The document discusses the development of a smartphone app called Thal Happy to help patients with beta thalassemia major better manage their complex treatment plans. The app aims to improve patient adherence by allowing them to log medications, appointments, and symptoms in one centralized place. It also seeks to educate and empower patients through resources on the latest treatment advances. The app is designed to be accessible across different ages, languages, and countries. It will utilize feedback from patient and provider focus groups to refine prototypes using lean development processes prior to broader release.
Standard of care / Standard of Practice / Clinical Guideline/ Clinical Pathway Naz Usmani
A very brief presentation about the clinical process improvements including practices, standards of care , guideline and pathway . I have reflected upon the basic differences between them . Hope it is useful
The best of clinical pathway redesign - practical examples of delivering bene...NHS Improvement
The examples here showcase just some of the innovations that have enabled thousands of patients to enjoy better health and well-being thanks to practicalservice improvements implemented on various clinical pathways
Standard of care / Standard of Practice / Clinical Guideline/ Clinical Pathway Naz Usmani
A very brief presentation to differentiate between clinical process improvement practice , guideline and pathway .
I have reflected on the basic differences between them .
Guidelines in the treatment of dyslipidemia
Clinical practice guidlines in the philippines in the management of dyslipidemia.Among patients diagnosed to have dyslipidemia, regardless.Among non-diabetics without ASCVD but with multiple risk factors, should statin therapy be given?
A national approach to improve the quality of Aftercare for survivors of TYA cancer - End of Treatment Summaries / Care Plans
Dr Helen Jenkinson, Consultant Paediatric Oncologist
on behalf of the NCSI steering group
Event held in London on Wednesday 9 October with the Teenage and Young Adult (TYA) Centre Champions and our Clinical Leads to share learning, good practice examples, the successes, challenges and barriers to implementing:
Treatment summaries
End of treatment care plans
Increased self-management for TYAs after cancer treatment
The output from the meeting will be to define what support NHS IQ can provide locally to assist TYA teams in order to make progress with their implementation plans.
Standard of care / Standard of Practice / Clinical Guideline/ Clinical Pathway Naz Usmani
A very brief presentation about the clinical process improvements including practices, standards of care , guideline and pathway . I have reflected upon the basic differences between them . Hope it is useful
The best of clinical pathway redesign - practical examples of delivering bene...NHS Improvement
The examples here showcase just some of the innovations that have enabled thousands of patients to enjoy better health and well-being thanks to practicalservice improvements implemented on various clinical pathways
Standard of care / Standard of Practice / Clinical Guideline/ Clinical Pathway Naz Usmani
A very brief presentation to differentiate between clinical process improvement practice , guideline and pathway .
I have reflected on the basic differences between them .
Guidelines in the treatment of dyslipidemia
Clinical practice guidlines in the philippines in the management of dyslipidemia.Among patients diagnosed to have dyslipidemia, regardless.Among non-diabetics without ASCVD but with multiple risk factors, should statin therapy be given?
A national approach to improve the quality of Aftercare for survivors of TYA cancer - End of Treatment Summaries / Care Plans
Dr Helen Jenkinson, Consultant Paediatric Oncologist
on behalf of the NCSI steering group
Event held in London on Wednesday 9 October with the Teenage and Young Adult (TYA) Centre Champions and our Clinical Leads to share learning, good practice examples, the successes, challenges and barriers to implementing:
Treatment summaries
End of treatment care plans
Increased self-management for TYAs after cancer treatment
The output from the meeting will be to define what support NHS IQ can provide locally to assist TYA teams in order to make progress with their implementation plans.
The annual physical exam allows physicians to detect changes that could affect their patients’ health, but there are debates as to whether it is really necessary.
Dr. Judith Hibbard presents The Case for Patient Activation - Activate 2017 b...mPulse Mobile
Leading patient activation researcher, Dr. Judith HIbbard, delves deep into the research findings of countless studies to reveal the definition, value and outcomes of patient activation during Activate 2017.
