Care Medical Center Research Articles

A Review of Disparities and Unmet Newborn Screening Needs over 33 Years in a Cohort of Mexican Patients with Inborn Errors of Intermediary Metabolism.

Advances in an early diagnosis by expanded newborn screening (NBS) have been achieved mainly in developed countries, while populations of middle- and low-income countries have poor access, leading to disparities. Expanded NBS in Mexico is not mandatory. Herein, we present an overview of the differences and unmet NBS needs of a group of Mexican patients with inborn errors of intermediary metabolism (IEiM), emphasizing the odyssey experienced to reach a diagnosis. We conducted a retrospective observational study of a historical cohort of patients with IEiM from a national reference center. A total of 924 patients with IEiM were included. Although 72.5% of the diseases identified are detectable by expanded NBS, only 35.4% of the patients were screened. The mortality in the unscreened group was almost two-fold higher than that in the screened group. Patients experienced a median diagnostic delay of 4 months, which is unacceptably long considering that to prevent disability and death, these disorders must be treated in the first days of life. Patients had to travel long distances to our reference center, contributing to their unacceptable diagnostic odyssey. This study highlights the urgent need to have an updated, expanded NBS program with adequate follow up in Mexico and promote the creation of regional medical care centers. We also provide compelling evidence that could prove valuable to decision makers overseeing public health initiatives for individuals impacted by IEiM from middle- and low-income countries.

Preventing Pediatric Medical Traumatic Stress in a Pediatric Urology Outpatient Setting: Application of the Pediatric Psychosocial Preventative Health Model (PPPHM).

The objectives of this topical review are to (1) increase understanding of pediatric medical traumatic stress (PMTS) in pediatric urology populations through literature review, (2) identify a theoretical model to guide prevention of PMTS in this population, and (3) provide clinical care recommendations based on the model identified. Authors introduce a new term "uropsychology" to describe psychological practice that specializes in the treatment of urology patients. Pediatric uropsychologists from 5 pediatric medical care centers gathered to discuss their experience with treating PMTS in their settings and to review existing literature related to PMTS in pediatric urology, PMTS in other populations, and established models for prevention. Authors provide recommendations based on literature review for preventing PMTS in a pediatric urology population. Gaps in the evidence base for preventing PMTS in this population are identified. Authors provide a series of clinical care recommendations, utilizing clinical experience, and the Pediatric Psychosocial Preventative Health Model (PPPHM) as a framework. While there is limited research on PMTS in pediatric urology populations, urologic interventions can be perceived as invasive, painful, distressing, and traumatic. Application of the PPPHM can guide prevention and intervention efforts. Future research is needed to characterize PMTS in this population, evaluate the efficacy of trauma-informed prevention and intervention practices, and develop screening measures that accurately identify at-risk patients. Authors recommend intradisciplinary collaboration among uropsychologists, urology specialists, and patients and families to create formal standards of care, avenues for other future research, and equitable access to uropsychology care.

Models for collaboration

In the future, a need-base health care system should be ensured by cooperation between the service providers. To promote this, the current legal framework is being adjusted to include the introduction of "day treatment at hospitals", distribution of "service groups" to individual clinics, and the establishment of integrated control centers and emergency centers. Healthcare providers are to be motivated to collaborate via financial support, and also the utilization of synergistic effects and the need of training of future professionals. However, the pursuit of collaboration is limited by professional law, regulations regarding anti-corruption, and the patients' interest in freedom of choice, up to competition law to antitrust law. Collaborations between hospitals and contracted physicians/practices are based on the specifications of the Hospital Remuneration Act (collaboration on afee basis or in an employment relationship) and the German Social Code (contractual forms of collaboration for emergency services, medical care centers, before/after in-patient treatment, outpatient surgery, specialized medical care on outpatient basis, cooperating with attending physicians, and special healthcare services), as well as being employed at the hospital. Due to their precarious situation, hospitals increasingly cooperate with each other through strategic alliances, up to mergers. To make these collaborations successful, certain principles need to be considered. These concepts entail risks and require trust and awell-balanced relationship between costs and benefits for all partners. The bold path of fair collaborations, focusing on high-quality and efficient patient care, can represent adisruptive innovation for addressing our challenges in urology and healthcare in general.

