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

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!

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.

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!

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! :)

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?

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

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!

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

Pray For Indonesia

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

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)

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.

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

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?