The ‘Abandoned Illness’ report published by the Schizophrenia Commission evidenced that:
• Psychosis is associated with a 15 – 20 year reduction in lifespan due to poor physical health
• Only 1 in 10 of those who could benefit have access to true CBT
• Only 8% of people with schizophrenia are in employment
• 87% of service users report experiences of stigma and discrimination
• Families who are carers save the public purse £1.24 billion per year, but they are not treated as equal partners
• £1.2 billion or 19% of the mental health budget is spent on secure care services, with many people spending too
long in expensive units
• Schizophrenia and psychosis costs society £11.8 billion in England alone
The government strategy ‘No health without mental health’ acknowledged that more must be done to address the disparity
in care for people experiencing psychosis. It highlighted the importance of prevention, early detection, and support for
evidence-based models such as Early Intervention in Psychosis (EIP) services. There is a strong cost-effectiveness argument
supporting EIP services; they have been shown to be more effective than the traditional community mental health team
approach 4
delivering savings of £38,000 per person over 10 years 7
.
The big picture
PHASE 1
Planning,
preparation
initiation
You can find out more about psychosis right here
6. 6 @WessexAHSN
To understand the local picture, Wessex AHSN worked in partnership with Janssen Healthcare Innovation
to analyse Hospital Episodes Statistics (HES) data and data held within the Mental Health Minimum Data Set
(MHMDS, now called Mental Health Services Data Set). This provided a picture of the needs of service users with
psychosis in Wessex.
It was found that people experiencing psychosis:
• are more likely to be admitted to a mental health inpatient ward when compared to those with other mental health
conditions
• stay significantly longer as an inpatient than other groups
• receive almost three times as many contacts with healthcare professionals as those with other mental health conditions
• who are from ethnic minorities are more likely to be admitted to mental health inpatient wards and stay for longer
• would, in many cases, like to work but do not have the opportunity to do so
A local audit of clinical notes also demonstrated variation in care provision and delays to commencing assessment
and NICE recommended treatments:
• Administrative delays were identified between referrals being made and them reaching EIP services
• Variation was identified in the quality of assessments being undertaken
• Minimal documentation was found in relation to physical health and there was a lack of clarity in where to record this
information
• Staff reported a lack of confidence in delivering physical health assessments
• There was a difference in anecdotally reported performance when compared to audit data
• There was variation between teams in the support available for carers
• It was difficult to understand from current documentation if people had been offered NICE interventions and when this
had occurred
• It was also identified that teams entered lots of data on to the current IT system, but there wasn’t a way of using it to inform
future practice
Understanding the problem
?
?
?
?
7. 7wessexahsn.org.uk
The perspective of service users, carers and staff was critical to understanding how improvements could be made.
Wessex AHSN worked with Stripe Partners to facilitate a workshop to understand key issues for people using and
working in services. To record views, the facilitators encouraged participants to describe stories from their patient
journey that they felt others should hear. Over 100 postcards were written yielding many first hand experiences.
Feedback was collated into themes and formed a shortlist of key areas to focus on:
• The need for compassionate care and more contact time
• The significance of early intervention
• A more holistic and person-centred approach
• Empowering the patient to lead their own recovery
• Better access for places of safety in a crisis
• The importance of peer support
• A greater need for more intensive care available at home
• Better signposting to support services
• A family centred approach
• The need for services to be consistent, seamless, and personalised
The feedback and personal stories were invaluable in making sure the person and their family were at the heart of
the work undertaken and were critical in informing the next part of the journey.
Developing a shared purpose
8. 8 @WessexAHSN
Establishing a steering group
Following the joint workshop between service users and staff, a steering group was set up to take the
findings forward. The group was initially established to map out a pathway of care which detailed specific
treatments and interventions and also included timeframes for the delivery of care.
Developing the pathway and the narrative document was an iterative process, with different individuals and groups
contributing to the final documents over a number of weeks.
The final pathways and accompanying narrative document are available to view here:
Routine and crisis referral pathways
Psychosis pathway narrative document
Latterly, the steering group became a forum for service improvement and a safe space to share challenges and discuss
solutions regarding implementation.
Another important function of the steering group was in facilitating governance and accountability; it allowed for regular
updates which provided senior members of the group with the knowledge to feed into wider Trust structures, such as
divisional board meetings.
It was at this time that the National Access and Waiting Time (AWT) Standard for psychosis was announced.
The Standard required that from 1 April 2016, more than 50% of people experiencing first episode psychosis commence
a NICE recommended package of care within two weeks of referral. Treatment is deemed to have commenced when
the person:
a. has had an initial assessment; AND
b. has been accepted on to the caseload of an EIP service capable of providing a full package of NICE-recommended
care; AND
c. has been allocated to, and engaged with, an EIP care coordinator
The pathway had now become the vehicle for successful delivery of the newly
announced national standards.
