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Chronic Illness & Palliative Care, Part 1

There are misperceptions about living with a chronic illness such as diabetes. Hear about some of the recent and future advancements in diabetes care helping patients live full and meaningful lives. See what happens when the chronic illness reaches its life-limiting stages. Hear how patients, families, and physicians can integrate palliative care into their treatment to support living the best life possible during this challenging time. Carlos Pellegrini, M.D., Henry N. Harkins Professor and Chair of the UW Department of Surgery Stuart Farber, associate professor, department of Family Medicine, Hospice Medical Director, University of Washington Edward Walker, M.D. Medical Director, UW Medical Center and Associate Dean, UW School of Medicine Irl Hirsch, MD, professor, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington 03/10/2004  
Nicole Chalmers
over 4 years ago
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14

Chronic Illness & Palliative Care, Part 2

There are misperceptions about living with a chronic illness such as diabetes. Hear about some of the recent and future advancements in diabetes care helping patients live full and meaningful lives. See what happens when the chronic illness reaches its life-limiting stages. Hear how patients, families, and physicians can integrate palliative care into their treatment to support living the best life possible during this challenging time. Carlos Pellegrini, M.D., Henry N. Harkins Professor and Chair of the UW Department of Surgery Stuart Farber, associate professor, department of Family Medicine, Hospice Medical Director, University of Washington Edward Walker, M.D. Medical Director, UW Medical Center and Associate Dean, UW School of Medicine Irl Hirsch, MD, professor, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington 03/10/2004  
Nicole Chalmers
over 4 years ago
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36

Anaemia of Chronic Disease

This is common, particularly in the hospital setting. It occurs as a result of: Chronic infection Chronic inflammation Neoplasia The anaemia is not related to bone marrow, bleeding or haemolysis, and is generally mild (Hb of 8.5-11.5g/dl).  
almostadoctor.com - free medical student revision notes
over 4 years ago
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9

ParkinsonNet: a new approach to management of chronic disease

Stream ParkinsonNet: a new approach to management of chronic disease by BMJ talk medicine from desktop or your mobile device  
SoundCloud
over 4 years ago
Www.bmj
1
10

Revolutionising management of chronic disease: the ParkinsonNet approach

Patients with Parkinson’s disease need long term support to manage their condition. Bastiaan Bloem and Marten Munneke describe the benefits of a model of integrated care provided by a network of specialists and suggest it has promise for other long term conditions  
bmj.com
over 4 years ago
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10

Does it work to pay people to live healthier lives?

With chronic diseases placing an ever growing burden on health services, governments are increasingly offering financial incentives to encourage healthier lifestyles. Sarah Strickland looks at the trends and the evidence  
bmj.com
over 4 years ago
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WHO | “Ageing well” must be a global priority

A major new Series on health and ageing, published in <i>"The Lancet"</i>, warns that unless health systems find effective strategies to address the problems faced by an ageing world population, the growing burden of chronic disease will greatly affect the quality of life of older people.  
who.int
almost 4 years ago
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23

Journal club: Chronic disease management for tobacco dependence

Stream Journal club: Chronic disease management for tobacco dependence by BMJ talk medicine from desktop or your mobile device  
SoundCloud
over 3 years ago
Www.bmj
1
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Guidelines, polypharmacy, and drug-drug interactions in patients with multimorbidity

Polypharmacy, defined as the chronic co-prescription of several drugs, is often the consequence of the application of disease specific guidelines, targeting disease specific goals, to patients with multiple chronic diseases. One common consequence of polypharmacy is the high rate of adverse drug reactions, mainly from drug-drug interactions (the ability of a drug to modify the action or effect of another drug administered successively or simultaneously).1 The risk of a drug-drug interaction in any particular patient increases with the number of co-existing diseases and the number of drugs prescribed.2  
bmj.com
over 3 years ago
Www.bmj
1
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Should vitamin D supplements be recommended to prevent chronic diseases? | The BMJ

