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Rise Of The Patient #ROTPt: A Trilogy in Health Care

12 Apr

See on Scoop.itOf human kindness

Join me, Shirley Williams, as I interview Dr. David Lewis as he shares his life experience in the health care system as a Family Doctor, Patient and Caregiver. Bio David Lewis FRCSEd, MRCGP David Lewis is a family doctor in United Kingdom.

David Lewis‘s insight:

If you have a moment, why not listen to my interview with Shirley.

See on www.blogtalkradio.com

Netiquette – playing nice on social media

24 Feb

A short note here following the helpful twitter chat today with #hcsmanz [transcript link]

Background

Wikipedia defines netiquette. However, the clearest summary is contained in the following picture:

Better understanding of the conventions for engaging in social media conversations will, hopefully, get more people to stop lurking and join in. Social media conversations are more than tea time conversations. Social media is not only “social” but can be a powerful tool for professional development.

Resources or not reinventing the wheel

Link at Learn the Net – Your online guide

BBC Webwise making the most of being online.

A useful podcast for social media education is The Social Hour [Friday’s 2100 UMT]

Some examples – why social media matters for health and social care

Link to Youth Health 2.0
for articles on social media and mobile technology in public health, e.g.

  • Social media and the medical needs of American Indians
  • The art of engaging indigenous youth via social media

For (health and social care) professionals @brookmanknight has the last word:

“with medical people I talk collaborative peer support open access learning. Social as a word is not useful to engage or invite.”

Image

2012 in review

3 Jan

The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

600 people reached the top of Mt. Everest in 2012. This blog got about 2,700 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 5 years to get that many views.

Click here to see the complete report.

Dying with dignity – Liverpool Care Pathway and Palliative Care 2012

11 Nov

With the furore over Liverpool Care Pathway showing little sign of going away it may be a good time to pull together some of the threads. Margaret McCartney has written about the issue in this week’s BMJ (http://goo.gl/VeqY1)

We need to go back to Dame Cicely Saunders who established the groundwork for the specialty of Palliative Care to understand how we arrived at the stage now:

She founded St. Christopher’s Hospice in 1967 as the first research and teaching hospice linked with clinical care, pioneering the field of palliative medicine.

I was a medical student in the 80’s at Monash University, Melbourne. An element of the curriculum included palliative care, especially pain management. We even has a pocketbook to help with prescription of analgesia. Even so, people were still suffering with pain, sometimes horrible pain, right up to death on the wards. The interns and other doctors in training feared giving too much morphine to our patients. The nurses hovered like hawks to ensure we never over-stepped the mark with pain relief. Patient-controlled analgesia was introduced onto surgical and medical wards to improve pain management with variable success (e.g. Macintyre, 2001).

So fast forward to the Liverpool Care Pathway or LCP

The LCP affirms the vision of transferring the model of excellence for care of the dying from hospice care into other healthcare settings.  We have demonstrated a process that inspires, motivates and truly empowers the generic workforce in caring for the patient and their family in the last hours or days of life.”
Deborah Murphy, National Lead Nurse-LCP, Associate Director MCPCIL

A detail of the process is here

So we get to the recent storm.

Daily Mail 13th Oct 2012

Did NHS kill my mother to free bed? The profoundly disturbing story by son of patient at controversial terminal illness care home
Peter Tulloch believes doctors sought to hasten his mother’s death

He was informed that mother Jean Tulloch had just weeks to live

Without his knowledge, doctors removed her drip but Mr Tulloch believes she was still aware of her surroundings

Daily Mail 14th Oct 2012

Care? No, this is a pathway to killing people that doctors deem worthless

But, as Margaret McCartney discovered, the Daily Mail was a fan only last year of end of live care that worked:

Daily Mail 30 Aug 2011

I’ll always be grateful to the GP who eased Mum’s pain – even if it hastened her death

This was after an example of poor nursing care at end of life was reported in 2009 in the same paper

Daily Mail 28 Aug 2009

Many NHS nurses are still the finest in the world. But they let my poor father die in agony like a dog

We were treated to a celebration of the care UK citizens receive at the end of life in 2010.

Daily Mail 15 Jul 2010

The country tops the Quality of Death Index, which ranked 40 countries according to the care offered to dying people. In second place was Australia, followed by New Zealand, Ireland, Belgium and Austria.

