*From lecture note on Nasocomial infection.
All the best Intermed 2007 in our block examination!
Header picture from http://www.boston.com/bigpicture
Friday, December 10, 2010
Wednesday, December 8, 2010
G H I
Finally!
Salam
Hello
Phase III of CPR is prolonged life support, a long-term resuscitation
G : Gauging (evaluation and critical care triage)
H : Humanizing the outcome by brain resuscitation measures
I : Intensive therapy for general life support.
Gauging
In every emergency and critical care setting attempts should be made to quantitative the clinical material in terms of types and severity of insults at that time patients enter the emergency system such as hypoxia time prior to arrest, arrest time, CPR time, hypoxia time after arrest and total insult time.
The degree of unresponsiveness (depth of coma) and its change over time can and should be followed, at least as long as the patient is in the ICU after a cerebral insult. This may be accomplished by standard neurologic evaluation using the Glasgow Coma Scale base on eye opening, motor response and verbal response.
Salam
Hello
Phase III of CPR is prolonged life support, a long-term resuscitation
G : Gauging (evaluation and critical care triage)
H : Humanizing the outcome by brain resuscitation measures
I : Intensive therapy for general life support.
Gauging
In every emergency and critical care setting attempts should be made to quantitative the clinical material in terms of types and severity of insults at that time patients enter the emergency system such as hypoxia time prior to arrest, arrest time, CPR time, hypoxia time after arrest and total insult time.
The degree of unresponsiveness (depth of coma) and its change over time can and should be followed, at least as long as the patient is in the ICU after a cerebral insult. This may be accomplished by standard neurologic evaluation using the Glasgow Coma Scale base on eye opening, motor response and verbal response.
After several hours of long-term life support, the degree of recovery at each point in time should be noted of overall and cerebral performance capability. Briefly, the cerebral performance catagories:
1. Conscious and normal, without disability.
2. Conscious with moderate disability.
3. Conscious with severe disability.
4. Coma or vegetative state, without brain damage.
5. Brain death or death.
The test:
Human Mentation
The patient's outcome in terms of survival and overall performance capability depends on the severity and duration of insult, the speed and quality of emergency resuscitation, and the early start and quality of brain-oriented, post resuscitation intensive therapy.
That is why after several hours of long-term, life support, the degree of recovery at each point in time should be noted of overall and cerebral performance capability, do brain resuscitation and/or protection.
Cerebral protection - preemptive use of therapeutic interventions to improve neurological outcome in patients who will be at risk for cerebral ischemia. The primary objective is prevention of the deleterious effects of ischemia.
Cerebral resuscitation - refers to therapeutic interventions initiated after an ischemic events. The goal is treatment is ischemia and attenuation of neuronal injury.
Intensive Care
General intensive care monitoring are invasive blood pressure monitoring, pulse oxymetri, continous ECG, SO2, Temperature, urine output, serum lactate, arterial blood gases, ureum creatinin, glucose, chest x ray.
That is why after several hours of long-term, life support, the degree of recovery at each point in time should be noted of overall and cerebral performance capability, do brain resuscitation and/or protection.
Cerebral protection - preemptive use of therapeutic interventions to improve neurological outcome in patients who will be at risk for cerebral ischemia. The primary objective is prevention of the deleterious effects of ischemia.
Cerebral resuscitation - refers to therapeutic interventions initiated after an ischemic events. The goal is treatment is ischemia and attenuation of neuronal injury.
Intensive Care
General intensive care monitoring are invasive blood pressure monitoring, pulse oxymetri, continous ECG, SO2, Temperature, urine output, serum lactate, arterial blood gases, ureum creatinin, glucose, chest x ray.
Advance haemodynamic monitoring is achocardiographym cardiac output monitoring
Cerebral monitoring are EEG for early detection and treatment of seizure activity, CT/MRI
There are also need to monitor patient's airway and breathing, circulation, treatment of Hypothermia, treatment of hyperpyrexia, glucose control and seizure control.
References;
1. Lecture on Prolonged Life Support Block 4.2
1. Lecture on Prolonged Life Support Block 4.2
2. Skills lab manual book of Prolonged Life Support Block 4.2
Monday, December 6, 2010
Can you hear me?
Salam.
Hello.
Communicating with others is an essential skill in business dealings, family affairs, and romantic relationships. Do you often find yourself misunderstanding others? Do you have difficulty getting your point across clearly? When it comes to communication, what you say and what you don't say are equally important. Being a good listener is quite crucial.
Good communication is very important. Not only in the aspect of social life, but it is also play an important role in the culture, religion and also community based aspect.
What is communication?
Communication is a process when information is enclosed , channeled and imparted by a sender to a receiver via some medium. The receiver then decodes the message and gives the sender a feedback. All forms of communication require a sender, a message, and an intended recipient, however the receiver need not be present or aware of the sender's intent to communicate at the time of communication in order for the act of communication to occur.
Communication requires that all parties have an area of communicative commonality. There are verbal means using language and there are nonverbal means, such as body language, sign language, and eye contact, through media like pictures, graphics and sound, and writing.
According to Miller 1966, the most highest level of communication is when a source transmits a message to receiver with conscious intent that can affect the latter’s behavior.
There are 4 principles of Interpersonal Communication (Donnel King, 2000), which are:
1. Inescapable.
We can't escape from communicate. The very attempt not to communicate communicates something. Even not through words, but it can be from tone of voice and gesture, posture or facial expression.Through these channels, we constantly receive communication from others. Remember a basic principle of communication in general: people are not mind readers. Another way to put this is: people judge you by your behavior, not your intent.
2. Irreversible
We can't really take back something once it has been said. The effect must inevitably remain. Like malay proverb says 'terlajak perahu boleh di undur, terlajak kata buruk padahnya' have a same meaning with Russian proverb "Once a word goes out of your mouth, you can never swallow it again."
3. Complicated
No form of communication is simple. Because of the number of variables involved, even simple requests are extremely complex. We don't actually swap ideas, we swap symbols that stand for ideas. This also complicates communication. Words (symbols) do not have inherent meaning; we simply use them in certain ways, and no two people use the same word exactly alike.
4. Contextual
References:
1. Practical session on Interpersonal and Organizational Communication.
2. http://www.pstcc.edu/facstaff/dking/interpr.htm
Hello.
Communicating with others is an essential skill in business dealings, family affairs, and romantic relationships. Do you often find yourself misunderstanding others? Do you have difficulty getting your point across clearly? When it comes to communication, what you say and what you don't say are equally important. Being a good listener is quite crucial.
Good communication is very important. Not only in the aspect of social life, but it is also play an important role in the culture, religion and also community based aspect.
Communication is seen as the central to our everyday ideas about what makes life worth living (Katherine Miller, 2002)
What is communication?
Communication is a process when information is enclosed , channeled and imparted by a sender to a receiver via some medium. The receiver then decodes the message and gives the sender a feedback. All forms of communication require a sender, a message, and an intended recipient, however the receiver need not be present or aware of the sender's intent to communicate at the time of communication in order for the act of communication to occur.