Find out more about the Access and Waiting Time Standard for Psychosis
For more information on the NICE quality standards for psychosis and schizophrenia
9. 9wessexahsn.org.uk
Stakeholder Engagement
Ensuring practice could now be aligned with the pathway meant that a number of key people needed to be
involved. The following groups were actively engaged to ensure the right people were at the steering group:
• Senior clinical/non-clinical leaders
• Team leaders
• Service users, their friends and family
• Team members, e.g. care coordinators psychologists, psychiatrists, support workers
• Commissioners
• Third sector
• Information Technology (IT)
• CAMHS
• Referring services e.g. GPs
• Performance Team
?
10. 10 @WessexAHSN
Priority Setting
Timeframes
It was important to understand the areas of focus
which would deliver better outcomes for people
accessing and using services. Following discussions
and in line with the newly announced national
standards, it was agreed that we would focus on and
measure the following:
• Population impact – the number of patients assessed
and then accepted or discharged from the pathway
• Access – the time taken from receiving the referral to
assessment by the EIP team
• Physical health – as recommended by NICE guidance
• Interventions – the number of people offered and then
engaged with evidence-based interventions; CBT, Family
Intervention, medication, employment and vocational
support and carer support
• Healthcare utilisation – the number of admissions
to mental health inpatient units and attendances at
Emergency Departments
It was agreed that the steering group would be held
on a monthly basis with dates set in advance. Notes
were recorded during each meeting and shared, with
a focus on reporting progress against actions and
milestones. A rolling agenda ensured meetings had
purpose and were productive.
11. 11wessexahsn.org.uk
On 1st June 2015 the pathway went live across four EIP teams in Hampshire. A part time Band 5 Psychology
Assistant supported EIP teams during implementation by promoting the pathway, educating individuals and
teams about the purpose of the work, and the anticipated outcomes. They also shared team performance data,
encouraged people to think about solutions to problems and supported individual team progress.
To make implementation of the pathway a reality, there was plenty of work to do. Following consultation with staff, a mixture of
quick wins, stakeholder priorities, high impact actions, and longer term priorities were identified:
Quick wins:
• Streamlining administration procedures to enable faster access to assessments and engagement
• Introducing a standardised assessment procedure across all teams
• Better signposting for employment/vocational support
• An increased focus on involving family/carers
Stakeholder priorities:
• Increasing the availability of physical health monitoring equipment
• Recruitment of psychologists/therapists
• Carers’ information packs
• Offering education to referrers to reduce delays in referrals reaching EIP services
High impact actions:
• Data collection and regular feedback to teams on progress and performance
• Process mapping to understand current practice
• Physical health training
• Developing and implementing a clinical checklist
• Updating referral form criteria
• Improving communication with colleagues working in the central triage centre
Longer term aims:
• Increased training for staff
• Increased resources/capacity within teams
• Advanced business planning
• Development of peer support services
• More supportive IT systems to enable recording (and using this for performance feedback)
• Improve office facilities and clinical spaces for 1:1 and group activities
The priorities listed above were integral to reducing variation, improving quality and efficiency and providing teams
with clear guidance and a vision to work towards.
Putting plans into practice
PHASE 2
Implementation
12. 12 @WessexAHSN
Measure, evaluate and learn
Making the changes required was an iterative
process, using a combination of service
improvement techniques, incremental changes
and careful evaluation to measure progress.
There are a variety of service improvement
techniques that can be used. The links here provide
excellent information and examples of what’s available.
Communication with stakeholders
Regular and effective communication was essential.
The importance of involving teams and keeping them
up to date with progress cannot be underestimated.
The following have been really helpful:
• Understand the personal values, beliefs and interests
of stakeholders; to help and support the spread of good
practice
• Prepare to pitch and share data at different levels;
to whole teams, individuals, commissioners, clinicians,
management and senior leadership
• Share the good news and the bad; celebrate peoples’
efforts and small wins, learn from what hasn’t worked
• Use influencing skills; empathetic, facilitative,
comfortable with conflict - if people are struggling,
creating a safe space to explore challenges and discuss
solutions can be invaluable
• Keep momentum going; good meeting notes and
tracking actions were key
• Keep the big picture in mind; regularly remind
people what it’s all about and the benefits
• Get people involved; plan, do, study, act (PDSA) cycles
• Remember, a change in culture takes time;
it’s a marathon, not a sprint
www.england.nhs.ukwww.mindsetqi.net
www.fabnhsstuff.net
www.nice.org.uk www.kingsfund.org.uk
www.improvement.nhs.uk
www.health.org.uk
www.rethink.org
www.wessexahsn.org.uk
13. 13wessexahsn.org.uk
Sustainability and spread
The pathway approach has been a vehicle for identifying, communicating and shaping practice. Two years
on, although there have been tangible successes, there is still work to do. A complicating factor is that
resource issues remain a challenge across mental health, and EIP services are no exception. However, as a
result of this journey, teams are in a much stronger position to continue to improve their services. Long term
actions identified by teams are ongoing, for example, peer support workers are being trained and their
impact evaluated before considering roll out to other teams.