It cannot be emphasised enough that the model of care exemplified by LCP helps reduce, if not eliminate, the disasters highlighted in the 2009 article. The knowledge, skills and attitudes which the LCP training gives healthcare professionals has virtually eliminated the scenes I witnessed as a medical student in the 80’s.

Now we come to the present again. The Association of Palliative Medicine will review end of life procedures

Daily Mail 24 Oct 2012 and here

the Association of Palliative Medicine has ordered a review of the concerns expressed by countless bereaved relatives, with a promise to explore ways of improving practice.

And the new Health Minister, Jeremy Hunt, has chipped in. (Surely not to gain political points)

Huffington Post UK 3 Nov 2012

NHS Constitution: Families To Get Consultation On ‘Death Pathway’ Decision, Says Jeremy Hunt

But wait! Is there anything actually wrong with the LCP?

Christian Medical Comment 16 Oct 2012

Consensus Statement: Liverpool Care Pathway for the Dying Patient (LCP) 

Published misconceptions and often inaccurate information about the Liverpool Care 
Pathway risk detracting from the substantial benefits it can bring to people who are dying and to their families. In response to this we are publishing this consensus statement to provide clarity about what the Liverpool Care Pathway is – and what it is not. 

Read full statement

The Catholic press also expresses view that nothing is wrong with the system two years ago.

Catholic Herald 23 Apr 2010

A dependable pathway to the life beyond

It is important that death and dying in our community is being debated. With the erosion of spirituality in our lives, our mortality is denied. However, it is so sad that some of the most vulnerable amongst us are being used to sell newspapers and gain political points.
Death and dying is part and parcel of excellent healthcare. The healthcare professionals who work in the NHS (and in private sector) understand this. It is a sign of the times that the authority of healthcare professionals (and priests) at the end of life are being called into question. We are the people who witness more death and dying in civilian populations not at war than any other group in our society. General practitioners with their teams are the midwives to dying process and the grief which follows for those left behind.

To give you an idea of the scope of knowledge and skills involved a selection books has been added.

Helpful Palliative Care resources for healthcare professionals

Paediatrics

Oxford Textbook of Palliative Care for Children

Paediatric Palliative Medicine (Oxford Specialist Handbooks in Paediatrics)

Adults

Oxford Textbook of Palliative Medicine

Oxford Handbook of Palliative Care (Oxford Medical Handbooks)

Palliative Care Nursing, Third Edition: Quality Care to the End of Life

Geriatric Palliative Care

Journals & websites

American Journal of Hospice and Palliative Medicine

Journal of Palliative Care & Medicine

International Association for Hospice & Palliative Care

General and popular books

A selection of books at Goodreads.com

Never miss another message or blog again?

18 Oct

Today I discover an answer to a prayer. A few weeks ago IFTTT (If this then that) service (at ifttt.com) lost access to Twitter. The little tool was a life line for me to keep track of all my tweets which were automatically archived in an Evernote notebook. I discussed Evernote in a recent post so will not elaborate further here.

Anyway, with a new project starting it was necessary to find an alternative. Zapier is a competitor to ifttt which I have never heard of. However, it seems to be more flexible than ifttt.com with corporate options. For my purposes, the free version is sufficient.

I am writing this note as much for my benefit as yours. Why not give Zapier a try. The “zaps” you can make are nearly infinite, just use your imagination. There is no limit to number of triggers on the free plan. There is a time limit; updates will only be sent every 5 hours. If you need quicker polling than this the next tier US$15/mo.

IFTTT

Calibre ebook management & Dropbox

23 Sep

                

Today was a day of discovery. A discovery which looks to help with book management using the popular Calibre e-book management tool (http://calibre-ebook.com/) and file management across several (mobile) devices and the popular cloud service Dropbox (http://www.dropbox.com ). I can now integrate these with my favourite ebook reader on Android, Aldiko (http://goo.gl/2fnCH )

Introducing dropsync (http://www.ttxapps.com/dropsync) which seems to be the answer to the prayers of many people trying to keep their cloud storage synchronised with their laptop, desktop and any other mobile devices. An amazing thing about this – it is Android only at the moment! For an extra £3.99 you can unlock the full functionality of this tool (http://goo.gl/kDAGU ).