Communication requires that all parties have an area of communicative commonality. There are verbal means using language and there are nonverbal means, such as body language, sign language, and eye contact, through media like pictures, graphics and sound, and writing.
According to Miller 1966, the most highest level of communication is when a source transmits a message to receiver with conscious intent that can affect the latter’s behavior.
There are 4 principles of Interpersonal Communication (Donnel King, 2000), which are:
1. Inescapable.
We can't escape from communicate. The very attempt not to communicate communicates something. Even not through words, but it can be from tone of voice and gesture, posture or facial expression.Through these channels, we constantly receive communication from others. Remember a basic principle of communication in general: people are not mind readers. Another way to put this is: people judge you by your behavior, not your intent.
2. Irreversible
We can't really take back something once it has been said. The effect must inevitably remain. Like malay proverb says 'terlajak perahu boleh di undur, terlajak kata buruk padahnya' have a same meaning with Russian proverb "Once a word goes out of your mouth, you can never swallow it again."
3. Complicated
No form of communication is simple. Because of the number of variables involved, even simple requests are extremely complex. We don't actually swap ideas, we swap symbols that stand for ideas. This also complicates communication. Words (symbols) do not have inherent meaning; we simply use them in certain ways, and no two people use the same word exactly alike.
4. Contextual
- Psychological context - which is who you are and what you bring to the interaction.
- Relational context - which concerns your reactions to the other person.
- Situational context - where place you are communicating. It may be different between in a room and in a bar.
- Environmental context - physical "where" you are communicating. The example like furniture, location, noise level, temperature, season and time of day.
- Cultural context - all the learned behaviors and rules that affect the interaction. Different culture will give different understanding about certain things. It also influence by the knowledge, open-minded and also experience.
References:
1. Practical session on Interpersonal and Organizational Communication.
2. http://www.pstcc.edu/facstaff/dking/interpr.htm
Sunday, December 5, 2010
D E F
Salam
Hello
After ABC procedure is already stable, then the process proceed with DEF in Advanced Cardiac Life Support.
D - defibrillator, drugs
E - electrocardiography (ECG)
F - fluids
For the complete algorithm of BLS and Pulseless arrest algorithm - the use of shockable (defibrillator) and non-shockable, view the image below:
How to used Defibrillator?
1. Turn on defibrillator by select the energy level at 360J for monophasic, or 120J to 200J for biphasic.
2. Set lead select switch on paddles
3. Apply gels to paddles or position conductor pads on patient's chest
4. Position the paddles on patients (sternum-apex)
5. Check the monitor and assess the rhythm (ventricular fibrillation (VF) / ventricular tachycardia (VT) / asystole / pulseless electrical activity (PEA) )
6. Announce to the team members 'charging defibrillator'
7. Press 'charge' button on the paddles.
8. When it is fully charges, shout out before each shock:
- I going to shock in three. One I'm clear
- Two, you're clear
- Three everybody is clear.
*make sure no one is touching the patients, bed or any equipment like ventilator, IVs, oxygen tube etc
9. If paddles are used, apply 25 pounds of pressure
10. Press 'shock' button
11. Immediately resume CPR, begin with compressions, 5 cycles then re-shock (if possible)
References:
1. Skills lab manual on Advanced Cardiac Life Support.
Hello
After ABC procedure is already stable, then the process proceed with DEF in Advanced Cardiac Life Support.
D - defibrillator, drugs
E - electrocardiography (ECG)
F - fluids
For the complete algorithm of BLS and Pulseless arrest algorithm - the use of shockable (defibrillator) and non-shockable, view the image below:
BLS adult algorithm
Pulseless Arrest Algorithm
How to used Defibrillator?
1. Turn on defibrillator by select the energy level at 360J for monophasic, or 120J to 200J for biphasic.
2. Set lead select switch on paddles
3. Apply gels to paddles or position conductor pads on patient's chest
4. Position the paddles on patients (sternum-apex)
5. Check the monitor and assess the rhythm (ventricular fibrillation (VF) / ventricular tachycardia (VT) / asystole / pulseless electrical activity (PEA) )
6. Announce to the team members 'charging defibrillator'
7. Press 'charge' button on the paddles.
8. When it is fully charges, shout out before each shock:
- I going to shock in three. One I'm clear
- Two, you're clear
- Three everybody is clear.
*make sure no one is touching the patients, bed or any equipment like ventilator, IVs, oxygen tube etc
9. If paddles are used, apply 25 pounds of pressure
10. Press 'shock' button
11. Immediately resume CPR, begin with compressions, 5 cycles then re-shock (if possible)
References:
1. Skills lab manual on Advanced Cardiac Life Support.
Saturday, December 4, 2010
Stress deh!
Salam
Hello
Post traumatic stress disorder or PTSD is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. It is included death of the lovely one, physical sexual and psychological abuse, man-made or natural disaster and so on, overwhelming the individual's ability to cope.
From both criteria from ICD-9 and DSM-IV, the symptoms need to be last more than one month and cause significant impairment in social, occupational, or other important areas of functioning.
There are also some factors that influence the vulnerabilities of PTSD:
Pre-Trauma factors -
Hello
Post traumatic stress disorder or PTSD is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. It is included death of the lovely one, physical sexual and psychological abuse, man-made or natural disaster and so on, overwhelming the individual's ability to cope.
From both criteria from ICD-9 and DSM-IV, the symptoms need to be last more than one month and cause significant impairment in social, occupational, or other important areas of functioning.
Pre-Trauma factors -
- A history of prior traumatization
- Underdeveloped protective skills
- Personality negative thought patterns
- Biology/ hereditery factor
- Family characteristics
- Recent life stressors
- Initial distress at the time of trauma
- Recovery environment - lack of support from family, friends and community
- Secondary victimization
- Conspiracy of silence
- Ineffective coping
- Lack of treatment or ineffective treatment
Diagnosis -
According to Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV-TR), it can be summerize as:
Exposure to a traumatic event
This must have involved both loss of physical integrity or risk of serious damage, to self or others, and an intense negative emotional response.
Persistent re-experiencing
One or more of these must be present in the victim: flashback memories, recurring distressing dreams, and any objects or subjects that be remainder to the traumatic event cause intense psychological and physical disturbance.
Persistent avoidance and emotional numbing
This involves a sufficient level of avoidance of stimuli associated with the trauma, such as certain thoughts or feelings, or talking about the events, avoidance of behaviors, places, or people that might lead to distressing memories, inability to recall major parts of the trauma or decreased involvement in significant life activities.
Persistent symptoms of increased arousal not present before
These are all physiological response issues, such as difficulty falling or staying asleep, or problems with anger, concentration, or hypervigilance.
Duration of symptoms for more than 1 month
If all other criteria are present, but 30 days have not elapsed, the individual is diagnosed with Acute stress disorder.
Significant impairment
The symptoms must lead to clinically significant distress or impairment to life activity, such as social relations, occupational activities and others.
Management -
Psychological therapy - basic counselling and education, cognitive behavioral therapy(changing behavioral or negative thinking of the patients) and also Eye movement desensitization and reprocessing (EMDR) is specifically targeted as a treatment for PTSD.