Day one versus day zero postoperative physical therapy among patients with lumbar spinal fusion: a length of stay comparison

BACKGROUND CONTEXTPostoperative physical therapy (PT) following lumbar spinal fusion is an effective form of postoperative rehabilitation. However, it is unknown when a postoperative PT protocol should be optimally initiated. PURPOSEThis study sought to compare lengths of stay between patients on a day zero PT protocol and those on a day one PT protocol. STUDY DESIGN/SETTINGRetrospective chart review. PATIENT SAMPLEPatients who underwent lumbar spinal surgery at a large midwestern tertiary medical care center from January 1, 2018 through April 30, 2019 were eligible for their medical record's inclusion. PRIMARY OUTCOME MEASURELength of hospital stay following surgery. METHODSPatients were stratified by having started postoperative PT on the same day as surgery (day zero) or having started postoperative PT on the day following surgery (day one). RESULTSA total of 164 patients were included in the study, 69 in the day zero group and 95 patients in the day one group. Most patients were female (59%, n = 98), and patients’ average age was 62 years (SD = 13). Average length of stay was 61 hours (SD = 20) for those on the day zero protocol and 75 hours (SD = 32) for those on the day one protocol. CONCLUSIONSThis study suggests that a postoperative physical therapy protocol initiated on day zero is associated with patients experiencing a shorter length of hospital stay compared to a similar PT protocol initiated on postoperative day one.

Private practice groups and medical care centers in Germany: afactual analysis of the current situation

Medical care centers (MCCs) are an important part of the German health care system and offer awide range of outpatient medical services. In recent years, the discussion about medical care centers has increased significantly and is largely emotional and interest-driven. The aim of this article is to provide afactual analysis of the current situation of MCCs in Germany and the role of private equity practice groups.

Evaluation of Paramedical Student’s Knowledge on COVID-19: A Comparative Study

Background & Objectives: The COVID-19 pandemic has presented the world community with its greatest challenges so far. Paramedics play a crucial role in providing pre-hospital care to patients who require urgent medical attention in clinical settings. Therefore, the aim of the study was to evaluate the knowledge on COVID-19 among health assistant (HA) students studying in different paramedical colleges in Janakpurdham. Material and Methods: A descriptive cross-sectional study was performed utilizing a structured questionnaire to acquire responses from HA Students studying in different colleges of Janakpurdham in the months of April and May 2022. Descriptive analysis was applied to calculate the frequencies and proportions. A p-value less than 0.05 were considered as significant. Results: Out of total 360 students, 280 were enrolled. The majority of students were under 20 years old. All of the students were aware of the COVID-19 infection at National Human Resource Development Academy (NHRDA) and Mithila Technical Academy (MTA) colleges, with the exception of 3.61% Care Medical Center (CMC) students. A large percentage of students (52.80% boys , 47.19% girls) responded that the respiratory tract is the primary route by which COVID-19 infections are spread, followed by the students from NHRDA and CMC. Most of the students from all colleges received satisfactory scores on the COVID-19 knowledge test. There was negative association of score of knowledge between 1st, 2nd and 3rd year students of CMC and MTA (p=0.96 and p=0.11) respectively. However, there was positive association of score of knowledge between 1st, 2nd and 3rd year NHRDA students (p=0.01). Conclusion: The majority of college students studying at different colleges had satisfactory knowledge, while a moderate number of students had poor and just a few had good knowledge scores on the COVID-19. In order to increase knowledge, various kinds of strategies, regulations, and initiatives should be accomplished and implemented effectively throughout the lower to higher level education.

