Hodges' Model: Welcome to the QUAD: November 2018

- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Wednesday, November 28, 2018

WHO Housing and health guidelines

"Recommendations to promote healthy housing for a sustainable and equitable future"

The quality of housing has major implications for people’s health. Housing in cities is of particular concern, with the world’s urban population predicted to double by 2050 and, with it, the demand for housing. In both developed and developing countries, improving housing conditions and reducing health risks in the home is thus critically important.

Improved housing conditions can save lives, reduce disease, increase quality of life, reduce poverty, help mitigate climate change and contribute to the achievement of a number of Sustainable Development Goals, including those addressing health (SDG 3) and sustainable cities (SDG 11). Housing is therefore a major entry point for intersectoral public health programmes and primary prevention. [Foreward, p.xii]

humanistic ------------ SDG 3 HEALTH----------- mechanistic
Mental Health
Peace of Mind
Sense of Well-Being

"Functional impairments are often operationalized in terms of whether a person can accomplish activities of daily living (ADL) or instrumental activities of daily living (IADL). IADL refers to basic tasks of everyday life such as bathing, dressing, transferring, toileting, continence and feeding. -

SDG 11 Sustainable cities
Housing - Dwellings
Indoors - Pollution - Outdoors
carbon monoxide, particulate matter, ...
Indoor heat :: Indoor cold
Injury hazards, structure
Heat - Temperature - Cold
Space, Noise, Fuel, Energy, Light
Accessible home environments for people with functional impairments

ADL refers to a range of activities that are required for independent living in the community, such as preparing meals, housekeeping, taking medication, shopping, managing one’s own finances, travelling and using the telephone." p.69.

 belonging, security and privacy

Household Crowding - health
Water access
WASH water, sanitation and hygiene
Social interactions

local, regional, national government
Ministries of Health
Housing regulations
Funding - Cost Effectiveness
Reduce poverty
Impact of housing on:
staying well, relapse risk
hospital admissions
recidivism  ...

Tuesday, November 27, 2018

Thought Cages: c/o BBC Radio 4

humanistic ----------------------------------------------- mechanistic


"Elephant in the brain"

Friends, Family (+ the test)
Receiving treatment
Patient - Professional relationship

Health expenditure

Be Successful or Be Loved: The NHS Dilemma

Wednesday, November 21, 2018

The - Profound Statement

humanistic ----------------------------------------------- mechanistic

Big (ethical?) questions

BIG questions

"We can do this"

“Fund the NHS properly” 

The Profound Statement here is just the same ...


help 2c More - help to Listen - help to Care

Hitchens, D. (2018) Deep and meaningless, (When did advertising become so banal? The more starry-eyed the corporate motto, the bleaker the reality it conceals). THE SPECTATOR, 22 September. p.12.

Stern, S. Chanting fake mantras won’t save the NHS. Proper funding will, The Guardian.

Tuesday, November 13, 2018

Purple Tuesday - National Day Disabled Shoppers

HUMANISTIC ----------------------------------------------- MECHANISTIC

Ability to exercise choice
(visually impaired - buying clothes)

Cognitive access

Do not assume a person
does not have mental capacity

Thought... that really counts

Physical access
mobility, reach

"Transact on the pavement"
Conduct business with the shopper
outside the store/shop without access

Equipment - maintenance  Extent of provision

Do not assume that the person
who is with
a disabled person is their carer.

The shopping experience
cafe, restaurant, shops


The Purple Pound 
£249bn a year on retail and leisure 
customers - clients - citizens

The Disability Discrimination Act 1995
The Equality Act 2010

My prompt and source:
BBC Radio 4 You and Yours - Consumer Affairs

Sunday, November 11, 2018

Self Care Week Europe 12th November @Self_Care_EU

What does self care involve...?