Management of Thallasemia Patient of Dental SurgerySyed Muhammad Ali
THALASSEMIA IS AN INHERITED BLOOD DISORDER IN PAKISTAN NO WORK ON ORAL AND MAXILLOFCIAL MANIFESTATION OF THALASSEMIA .IN PAKISTAN DR SYED MUHAMMAD ALI START WORK ON ORAL AND MAXILLOFACIAL UNDER THE SUPERVISION OF EMINENT PROFFESSOR OF ORAL AND MAXILLOFACIAL SURGERY PROF DR SYED MAHMOOD HAIDER THIS WORK IS THE ATTEMP IN DENTISTRY IN PAKISTAN ON ORAL AND MAXILLOFACIAL MANIFESTATION
The annual physical exam allows physicians to detect changes that could affect their patients’ health, but there are debates as to whether it is really necessary.
Dr. Judith Hibbard presents The Case for Patient Activation - Activate 2017 b...mPulse Mobile
Leading patient activation researcher, Dr. Judith HIbbard, delves deep into the research findings of countless studies to reveal the definition, value and outcomes of patient activation during Activate 2017.
Management of Thallasemia Patient of Dental SurgerySyed Muhammad Ali
THALASSEMIA IS AN INHERITED BLOOD DISORDER IN PAKISTAN NO WORK ON ORAL AND MAXILLOFCIAL MANIFESTATION OF THALASSEMIA .IN PAKISTAN DR SYED MUHAMMAD ALI START WORK ON ORAL AND MAXILLOFACIAL UNDER THE SUPERVISION OF EMINENT PROFFESSOR OF ORAL AND MAXILLOFACIAL SURGERY PROF DR SYED MAHMOOD HAIDER THIS WORK IS THE ATTEMP IN DENTISTRY IN PAKISTAN ON ORAL AND MAXILLOFACIAL MANIFESTATION
Impact of health education on tuberculosis drug adherenceSkillet Tony
Adherence is defined as the extent to which patients follow the instructions they are given for prescribed treatments. Until recently, adherence expertise was hard to find, assemble and empower. The study shall solely aim at investigating the influence of patients’ health education on Tuberculosis drug adherence. It will be guided by the following specific objectives; to identify the level of adherence among TB patients at MTRH, to assess the level of patient’s health education on TB drugs, to identify barriers of TB education, to investigate the challenges facing TB patients on treatment and to determine the level of training given to health workers on TB drug adherence. These objectives will enable the researcher to elaborate more on the topic and ensure that those who read through this research shall have a better perspective on the effects of health education on tuberculosis drug adherence. It will take place between the months of July and August. The study will target 17 doctors, 119 nurses and 143 patients of Tuberculosis. The study will employ a case study research design. The case study will enable the researcher be able to collected detailed information as to the influence of patients’ health education on TB drug adherence. The study will employ purposive sampling to sample the doctors and simple random sampling to select both the nurses and the patients who will participate in the study. The researcher will use one research instrument to collect data from the respondents selected to participate in the study which is a questionnaire that will be issued to the respondents on the day of the data collection.
Write down the clinical importance of occupational history in medical practice.
Identification of potential health risks: Obtaining an occupational history can help healthcare providers identify potential health risks associated with a patient's occupation. For instance, a patient working in a factory that uses toxic chemicals may be at risk of developing respiratory problems or cancer.
Diagnosis and management of work-related illnesses and injuries: Understanding a patient's work history can help healthcare providers diagnose and manage work-related illnesses and injuries. For example, a patient with carpal tunnel syndrome may be diagnosed with a work-related injury if their job involves repetitive hand motions.
Appropriate preventive measures: Knowledge of a patient's occupation can help healthcare providers provide appropriate preventive measures to reduce the risk of developing work-related illnesses or injuries. For instance, a healthcare worker may be advised to use personal protective equipment (PPE) to prevent exposure to infectious diseases.