Anyone who uses an ebook reader like the Kindle and Kobo should have Calibre on their desktop. Using dropbox on the desktop with dropsync permits 2 way real-time synchronisation with your work at home, work and on your mobile device. You have full control over the folders you wish to manage in this way.

For my ebooks, this provides a very efficient way of keeping your ebook readers synchronised (be warned this will use a lot of data on your mobile plan, so you should only sync on WiFi unless you are on an unlimited data plan. If you are like me the tablet is not always available, so it can be helpful to have the document (book) updated automatically on the phone. For aldiko, the books are saved to /sdcard/eBooks so this is the folder which is synchronised on Dropbox.

Keeping working documents synchronised is also straightforward with dropsync.

Calibre companion (http://goo.gl/FEhO3 ) is a paid app (£1.99) which efficiently keeps your ebook library on your mobile device(s) up to date with your main Calibre ebook library. Just wirelessly connect the mobile device with your PC, tell Calibre companion where to store your ebooks (I chose the Aldiko ebook directory).

So one great program for Mac or Android to exploit cloud storage (dropbox), with two fabulous programs for android only at the moment to go further with real time synchronisation of any files/folders (Dropsync) and ebook management on your mobile devices (Calibre companion).

QR Codes

Calibre book management (Windows/android/Mac/Linux) (free)
Calibre companion (android) (£1.99)
Dropbox (android) (free)
Dropbox (windows) (free)
Dropbox (Mac) (free)
Dropsync (android) (free)
Dropsync Pro Key(android) (£3.99)
Aldiko ebook reader(android) (free) ($2.99 [in 2010])

What does MobiMOOC 2012 offer me?

8 Sep

The gauntlet has been thrown.  MobiMOOC 2012 starts this weekend.

Two essays have me thinking – “what does MobiMOOC 2012 offer me?”; “why have I signed up for this activity?”

Michael and Rebecca have written well on their hopes and objectives.  So why shouldn’t I do so too?

Why am I signed up for MobiMOOC 2012?

The simple answer is the 2011-2012 annual appraisal concluded with my Appraiser advising I should be more active sharing what I do and know about eLearning technology and resources with my colleagues.

This sounded easy, but how do you go about demonstrating competence in an area which remains poorly defined, at least in medical education.  Yes, I use android tablet and phone. Yes, I use the cloud to share resources with my students and colleagues. However, this seems trivial when reading all about the activities of many of the facilitators and students in this year’s MobiMOOC 2012.

MobiMOOC 2012 notice turned up on Google Plus I thought this is what I think I need to gain sufficient skills, knowledge and understanding to encourage my colleagues and students to explore the education technologies available to improve the effectiveness and efficiency of their continuing professional development.

What does MobiMOOC 2012 offer me?

Well the simple answer for what is offered is contained in the introduction from Inge

There is a wealth of information and applications and contacts.  But this is worth nothing if I do not implement some of the learning points and engage with my colleagues and students to attempt to persuade more to invest some time and effort into using education technology.

So this gets me to the heart of the matter.  How do you overcome the reluctance of peers to embrace new technology to improve patient care?  Actually, is there evidence that eLearning does improve patient outcomes?  How much additional effort is needed to learn the new tools? What sort of investment?  What is the best device? Why are some patient settings so difficult to work with to improve point of care education and decision tools?

There are probably many more questions. And I hope that the discussions over the coming weeks and beyond will help me overcome the pain points which obstruct progress in the uptake of elearning tools in healthcare.

David

Is it SMART to use Social Media?

11 Mar

Terms behind the letters

There is no clear consensus about what the five or seven keywords mean, or even what they are in any given situation. Typically accepted values are:
Letter Major Term Minor Terms
S Specific Significant, Stretching, Simple
M Measurable Meaningful, Motivational, Manageable
A Attainable Appropriate, Achievable, Agreed, Assignable, Actionable, Ambitious, Aligned, Aspirational, Acceptable, Action-focused
R Relevant Results-oriented, Realistic, Resourced, Resonant
T Timely Time-oriented, Time framed, Timed, Time-based, Timeboxed, Time-bound, Time-Specific, Timetabled, Time limited, Trackable, Tangible
E Evaluate Ethical, Excitable, Enjoyable, Engaging, Ecological
R Reevaluate Rewarded, Reassess, Revisit, Recordable, Rewarding, Reaching