Medication -
SSRIs (selective serotonin reuptake inhibitors) are considered to be a first-line drug treatment include citalopram, escitalopram, fluoxetine, and fluvoxamine.
Beta blockers -Propranolol - similarly to clonidine, may be useful if there are significant symptoms of "over-arousal"
Alpha-adrenergic agonists -clonidine- to reduce traumatic stress symptoms that it may have benefit in preventing PTSD.
Benzodiazepines- can be used with caution for short-term anxiety relief, hyperarousal, and sleep disturbance.
References:
1. Lecture note on Post Traumatic Stress disorder management by dr Bambang Hastha Yoga.
2. Wikipedia
Friday, December 3, 2010
Travel Medicine
Salam
Hello
I know some of you love travelling. But do you know that even travelling can give you bad impact besides lost a lot of money?
Travel medicine is a branch of science that focus on the disease that a traveler can get besides high risk of opportunity disease when you travel to other country. Travellers are thus exposed to a variety of health risks in unfamiliar environments. Most such risks, however, can be minimized by suitable precautions taken before, during and after travel.
The traveller in high risk of travel-related disease, depends on:
1. Mode of transport - there is difference risk when you travel with airplanes and cruise, and any otherr transportation like train and cars (risk like accident, longer time of journey related with deep vain thrombosis and so on)
2. Destination(s) - where accommodation, hygiene and sanitation, medical care and water quality are of a high standard pose relatively few serious risks to the health of travellers, unless there is pre-existing illness. Besides, they should be aware of the endemic of the disease, occurrence of any disease outbreaks in their destination countries, unforeseen natural or manmade disasters.
3. Duration and season of travel - duration of visit may determine whether the traveller is subjected to marked changes in temperature and humidity or to prolonged exposure to atmospheric pollution. season of the certain country also play important role because some season like winter have low opportunity of communicable disease, but high in systemic disease like frost bite or hypothermia.
4. Purpose of travel - the purpose of travel like conference and business trip is usually held in the city, with good accommodation, clean water supply and well- organized food have lower risks than do hiking, camping and do researches in the rural area.
5. Standards of accommodation and food hygiene - the clean, well-managed accommodation with good services hotel and resort have lower risk of transmittion of disease than poor dirty motel with no cleaner services provided. Food also important aspect of travel disease since poor food hygiene contains a lot of bacteria and virus related to typhoid, hepatitis A and diarrhea.
6. Behaviour of the traveller - behavior like keep good hygiene and sanitation, used proper attire for certain activity like shoes, long pants and long sleeves shirt to avoid from be bitten with mosquito, used repellent, always wash your hand before and after eat and also eat the clean and cooked food to avoid food related disease.
7. Underlying health of the traveller - previous history of disease and current diseases like heart related disease like congestive heart failure and heart attack, and respiration relate disease like asthma.
Travellers also can prepared some first aid kits before travelling that consist of:
antiseptic wound cleanser, bandages, emollient eye drop, insect repellent, insect bite treatment, antihistamine cream or tablets, nasal decongestant, oral rehydration salts, scissors and safety pins, simple analgesic (e.g. paracetamol), sterile dressing, clinical thermometer, sunscreens and earplugs
Besides, depends on the individual needs and destination:
antidiarrhoeal medication (to include an antibiotic, an antimotility drug and oral dehydration sachets with appropriate written instructions regarding their use), broad spectrum antibiotics (e.g. flucloxacillin, amoxicillin), antifungal powder, antimalarial medication, bednet and adequate supplies of condoms and the oral contraceptive.
Prevention
1. Vaccination - Contact the nearest travel medicine centre or a physician as early as possible, preferably 4–8 weeks before departure. For certain country, you can get free of charges for typhoid and hepatitis A vaccination. For typhoid vaccination, the duration and last for 3 years and for hepatitis A vaccination, first injection can last for 12 months. So you need second injection after 6-12 months from first injection, that can last for 20 years.
2. Malaria - Request information on malaria risk, prevention of mosquito bites, possible need for appropriate preventive medication and emergency reserves, and plan for bednet and insect repellent. There are also prophylaxis injection for malaria to reduce the risk, not to eliminate it because some countries have different resistant of malaria medication.
3. Food hygiene - Eat only thoroughly cooked food and drink only well-sealed bottled or packaged cold drinks. Boil drinking-water if safety is doubtful. If boiling is not possible, a certified well-maintained filter and/or disinfectant agent can be used.
4. Specific local diseases - Consult the appropriate sections of this volume as well as www.who.int and national travel health web sites.
For further information and guides, feel free to visit WHO website and International Travel and Health manual book.
Hello
I know some of you love travelling. But do you know that even travelling can give you bad impact besides lost a lot of money?
Travel medicine is a branch of science that focus on the disease that a traveler can get besides high risk of opportunity disease when you travel to other country. Travellers are thus exposed to a variety of health risks in unfamiliar environments. Most such risks, however, can be minimized by suitable precautions taken before, during and after travel.
The traveller in high risk of travel-related disease, depends on:
1. Mode of transport - there is difference risk when you travel with airplanes and cruise, and any otherr transportation like train and cars (risk like accident, longer time of journey related with deep vain thrombosis and so on)
2. Destination(s) - where accommodation, hygiene and sanitation, medical care and water quality are of a high standard pose relatively few serious risks to the health of travellers, unless there is pre-existing illness. Besides, they should be aware of the endemic of the disease, occurrence of any disease outbreaks in their destination countries, unforeseen natural or manmade disasters.
3. Duration and season of travel - duration of visit may determine whether the traveller is subjected to marked changes in temperature and humidity or to prolonged exposure to atmospheric pollution. season of the certain country also play important role because some season like winter have low opportunity of communicable disease, but high in systemic disease like frost bite or hypothermia.
4. Purpose of travel - the purpose of travel like conference and business trip is usually held in the city, with good accommodation, clean water supply and well- organized food have lower risks than do hiking, camping and do researches in the rural area.
5. Standards of accommodation and food hygiene - the clean, well-managed accommodation with good services hotel and resort have lower risk of transmittion of disease than poor dirty motel with no cleaner services provided. Food also important aspect of travel disease since poor food hygiene contains a lot of bacteria and virus related to typhoid, hepatitis A and diarrhea.
6. Behaviour of the traveller - behavior like keep good hygiene and sanitation, used proper attire for certain activity like shoes, long pants and long sleeves shirt to avoid from be bitten with mosquito, used repellent, always wash your hand before and after eat and also eat the clean and cooked food to avoid food related disease.
7. Underlying health of the traveller - previous history of disease and current diseases like heart related disease like congestive heart failure and heart attack, and respiration relate disease like asthma.
Travellers also can prepared some first aid kits before travelling that consist of:
antiseptic wound cleanser, bandages, emollient eye drop, insect repellent, insect bite treatment, antihistamine cream or tablets, nasal decongestant, oral rehydration salts, scissors and safety pins, simple analgesic (e.g. paracetamol), sterile dressing, clinical thermometer, sunscreens and earplugs
Besides, depends on the individual needs and destination:
antidiarrhoeal medication (to include an antibiotic, an antimotility drug and oral dehydration sachets with appropriate written instructions regarding their use), broad spectrum antibiotics (e.g. flucloxacillin, amoxicillin), antifungal powder, antimalarial medication, bednet and adequate supplies of condoms and the oral contraceptive.