Legal and insurance purposes: Occupational history can also be important for legal and insurance purposes. For example, a worker's compensation claim may require documentation of the patient's occupation and the circumstances surrounding the injury.
Social and environmental factors: Occupational history can provide information about a patient's social and environmental factors that may contribute to their health status. For example, a patient with a stressful job may be at higher risk of developing mental health conditions.
In summary, obtaining a patient's occupational history is crucial for healthcare providers to understand potential health risks, diagnose and manage work-related illnesses and injuries, provide appropriate preventive measures, and consider social and environmental factors.
Question: Mention the importance of past history in medical practice.
Past medical history is an important aspect of medical practice as it provides valuable information about a patient's health status and can help healthcare providers make informed decisions about their diagnosis, treatment, and management. Here are some points and examples elaborating the importance of past medical history in medical practice:
Understanding the patient's medical background: A patient's past medical history can provide information about their medical conditions, surgeries, hospitalizations, and medications. This information can help healthcare providers understand the patient's medical background, which is essential for accurate diagnosis and treatment. For example, a patient with a history of heart disease may be at higher risk of developing complications from a respiratory illness.
Identifying risk factors and potential health problems: Past medical history can help identify risk factors and potential health problems that may be relevant to a patient's current condition. For instance, a patient with a his
Nurses play a critical role in any team of healthcare professionals involved in the care of patients with chronic diseases, including Hb disorders such as thalassaemia
and sickle dell disease. These are extremely challenging diseases that are fatal if left untreated.
However, by sharing expert knowledge on their prevention and treatment, these conditions can be effectively managed.
TIF places great importance on nursing as a valued part of patient care well beyond the medical component. We hope that this Guide will help and motivate more nurses across
the world to become involved in the care of patients with this group of diseases.
Focussing on cytotoxic treatment alone is not enoughinemet
PharmaCon2007 Congress, Dubrovnik, Croatia "New Technologies and Trends in Pharmacy, Pharmaceutical Industry and Education" http://www.pharmacon2007.com
Abstract is available at http://www.pharmaconnectme.com
provide recommendations for alternative drug treatments to address.docxsimonlbentley59018
provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples
Week 9 Initial Post- Mel Mal,
COLLAPSE
Top of Form
This case study presents a particularly hard case to untangle. The 46-year-old women is exhibiting the night sweats, hot-flushing, and genitourinary symptoms common in menopause. The patient is still getting a regular period, so these symptoms are most likely pre-menopausal, as periods stop in true menopause. In a patient with no familial history increasing the patient’s risk for breast cancer, an estrogen or combination estrogen/progestin therapy would most likely be initiated (Rosenthal et al. 2021). This therapy would likely reduce the uncomfortable symptoms, however in a patient with a family history of breast cancer, the therapy can increase the likelihood of breast cancer occurrence.
Luciano et al., found that both estrogen therapies and combined estrogen/progestin therapies increased the risk for breast cancer (2020). It is important to notice that this study notes that the risks for patients who take the therapy on a short-term basis are at a slightly lower risk, however this patient is young at 46 years old and would possibly need a long-term medication solution.
On the opposite side, Carr summarizes the North American Menopause society’s 2022 updated guidelines on hormonal replacement therapy and explains that a patient with menopausal symptoms can take combined hormone therapy until at least the mean age of menopause (53) without any significant increase in breast cancer (2022). With the newest recommendations, I would recommend that the patient start a combined estrogen and progestin hormone therapy for reduction in symptoms. With this recommendation is the caveat that the patient will need regular visits to re-evaluate the need for the therapy with hopeful cessation of treatment within three to five years to keep any increase in breast cancer risk to a minimum.
The lowest dose medication should be used for the shortest time period in order to reduce comorbidity risk so this patient recommendation will be to start Prempro 0.3mg/1.5mg daily and then reevaluate for effectiveness and need to increase dosage (Rosenthal et al., 2021).