COMPARATIVE EVALUATION OF THREE SEROLOGICAL TESTS FOR HIV DETECTION IN HARIPUR, PAKISTAN

Since many years ago and with rapid population growth, the human immunodeficiency virus (HIV) has been acknowledged as a serious public health concern worldwide. However, there does not appear to be enough information available on the prevalence of HIV infection in Haripur, Pakistan, as a whole. The current study's goals were to assess the effectiveness of three different HIV screening methods and to ascertain the seroprevalence of HIV infection in Haripur, Pakistan, among the general population. An immunochromatographic test (ICT), enzyme-linked immunosorbent assay (ELISA), and reverse transcription polymerase chain reaction (RT-PCR) were used to test a total of 5370 blood samples for the presence of anti-HIV antibodies and HIV-RNA at the antiretroviral therapy (ART) center in Hayatabad Medical Complex (HMC), Haripur. 756 (14.07%) of the 5370 blood samples tested positive for ICT, 639 (11.89%) for ELISA, and 606 (11.28%) for RT-PCR. Males were more likely to have an active HIV infection than females, with 468 having it compared to 138 who did (7.14%). The age group of 01–10 years showed no signs of infection, whereas the age group of 21–30 years had the highest infection rate (237, or 16.80%). However, the HIV seroprevalence in the married population was 423 (13.83%), compared to 183 (7.91%) in the single population. ICT should not be used to detect anti-HIV antibodies, and RT-PCR instead of ELISA should be used to detect HIV RNA. In order to avoid this illness, medical care centers in rural regions should guarantee the availability of treatment and screening facilities against this virus.

The current status of emergency departments in secondary emergency medical institutions in Japan: a questionnaire survey

BackgroundWhile emergency medicine (ER)-based emergency care is prevalent in many countries, in Japan, the “department-specific emergency care model” and the “emergency center model” are mainstream. We hypothesized that many secondary emergency medical institutions in Japan have inadequate systems. Using a questionnaire, we investigated the status of and problems in the emergency medical services system in secondary emergency medical institutions in Japan. Until date, there has not been an exhaustive survey of emergency facilities on a countrywide scale. The main objective of this study was to investigate problems in the Japanese emergency medical services system and thereby improve optimal care for emergency patients.ResultsA nationwide questionnaire survey involving 4063 facilities (all government-approved emergency medical facilities certified by prefectural governors) in Japan was conducted. Of the facilities that responded, all secondary emergency facilities were included in the analysis. Responses from 1289 facilities without a tertiary emergency medical care center were analyzed. Among them, 61% (792/1289) had ≤ 199 beds, and 8% were emergency department specialty training program core facilities. Moreover, 42% had an annual patient acceptance number of ≤ 500, 19% did not calculate the number of acceptances, 29% had an acceptance rate of ≥ 81%, and 25% had an acceptance rate of 61–80%. Pregnant women (63%) and children (56%) were the major types of patients that affected the acceptance rate. Factors affecting facilities with a response rate of 81% or higher were “hospitals designated for residency training” and “facilities making some efforts to improve the quality of emergency care and the emergency medical system” (logistic analysis, P < .001).ConclusionRelevant authorities and core regional facilities should consider and implement specific measures for regions and hospitals with a shortage of emergency medicine specialists and physicians (e.g., development of ER-based emergency medicine and provision of education). This study may lead to further improvement in the optimal care of emergency patients through the nationwide establishment of the proposed measures as well as through grouping and integrating the structures and systems in emergency and other medical facilities.

Knowledge, Attitude, and Associated Factors towards Prehospital Care among Emergency Health Care Providers Working in Selected Prehospital Care Centers in Addis Ababa, Ethiopia: A Cross-Sectional Study.