Prevention
1. Vaccination - Contact the nearest travel medicine centre or a physician as early as possible, preferably 4–8 weeks before departure. For certain country, you can get free of charges for typhoid and hepatitis A vaccination. For typhoid vaccination, the duration and last for 3 years and for hepatitis A vaccination, first injection can last for 12 months. So you need second injection after 6-12 months from first injection, that can last for 20 years.
2. Malaria - Request information on malaria risk, prevention of mosquito bites, possible need for appropriate preventive medication and emergency reserves, and plan for bednet and insect repellent. There are also prophylaxis injection for malaria to reduce the risk, not to eliminate it because some countries have different resistant of malaria medication.
3. Food hygiene - Eat only thoroughly cooked food and drink only well-sealed bottled or packaged cold drinks. Boil drinking-water if safety is doubtful. If boiling is not possible, a certified well-maintained filter and/or disinfectant agent can be used.
4. Specific local diseases - Consult the appropriate sections of this volume as well as www.who.int and national travel health web sites.
For further information and guides, feel free to visit WHO website and International Travel and Health manual book.
Thursday, December 2, 2010
Posko Maguwoharjo
Salam
Hello
On 27th Nov 2010, I went to visit Posko Maguwoharjo (I still got problem to spell and pronounce it!) -temporary shelter for the Merapi Eruption victims- with some of my batchmates. Although it was a short visit, and we only be able to talk with a few evacuee there and gave a very little help, but it was very memorable moment.
A picture is worth a thousand words.
So I give you six. And a countless words.
Hello
On 27th Nov 2010, I went to visit Posko Maguwoharjo (I still got problem to spell and pronounce it!) -temporary shelter for the Merapi Eruption victims- with some of my batchmates. Although it was a short visit, and we only be able to talk with a few evacuee there and gave a very little help, but it was very memorable moment.
A picture is worth a thousand words.
So I give you six. And a countless words.
Lets meet my friends that join the visit as well. And hear their story.
Disaster
Salam
Hello
Before this, I already mention a bit about disaster and give some example of it. But, do you know exactly what is disaster. In my mind, i thought that disaster is some phenomena that causes destruction. But do you know that as long as it doesn't needs any external help, it is not consider as disaster.
According to WHO, disaster is a sudden ecological phenomenon of sufficient magnitude to require external assistance. While according to American college of Emergency Physicians disaster is a destructive effect of natural or manmade force overwhelm the ability of given area or community to meet the demand for health care.
Disaster management
Disaster management plan is very important since it can reduce the impact and damage to the society. We can not control the the disaster itself, but at least by making a good prevention, mitigation and preparedness can reduce the damage that will occur.
Mitigation - any activity that reduces either the chance of a hazard taking place or a hazard turning into disaster.
Prevention - avoiding and reduce the chances of disaster, usually the impact and damage of disaster.
Preparedness - plans or preparations made to save lives or property, and help the response and rescue service operations. This phase covers implementation/operation, early warning systems and capacity building so the population will react appropriately when an early warning is issued.
Response - includes actions taken to save lives and prevent property damage, and to preserve the environment during emergencies or disasters. The response phase is the implementation of action plans.
Recovery - includes actions that assist a community to return to a sense of normally after a disaster.
References:
1. Lecture note on Conceptual Frame work of Disaster and Disaster Management by dr Hendro Wartatmo
Hello
Before this, I already mention a bit about disaster and give some example of it. But, do you know exactly what is disaster. In my mind, i thought that disaster is some phenomena that causes destruction. But do you know that as long as it doesn't needs any external help, it is not consider as disaster.
According to WHO, disaster is a sudden ecological phenomenon of sufficient magnitude to require external assistance. While according to American college of Emergency Physicians disaster is a destructive effect of natural or manmade force overwhelm the ability of given area or community to meet the demand for health care.
Disaster management plan is very important since it can reduce the impact and damage to the society. We can not control the the disaster itself, but at least by making a good prevention, mitigation and preparedness can reduce the damage that will occur.
Mitigation - any activity that reduces either the chance of a hazard taking place or a hazard turning into disaster.
Prevention - avoiding and reduce the chances of disaster, usually the impact and damage of disaster.
Preparedness - plans or preparations made to save lives or property, and help the response and rescue service operations. This phase covers implementation/operation, early warning systems and capacity building so the population will react appropriately when an early warning is issued.
Response - includes actions taken to save lives and prevent property damage, and to preserve the environment during emergencies or disasters. The response phase is the implementation of action plans.
Recovery - includes actions that assist a community to return to a sense of normally after a disaster.
References:
1. Lecture note on Conceptual Frame work of Disaster and Disaster Management by dr Hendro Wartatmo
2. Sahana foundation. (pdf)
Wednesday, December 1, 2010
Sunset Ribbon Red
This post is related with this post.
Together we can make a difference.
Levi's® South Africa was responsible for music collaboration called CD 4 involving
15 of Souh Africa's top music artists. This unique music collaboration on one album was a Levi's® Red for Life HIV / AIDS initiative. Featuring a collection of South Africas most prominent artists, CD 4 is the product of a collective give. As a non-profit initiative in its entirety, all musicians involved in this album have discounted their time and services for what is ultimately not only a good cause, but a necessary one.
December 1st of every year is WORLD AIDS DAY!
Theme for this year is: Universal Access and Human Rights
Do you know about HIV/AIDS? You can also test your knowledge about it by playing this games. Seriously, it is like take forever to load. Promotion failed. :'( but there are also sex education game and condom game. Menarik kan? So what are you waiting for? Pergi la reload sampai boleh! Teehee..
For further info about HIV/AIDS, you can read here: http://www.worldaidscampaign.org/ or http://www.avert.org
For further info about HIV/AIDS, you can read here: http://www.worldaidscampaign.org/ or http://www.avert.org
Tuesday, November 30, 2010
A B C
Salam
Hello
Guys, do you know the acronym for A B C?
Hint: Something important.
No, it's not ABCDEFGHIJKLMN...Z. I know it's important and need to be mastered before you can qualified to enter primary school. But can you think other than that?
Hint: Something to do during emergency condition.
No! It's not Air Batu Campur. -_-
Haha' thanks for answering my lame question.
Actually, today, my post is about Basic Life Support! Since we are going to learn about triage tomorrow and already got a lecture about Prolong Life Support, and Advanced Life Support for our last block, so better I rewind you guys a bit about it.
ABC stands for:
A - airway - the protection and maintenance of a clear passageway for gases (principally oxygen and carbon dioxide) to pass between the lungs and the outside of the body
B - breathing - inflation and deflation of the lungs (respiration) via the airway
C - circulation - providing an adequate blood supply to the body, especially critical organs, so as to deliver oxygen to all cells and remove carbon dioxide, via the perfusion of blood throughout the body
Adult BLS sequence
1. Ensure that the scene is safe.
2. Assess the victim's level of consciousness by asking loudly "are you okay?" and by checking for the victim's responsiveness to pain.
