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18

Journal club: Lebrikizumab treatment in adults with asthma

Stream Journal club: Lebrikizumab treatment in adults with asthma by BMJ talk medicine from desktop or your mobile device  
SoundCloud
over 4 years ago
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1
24

Bronchi and the bugs: what kickstarts asthma

Stream Bronchi and the bugs: what kickstarts asthma by BMJ talk medicine from desktop or your mobile device  
SoundCloud
over 4 years ago
Preview
1
32

Asthma | Patient

Asthma is characterised by paroxysmal and reversible obstruction of the airways. It is increasingly understood as an inflammatory condition combined with bronchial hyper-responsiveness. Acute asthma involves:  
Patient.co.uk
over 4 years ago
Www.bmj
2
34

Diagnosis and management of asthma in children

In problematic cases of childhood asthma, rather than escalating treatment, a systematic approach is needed, including a review of the diagnosis; adherence, including ability to take drugs correctly; and the child’s environment  
bmj.com
over 4 years ago
Www.bmj
1
37

Diagnosis and management of asthma in children

In problematic cases of childhood asthma, rather than escalating treatment, a systematic approach is needed, including a review of the diagnosis; adherence, including ability to take drugs correctly; and the child’s environment  
bmj.com
over 4 years ago
Www.bmj
1
13

Diagnosis and management of asthma in children

In problematic cases of childhood asthma, rather than escalating treatment, a systematic approach is needed, including a review of the diagnosis; adherence, including ability to take drugs correctly; and the child’s environment  
bmj.com
over 4 years ago
Www.bmj
1
11

A persisting puzzling pneumonia in a young man

A 23 year old immunocompetent man with a history of childhood asthma was referred to the respiratory physicians with a four week history of productive cough, painful throat, fever, rigors, generalised myalgia, and vague discomfort in his left chest. He also had slight abdominal tenderness in the left upper quadrant.  
bmj.com
over 4 years ago
3
0
24

Why is MgSO4 used in acute asthma management?

The anesthetists loves magnesium. But when I asked of the mechanism from A&E consultants, I got replies that it is wonder drug, or not well understood. Anyone got a more comprehensive answer than that?  
Stuart Chan
almost 7 years ago
10
0
5

Question on step 4 asthma management in adults.

First thing you do is increase the inhaled steroid dose, but then you can consider adding a theophylline, leukotriene receptor antagonist or B2 agonist. Is there any preference over which one to choose when, or do you literally pick one and see if it suits the patient, if not pick another?  
Conrad Hayes
over 6 years ago
Foo20151013 2023 184etvn?1444773944
3
133

Aspergillus and Human Health

Many may be familiar with aspergillosis as the infecting agent in acute cases where the patient is severely immunocompromised - but there is more to this fungus' repertoire. There are rare cases where the patient's immune system is overwhelmed by a large inhalation of spores e.g. after gardening, but these are insignificant in terms of total numbers effected. The following are far more common:- Aspergillus and other fungi are increasingly identified as the active agent in sinusitis - if you have cases that don't respond to antibiotics this is worth thinking about. Chronic pulmonary aspergillosis (CPA & aspergilloma) is an infection of immunocompetent people, causing respiratory difficulty, coughing and haemoptysis. The UK NHS has a specialist centre for these patients In Manchester (National Aspergillosis Centre (NAC)). NAC has particular expertise and extensive facilities for the diagnosis of CPA, ABPA, SAFS and use of systemic antifungal drugs. Allergic infection (Allergic Bronchopulmonary Aspergillosis - ABPA and chronic sinusitis) is thought to be heavily underdiagnosed and undertreated. ABPA is particularly common in Asthma, Cystic Fibrosis patients and those with bronchiectasis. There is estimated to be 25 000 cases in the UK alone. Many (50%) of the most severe asthma cases are sensitive to fungi (SAFS) - in particular Aspergillus. These tend to be the most unstable cases that don't respond to antibiotics and several studies have been published that show giving an antifungal helps reduce the use of steroids for these patients. Last but not least - Tuberculosis is on the rise in the UK and the rest of the world. It is estimated that 2% of cases progress to CPA and should be treated using an antifungal - this is usually not done until considerable time has passed and much damage has been done. In total it is estimated that many millions of people across the world suffer from aspergillus - ABPA - 5 million, Tb - 400 000 per year and Asthma (SAFS - 1 - 4 million cases in EU & US). Sinusitis cases may number many tens of millions worldwide. So - the next time you assume aspergillus infections and aspergillosis are rare and confined to those who are profoundly immunocompromised - think again! If you have a patient who has increasingly severe respiratory symptoms, doesn't respond to multiple courses of antibiotics then give aspergillus a thought. Browse around these articles for further information Aspergillus Website Treatment Section. NB For a broader look at the prevalence of fungal diseases worldwide the new charity Leading International Fungal Education (LIFE) website is worth looking at.  
Graham Atherton
over 6 years ago
Foo20151013 2023 1juzlhe?1444774136
2
309

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 6 years ago
Www.bmj
0
5

Diagnosis and management of asthma in children

In problematic cases of childhood asthma, rather than escalating treatment, a systematic approach is needed, including a review of the diagnosis; adherence, including ability to take drugs correctly; and the child’s environment  
feeds.bmj.com
over 4 years ago
Www.bmj
0
18