Do not recommend vitamin D supplements to prevent chronic disease because clear evidence of benefit does not currently exist and adverse effects cannot be excluded - currently located behind a paywall. Your institution may have access through Athens/Elservier or similar.  
bmj.com
over 3 years ago
Www.bmj
1
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Guidelines, polypharmacy, and drug-drug interactions in patients with multimorbidity

Polypharmacy, defined as the chronic co-prescription of several drugs, is often the consequence of the application of disease specific guidelines, targeting disease specific goals, to patients with multiple chronic diseases. One common consequence of polypharmacy is the high rate of adverse drug reactions, mainly from drug-drug interactions (the ability of a drug to modify the action or effect of another drug administered successively or simultaneously).1 The risk of a drug-drug interaction in any particular patient increases with the number of co-existing diseases and the number of drugs prescribed.2  
bmj.com
over 3 years ago
Preview
1
11

Should vitamin D supplements be recommended to prevent chronic diseases?

Do not recommend vitamin D supplements to prevent chronic disease because clear evidence of benefit does not currently exist and adverse effects cannot be excluded  
bmj.com
over 3 years ago
Www.bmj
2
54

Guidelines, polypharmacy, and drug-drug interactions in patients with multimorbidity

Polypharmacy, defined as the chronic co-prescription of several drugs, is often the consequence of the application of disease specific guidelines, targeting disease specific goals, to patients with multiple chronic diseases. One common consequence of polypharmacy is the high rate of adverse drug reactions, mainly from drug-drug interactions (the ability of a drug to modify the action or effect of another drug administered successively or simultaneously).1 The risk of a drug-drug interaction in any particular patient increases with the number of co-existing diseases and the number of drugs prescribed.2  
bmj.com
over 3 years ago
Foo20151013 2023 xiiska?1444773936
8
502

I'm Not Your Typical SHO...

I'm an SHO, but I don't have your typical ward based job. In the last four years I have treated in jungles, underwater (in scuba gear), 5m from a gorilla, up a volcano, on a beach, at altitude, on safari, in a bog and on a boat. Expedition medicine is a great way to travel the world, take time out whist expanding your CV, and be physically and mentally challenged and develop your skill and knowledge base. As a doctor, you can undertake expeditions during your 'spare time' but it is more common for doctors to go on expeditions between F2 and specialty training. This is the ideal time either because you have been working for the last 7 years and either you need a break, the NHS has broken you, or you don't know what you want to do with your career and need time to think. At this point I would recommend using your F2 course/study budget on an Expedition Medicine course. They are expensive, but the knowledge and skill base you gain makes you more prepared and competitive for expedition jobs. There are many types of Expedition Medicine jobs ranging from endurance sports races to scientific expeditions. Although the jobs differ, there are many ailments common to all. You should expect to treat diarrhoea and vomiting, insect bites, blisters, cuts, injuries, and GP complaints such headaches and exacerbations of chronic illnesses. More serious injuries and illnesses can occur so it is good to be prepared as possible. To help, ensure your medical kit is labelled and organised e.g. labelled cannulation kit, emergency kit is always accessible and you are familiar with the casevac plan. Your role as an Expedition Medic involves more that the treatment of clients. A typical job also includes client selection and education, risk assessment, updating casevac plans, stock-checking kit, health promotion, project management and writing debriefs. What's Right For You? If you're keen to do Expedition Medicine, first think about where you want to go and then for how long. Think hard about these choices. A 6 month expedition through the jungle sounds exciting, but if you don't like spiders, creepy-crawlies and leaches, and the furthest you have travelled is an all-inclusive to Mallorca, then it might be best to start with a 4 week expedition in France. When you have an idea of what you want to do there are many organisations that you can apply to, including: Operation Wallacea Raleigh Across the Divide World Challenge Floating Doctors Doctors Without Borders Royal Geographical Society Action Challenge GapForce Each organisation will have different aims, clients, resources and responsibilities so pick one that suits you. Have fun and feel free to post any question below.  
Dr Rachel Saunders
over 5 years ago
Foo20151013 2023 38zku8?1444774057
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1845

