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Introducing Competency-based postgraduate medical education (CbPME) In Cruces Hospital (Basque Country- Span)

Fierst experience in Spanish Hospital. We have adopted the seven roles of the Global Minimum Essential Requirements (International Institute of Medical Education-New York) with contributions based on CanMEDS-2000 and the Outcome Project-ACGME-USA. The main objective is to change the medical education culture of trainees, supervisors and medical teams. Summary of results. Implementation actions: 1. Reflexive Portfolio: Evidence of skills and knowledge, with written reflection in each of the seven roles. In 2009, 31% (43/137) of the residents of the first and the second year, wrote reflections on the seven roles. 2. A new design of Global Resident Competency Rating Form (seven roles). 3. A Continuing Medical Education programme focused on the supervisor  
Jesús Morán_Barrrios
about 9 years ago
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59

Blood Cultures - Full Process

Blood Cultures - Full Procedure The Blood Cultures procedure performed following official University Hospitals of Leicester (UHL) Guidelines Stage 1 - Consent 0:35 Stage 2 - Equipment 2:14 Stage 3 - Procedure 3:24 Stage 4 - After Care 9:59 http://leicesterclinicalskills.weebly.com  
Leicester Clinical Skills
almost 8 years ago
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Sterilisation

Sterilisation Can be controversial in some cultures Should only be undertaken in stable relationships where the couple is certain they do not want any more children   Epidemiology Rates falling in developed countries UK is unusual as the number of men receiving the operation is greater than the number of women 18% of men between 18-69 have had a vasectomy  
almostadoctor.com - free medical student revision notes
almost 8 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
about 8 years ago
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Clinical Cases and Images: ClinicalCases.org: Prerenal Acute Renal Failure due to Volume Depletion

This is a good practical case and very useful for new clinicians. For any clinician:No foley catheter unless oliguric, anuric, obstructed since any catheter is a foreign body and increases infection risk.Rehydrate if U/A has high spec gavity, mucous membranes dry, or if BUN is >30 times the creatinine as in this case. Even CHF pts get dry if not in heart failure. If in doubt, do CXR, BNPT, listen for crackles.Start with 250cc IVF if BNPT not less than 150 or give carefully while checking lung bases posteriorly after each bolus along with pulse ox, etc as above. Half of pts in acute renal failure are septic. Look for and eliminate source such as pneumonia, foreign body, pyelonephritis, joint infections. May be afebrile/ low temp or low WBCs with sepsis. Do cultures, check lactate ASAP to detect sepsis BEFORE the BP drops. Lactic acid "the troponin of sepsis." If septic, give a lot of fluids (up to 10 liters often) since capillary leak syndrome will lead to severe hypotension. If septic expect edema to develop with IV boluses yet be aware pt is intravascularly depleted. No pressors without fluids "pressors are not your friend" as per lecturers on Surviving Sepsis campaign.  
clinicalcases.org
over 6 years ago
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6 Amazing 3D-Printed Body Parts That Changed Patients' Lives

Ball's in your court, ​nature​.  
huffingtonpost.com
over 6 years ago
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Lever systems in the human body

After watching this video session, it is expected that you will be able to Define levers. Enumerate the main uses of levers Identify the three classes of lev...  
youtube.com
almost 6 years ago
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EXPERIENCE OF A MALE OB & GYN IN A MUSLIM CULTURE IN PAKISTAN.