Patients' health outcomes can suffer as a result of poor knowledge and unfavorable attitude towards prehospital emergency care. The purpose of this study was to assess emergency health care providers' (EHCPs') knowledge, attitude, and associated factors towards prehospital care in selected prehospital Emergency Medical Service institutions in Addis Abeba, Ethiopia. An institutional-based cross-sectional study design was conducted among EHCPs working in the three selected prehospital emergency medical care centers in Addis Ababa. Data were collected using a standard self-administered questionnaire, cleaned, coded, and entered into EPI Data Version 6, and then exported to SPSS Version 26 for further analysis. The generated data were compiled using frequency tables, charts, and percentages. Logistic regression analysis was used to see the association between independent and dependent variables. One hundred thirty-five (135) study participants were included in this study, with a response rate of 95.7%. The mean age of the respondents was 29.2 years (SD = 4.86). Almost three-quarters of the respondents (71.1%) were aged between 26 and 35 years. Of the total participants, 58.5% and 62.2% of EHCPs had good knowledge and a favorable attitude towards prehospital care, respectively. The study revealed that profession (AOR = 3.2; 95% CI, 1.03 - 7.65), educational status (AOR = 1.17; 95% CI, 1.08 - 4.93), and having training (AOR = 2.25; 95% CI, 1.33 - 4.52) were significantly associated with the knowledge of EHCPs. This finding also revealed that the respondent's knowledge (AOR = 1.36; 95% CI, 1.05 - 2.32) and having training (AOR = 3.2; 95% CI, 1.24 - 7.83) were significantly associated with EHCPs' attitudes towards prehospital care. The knowledge and attitude of EHCPs regarding prehospital care were found to be good and favorable as compared to previous studies. In-service training regarding emergency health conditions and the time needed to care for the patient is important for quality prehospital emergency medical care.

Immuno-inflammatory markers of syntropic cardiovascular diseases

Objective: To study the immuno-inflammatory markers of coronary heart disease, arterial hypertension and their combined course. The research work included 116 patients with cardiovascular disease of middle and old age. The average age of patients is 62.4±1.27. All patients were examined at the Bukhara branch of the Republican scientific and practical Center for emergency medical care. During the analysis, it was found that the level of systolic arterial blood pressure directly depends on the concentration of fibrinogen – r = 0.30 and oppositely depends on the concentration of procalcitonin (PCT) – r = -0.3 and IL-6 – r = -0.26. At the same time, a noticeable positive association of heart rate with creatinine in the blood – r = 0.35 was also revealed. The established connections show the contribution of inflammation syndrome (immune) in the progression of hypertension, or rather, indicators of the progression of hypertension in coronary heart disease are creatinine, fibrinogen, PCT and IL-6. Due to the high and noticeable correlation with the studied immuno-biochemical parameters of blood and functional parameters of the heart, IL-6 is a more informative indicator of the progression of coronary heart disease with the risk of complications and multiple organ failure. Thus, the established connections in our studies allow us to include the conclusion that, along with the above, risk factors for the development of rupture and/ or aneurysm of the aorta in CHD are an increase in the blood level of complement C3, IL-17 and PCT. Consequently, with an increase in the level of VEGF in the blood in CHD AS, the risk of an increase in the thickness of the LV in the diastole increases, and an increase in IL-6, IL-17A and urea in the blood shows a decrease in the thickness of the LV in the diastole, which makes it possible to differentiate the restrictive variant from the hypertrophic form in atypical angina. Due to the high and noticeable correlation with the studied immuno-biochemical parameters of blood and functional parameters of the heart, IL-6 is a more informative indicator of the progression of coronary artery disease with the risk of complications and multiple organ failure.

Spatial analysis of provision the population of Kharkiv with civil defense facilities