The BioPsychoSocial Model of Disease comes to life

The biopsychosocial model of disease existed in my notes... an excuse to get out the colouring crayons and draw a diagram, but ultimately another collection of facts that needed to be digested then regurgitated in the summer exams, something to be fitted in around learning about the important stuff - the science. But the biopsychosocial model has come alive for me recently, now I realise what an impact the later two components, psychological and social, can have on patients. As a former medical student and now full time patient, the model really means something to me now. In the 1977 paper in Science, George Engel introduced the biopsychosocial model: "The dominant model of disease today is biomedical, and it leaves no room within it's framework for the social, psychological and behavioural dimensions of illness. A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching and a design for action in the real world of health care." Following some conversations on Twitter recently and from my own experience at medical school and now as a patient, I wanted to explore my thoughts on this model. Twitter, in the wonderful way it does, recently introduced me to the Disabled Medic blog, which among many other great posts, has also explored the biopsychosocial model, and I would recommend a read. The biopsychosocial model shows the influence that emotions and social circumstances have on physical health, which is important. But while conversations about the model focus on the way it can be used by healthcare professionals (very important!), it needs emphasising that the model can provide a framework for patients to look at/after themselves. The model highlights the psychological and social causes of disease, but more optimistically, it can show that there are a range of treatments for disease, from the medical to the social and psychological. A diagnosis of a long-term health conditions is often simultaneous with loss of control. There are limitations to the success of medications, treatments and surgeries. And in receiving these, we are relatively passive as patients, no matter how engaged we are. The biopsychosocial model looks at our biological, psychological and social needs, and how these factors influence our overall health. Establishing that these factors affect our health is only the first step. As patients, when psychological and social factors are brought in to the equation, it becomes clear that we ourselves have some power to help ourselves. By framing our health in this more holistic way, as patients we are not as powerless as suggested by the medical model. Through self-management we can make positive changes to our own psychological and social situations, which can in turn benefit our physical biological health. To return to the traditional ground of the model - healthcare professionals.... One strength of the model is that it places psychology side beside its (generally considered) more superior counter-part, biology. I hope that by seeing the biopsychosocial model in action, physicians can appreciate the detrimental psychological impact of a diagnosis, and the assumption of "it is all in the mind" can fall by the way side. By integrating all three elements, the model shows that neither is independent of the others, so it can't be all in the mind, because other factors, biological or social, will be involved to some degree. For me personally, the biopsychosocial model makes me look at what a 'life' is. One of the attractions of medicine is saving lives. Without getting too deeply into philosophy or ethics, I just want to explore for a second what saving a life really means for me, as a patient. I still believe that A&E staff heroically save lives. But I have come to realise that a life is more than a swiggly line on a heart rate monitor. My counsellor has been just as heroic in saving my life, through addressing my emotions. My life is now something I can live, rather than endure. With saving lives being a key (and honourable) motivation among medical staff, it is important that we can allow them to save lives as often as possible, and in many different ways. It may not always be through emergency treatment in resuscitation, but if we embrace the biopsychosical model, they can save lives in many more ways. When there is a limit to the effectiveness of the biological approaches to an ill person, and they can't be returned to the land of the healthy, medical science becomes unstuck. Within the biopsychosocial model, the issue of doctors not being able to do anything is slightly less. As I mentioned in my post about making the transition from medical student to patient, I went to medical school because I wanted to make people better. But I was only being taught one way to make people better - drugs and surgery. If we really embraces the biopsychosocial model, doctors could make a difference, even if their standard tools of drugs aren't available because they could turn to psychological and social support. This isn't to say that all clinicians have to be counsellors or social workers - far from it. But an awareness and appreciation of their contribution to the management of a patient is important, as well as an understanding of the basic principles and skills such as motivational interviewing. In 2013, I don't think I can talk about social in this context without mentioning social media. It was not was Engel originally meant in 1977, but social media has become a vital social tool for patients to manage their health. Ignoring anxieties and postural problems associated with sitting at a screen seeing everyone else's photo-shopped lives, it is undeniable that social media is a big and good resource that can empower patients to take responsibility and manage their own health. To see the best examples in action, take a look at Michael Seres and his blog, Being a Patient Isn't Easy to see a whole new meaning to the social in biopsychosocial! I am still very grateful for the biological expertise of my medical team. Don't get me wrong - it's a good place to start and I wouldn't be here writing this post today if it wasn't for the biological support. But with chronic illness, when you are past the dramatic relapses, the biological isn't enough.... The biology has allowed me to live, but its the psychological and social support I have received that has allowed me to live. Anya de Iongh @anyadei www.thepatientpatient2011.blogspot.co.uk  
Anya de Iongh
over 5 years ago
Foo20151013 2023 1juzlhe?1444774136
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Dr Mark Newbold “Why Should Doctors Get Involved in Management – Understanding the Problems” - Birmingham Medical Leadership Society Lecture 3