As part of my post retirement ob & gyn activities, I spent two years in the early nineties, working at the Aga Kahn Medical School in Karachi, Pakistan. That is a most modern facility with excellent staff and resources and great medical students. One can imagine that the majority of obstetricians and gynecologists in a muslim country, like Pakistan, are female and that male ob & gyn might encounter some difficulties It was my distinct impression that often it is not the woman herself who objects to being examined and treated by a male, but rather the husband. An anecdote of a real situation which I encountered will illustrate this. One day I was sitting in my office next to the labor and delivery suite as one of the more junior female residents came running into my office, quite excited. “Doctor Le Maire, could you please come quickly? One of the laboring patients has some very major drop in the baby’s heartbeat. I am worried but cannot reach her private doctor and the doctor on call is in the operating room.” I ran over to the delivery suite with the resident and into the patient’s room. She was obviously in much discomfort and her husband was at her side. One of the first things an obstetrician may do when a woman in labor shows signs of some problem with the undelivered baby as evidenced by a drop in the baby’s heart rate, is to examine the woman vaginally. In doing so, the he or she can determine if the baby can be quickly delivered or if there is a reason for the drop in the baby’s heart rate, such as a loop of the umbilical cord being compressed by the head, in which case an immediate C- Section might be necessary. So I immediately put on a pair of sterile gloves and got ready to examine the woman. She herself was perfectly ready to let me do this, but her husband stopped me and told me that he objected to his wife being examined by a male. This was even in the face of a serious situation with potential for harm to his unborn baby. There was no time to be lost trying to reach one of the female attendings, so I did the next best thing and told the very junior resident to take the patient into the operating room and examine her there and let me know the findings, while I was getting the operating room organized to do a C-Section, if called for. The strange thing is that the husband would have let me do a C- Section on his wife, but not a vaginal exam. As it turned out, by the time the patient ended up in the operating room, her private doctor had been located and was in attendance. The outcome was good and a healthy baby was delivered soon after. However the situation could have been quite different and catastrophic. Even stranger to me was that the woman’s husband was not a lay person but actually a chief resident in anesthesiology in the same hospital, with whom I had worked together in the operating room on a number of occasions. I would never have thought that an educated person and a medically educated person at that, would jeopardize the well being of his unborn child and wife, based on cultural and religious beliefs. Later on in the year this same anesthesiology resident came to ask me for a letter of recommendation as he wanted to apply for a specialized fellowship in the USA. I hope that the reader can understand why I politely (perhaps not so politely) refused. Those interested can read more about my experiences in an e book, entitled "Crosscultural Doctoring. On and Off the Beaten Path." One can down load it for free to the reader device of your choice from Smashwords at: http://smashwords.com/books/view/161522. Or just Google Crooscultural Doctoring.  
DR William LeMaire
over 5 years ago
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Listen to the lecture: Injustice and the chronic pain sufferer

<embed type="application/x-shockwave-flash" width="350" height="24" allowfullscreen="true" allowscriptaccess="always" src="http://www.archive.org/flow/flowplayer.commercial-3.0.5.swf" w3c="true" flashvars='config={"key":"#$b6eb72a0f2f1e29f3d4","playlist":[{"url":"http://www.archive.org/download/InjusticeAndTheChronicPainSufferer/InjusticeAndTheChronicPainSufferer.mp3","autoPlay":false}],"clip":{"autoPlay":true},"canvas":{"backgroundColor":"0x000000","backgroundGradient":"none"},"plugins":{"audio":{"url":"http://www.archive.org/flow/flowplayer.audio-3.0.3-dev.swf"},"controls":{"playlist":false,"fullscreen":false,"gloss":"high","backgroundColor":"0x000000","backgroundGradient":"medium","sliderColor":"0x777777","progressColor":"0x777777","timeColor":"0xeeeeee","durationColor":"0x01DAFF","buttonColor":"0x333333","buttonOverColor":"0x505050"}},"contextMenu":[{"Listen+to+InjusticeAndTheChronicPainSufferer+at+archive.org":"function()"},"-","Flowplayer 3.0.5"]}'> </embed><br /><br />Lecture given by Dr Joanna McParland of Glasgow Caledonian University to the West of Scotland Pain Group on Wednesday 24th March 2010. Dr McParland discusses beliefs about justice and fairness and how they impact on the person with chronic pain.<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/13562045-963312561037419203?l=wspain.blogspot.com' alt='' /></div>  
West of Scotland Pain Group lectures
over 11 years ago
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Listen to the lecture: The role of illness perceptions and medicine beliefs in adherence to chronic pain medication