HUMANISTIC ----------------------------------------------- MECHANISTIC

(States of) Mind
Basic (and greater) Education
 Knowledge and Skills - Health Literacy
Cognitive access - understanding
Motivation, Attitude
Personal ethics, personal values
Self-esteem, Self-image
Personal philosophy, beliefs, expectations
Emotional - mental well-being
Resilience, coping strategies
Balanced Life experiences
Formative experiences
Upbringing, memory, character
Stress and Vulnerability
Risk taking: substance (mis-)use

(States of) Matter
Knowledge of physical fitness
Daily exercise
Presence of medical conditions, patient education: self- monitoring, treatment, recording, reporting
Body image, diet, nutrition
Treatments, Research - Antibiotics
Physical infrastructure:
Built environment,
Rural, Transport.
Physical access
Environment, climate change,
Eco-systems, Sustainability

Care, Compassion, Love
Social network (actual / virtual)
Community infrastructure
Carer support

Global Eco-nomies
Financial knowledge, access to banking
Health Service provision - Systems
Public Mental Health Programmes
Professionals, Global Health
Government policies
Welfare funding
Employment opportunities
Health, SDGs
Food industry

Saturday, November 10, 2018

South Sudan Medical Journal - November 2018


Dear SSMJ Reader,

The November 2018 issue of the South Sudan Medical Journal is now on online and includes articles on Ebola, Caesarean Section and Obstetric fistula. You can download the complete issue as a pdf here or the individual articles listed below.

Please share this notice with your colleagues.

Keeping an eye on Ebola Virus Disease Edward Eremugo Kenyi
Between June and November 1976, the medical world was baffled by an outbreak of a ferocious haemorrhagic disease in Nzara, South Sudan (then part of Sudan). This became known as Ebola Virus Disease (EVD). The West African outbreak in Guinea, Liberia and Sierra Leone in 2014 was devastating.  A new outbreak in DR Congo in 2018 is a warning to South Sudan to be on high alert.

Knowledge of type 2 diabetes mellitus and adherence to management guidelines: a cross-sectional study in Juba, South Sudan Alexandre Ali M. Bili and Longying Zha
Inadequate education and the lack of efficient diabetes care centres compounded by high costs are common barriers for diabetes care. This study assesses the level of knowledge and adherence to guidelines for management of type 2 diabetes in South Sudan.

Knowledge, attitude and willingness to accept Caesarean Section among women in Ogbomoso, southwest Nigeria Olumuyiwa A Ogunlaja, Idowu P Ogunlaja, Samuel E Akinola, Olufemi O Aworinde
Caesarean Section (CS) is a common procedure in obstetrics and has contributed immensely to improving maternal and foetal outcome. The study which seeks to assess the level of knowledge, attitude and acceptance of women about CS in Ogbomoso, Nigeria, concludes that mothers should be educated on the process involved in Caesarean delivery.

Obstetric fistulae, birth outcomes, and surgical repair outcomes: a retrospective analysis of hospital-based data in Dodoma, Tanzania Athanase Lilungulua, Balthazar Gumodokab, Mzee Nassoroc, Patrice Sokac and Kibusi Stephen
Obstetric Fistula (OF) among pregnant women remains a widespread condition with devastating consequences and poses a significant challenge in a community as well as globally. The study concludes that timely fistula repair by experienced fistula surgeons will improve outcomes and limit the clinical insult and distress that OF invariably causes.

How to repair a vesico-vaginal fistula Brian Hancock
Most fistulae are caused by ischaemic necrosis of the genital tract and adjacent organs through prolonged obstructed labour. This article provides a brief overview and refers the reader to resources that cover the practical aspects of the surgery and holistic care of the patient.

Ebola Virus Disease: epidemiology, management, prevention and control Gasim Abd-Elfarag
Ebola Virus Disease (EVD) is part of the group of illnesses known as viral haemorrhagic fevers, and was previously known as Ebola haemorrhagic fever. Infection with EVD is acute, severe and often fatal in humans. The paper provides an outline of what is known about EVD.

Ebola on our doorstep: Ebola Virus Disease preparedness in South Sudan Richard Lako and Otim Patrick Cossy Ramadan
South Sudan has previously experienced three EVD outbreaks in 1976, 1979 and 2004. With recent outbreaks in DR Congo, it is possible that a sporadic outbreak can happen in South Sudan, and so the country is always at risk. Preparedness is key.