3. Call for help
4. If the victim has no suspected cervical spine trauma, open the airway using the head-tilt/chin-lift maneuver; if the victim has suspected trauma, the airway should be opened with the jaw-thrust technique. If the jaw-thrust is ineffective at opening/maintaining the airway, a very careful head-tilt/chin-lift should be performed.
5. Assess the airway for foreign object obstructions, and if any are visible, remove them using the finger-sweep technique. Blind finger-sweeps should not be performed, as they may push foreign objects deeper into the airway.
6. Look, listen, and feel for breathing for at least 5 seconds and no more than 15 seconds.
7. If the patient is breathing normally, then the patient should be placed in the recovery position and monitored and transported; do not continue the BLS sequence.
8. If patient is not breathing normally, and the arrest was witnessed immediately before assessment, then immediate defibrillation is the treatment of choice.
9. Attempt to administer two artificial ventilations using the mouth-to-mouth technique, the mouth-to-mask technique, or a bag-valve-mask. Verify that the chest rises and falls; if it does not, reposition the airway using the appropriate technique and try again. If ventilation is still unsuccessful, and the victim is unconscious, it is possible that they have a foreign body in their airway. Begin chest compressions, stopping every 30 compressions, re-checking the airway for obstructions, removing any found, and re-attempting ventilation.
10. If the ventilations are successful, assess for the presence of a pulse at the carotid artery. If a pulse is detected, then the patient should continue to receive artificial ventilations at an appropriate rate and transported immediately. Otherwise, begin CPR at a ratio of 30:2 compressions to ventilations at 100 compressions/minute for 5 cycles.
11. After 5 cycles of CPR, the BLS protocol should be repeated from the beginning, assessing the patient's airway, checking for spontaneous breathing, and checking for a spontaneous pulse. If an AED is available after 5 cycles of CPR, it should be attached, activated, and (if indicated) defibrillation should be performed. If defibrillation is performed, 5 more cycles of CPR should be immediately repeated before re-assessment.
12. BLS protocols continue until (1) the patient regains a pulse, (2) the rescuer is relieved by another rescuer of equivalent or higher training, (3) the rescuer is too physically tired to continue CPR, or (4) the patient is pronounced dead by a medical doctor.
13. At the end of five cycles of CPR, always perform defibrillation (AED), and repeat assessment before doing another five cycles.
14. CPR continues indefinitely, until the patient is revived, or until the caregiver is relieved, or discharged by a higher medical authority
15. The CPR cycle is often abbreviated as 30:2 (30 compressions, 2 ventilations or breaths). Note CPR for infants and children uses a 15:2 cycle when two rescuers are performing CPR (but still uses a 30:2 if there is only one rescuer)
Wait for the next DEFGHI okay? :)
References:
1. Adult basic life support, Resuscitation Council UK (pdf)
2. Wikipedia
Hello
Guys, do you know the acronym for A B C?
Hint: Something important.
No, it's not ABCDEFGHIJKLMN...Z. I know it's important and need to be mastered before you can qualified to enter primary school. But can you think other than that?
Hint: Something to do during emergency condition.
No! It's not Air Batu Campur. -_-
Haha' thanks for answering my lame question.
Actually, today, my post is about Basic Life Support! Since we are going to learn about triage tomorrow and already got a lecture about Prolong Life Support, and Advanced Life Support for our last block, so better I rewind you guys a bit about it.
ABC stands for:
A - airway - the protection and maintenance of a clear passageway for gases (principally oxygen and carbon dioxide) to pass between the lungs and the outside of the body
B - breathing - inflation and deflation of the lungs (respiration) via the airway
C - circulation - providing an adequate blood supply to the body, especially critical organs, so as to deliver oxygen to all cells and remove carbon dioxide, via the perfusion of blood throughout the body
Adult BLS sequence
1. Ensure that the scene is safe.
2. Assess the victim's level of consciousness by asking loudly "are you okay?" and by checking for the victim's responsiveness to pain.
3. Call for help
4. If the victim has no suspected cervical spine trauma, open the airway using the head-tilt/chin-lift maneuver; if the victim has suspected trauma, the airway should be opened with the jaw-thrust technique. If the jaw-thrust is ineffective at opening/maintaining the airway, a very careful head-tilt/chin-lift should be performed.
5. Assess the airway for foreign object obstructions, and if any are visible, remove them using the finger-sweep technique. Blind finger-sweeps should not be performed, as they may push foreign objects deeper into the airway.
6. Look, listen, and feel for breathing for at least 5 seconds and no more than 15 seconds.
7. If the patient is breathing normally, then the patient should be placed in the recovery position and monitored and transported; do not continue the BLS sequence.
8. If patient is not breathing normally, and the arrest was witnessed immediately before assessment, then immediate defibrillation is the treatment of choice.
9. Attempt to administer two artificial ventilations using the mouth-to-mouth technique, the mouth-to-mask technique, or a bag-valve-mask. Verify that the chest rises and falls; if it does not, reposition the airway using the appropriate technique and try again. If ventilation is still unsuccessful, and the victim is unconscious, it is possible that they have a foreign body in their airway. Begin chest compressions, stopping every 30 compressions, re-checking the airway for obstructions, removing any found, and re-attempting ventilation.
10. If the ventilations are successful, assess for the presence of a pulse at the carotid artery. If a pulse is detected, then the patient should continue to receive artificial ventilations at an appropriate rate and transported immediately. Otherwise, begin CPR at a ratio of 30:2 compressions to ventilations at 100 compressions/minute for 5 cycles.
11. After 5 cycles of CPR, the BLS protocol should be repeated from the beginning, assessing the patient's airway, checking for spontaneous breathing, and checking for a spontaneous pulse. If an AED is available after 5 cycles of CPR, it should be attached, activated, and (if indicated) defibrillation should be performed. If defibrillation is performed, 5 more cycles of CPR should be immediately repeated before re-assessment.
12. BLS protocols continue until (1) the patient regains a pulse, (2) the rescuer is relieved by another rescuer of equivalent or higher training, (3) the rescuer is too physically tired to continue CPR, or (4) the patient is pronounced dead by a medical doctor.
13. At the end of five cycles of CPR, always perform defibrillation (AED), and repeat assessment before doing another five cycles.
14. CPR continues indefinitely, until the patient is revived, or until the caregiver is relieved, or discharged by a higher medical authority
15. The CPR cycle is often abbreviated as 30:2 (30 compressions, 2 ventilations or breaths). Note CPR for infants and children uses a 15:2 cycle when two rescuers are performing CPR (but still uses a 30:2 if there is only one rescuer)
Wait for the next DEFGHI okay? :)
References:
1. Adult basic life support, Resuscitation Council UK (pdf)
2. Wikipedia
Sunday, November 28, 2010
Because We Care
Salam
Hello
Yesterday, my friends and I went to Posko Maguwoharjo, the evacuation camp for Merapi eruption victims. There are around 6500 victims staying there for the temporary shelter, since most of them lost their home and place to stay.