The following have been key learning points for ensuring sustainability:
• Ensure senior buy-in and clinical leadership from the start – work with directors, clinical leads and
commissioners to ensure the right people can advocate for the project. The involvement of commissioners is critical
for effective forward planning, especially if major service changes are required
• Use data to understand what’s happening in services – it wins ‘hearts and minds’, speeds up progress and
means you have a benchmark to reflect upon. Identify/work towards the availability of real time data
• Identify champions within teams – they are important advocates who build relationships and can navigate
boundaries. They can be anyone; for example, it could be a support worker who is passionate about physical health
• Build capability - employees must have the skills required to make improvements
• Have a strategy – exit plan from the start
• Set up regular meetings for the duration of the work to keep momentum going
• Use subgroups to progress work – one person can’t do it all. Use these groups to progress actions identified in
the steering group
• Delegate tasks and empower people – this could be to anyone with an interest; a service user, a care coordinator
or a director
• Include stories – regularly utilise personal experiences to shape practice, both from service users and staff
• Reduce variation – implement systems to standardised delivery and ensure quality, find the best practice then
adapt and adopt it
• Involve IT services early – make people’s work as easy as possible; remodel systems to assist in data recording and
provide performance insight. It empowers teams to monitor their own progress. Don’t underestimate how long this
can take – involve the experts as early as possible
• Have a regular stocktake – measuring project progress against milestones, have staff attitudes changed?
Have new ways of working been normalised?
• Identify and gain support from corporate functions – e.g. admin support, business planning expertise,
the communications team to update your web page
• Ensure that learning and success can be shared and utilised by other teams as a way of creating efficiencies
both locally and on a wider scale across the NHS
PHASE 3
Keeping
momentum
time for
reflection
14. 14 @WessexAHSN
Sustainability and spread
Improvement is a journey and is rarely smooth; however, perseverance can
have a huge impact on service users, their family and staff by reducing
variation and promoting better and ever evolving care. Learning from one area
often provides valuable insight into another. If you would like to know more
about the work described, please contact us.
Alison.Griffiths@wessexahsn.net
Programme Manager, Mental Health, Wessex AHSN
Shanaya.Rathod@southernhealth.nhs.uk
Consultant Psychiatrist, Southern Health NHS Foundation Trust
Christie.Garner@southernhealth.nhs.uk
Assistant Psychologist, Southern Health NHS Foundation Trust
enquiries@wessexahsn.net
023 8202 0840
@WessexAHSN
wessexahsn.org.uk
15. 15wessexahsn.org.uk
References
1. Kirkbride, J.B., Errazuriz, A., Croudace, T.J., Morgan, C., Jackson, D., Boydell, J., Murray, R.M. and Jones, P.B., 2012.
Incidence of schizophrenia and other psychoses in England, 1950–2009: a systematic review and meta-analyses. PloS one,
7(3), p.e31660.
2. Kirkbride, J.B., Barker, D., Cowden, F., Stamps, R., Yang, M., Jones, P.B. and Coid, J.W., 2008. Psychoses, ethnicity and
socio-economic status. The British Journal of Psychiatry, 193(1), pp.18-24.
3. Emsley, R., Chiliza, B., Asmal, L. and Harvey, B.H., 2013. The nature of relapse in schizophrenia. BMC psychiatry, 13(1), p.50.
4. Knapp, M., Andrew, A., McDaid, D., Iemmi, V., McCrone, P., Park, A.L., Parsonage, M., Boardman, J. and Shepherd, G.,
2014. Investing in recovery: making the business case for effective interventions for people with schizophrenia and
psychosis.
5. National Institute for Health and Care Excellence., 2015. NICE Quality Standards: Psychosis and Schizophrenia in Adults.
6. McGorry, P.D., Edwards, J., Mihalopoulos, C., Harrigan, S.M. and Jackson, H.J., 1996. EPPIC: an evolving system of early
detection and optimal management. Schizophrenia bulletin, 22(2), p.305.
7. HM G., 2011. No health without mental health: a cross-government mental health outcomes strategy for people of all ages.
London: Department of Health.
8. National Institute for Health and Care Excellence., 2014. Psychosis and schizophrenia: treatment and management. Clinical
guideline 178. guidance.nice.org.uk/CG178.
9. Rathod, S., Garner, C., Griffiths, A., Dimitrov, B.D., Newman-Taylor, K., Woodfine, C., Hansen, L., Tabraham, P., Ward,
K., Asher, C. and Phiri, P., 2016. Protocol for a multicentre study to assess feasibility, acceptability, effectiveness and
direct costs of TRIumPH (Treatment and Recovery In PsycHosis): integrated care pathway for psychosis. BMJ open, 6(12),
p.e012751.
10. Rathod, S., 2015. TRIumPH: psychosis care pathway and narrative. Wessex Academic Health Sciences Network,
Southampton, Wessex.
11. Royal College of Psychiatrists., 2012. Report of the National Audit of Schizophrenia (NAS). London: Healthcare Quality
Improvement Partnership.
12. Schizophrenia Commission., 2012. The abandoned illness: a report from the Schizophrenia Commission. London: Rethink
Mental Illness.