Internship training in South Sudan: the challenges and way forward Jessry Pasquali Oboya
The House Officer is the professional whom the patient meets most often when entering hospital and will remember for a long time. The extraordinary commitment and work load of the House Officers at Juba Teaching Hospital has received little recognition by the authorities despite the challenges they face in the course of their training.

The current crisis of human resource for health in Africa Brian Madison
Brain drain has been a source of despair for developing countries, and the healthcare sector arguably bears the biggest brunt imposed by this growing problem. The author argues that if Africa is to counter the healthcare human resources crisis, member states may need to adopt radical reforms in the healthcare sector.

Caesarean Section acceptability and rate in South Sudan
Call for submissions

Neonatal resuscitation chart
This chart is designed with the ‘Helping Babies Breath’ training in mind. However, it incorporates external cardiac massage, which can be effective in some cases.

All previous issues of the journal are in the Archive section, and you can ‘search’ for particular articles.

Please support the journal by submitting items for future issues. We are interested in articles on your research, case reports, and clinical guidance, as well as news of projects, and relevant photographs. We can help you prepare these for publication (see our ‘Authors’ Guidelines’). We welcome letters to the editor and questions. Send your contributions to the Editor-in-Chief, Dr Edward Luka admin@southernsudanmedicaljournal.com

If you are not already a member, join our Facebook Group and share your news and experiences and ideas.

You can follow us on twitter: @SSMedJournal. Other people can be added to our mailing list by clicking here.

SSMJ is a member of African Journals Online – see who is downloading SSMJ abstracts and articles here. We are listed in the Directory of Open Access Journals (DOAJ), you can find and search DOAJ for SSMJ articles here.

Kind regards
The SSMJ team

Wednesday, November 07, 2018

Articulating the Socio-Technical and much more c/o @Atul_Gawande

HUMANISTIC ----------------------------------------------- MECHANISTIC

John ---- Atul

"The story of modern medicine is the story of our human struggle with complexity. Technology will, without question, continually increase our ability to make diagnoses, to peer more deeply inside the body and the brain, to offer more treatments. It will help us document it all—but not necessarily to make sense of it all. Technology inevitably produces more noise and new uncertainties.

Perhaps a computer could have alerted me to the possibility of a genetic disorder in John Cameron, based on his history of skin lesions and the finding of high calcium. But our systems are forever generating alerts about possible connections—to the point of signal fatigue. Just ordering medications and lab tests triggers dozens of alerts each day, most of them irrelevant, and all in need of human reviewing and sorting. There are more surprises, not fewer. The volume of knowledge and capability increases faster than any individual can manage—and faster than our technologies can make manageable for us. We ultimately need systems that make the right care simpler for both patients and professionals, not more complicated. And they must do so in ways that strengthen our human connections, instead of weakening them."
Cameron ---- Gawande

"I had more time for his questions now, and I let him ask them. When we were done and I was about to get off the phone, I paused. I asked him if he’d noticed, during our office visit, how much time I’d spent on the computer.

“Yes, absolutely,” he said. He added, “I’ve been in your situation. I knew you were just trying to find the information you needed. I was actually trying not to talk too much, because I knew you were in a hurry, but I needed you to look the information up. I wanted you to be able to do that. I didn’t want to push you too far.”

It was painful to hear. Forced to choose between having the right technical answer and a more human interaction, Cameron picked having the right technical answer."

Atul Gawande, Why Doctors Hate Their Computers. Annals of Medicine, November 12, 2018 Issue

Tuesday, November 06, 2018

Liminality: "We are all conceptual artists"

humanistic ----------------------------------------------- mechanistic

Liminal states: This space is likened to that which adolescents inhabit: - not yet adults; not quite children. It is an unstable space in which the learner may oscillate between old and emergent understandings just as adolescents often move between adult-like and child-like responses to their transitional status. But once a learner enters this liminal space, she is engaged with the project of mastery unlike the learner who remains in a state of pre-liminality in which understandings are at best vague. The idea that learners enter into a liminal state in their attempts to grasp certain concepts in their subjects presents a powerful way of remembering that learning is both affective and cognitive and that it involves identity shifts which can entail troublesome, unsafe journeys. Often students construct their own conditions of safety through the practice of mimicry. In our research, we came across teachers who lamented this tendency among students to substitute mimicry for mastery (Cousin, 2006b, p.139). Cousin (2006a)


This space, behind-around, reveals...