The Birmingham Student’s Medical Leadership Society (MLS) held it’s third and final lecture of 2013 on Thursday December 5th. The final lecture was given by Dr Mark Newbold CEO of the Heart of England NHS Foundation Trust and was a particularly enlightening end to our autumn lecture series on why healthcare professionals should become involved in management and leadership. In contrast to the previous talk by Mr Tim Smart this lecture did not focus on why doctors would be suitable for management roles but rather on why clinical leadership is absolutely necessary to tackle the fundamental problems in our hospitals today. Once again, the Birmingham MLS heartily thanks Dr Newbold for giving up his valuable time to speak to us and we must also thank Michelle and Angie for video recording this event as well. Fingers crossed, the recordings of both of our last events should be available fairly shortly. The lecture began with a brief career history of why and how Dr Newbold became involved in hospital management, from front line doctor, to department lead and on to chief exec of a major NHS foundation trust. The second part of the lecture was a brief history of the recent NHS beginning with the Labour years. Between 1997 and 2010 NHS funding increased enormously, which was a good thing. Targets increased proportionally with the funding, not necessarily a good thing. Expectations to meet the targets at all costs and punishments for failure also increased, not a good thing. Focus became diverted from providing the best possible care to ensuring that the hospital didn’t go bankrupt from failing to hit it’s targets. The “budget culture” was an unintended consequence of overzealous central target setting. This system did have some major successes, such as overall reduced waiting times and new specialist urgent cancer referral pathways. However, these successes did not necessarily transform into better patient care or higher patient satisfaction. This came to ahead as well all know with the Mid-Staffs Enquiry, the Francis report and the Keogh review. The recent NHS reforms have tried to change the NHS management culture away from target driven accounting and more towards affordable, yet excellent patient care – a “quality culture”. The NHS structural reforms have been well meaning but messy and complicated. The NHS culture change has begun, but trying to change something as huge as the NHS is like trying to steer an oil tanker, it takes time for the tiniest change in direction to be noticed. Add to this list of changes, an ever ageing population, an ever growing population, an increasingly chronically ill, co-morbid population and a relative freeze in budget and you can start to see why NHS managers are having such a tough time at the moment. How can NHS managers adopt this culture? Put their priorities in order. Quality care + Patient satisfaction > Waiting lists > Budgets Engage with the public in a more meaningful way. Have a social media presence so that you, your hospital and its staff are more than just a faceless organisation. Have a twitter account and write blogs about your challenges and successes. This will increase patient satisfaction with your hospital. Ask for and listen to patient reviews regularly. Make sure these reviews are public and this will help ensure that any changes made are recognised. Better articulate why you are changing a service, e.g. you are not shutting a local A/E to save money but to save lives! Specialist centres have been shown to have better patient outcomes than smaller, less specialised centres. The London stroke service reforms are an excellent example of this principle. Realise that a budget is a constraint, not an aim! Create a dialogue with doctors about which targets are important and why they are important. If doctors don’t agree with the targets then they will not try to improve the measures. For example, the A/E 4 hour waiting time target annoys a lot of healthcare professionals, who see it as a criticism of their work. However, this target is in fact not a measure of A/E efficiency but actually a measure of FLOW through the entire hospital. If the 4h target is missed then there is a problem within the hospital system as a whole and the doctors needed to be aware that their service is reaching capacity and that this may affect their practice. They should also consider why the 4h target was missed and what can they do to increase the patient flow through the hospital – are they needed in an understaffed department? The essence of this part of the lecture can be summarised by saying that “poor hospital performance has consequences for that hospital and its staff, these consequences affect clinical care and therefore, healthcare professionals need to care about the bigger picture otherwise it will affect frontline care”. The next part of the talk went on to outline some of the recent problems that Dr Newbold has been made aware of and how this affects his hospitals performance. 