The article analyzed the territorial aspect of the distribution and capacity characteristics of civil defense structures in the city of Kharkiv, comparing it with the population size. In the first stage, population density was calculated for specific areas within the maximum permissible radius of the nearest available shelter. The spatial characteristics of the location (level of clustering) and capacity of the defense structures were examined for these same areas. Finally, the population size was correlated with the capacity of the civil defense structures, and spatial clustering of the identified areas was conducted based on this attribute. The geostatistical method of spatial interpolation was used to determine population density in specific areas and fill gaps in the primary data. The application of this method required the following sequential procedures: transforming the primary data according to a normal distribution, constructing a semivariogram model of the transformed variables, aggregating the model into a surface, and defining target polygons. During the calculation of the territorial provision of various types of shelters in the city of Kharkiv, the following sources were utilized: a layer of point objects from the interactive map of open data on the Kharkiv Geoportal (to determine the locations and types of protective structures), and information from the website of the non-commercial enterprise «Emergency Medical Care and Disaster Medicine Center» of the Kharkiv Regional Council (to update information on the capacity of storage facilities and anti-radiation shelters). The Global Moran’s Index and Local Moran’s Index are statistical methods used to assess spatial autocorrelation, which is the degree of clustering or spatial pattern in a variable across a defined area. In this case, they were employed to evaluate the spatial autocorrelation of the capacity of civil defense structures in specific parcels in Kharkiv. The Global Moran’s Index indicated a high level of clustering of areas based on this attribute. Using the Local Moran’s Index, parcels were classified into five object classes: High-High cluster (HH), Low-Low cluster (LL), a high-value outlier surrounded by low-values (HL), a low-value outlier surrounded by high-values (LH), and areas without cluster or outliers (non-significant). The scientific novelty of the article, compared to related studies on a similar topic, lies in the utilization and transformation of a hexagonal grid of population density distribution in the city of Kharkiv, in accordance with the research requirements. In the conclusions, based on the results of cluster analysis and through the adaptation of the tectological principle of the weakest link to the realities of the present, a comprehensive sequential strategy for addressing the shortcomings of territorial provision of civil defense structures in ensuring the population of Kharkiv was proposed.

Knowledge, Awareness, and Attitude toward Dental Implants among Patients Attending a Comprehensive Medical Care Center in Jordan

Knowledge, Awareness, and Attitude toward Dental Implants among Patients Attending a Comprehensive Medical Care Center in Jordan

Retrospective analysis of causes of death in severe PIH, Preeclampsia &amp; Eclampsia cases in a tertiary medical care centre from January 2015 to December 2016

: PIH, preeclampsia and eclampsia cases are one of the leading cause of maternal death especially in underdeveloped countries. Substandard maternity care is thought to be the reason behind it. Hypertensive disorders in pregnancy is a multi-organ involving disease of unknown etiology. Early detection, timely intervention, strict vigilance and intensive monitoring is needed to prevent maternal mortality and morbidity.: Our aim was to detect the cause of death among pregnant women admitted with hypertensive disorders so that measures can be taken to improve the maternity service.: It was a Retrospective analytical study of causes of maternal death among hypertensive disorders in pregnancy cases admitted in our institution from 1 January 2015 to 31 December 2016.Data were collected from case sheets, death certificates and review report on maternal death cases and were analysed and presented. It was found that pulmonary oedema was the most common (75%) cause of maternal death in PIH cases. Improper antepartum care and delay in seeking medical help, moreover, lack of proper utilization of maternity services was the main cause behind the high maternal mortality in PIH cases (89.6%).: Substandard maternity care was found to be responsible for so high maternal death in PIH cases. This result was similar to the other studies in this context. These deaths are preventable to a large extent.

Prevalence and correlates of workplace violence against medical assistants in Germany: a cross-sectional study

BackgroundWorkplace violence is widespread, but studies on workplace violence against health professions in outpatient settings are sparse. We aimed to examine, for the first time, the prevalence of workplace violence against medical assistants as well as potential sociodemographic, occupational and health-related correlates of the exposure to workplace violence.MethodsWe used data from a survey (03–05/2021) among medical assistants in Germany (n = 424). We assessed the 12–month prevalence (yes/no) of verbal violence, physical violence, and sexual harassment as well as the types of perpetrators of workplace violence. Further, information was gathered on sociodemographic (e.g., age, educational level), occupational (e.g., years in job), and mental health-related factors (i.e., anxiety, depression). The 12–month prevalences of the different types of workplace violence were merged into a single variable (“any workplace violence” vs. none) for association analysis. We ran multivariable Poisson regression models to examine potential associations between sociodemographic and occupational correlates (i.e., independent variables) with any workplace violence as dependent variable and in addition between any workplace violence (independent variable) and dichotomized mental health as dependent variable.ResultsOverall, 59.4% of the medical assistants reported verbal violence, 5.9% reported physical violence, 3.8% reported sexual harassment, and 60.1% reported any workplace violence in the previous 12 months. Patients were reported to be the main perpetrators, followed by patients’ relatives. Younger age, being single, and working in a medical care center were sociodemographic and occupational correlates of workplace violence (PRs ≥ 1.27). Workplace violence was significantly associated with mental health variables (PRs ≥ 1.72).ConclusionMedical assistants experience workplace violence, in particular verbal violence. To devise preventive measures, prospective studies are needed to confirm the potential risk groups for workplace violence and the potential mental health sequels of workplace violence observed in our study.