Leo Villareal’s ‘Liminal Gradient for (RED)’ (2018)

... that we are all 'conceptual artists'.

My source: Spence, R. (2018) Seeing Red, Collecting, FT Weekend, 3-4 November, pp.1-2.

Monday, November 05, 2018

Social prescribing: c/o @TheKingsFund - Three questions

humanistic ----------------------------------------------- mechanistic

Does it work?

What is it?

And how does it fit in 
with wider health and care policy?

Social prescribing is not a quick fix, a social distraction from a clinical problem. How this is approached - negotiated - will be a clear factor in the shared success of social prescribing as an effective, intervention for the person concerned, the NHS AND society.

Friday, November 02, 2018

1959 - 60 years and still all to do ...

humanistic ----------------------------------------------- mechanistic

'Computers' have not always been a matter of mechanism. Depending on your definition, what we describe as medical informatics, clinical informatics and nursing informatics could be said to originate in the data-gathering, recording and graphic work of John Bell, Florence Nightingale and many other pioneers. If John Bell and Florence Nightingale introduced the arrival of modern public health and nursing respectively, there is still a need to 'fix' the history of medical informatics.

"Pinpointing the beginning of the field of medical informatics is challenging, but it is perhaps best to begin any discussion of the field with the 1959 paper “Reasoning foundations of medical diagnosis; symbolic logic, probability, and value theory aid our understanding of how physicians reason” by Ledley and Lusted [19]. Ledley went on to invent the whole-body CT scanner [20], and Lusted became a leader in the field of medical decision-making. Their 1959 paper, however, laid out a probabilistic model for medical diagnosis, with grounds in set-theory and Bayesian inference." p.642.
[19] R.S. Ledley, L.B. Lusted, Reasoning foundations of medical diagnosis; symbolic logic, probability, and value theory aid our understanding of how physicians reason, Science 130 (3366) (1959) 9–21.
[20] D.F. Sittig, J.S. Ash, R.S. Ledley, The story behind the development of the first whole-body computerized tomography scanner as told by Robert S. Ledley, J. Am. Med. Inform. Assoc. 13 (5) (2006) 465–469.

Wright, A., Sittig, D.F. (2008) A four-phase model of the evolution of clinical decision support architectures, International Journal of Medical Informatics. 77: 641–649.

Thursday, November 01, 2018

A Toolbox from: BCS 2nd Sociotechnical Annual Symposium

On the 26th October 2018 I attended the Sociotechnical symposium in London as planned.

There was a sense of deja-vu in terms of speakers and some content but it was worthwhile.

Peter Bednar presented his SOCIO-TECHNICAL TOOLBOX v.13.2 and I like the inclusion on the hyphen as there still is a divide to bridge, or at the very least for people on IT and complex projects to acknowledge. Peter explained how he 'landed' within academia. He also brought some copies of the toolkit and I was able to pick up one.

As a toolkit and on this particular topic the text is helpfully concise at 130 pages. As readers here will know 'information' is a concept of great interest here. The cover (lid?) appeals instantly, referring to "Information Systems Analysis and Design" that eventually arrives at "Job-Crafting". Below this is the "Infological Equation":

I = i(D, S, t)

Of course, it is what's inside that counts. There is an introduction to information systems, the above equation and ten pages devoted to systems thinking. There then follows the main section comprised of templates with descriptions, elements explained were necessary, advice, and examples of paperwork (in many cases e-forms also no doubt). From p.109 the appendix provides a series of questionnaires. Peter's own approach is included 'Critical Systems Analysis'.

What stands out looking at the various tools listed is how h2cm operates at a more generic and yet  still very useful level.

You can use h2cm to reflect and consider projects socio-technically across (potentially) all contexts. You can also however deal with so many other crucial dichotomies:

human-machine (humanistic-mechanistic)
one-to-many (individual-group)

There is no link but the toolkit 2nd edition 2018 is published by Craneswater Press Ltd

inquiries AT craneswaterpress.co.uk

I'll revisit the event and there is a related call for papers which I will post soon.