35% of patients who present to the A/E department have at least 1 chronic condition. 12% of patients are re-admitted within 30 days. Did they receive suboptimal care the first time? Patients who are re-admitted have a far higher mortality rate than other patients. Once, a patient has been in hospital for longer than 5 days their mortality rate begins to rise drastically. Being in a hospital is bad for your health and patients are often not discharged as soon as they should be. A hospital of 1500 people needs to discharge over 200 patients a day just to maintain its flow of patients. If this discharge rate decreases then the pressure on the system increases and beds are no longer available, which starts to decrease the services a hospital can provide, such as elective operations. Hospitals tend to be managed on 4 layers of alert. When the hospital is on top alert i.e. the most under pressure, mortality rates can be up to 8% higher than when the hospital is at its least pressured. By not discharging patients promptly, doctors are increasing the pressure on the system as a whole with awful unintended consequences for the patients. By admitting patients to the wards, who do not necessarily require in-patient care, doctors are also increasing the pressure on the system. Bed blocking has consequences for the patients, not just the budgets. The list above demonstrates how unintended consequences of frontline staff decisions affect patient outcomes. That is why it is critical that frontline staff are involved with helping to improve some of these problems. Does that patient really need to be admitted to an already full hospital? Does that patient really need to stay on the ward until Friday? Did that man with an exacerbation of asthma get the best acute treatment and has a plan been made for his long term management that will decrease the chance of him re-admitting? Healthcare staff can help by adjusting their practice to the situation and by helping to change the systems overall, so that the above consequences are less likely to occur. This part of the lecture was really quite sobering. It spelled out some hard facts about how such a complex system as a hospital operates. But more importantly it helped clarify just what needs to be done in the future to make hospital care the best it can be. Dr Newbold quoted the RCP report “Hospitals are not the problem, they have a problem” to highlight his believe that in the future the health service needs to change to be less focussed on acute crises and more focussed on exacerbation prevention. Hospitals should be a last resort, not a first choice. Hospitals themselves need to change how they deliver care. NHS staff need to explore ways of providing their services in an ambulatory fashion, so that patients don’t need to stay on the wards for any pre-longed period of time but come and go as quickly as possible. This will involve a major shake up in how hospital trusts fund care. They will need to increase their funding for the provision of more services at home. They need to get their employs out of the hospital and into the community. They need to work more closely with GP’s and with local social services. As the previous Chief Medical Officer said “Good Health is about team work”. Only when GP’s, community staff, hospital staff and social services work as a team will patient care really improve. At the present The University of Birmingham Students Medical Leadership Society is in contact with the FMLM and other similar groups at the Universities of Bristol, Barts and Oxford. We are looking to get in contact with every other society in the country. If you are a new or old MLS then please do get in touch, we would love to hear from you and are happy to help your societies in any way we can – we would also love to attend your events so please do send us an invite. Email us at med.leadership.soc.uob@gmail.com Follow us on Twitter @UoBMedLeaders Find us on Facebook @ https://www.facebook.com/groups/676838225676202/ Come along to our up coming events… Wednesday 22nd January 2014 LT3 Medical School, 6pm ‘Has the NHS lost the ability to care?’ – responding to the Mid Staffs inquiry’ By Prof Jon Glasby, Director of the Health Services Management Centre , UoB Thursday 20th February LT3 Medical School, 6pm ‘Reforming the West Midlands Major Trauma Care” By Sir Prof Keith Porter, Professor of Traumatology, UHB Saturday 8th March WF15 Medical School, 1pm “Applying the Theory of Constraints to Healthcare” By Mr A Dinham and J Nieboer ,QFI Consulting  
jacob matthews
almost 5 years ago
Foo20151013 2023 o7es6t?1444774265
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257