And a lot of loses, while the list keeps going on, they need help!
There are also a lot of organizations that join together to help. This is the question. Who actually we can trust and make sure that our money/donations is received by the right people? Oh, you read the right blog. Ecece~
To donate, you can straight go to UNICEF website. Besides, William, together with Persatuan Kebangsaan Pelajar-pelajar Malaysia di Indonesia (PKPMI-CY), launch a Donation drive for the Merapi victims.
Do Help and care, people!
Hello
Yesterday, my friends and I went to Posko Maguwoharjo, the evacuation camp for Merapi eruption victims. There are around 6500 victims staying there for the temporary shelter, since most of them lost their home and place to stay.
And a lot of loses, while the list keeps going on, they need help!
There are also a lot of organizations that join together to help. This is the question. Who actually we can trust and make sure that our money/donations is received by the right people? Oh, you read the right blog. Ecece~
To donate, you can straight go to UNICEF website. Besides, William, together with Persatuan Kebangsaan Pelajar-pelajar Malaysia di Indonesia (PKPMI-CY), launch a Donation drive for the Merapi victims.
Do Help and care, people!
Saturday, November 27, 2010
Please. It is enough!
We already have thousands of natural and man-made disasters.
Merapi Eruption - November 2010 - more than 140 people died, hundreds of thousands of residents have been evacuated and lost their home and shelters.
Merapi Eruption - November 2010 - more than 140 people died, hundreds of thousands of residents have been evacuated and lost their home and shelters.
Earthquake in Haiti - January earthquake struck Haiti, reducing Port-au-Prince to rubble and claiming over 300,000 lives.
Shanghai apartment fire - a fire erupted, apparently within construction materials and scaffolding surrounding an occupied 30-story apartment building under renovation.Unfortunately, 58 people were unable to escape, losing their lives, and 70 more were injured.
Do we really need any other war to destroy the world?
Massacred in Gaza - On January 3rd, the Israeli Defense Force ground troops began entering Gaza, soon cutting the territory in half. Israel's stated goals are to end rocket attacks originating from Gaza - which had increased sharply following the end of a cease-fire agreement in December.
Korea in war - November 23rd, North Korea fired scores of artillery shells at the South Korean island of Yeonpyeong, killing at least four (two soldiers, two civilians), wounding 18 more, and yet destroying several houses.
I mean, seriously?
*the great outstanding pictures taken from The Big Picture!
Thursday, November 18, 2010
How Can I Save Money on Healthcare?
Very smart yet entertaining video on how you can save money on healthcare. Fuuhhh!
Stay smart, and stay healthy! :)
Tuesday, November 16, 2010
Red Ribbon
Salam
Hello
Acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV).
According to WHO, the are around 2.6 million newly infected people with HIV in 2009, and number of people living with HIV until 2009 is about more than 33.3 million wild world. Besides the AIDS death in the same year with total 1.8 million is quite a huge number.
Eventhought there are a lot of promotion and education from the government and non government organizations according to the impact of HIV/AIDS, surprisingly, but the number of infected people together with newly people infected is still keep increasing. What is actually the main problem here?
1. World Health Organization (WHO)
2. http://www.multiculturalhivhepc.net.au/indonesian/portal.asp?lang=ind
3. Lecture note on HIV/AIDS DISASTER AND HIV/AIDS IN NATURE DISASTER by dR Sunardi Radiono
Hello
Acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV).
According to WHO, the are around 2.6 million newly infected people with HIV in 2009, and number of people living with HIV until 2009 is about more than 33.3 million wild world. Besides the AIDS death in the same year with total 1.8 million is quite a huge number.
No effctive treatment ?
No effective vaccine ?
No effective prevention?
No appropriate programe ?
Stigmatization?
No supporting fund?
No attention ?
No participation?
Atheism?
Moral decadence ?
Ignorance?
Poverty?
How is HIV transmitted
HIV is found in body fluids such as blood, semen, vaginal fluids and breast milk. Infection with HIV can only occur when body fluids from an infected person enters the blood stream of another person. HIV CAN BE transmitted by:
• Sex without a condom (unprotected sex).
• Sharing needles, syringes and other equipment for injecting drugs.
• Unsterile body piercing or tattooing.
• Mother to child during pregnancy, childbirth or breast feeding.
• Blood transfusion and/or blood products
HIV CANNOT BE transmitted by:
Coughing; kissing; sneezing; spitting; crying; sharing cutlery and crockery; bed linen; toilets, showers; or through any form of casual contact and insects such as mosquitoes
What should we do then?
And this is WHO strategy in handling the HIV/Aids.
Consultations on the development of the WHO Global Health Sector Strategy for HIV 2011-2015
The Sixty-third Session of the World Health Assembly adopted a resolution that requests the WHO Director-General to develop a WHO HIV/AIDS Strategy for 2011-2015, through a broad consultative process. The Strategy will:
- build on the achievements and experiences of the "3 by 5" initiative and the five strategic directions of the WHO HIV/AIDS Universal Access Plan 2006-2010;
- take into consideration the broad global HIV, health and development architecture, including the UNAIDS Strategy and Outcome Framework, and existing commitments to achieving Universal Access and the Millennium Development Goals;
- identify existing and agreed global targets to motivate countries to plan for bold HIV/AIDS responses through to 2015;
- provide guidance to countries on how to prioritize their HIV and broader health investments;
- provide a framework for concerted WHO action at the global, regional and country levels and across all relevant WHO departments.References:
1. World Health Organization (WHO)
2. http://www.multiculturalhivhepc.net.au/indonesian/portal.asp?lang=ind
3. Lecture note on HIV/AIDS DISASTER AND HIV/AIDS IN NATURE DISASTER by dR Sunardi Radiono
Sunday, November 14, 2010
Money money!
Salam
Hello
I'm curious how the physician is paid and get money. Because some said if you want to be rich, doctor is not in the list.
But do you think Mercedes, Gucci and Rolex are cheap?
Basically, there are two types of provider payment mechanism:
1. Prospective payment system
Capitation - under capitation system, physicians are paid a set amount for each enrolled person assigned to that physician or group of physicians, whether or not that person seeks care, per period of time. For example, there is a difference between physician that work in the big city than the physician that work in the rural area with small amount of people live there. The payment of the physician is based of the population. If in the big city, the population there is about 10,000 people, so for every each people that seek treatment, you will be paid for $20 each, then you will get around $200,000 payment in a month! Compared to physician that work in the small population, you will get less. This payment is regardless how many patient come to see you, even if only 50 people, you will be paid with the same amount. So lets pray for the good health condition patient!
Salary - salary means the basic payment that you will get in a month. The physician will be paid with the fixed amount, regardless how many hours you work, how many patients you treated and how many times you make excuse as 'Lunch hour'. In this salary payment, some physician can be paid extra with the certain condition, if you do overtime/on call or you get extraordinary talent, which means you do extra jobs. So lets pray for more tea time!