The patient also needs adjustments in her hypertension medication. The patient is currently on Norvasc 10mg daily, and HCTZ 25mg daily. This therapy is within guidelines because she is on Norvasc, a calcium-channel blocker, and Hydrochlorothiazide, a thiazide diuretic, are being used to potentiate each other’s effects. In cases where a thiazide diuretic is ineffective in controlling HTN, a loop diuretic may be added. In this patient, we will recommend adding Furosemide to hopefully control the hypertension. This dosage will start low, at 20mg daily, (taken in the morning to decrease nocturia), with regular home blood pressure checks as well as in office re-evaluation to determine how effective the medication and dosage are (.
Introduction of the NZ Health IT Plan enables better gout management - Reflections of an early adopter. Presented by Peter Gow, Counties Manukau DHB, at HINZ 2014, 12 November 2014, 11.37am, Plenary Room
Running head NARRATIVE 10- BURN UNIT1NARRATIVE 10- BURN UNIT.docxtoltonkendal
Running head: NARRATIVE 10- BURN UNIT 1
NARRATIVE 10- BURN UNIT 2
New practice approaches
An experience with new technology and better ways of dealing with burn cases, treatment is quite fast and easy! Unlike the traditional way of airway maintenance, the new way that follows the ATLS guidelines enables the nurse to have a definitive airway maintenance as well as ventilation monitoring.
Extraprofessional collaboration
The burn unit required a great deal of collaboration between different medical practitioners in order to achieve quick recovery and optimum treatment results. With the airway and c-spine protection, monitoring the heart rate and blood pressure would require different physicians to acquire optimum results.
Health care delivery and clinical systems
With the Airway with C-spine Protection, different procedures and systems collaborate together to produce the best treatment results. Assessment of breathing, circulation, disability and exposure worked well with the clinical system each stage was important in contributing to the greater good.
Ethical considerations in health care
When it comes to Airway with C-spine Protection, Improving access to care, Protecting patient privacy and confidentiality are paramount. Building and maintaining strong health care workforce, Marketing practices and Care quality helps the unit achieve quality care.
Population health concerns
In the Airway with C-spine Protection, the section has the mandate of providing quality and convenient care. These help to improve the workability of the hospital system in general.
The role of technology in improving health care outcomes
When accessing the Airway with C-spine Protection, use of technology proved to be important especially when inspecting for singed nasal, facial and eyebrow hairs.
Health policy
Definitely, health policies serve as important ways through which the burn unit could provide quality healthcare. I did notice this when it comes to ensuring that each patient gets the most out of treatment they undergo.
Leadership and economic models
At the burn unit, it is almost blatant that leaders are responsible and are economical in their decision making. This is evident by the efficient allocation of resources.
Health disparities
Different patients come with different conditions. However, it is the function of the nurses to do all they can to ensure that their patients get well.
Running Head: Reflective Narrative 1
Oncology Unit: Reflective Narration
Student’s Name:
Institution- Affiliated:
Health disparities in Cancer
One of the most significant issues I encountered during of the course of the week is the existing disparities in various aspects of cancer such as death rates, higher rates of advanced cancer diagnoses, less frequent use of proven screening test in specific populations is an area in which progress has not been at par. I noted health disparities existed in African American women compared to women from other ethnic ...
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
- 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
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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...
Thal happy proposal
1. Thal Happy! A thalassemia coach in your pocket
Background and Problem Statement
The management of beta thalassemia major is complex. It includes ensuring adequate
transfusions, monitoring of organ iron load, ensuring regular iron chelation therapy, and
monitoring and management of complications. Optimization of a transfusion regimen and iron
chelation therapy based on organ iron load significantly reduces complications and improves
survival. A comprehensive care team consisting of multiple healthcare providers collaborate with
the patient with the goal of achieving best outcomes. Thus optimal care is a complex set of
appointments, laboratory testing, radiological investigations, and, especially important,
adherence to medications and appropriate drugspecific monitoring. Coordination of these key
tasks, lack of communication, and the ever increasing amount of information can be
overwhelming and are significant stressors for the thalassemia patient.