Download an <a href="http://www.archive.org/download/TheRoleOfIllnessPerceptionAndMedicineBeliefsInAdherenceToChronic/TheRoleOfIllnessPerceptionsAndMedicineBeliefsInAdherenceToChronicPainMedication-LeanneRamsayMartinDunbar_64kb.mp3">mp3 file</a> of the lecture or listen to streaming audio:<br /><br /><embed src="http://www.archive.org/flow/FlowPlayerLight.swf" allowfullscreen="true" allowscriptaccess="always" quality="high" bgcolor="ffffff" type="application/x-shockwave-flash" pluginspage="http://www.adobe.com/go/getflashplayer" flashvars="config={&quot;controlBarBackgroundColor&quot;:&quot;0x000000&quot;,&quot;loop&quot;:false,&quot;baseURL&quot;:&quot;http://www.archive.org/download/&quot;,&quot;showVolumeSlider&quot;:true,&quot;controlBarGloss&quot;:&quot;high&quot;,&quot;playList&quot;:[{&quot;url&quot;:&quot;TheRoleOfIllnessPerceptionAndMedicineBeliefsInAdherenceToChronic/TheRoleOfIllnessPerceptionsAndMedicineBeliefsInAdherenceToChronicPainMedication-LeanneRamsayMartinDunbar_64kb.mp3&quot;}],&quot;showPlayListButtons&quot;:true,&quot;usePlayOverlay&quot;:false,&quot;menuItems&quot;:[false,false,false,false,true,true,false],&quot;initialScale&quot;:&quot;scale&quot;,&quot;autoPlay&quot;:false,&quot;autoBuffering&quot;:false,&quot;showMenu&quot;:false,&quot;showMuteVolumeButton&quot;:true,&quot;showFullScreenButton&quot;:false}&amp;" width="350px" height="28px"></embed><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/13562045-1273844229544930067?l=wspain.blogspot.com' alt='' /></div>  
West of Scotland Pain Group lectures
over 11 years ago
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Maternal preconception and gender selection

Maternal preconception and gender selection has long been a controversial topic. Are you more likely to conceive a boy if you eat red meat, and a girl if you make love under a full moon? Oldwives tales and fantasies exploring sexual position, diet, and dominance circulate the Internet however how can we logically distinguish between fact and fiction? The topic has widespread cultural implications. Sex-related abortions are on the increase in China and India where local customs and religious virtues appear to strongly correlate with the systematic elimination of girls. In an effort to challenge the dogma of chance fertilization two main research streams have explored variations in maternal condition and gender conception. The ‘Maternal Dominance’ hypothesis has suggested trait dominance, underpinned by serum testosterone, correlates with increased male conception rates. The second, ‘Maternal condition’ hypothesis relates to pre-conceptual maternal diet, investigating variations in both quantity and quality of diet and effects on sex ratios. However such assumptions have been difficult to replicate and more recent evidence has suggested changes in maternal condition may have a stronger influence Maternal adaptations in behavior appear to closely correlate with biased gender ratios and can have wider connotations on sex-linked disease inheritance. However unless we can identify molecular mechanisms influencing the intrauterine environment and follicular development, hypothesis will remain mere assumptions.  
Langhit Kurar
almost 11 years ago
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Behind the scenes - medical illustration

Time lapse video showing how Matt Skalski creates his amazing custom medical illustrations for our radiology video tutorials.  
Radiopaedia
almost 9 years ago
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Blood Cultures - Procedure only

Blood Cultures performed following University Hospitals of Leicester (UHL) guidelines. This video demonstrates how to perform the procedure only. If you want a more in depth video visit our website or youtube page. http://leicesterclinicalskills.weebly.com/  
Leicester Clinical Skills
almost 8 years ago
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Medical Student Podcast Special Edition - Ben Goldacre

Ben Goldacre answers your questions. 00:12 Affect of big data on medicine. 2:18 How med students can change pharma industry. 3:25 What culture change is needed to change bad medicine?  
Audioboo
over 7 years ago
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The culture of a trauma team in relation to human factors

J Clin Nurs. 2006 Oct;15(10):1257-66.  
ncbi.nlm.nih.gov
over 7 years ago
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Death discussions 'taboo' for many in UK, survey finds - BBC News

Discussing dying and making end of life plans remain taboo for many Britons, a survey finds.  
BBC News
over 7 years ago
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Medical revalidation

Our qualitative assessment of the impact to date of medical revalidation on the behaviour of doctors and the culture of organisations within seven case study sites across England. Medical revalidation of doctors became a statutory obligation for all employing organisations in 2012, but its origins stretch back to 2000. In that period, the NHS has undergone many changes and been scrutinised by several reviews. It was against this shifting context that The King's Fund carried out a qualitative assessment of the impact to date of medical revalidation on the behaviour of doctors and the culture of organisations within seven case study sites across England.  
kingsfund.org.uk
over 7 years ago