Advancing equity in healthcare

Healthcare reforms in Massachusetts that began in 2006 might foreshadow the effects of President Obama’s national Affordable Care Act and have been subject to intense scrutiny as a result. Two linked studies of the reforms in Massachusetts indicate that expanding of health insurance is helpful but not enough to eliminate important social and ethnic disparities in care and outcomes.1 2 Hanchate and colleagues (doi:10.1136/bmj.h440) studied joint replacement surgery, an effective treatment for end stage joint disease that reduces pain and improves function and quality of life3 but is underused among patients on low incomes and those from racial and ethnic minority backgrounds.4 In their study, greater access to health insurance in Massachusetts was associated with increased rates of knee and hip replacement surgery among Hispanic and black people compared with white people but was not associated with increased rates among people on low incomes relative to richer people.1 In a second study, McCormick and colleagues (doi:10.1136/bmj.h1480) found no association between Massachusetts healthcare reforms and reduced racial and ethnic disparities in admissions to hospital for diseases such as asthma, diabetes, and heart failure. Many admissions for these “ambulatory care sensitive conditions” are preventable if patients have access to high quality outpatient …  
feeds.bmj.com
over 4 years ago
Www.bmj
0
8

A persisting puzzling pneumonia in a young man

A 23 year old immunocompetent man with a history of childhood asthma was referred to the respiratory physicians with a four week history of productive cough, painful throat, fever, rigors, generalised myalgia, and vague discomfort in his left chest. He also had slight abdominal tenderness in the left upper quadrant.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
12

Advancing equity in healthcare

Healthcare reforms in Massachusetts that began in 2006 might foreshadow the effects of President Obama’s national Affordable Care Act and have been subject to intense scrutiny as a result. Two linked studies of the reforms in Massachusetts indicate that expanding of health insurance is helpful but not enough to eliminate important social and ethnic disparities in care and outcomes.1 2 Hanchate and colleagues (doi:10.1136/bmj.h440) studied joint replacement surgery, an effective treatment for end stage joint disease that reduces pain and improves function and quality of life3 but is underused among patients on low incomes and those from racial and ethnic minority backgrounds.4 In their study, greater access to health insurance in Massachusetts was associated with increased rates of knee and hip replacement surgery among Hispanic and black people compared with white people but was not associated with increased rates among people on low incomes relative to richer people.1 In a second study, McCormick and colleagues (doi:10.1136/bmj.h1480) found no association between Massachusetts healthcare reforms and reduced racial and ethnic disparities in admissions to hospital for diseases such as asthma, diabetes, and heart failure. Many admissions for these “ambulatory care sensitive conditions” are preventable if patients have access to high quality outpatient …  
feeds.bmj.com
over 4 years ago
Www.bmj
0
3

Diagnosis and management of asthma in children

In problematic cases of childhood asthma, rather than escalating treatment, a systematic approach is needed, including a review of the diagnosis; adherence, including ability to take drugs correctly; and the child’s environment  
feeds.bmj.com
over 4 years ago
Www.bmj
0
14

Advancing equity in healthcare

Healthcare reforms in Massachusetts that began in 2006 might foreshadow the effects of President Obama’s national Affordable Care Act and have been subject to intense scrutiny as a result. Two linked studies of the reforms in Massachusetts indicate that expanding of health insurance is helpful but not enough to eliminate important social and ethnic disparities in care and outcomes.1 2 Hanchate and colleagues (doi:10.1136/bmj.h440) studied joint replacement surgery, an effective treatment for end stage joint disease that reduces pain and improves function and quality of life3 but is underused among patients on low incomes and those from racial and ethnic minority backgrounds.4 In their study, greater access to health insurance in Massachusetts was associated with increased rates of knee and hip replacement surgery among Hispanic and black people compared with white people but was not associated with increased rates among people on low incomes relative to richer people.1 In a second study, McCormick and colleagues (doi:10.1136/bmj.h1480) found no association between Massachusetts healthcare reforms and reduced racial and ethnic disparities in admissions to hospital for diseases such as asthma, diabetes, and heart failure. Many admissions for these “ambulatory care sensitive conditions” are preventable if patients have access to high quality outpatient …  
feeds.bmj.com
over 4 years ago
Preview
0
84

The Basics of Immunotherapy with Dr. Lee

Dr. Gerald Lee is an Assistant Professor on faculty at the University of Louisville. He is the Division Chief of both the adult and pediatrics department of ...  
youtube.com
over 4 years ago
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0
35

Asthma Drugs - Omalizumab

http://usmlefasttrack.com/?p=6084 Asthma, Drugs, -, Omalizumab, Findings, symptoms, findings, causes, mnemonics, review, what is, video, study, Rapid Review,...  
youtube.com
over 4 years ago
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0
0

Asthma Drugs - Omalizumab - YouTube

http://usmlefasttrack.com/?p=6084 Asthma, Drugs, -, Omalizumab, Findings, symptoms, findings, causes, mnemonics, review, what is, video, study, Rapid Review,...  
youtube.com
over 4 years ago