In order to live healthy and full lives, people with thalassemia major must find a way to manage
chronic transfusion appointments, multiple specialist appointments and multiple medication
regimens over the course of a lifetime. Since research on chelation medications and
management of this chronic illness is ongoing, it is also in a patient’s best interest to stay
informed of the newest updates in thalassemia care. Patients are expected to remember a large
number of details about their medication adherence, appointments attended, and symptoms
experienced in order to report this information to multiple medical providers who may or may not
communicate with each other. In order to reduce this burden on the patient it is important for a
tool to be developed that can streamline the process of recording data and which allows
thalassemia patients to consistently communicate accurate information to all of their medical
providers.
Currently, there is no smartphone app that is personalized to the experience of people living with
thalassemia. Many medication management apps do not even list common chelators in their
medication lists. And most of the medication management apps only focus on helping patients to
remember to take their medications only one aspect of managing a chronic illness such as
thalassemia. Many medical providers are still unfamiliar with best practices in caring for
thalassemia patients, thus it is even more important for patients of all ages to be well informed
about their medical care and to be able to communicate their medical information effectively.
The proposed app, Thal Happy, aims to empower thalassemia patients by giving them the tools
to record all information about their thalassemia management in one place and to then easily
share this information with their providers. Another important purpose of this app is to continue to
inform patients about the newest updates in thalassemia care. Existing thalassemia programs
have found that as thalassemia patients move through childhood and into adolescence and
adulthood they often have gaps in knowledge about their medical care and therefore take a less
active role in the management of their health 1
. Patients who are uninformed about why providers
prescribe certain medications, for example, and require certain procedures are less adherent
because they do not see the value in these recommendations. It is our hope that Thal Happy will
empower people living with thalassemia to become or remain adherent to their medications,
appointments and procedures by making it easier to record medical information, share this
2. information with providers and remain informed about medical advances in the field of
thalassemia.
Goals for Patient Outcomes
● Improving Adherence to Treatment Plans: Poor adherence to chelation therapy is a
significant barrier to good clinical outcomes. Poor adherence to monitoring of chelator
toxicity has the potential for adverse outcome. By providing a log and reminders for
medications, laboratory investigations, and appointments we aim to improve patient
adherence.
● Educating and Empowering Patients: By providing a tool for patients to enter their
medical information, schedule appointments, and track their medical progress, we hope
to empower patients to take control of their disease and their life. Education is power, and
by facilitating transfer of information and education on thalassemia, we aim to improve
patient engagement and involvement in their care. The Media & Resource section of this
app allows patients to keep up to date on the most current developments in the field of
thalassemia. This will empower patients by giving them access to the most current
research on chelation medications, gene therapy trials, etc which will give them the
knowledge they need to make decisions about their care with their providers. It is clear
that patients are more adherent to courses of care that they have an active role in
choosing. Many thalassemia patients find it empowering to develop relationships with
other people living with thalassemia. The app will give patients the opportunity to easily
connect with thalassemia organizations, receive updates from these organizations and
become an active member of the thalassemia community.
● Facilitating Caregiver Involvement: Thal Happy can be used by a parent on behalf of a
child, later transitioning so that the patient may use it directly. Caregivers can also be
kept informed via the data reporting feature which sends reports by email in PDF. These
data include adherence tracking, test result scores, and symptom reporting.
● Promoting Communication with Clinical Teams: The app allows patients to keep all
the information necessary for the management of their thalassemia care in one place.
This will make it possible for patients to easily pull information from the app during
appointments with providers instead of relying on their memory to communicate
symptoms, adherence, appointments attended, and questions. It is common for patients
to feel overwhelmed in a clinical environment and when communicating with medical
providers, especially providers they are not familiar with. This can lead to unproductive
medical appointments because patients can forget questions they had prior to the
appointment or feel uncomfortable asking questions. If patients feel prepared for
appointments and have accurate answers to providers’ questions about their adherence
and symptoms this will empower them to become active members of their care team.