2. Retrospective payment system
Fee-for-service/ out of pocket - In this system payment, the physician will get money depends on the amount of patients. The more patient you have, the more money you will get. In the health care industries, fee-for-service occurs when doctors and other health care providers receive a fee for each service such as an office visit, test, procedure, or other health care service. If you are lucky enough, sometimes there are patients that give you bonus for your extra work, so lets pray for the rich patient!
Hello
I'm curious how the physician is paid and get money. Because some said if you want to be rich, doctor is not in the list.
But do you think Mercedes, Gucci and Rolex are cheap?
Basically, there are two types of provider payment mechanism:
1. Prospective payment system
Capitation - under capitation system, physicians are paid a set amount for each enrolled person assigned to that physician or group of physicians, whether or not that person seeks care, per period of time. For example, there is a difference between physician that work in the big city than the physician that work in the rural area with small amount of people live there. The payment of the physician is based of the population. If in the big city, the population there is about 10,000 people, so for every each people that seek treatment, you will be paid for $20 each, then you will get around $200,000 payment in a month! Compared to physician that work in the small population, you will get less. This payment is regardless how many patient come to see you, even if only 50 people, you will be paid with the same amount. So lets pray for the good health condition patient!
Salary - salary means the basic payment that you will get in a month. The physician will be paid with the fixed amount, regardless how many hours you work, how many patients you treated and how many times you make excuse as 'Lunch hour'. In this salary payment, some physician can be paid extra with the certain condition, if you do overtime/on call or you get extraordinary talent, which means you do extra jobs. So lets pray for more tea time!
2. Retrospective payment system
Fee-for-service/ out of pocket - In this system payment, the physician will get money depends on the amount of patients. The more patient you have, the more money you will get. In the health care industries, fee-for-service occurs when doctors and other health care providers receive a fee for each service such as an office visit, test, procedure, or other health care service. If you are lucky enough, sometimes there are patients that give you bonus for your extra work, so lets pray for the rich patient!
But every each of payment have their own pros and cons. So, lets check it out.
References:
1. Lecture note on Payment for Physicians. Prof. Dr. Laksono Trisnantoro, MSc, PhD.
2. Winda's : http://bincangsehatsistemkesehatan.blogspot.com
Friday, November 12, 2010
Wednesday, November 10, 2010
Clinical Audit
Salam.
Hello.
Society has increasingly questioned quality of care and concepts of professional discretion or clinical freedom.The stark evidence of this shift in attitudes is shown in the demands of pressure groups, press coverage, calls for public inquiries, and the rise of complaints, legal challenges and claims for redress.
Yet patients and the public have not lost their respect and appreciation for the caring professions in the health service. Practitioners, patients, and the wider public all share equally in the need to establish and maintain confidence in the quality of clinical care. Audit is one way in which we can work to retain the trust and respect in an increasingly critical environment.As a quality improvement tool, audit can demonstrate that real efforts are being made by dedicated, hard-pressed staff to deliver high-quality professional care to all their patients.
According to National Institute for Health and Clinical Excellence (NICE), clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to improvement in healthcare delivery. Basically, clinical audit is as a guideline what should be done, and if not, something improvement must be made.
Clinical audit is very important because it helps to improve the quality of services we offered. Besides that, it also:
- identifies and promotes good practice and can lead to improvements in service delivery and outcomes for users
- can provide the information you need to show others that your service is effective (and cost-effective) and thus ensure its development
- provides opportunities for training and education
- helps to ensure better use of resources and, therefore, increased efficiency
- can improve working relationships, communication and liaison between staff, staff and service users, and between agencies.
There are 5 steps in clinical audit process:
1. Preparing for the audit (involving stakeholders, including consumers, in the process) - during this step, we need to select a topic, defining the purpose of the audit, establishing or activating necessary structures, identifying skills and people needed to carry out audit and providing training to audit team as necessary. This is important to make sure that the next step can be done smoothly.
2. Selecting criteria - defining criteria and standards against which to assess the process and or outcome of care, drawing criteria from existing guidelines and or systematic reviews, prioritising criteria and making criteria explicit and subjecting it to external peer review. Topic is selected in a meeting and using all of the informations such as routine data, patient satisfaction survey, observation of care delivery, inputs from the stakeholders and enthusiasm of a certain care groups.
3. Measuring performance level - identifying the data to be collected (patient and case types, healthcare professionals and their involvement, time period), determining sample size, data sources, data extraction tools and techniques, reviewer training and method of analysis. Data collection can be either retrospective (data already collected routinely or available in a certain register ) or concurrent/prospective (data collected during the process of care)
4. Making improvement - the most important in audit is changes. By identifying the level and location of change (organisational, group, individual) the barriers to change establishing the environment for the audit and involving stakeholders, we can make a changes to the system. Some of the categories that needed changes are eliminate waste, improve work-flow, optimize inventory, change the work environment, enhance the producer-customer relationship, manage time and focus on the product or service.
5. Sustaining improvement - Although improving performance is the primary goal of audit, sustaining that improvement is also essential. Indeed, any systematic approach to changing professional practice should include plans to monitoring and evaluating change, maintaining and reinforcing the change.
References:
1. Lecture note on Briefing for Clinical Audit Practical Sessions by Prof.dr. Adi Utarini, MPH, M.Sc, Ph.D.
2. East Kent Clinical Audit service NHS and pdf.
3. Principles for Best Practice in Clinical Audit , Radcliffe Medical (pdf)
4. The Centre for Clinical Governance Research in Health, University of New South Wales, Sydney
Hello.
Society has increasingly questioned quality of care and concepts of professional discretion or clinical freedom.The stark evidence of this shift in attitudes is shown in the demands of pressure groups, press coverage, calls for public inquiries, and the rise of complaints, legal challenges and claims for redress.
Yet patients and the public have not lost their respect and appreciation for the caring professions in the health service. Practitioners, patients, and the wider public all share equally in the need to establish and maintain confidence in the quality of clinical care. Audit is one way in which we can work to retain the trust and respect in an increasingly critical environment.As a quality improvement tool, audit can demonstrate that real efforts are being made by dedicated, hard-pressed staff to deliver high-quality professional care to all their patients.
According to National Institute for Health and Clinical Excellence (NICE), clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to improvement in healthcare delivery. Basically, clinical audit is as a guideline what should be done, and if not, something improvement must be made.
Clinical audit is very important because it helps to improve the quality of services we offered. Besides that, it also:
- identifies and promotes good practice and can lead to improvements in service delivery and outcomes for users
- can provide the information you need to show others that your service is effective (and cost-effective) and thus ensure its development
- provides opportunities for training and education
- helps to ensure better use of resources and, therefore, increased efficiency
- can improve working relationships, communication and liaison between staff, staff and service users, and between agencies.
1. Preparing for the audit (involving stakeholders, including consumers, in the process) - during this step, we need to select a topic, defining the purpose of the audit, establishing or activating necessary structures, identifying skills and people needed to carry out audit and providing training to audit team as necessary. This is important to make sure that the next step can be done smoothly.