Choosing certain combinations of these labels can cause duplication, such as selecting ‘Attainable’ and ‘Realistic’, or can cause significant overlapping as in combining ‘Appropriate’ and ‘Relevant’ for example. The term ‘Agreed’ is often used in management situations where buy-in from stakeholders is desirable (e.g. appraisal situations).
[edit] Developing SMART goals

Paul J. Meyer describes the characteristics of S.M.A.R.T. goals in Attitude is Everything. Meyer, Paul J (2003). What would you do if you knew you couldn’t fail? Creating S.M.A.R.T. Goals. Attitude Is Everything: If You Want to Succeed Above and Beyond. Meyer Resource Group, Incorporated, The. ISBN 9780898113044

Good question on #hcsmanz made me ponder on the question of why using Twitter and other social media is attractice way to learn and interact with people removed from my immediate local circle of contacts.

The S.M.A.R.T. framework does seem to hold the answer. And I am grateful to the team from #hcsmanz for indentifying this concept here.

I have learned much more from social media interactions in the past 6 months than from other sources of information. And here is why.

The topics which matter are SIGNIFICANT to me. The format is MANAGEABLE and MEANINGFUL. The concepts are ALIGNED (not least because social media does tend to herd like minded people together) and APPROPRIATE for the moment. The sentiments are RESONANT with my own. Twitter chat sessions are TIME-BOUND and TIMETABLED, while many of the ideas are TANGIBLE. The crux of the discussion today is “evaluation”, and it feels to me that most discussions do meet goals for learning for the aforementioned reasons. But there is more to social medial chat too: I find the discussions ENJOYABLE, ENGAGING, and ETHICAL. Finally, after the event, I have discovered that the discussions are RECORDABLE (transcripts often available soon afterwards), and REWARDING because some ideas and suggested actions can be used in my clinical work or interactions with colleagues soon after.

It will be a shame if bureaucrats impose more concrete evaluation on the social media discussions because, in my opinion, the unstructured nature of the social media discussion would lose something precious if the conversation were reduced to measurable outcomes. David Haslam, former RCGP Chief Examiner once stated, that not all that is measurable counts while not all that counts is measurable. It is worth keeping this in mind when thinking about evaluation of social media.

Kinda Learning Stuff: If this then that…

4 Mar

Kinda Learning Stuff: If this then that…. by Sarah Horrigan

I don’t see many people mentioning this, but it’s something I came across a while ago and it is brilliant.

‘It’ being the website ifttt

Okay, so brilliant is a nerdy kind of brilliance but nevertheless for helping to make connections between bits of yourself on the web, it’s fabulous.  The basic premise is built on the idea of recipes.  You combine tasks to create recipes.  And the tasks are attached to various services – called channels – from Twitter to Facebook, SMS to email.

You then use the formula ‘if this then that’ (if this then that = ifttt – geddit?) to combine those tasks to get it to do brilliant stuff.

For example, whenever I post something to this blog, I want it to appear on Twitter.  I just set up a recipe that says ‘when there’s a new entry on the RSS feed… put out a Tweet that looks like that’ and away it goes.  I want to know when it’s going to rain… I create a recipe that says ‘when this website says it’s going to rain tomorrow in my region… send me a text message to remind me to take a brolly’.  Favourite a Tweet and the link automatically gets saved to your Diigo account etc… save something on Diigo with a particular tag and a Tweet broadcasts it or it appears on your Facebook page.  Want to backup your Instagram photos to Dropbox then ifttt can do that automatically.  Got the idea?

Blogging is a bit like an ifttt recipe – if I see something I want to share then I’m going to blog about it – only ifttt automates the bit in the middle! It’s the combining of services and tasks which makes this just a genius little site.  Oh, and you don’t even have to do the combining yourself… people also publish ‘recipes‘ which you can reuse / tweak.

‘if this then that’ – a little combination of words I never knew I needed until I started using them!

Introducing Amazon Silk

2 Oct

Introducing Amazon Silk.

Illusions of Autonomy

Where medical ethics and human behaviour meet

Enjoying every second

Cada lugar, cada rincón, cada momento compartido arreglando el mundo entre imprescindibles

The Commonplace Book

Jim McManus blogs on public health, ethics, books, theology and more

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