● Serving Transitions of Care: The app helps to coordinate information around transitions
between providers. One particular transition is that of pediatric care to adult care. The
app acts as a tailored Personal Health Record (PHR) which can export data to EHR
systems. This app allows adolescents and young adults to gain independence in
managing their chronic illness in a simple and rewarding way. The “Ask an Expert”
feature also gives adolescents and young adults the opportunity to ask questions about
their care that they may not be comfortable asking providers in person or with caregivers
3. present during appointments. By housing all of their medical information in one place, this
app will allow young adults to walk into new adult provider offices with confidence,
knowing they have answers to their provider’s questions.
Product Design
● Accessibility: Thal Happy is not targeted to any specific community, age group, or
country. Rather, it aims to serve the spectrum of populations with the disease. It
supports multiple languages and platforms, and strikes a balance of fun and efficiency
that is appreciated by all ages. Dates and phone number formats are internationally
appropriate.
● Interoperability: Data can be copied to PHR and EHR systems using the recently
recognized BlueButton+ format. Or it can be saved as a PDF and emailed to a family
member or provider.
● Game Design Principles: The app breaks a complex set of self management tasks into
small, achievable chunks and provides reinforcement at that level. It also shows
progress, and allows the user to take control over their regimen.
● Behavior Theory: The app applies some aspects of the Health Belief Model (HBM): to
educate the user in order to promote proper perceived risks and severity; and to use
cues to remind users of when behavior is needed.
● Privacy of Data: Data is stored locally on devices, not on centralized storage, so the
app remains fast and responsive and does not rely on network connectivity or speed.
Furthermore the data is confined to the local device.
Product Development & Business Development
● CoDesign Approach: Several prototype versions will be created and put in the hands
of volunteer patients and providers in order to collect feedback. The formation of the
group of focus group participants will use the team’s connections in the academic health
system and thalassemia patient support groups all team members work with Penn
Medicine (the University of Pennsylvania Health System including 3 hospitals and many
outpatient practices).
● Lean Development Processes: The app uses an iterative, rapid development process
to develop multiple prototypes to be tested and refined.
● Distributed and Cloud Based Infrastructure: Prototypes are developed on Amazon
Web Services for availability at very low cost. And the app is distributed to app stores
which are able to handle fluctuation in demand.
● Business Model for Sustainability: Due to the distributed and lowtouch design of Thal
Happy the cost of maintaining is kept low. This cost can be covered by charging patients
$5 each to install via app stores.
● First Marketing Strategy: The position of the team as academically based will make
Thal Happy attractive to the various providers for these patient populations across the
world. If, through an effectiveness study, we demonstrate that this app improves patient
engagement and adherence, then providers have an incentive to “prescribe” the app to
all thalassemia patients.
● Second Marketing Strategy: If demonstrating effectiveness for improved patient
outcomes, this app is also suitable for recognition by nonprofit organizations who work
4. with thal patients. They would then help to publicize the app and include it in educational
and outreach programs.
● Next Step: We propose evaluating effectiveness through a pilot study of thalassemia
patients at multiple Philadelphia health systems randomized to use this app.
Features in Initial Prototype
● Home Screen: One quick place to view all important reminders and To Do items. This
view also gives uptodate medication adherence progress and serves as a quick way to
access the most important information to communicate during ED visits.
● Medication Adherence: Text message reminders customized to each patient's
medication schedule, visual weekly medication adherence tracking, the ability to record
symptoms along with medication adherence data.
● Info Card for Emergency Department: With one click patients or anyone accompanying a
patient to the ED is able to communicate all of the most important information necessary
to getting the best care for Thalassemia patients even when providers are not familiar
with treating Thalassemia patients. This feature will include information such as fever
precautions in Thalassemia patients and custom information about each patient’s
transfusion requirements, antibodies, medication dosage and frequency.