2. Selecting criteria - defining criteria and standards against which to assess the process and or outcome of care, drawing criteria from existing guidelines and or systematic reviews, prioritising criteria and making criteria explicit and subjecting it to external peer review. Topic is selected in a meeting and using all of the informations such as routine data, patient satisfaction survey, observation of care delivery, inputs from the stakeholders and enthusiasm of a certain care groups.
3. Measuring performance level - identifying the data to be collected (patient and case types, healthcare professionals and their involvement, time period), determining sample size, data sources, data extraction tools and techniques, reviewer training and method of analysis. Data collection can be either retrospective (data already collected routinely or available in a certain register ) or concurrent/prospective (data collected during the process of care)
4. Making improvement - the most important in audit is changes. By identifying the level and location of change (organisational, group, individual) the barriers to change establishing the environment for the audit and involving stakeholders, we can make a changes to the system. Some of the categories that needed changes are eliminate waste, improve work-flow, optimize inventory, change the work environment, enhance the producer-customer relationship, manage time and focus on the product or service.
References:
1. Lecture note on Briefing for Clinical Audit Practical Sessions by Prof.dr. Adi Utarini, MPH, M.Sc, Ph.D.
2. East Kent Clinical Audit service NHS and pdf.
3. Principles for Best Practice in Clinical Audit , Radcliffe Medical (pdf)
4. The Centre for Clinical Governance Research in Health, University of New South Wales, Sydney
Friday, November 5, 2010
Health System
Salam
Hello
After a brief explanation about a system from my previous post, now I will tell you guys about health system.
What is a health system?
Health system is a system that consists of the components, organizations, institutions and people that mainly focus to improve health.
Basically, the function of health system is to balance between population's needs and expectations by:
- improving the health status of individuals, families and communities
- defending the population against what threatens its health
- protecting people against the financial consequences of ill-health
- providing equitable access to people-centred care
- making it possible for people to participate in decisions affecting their health and health system
There are 6 (six) components that play important role to make sure that the health system functioning well. They are:
1. Leadership and governance - mainly focus on set goals, policy makers and enforce regulations, dealing with any problems and challenges.
2. Health information system - make information accessible to all communities involved,
3. Health financing - mainly target on financial, how to deal with insurance, to rise funds and ensure effectiveness used of money.
4. Essential medical products and technologies - list of essentials medical products, availability, accessibility, safety monitoring and quality control.
5. Human resources - Patients, families, communities, Ministries of Health, health providers, health services organizations, pharmaceutical companies, health financing bodies, and other organizations.
6. Health services - to control the standards, norms and guidance, to ensure access and essential dimensions of quality: safety, effectiveness, integration, continuity, and people -centered.
References:
1. World Health Organization (WHO) webside.
2. Healthy Development, The World Bank Strategy for HNP Results. (pdf)
3. WHO health system (pdf)
Wednesday, November 3, 2010
Systemic thinking
Salam.
Hello.
Today, I would like to talk about a system. Like I said in my previous post, I will try my best to explain with my own word, literally.
What is a system? According to Dictionary Reference.com, system is an assemblage or combination of things or parts forming a complex unitary whole. To make it more clearly, I will give you an example.
In a house (big system), it requires a few things (middle system) to make it as a house. A house should have a human resources - a family - consist of father (husband), mother (wife) and children; electricity; furniture's; foods; facilities like television, rice cooker and washing machine; and compartment like bedroom, living room, kitchen, dining room and toilet.
Every single thing (subsystem) in a house plays some important rules to make sure that the house functioning smoothly and efficiently, and give a good environment for the family to live. For example, a father is a leader in the house. He should make sure that the subsystem and the system functioning well because if one of it in a bad condition, it can affect the whole system (the house).
But, you should bear in mind that not all of the components in the system is essentials. There are also some components that stated as accessories.
Hello.
Today, I would like to talk about a system. Like I said in my previous post, I will try my best to explain with my own word, literally.
What is a system? According to Dictionary Reference.com, system is an assemblage or combination of things or parts forming a complex unitary whole. To make it more clearly, I will give you an example.
In a house (big system), it requires a few things (middle system) to make it as a house. A house should have a human resources - a family - consist of father (husband), mother (wife) and children; electricity; furniture's; foods; facilities like television, rice cooker and washing machine; and compartment like bedroom, living room, kitchen, dining room and toilet.
Every single thing (subsystem) in a house plays some important rules to make sure that the house functioning smoothly and efficiently, and give a good environment for the family to live. For example, a father is a leader in the house. He should make sure that the subsystem and the system functioning well because if one of it in a bad condition, it can affect the whole system (the house).
But, you should bear in mind that not all of the components in the system is essentials. There are also some components that stated as accessories.
Essentials are the component that very important and must be present in the system. That means, if the essentials components disappear or not present, it can affect the whole system and the system can be broken. For example, a roof. Without a roof, a house can not functioning well because the main goal of a house is to protect the family and component inside it from the sun and rain.
While accessories are the components that are not important, and if they are not present, it's not affecting the overall function in the system. The function of the accessories is more likely to make it look good, beautiful and to support the system that already strong with basic components (essentials)
Maybe it is difficult to differentiate between essentials and accessories in a house. Because some people will have different needs and every single components give a variety of impact.
Conclusion
A system can be said to consist of four things.
The first is objects - the parts, elements or variables within the system. These may be physical or abstract or both, depending on the nature of the system. A father, a mother, children, washing machine, oven, stove, etc.
Second, a system consists of attributes - the qualities or properties of the system and its objects. The role of washing machine is to wash clothes while a father needs to work to get money.
Third, a system had internal relationships among its objects. The mother needs to use stove to cook for dinner.
Fourth, a system exists in an environment. Tadaa, it is called as a house!
References:
1. Health system and disaster, Practical guide Block 4.2
Tuesday, November 2, 2010
Introduction
Salam.
Hello.
This is not the first since I started blogging. But it's kind of weird when I need to post it in English. Ya, kill me because of my broken English with 5.5 for my IELTS. Duhhh.
Ops, sorry for the lame introduction. And the tittle. It's look like I'm enjoying gossiping in my blog. Like always.
Okay, actually this blog is part of my way to get an A for my block examination. But it's doesn't mean that I'm here begging for my A result, people, but it's kind of. Hehe'
I will try my best to share my ideas and opinion regarding our Health System and Disaster's block. Hah? What is health system? Okay, don't panic. I will explain everything (everything doesn't mean everything) about it in my next post.
Keep support my blog. And I'll support yours too. Baik kan I?
Hello.
This is not the first since I started blogging. But it's kind of weird when I need to post it in English. Ya, kill me because of my broken English with 5.5 for my IELTS. Duhhh.
Ops, sorry for the lame introduction. And the tittle. It's look like I'm enjoying gossiping in my blog. Like always.
Okay, actually this blog is part of my way to get an A for my block examination. But it's doesn't mean that I'm here begging for my A result, people, but it's kind of. Hehe'
I will try my best to share my ideas and opinion regarding our Health System and Disaster's block. Hah? What is health system? Okay, don't panic. I will explain everything (everything doesn't mean everything) about it in my next post.
Keep support my blog. And I'll support yours too. Baik kan I?
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