Chronic: How one word can change everything

So, I think its about time I posted another blog post! A few weeks ago I received the results from my most recent scan. I was both nervous and excited to find out my results, after months of tests and being misdiagnosed several times I just wanted to know what was wrong with me. However, as I read through the letter from my consultant I realised that my journey was just beginning. I was diagnosed with a rare stomach condition. Gastroparesis. A chronic illness. There is no known cure, just various treatments with limited success. I didn’t really know how to react to this news. Shouldn’t I be happy that I finally knew what was wrong? I had convinced myself for months that as soon as the doctors found out what was wrong, they could fix it and I’d be better in no time, but this wasn’t to be. I couldn’t understand how this could happen. Slowly the reality began to sink in, I’ll probably be fighting this battle for the rest of my life. I think the mental aspect of chronic conditions is so commonly overlooked. I’ve sat through endless lectures about the pathophysiology of illnesses but I’ve never once stopped to think what it must be like to actually have it. The way it can limit your life, from not being able to go for a drink with friends because you’re in too much pain to the countless hospital appointments that your life seems to revolve around. The thing that hit me the most is the amount of medications I have to take on a daily basis just to make my symptoms bearable. I no longer have full control of my life and that's the worst part. This experience has given me an invaluable insight into how patients with chronic illness feel. It affects almost every aspect of your life and you can never escape. It scares me to think of the future, I never know when I’m going to get my next flare up or how long its going to last. I just have to take one day at a time and hope that when I wake up tomorrow I won’t be too nauseous. After spending a few weeks feeling down about it all, I’ve realised that I just have to enjoy life when I can and be grateful that I can still live a normal-ish life. It doesn’t matter how much I complain, it's not going to go away, and I think I’ve finally accepted that fact. If anything, this experience has made me more determined to achieve my dream of becoming a doctor. I’ve been a lot more motivated to work harder so that one day I can help others like me through some of their toughest times, hopefully bringing them some comfort and relief.  
Nicole Mooney
over 4 years ago
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Chronic Illness

The Newest Edition Of Best-Selling Chronic Illness Continues To Focus On The Various Aspects Of Chronic Illness That Influence Both Patients And Their Families. Topics Include The Sociological, Psychological, Ethical, Organizational, And Financial Factors, As Well As Individual And System Outcomes. This Book Is Designed To Teach Students About The Whole Client Or Patient Versus The Physical Status Of The Client With Chronic Illness. The Study Questions At The End Of Each Chapter And The Case Studies Help The Students Apply The Information To Real Life. Evidence-Based Practice References Are Included In Almost Every Chapter.  
books.google.co.uk
over 3 years ago
Www.bmj
0
1

Collaboration is needed to promote the good medicine of exercise

MacAuley and colleagues rightly state that it’s “extraordinary how long mainstream medicine is taking to accept the importance of physical activity.”1 If we are serious about providing the best care for every patient every time, something that is proved to increase happiness, prevent and treat more than 40 chronic diseases, and significantly increase life expectancy should be a key weapon.2  
feeds.bmj.com
over 3 years ago
Www.bmj
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Chronic disease causes more visits to emergency departments while visits for injuries fall, US study finds

The mix of patients seeking care in emergency departments in California has shifted, a new study shows, as the proportion of visits by patients needing care for injuries fell slightly while the proportion seeking care for non-injury diagnoses rose significantly.  
feeds.bmj.com
over 3 years ago