● My Log: Thal Happy is designed to accommodate all of the medications, lab tests and
procedures that Thalassemia patients typically need. Thal Happy organizes this
information in a way that makes it easy to document changes in medications, symptoms
and results of procedures and tests.
● Appointments: Thal Happy gives patients the opportunity to easily schedule
appointments and communicate with providers because patients are able to contact
providers with the click of a button on one screen. The app also allows patients to send
custom appointment reminders through text messages and link appointments to their
existing phone calendar.
● Care Team: Thal Happy stores all of a patient’s Care Team information in one place,
serving as a reminder to regularly schedule visits with all providers and making it easier
to access provider contact information to schedule, cancel and reschedule appointments
as well as communicate important information.
● Media & Resources: Thal Happy houses the most uptodate and reliable information
about developments in Thalassemia care and serves as a connection to the
Thalassemia community. Patients are able to find answers to their questions through the
Ask an Expert feature and connect with the Cooley's Anemia Foundation all in one place.
● Thalassemia Center Locator: This feature gives contact info and video introductions to
each of the Comprehensive Thalassemia Centers. This allows patients to plan in
advance when moving from one location to another or when transitioning care from
pediatric to adult providers.
● Download: Data Download or PDF snapshot allows patients to easily pull information
from Thal Happy to share with providers and caregivers so that all members of their Care
Team receive accurate and uptodate information about their medication adherence, lab
results, appointment outcomes and future appointments, procedures and tests.
● Language Selection: Thal Happy gives patients the ability to select from a list of
languages, which makes it possible for Thalassemia patients around the world to use this
amazing app!
5. The Team
● Damien Leri, MS.Ed, MPH [c] is the CEO and lead developer for Big Yellow Star
(http://bigyellowstar.com). This health information technology company provides
consulting and application development and integration services for Penn Medicine,
Children’s Hospital of Philadelphia, and the Camden Health Coalition, among others.
● Genevieve Cattanea, MSW, LSW is currently the Social Worker for the HeartStrong
Program (Automated Hovering to Improve Medication Adherence among Myocardial
Infarction Patients) at the University of Pennsylvania’s Center for Health Incentives and
Behavioral Economics at the Leonard Davis Institute. Past experience in health care
includes her work as the Thalassemia Program Social Worker in the Division of
Hematology at the Children’s Hospital of Philadelphia. Prior to joining CHOP Hematology
in December 2010, she worked as the Social Work Intern at CHOP’s Regional Autism
Center. She holds a Master’s of Social Work degree from the University of Pennsylvania.
● Farzana Sayani, MD MSc is an adult hematologist with experience in the care and
management of patients with thalassemia. She is currently the program director of the
adult comprehensive thalassemia clinic at the Penn–CHOP Blood Center for Patient
Care and Discovery at the Hospital of the University of Pennsylvania. Her training
includes a clinical fellowship in Hemoglobinopathies from the Hospital for Sick Children
(Toronto, Canada) and a Master’s in Haemoglobinopathies (University College London,
UK). She was the lead author for the ‘Guidelines for the Clinical Care of Patients with
Thalassemia in Canada’. Her areas of interest include iron overload, complications of iron
overload, and pediatricadult transition care for patients with thalassemia.
● Lauren HalldenAbberton is the Program Coordinator at the Center for Public Health
Initiatives at the University of Pennsylvania, where she manages communications and
marketing in support of the center’s programming. Her work includes print and web
design, data visualization, and presentation design in a variety of media. She received
her BFA from the Moore College of Art and Design and is currently a Graphic Design
Certificate student at the University of Pennsylvania.
References
1. Levine L, Levine M. Health care transition in thalassemia: pediatric to adultoriented care. Ann
N Y Acad Sci. 2010. 1202: 2447.