COUNSELLING AND LANGUAGE EDUCATION AS TOOLS FOR PROMOTING FAMILY HEALTHCARE IN A DIVERSE SOCIETY IN NIGERIA

In medical and health care centres, the medical practitioners and health care specialists make provision of support and medical treatment to the individuals, particularly the ones who suffer from health problems and illnesses. Apart from medical treatment and facilities, the individuals need to be provided with health care counselling and language. It was shown that, ccounselling and language education focuse upon in imparting information in terms of ways of promoting good health and well-being of an individual and the family at large. Furthermore, it focuses on ways to prevent the occurrence of family health problems, illnesses and promoting healthy lifestyles. Counselling education for family healthcare takes place simultaneously with medical treatment. When medical practitioners and health care specialists are providing treatment to health problems and illnesses, they need to provide counselling as well. Counselling in terms of health care is considered important in the case of physical as well as psychological health. The important measures to promote health care counselling are, conducting analysis of areas, augmenting one’s knowledge, improving communication skills, implementing listening skills, implementing anti-discrimination policies, concentrating on facts, focusing on personality traits of counselees, focusing on reflection, practicing rephrasing and summarising and writing. The areas requiring the implementation of health care counselling are in terms of promoting good health, preventing diseases and health problems, curbing psychological problems, promoting healthy mind-sets, and promoting healthy lifestyles. Finally, it can be stated, Counselling and language education contribute significantly in making provision of knowledge and understanding to the individuals in promoting good health and well-being. There is need to be ensured that counselling is suitable to the individuals. The medical practitioners, health care specialists and professional counsellors need to make use of innovative methods in counselling sessions.

Change Management Strategies Towards Dismantling Race-Based Structural Barriers in Radiology.

Political momentum for antiracist policies grew out of the collective trauma highlighted during the COVID pandemic. This prompted discussions of root cause analyses for differences in health outcomes among historically underserved populations, including racial and ethnic minorities. Dismantling structural racism in medicine is an ambitious goal that requires widespread buy-in and transdisciplinary collaborations across institutions to establish systematic, rigorous approaches that enable sustainable change. Radiology is at the center of medical care and renewed focus on equity, diversity, and inclusion (EDI) provides an opportune window for radiologists to facilitate an open forum to address racialized medicine to catalyze real and lasting change. The framework of change management can help radiology practices create and maintain this change while minimizing disruption. This article discusses how change management principles can be leveraged by radiology to lead EDI interventions that will encourage honest dialogue, serve as a platform to support institutional EDI efforts, and lead to systemic change.

Clinical Characteristics and Prognosis of Life-Threatening Acute Myocardial Infarction in Patients Transferred to an Emergency Medical Care Center.

Patients with acute myocardial infarction (AMI) triaged as life-threatening are transferred to our emergency medical care center (EMCC). However, data on these patients remain limited. We aimed to compare the characteristics and AMI prognosis of patients transferred to our EMCC with those transferred to our cardiovascular intensive care unit (CICU) using whole and propensity-matched cohorts.We analyzed the data of 256 consecutive AMI patients transferred from the scene to our hospital by ambulance between 2014 and 2017. The EMCC and CICU groups comprised 77 and 179 patients, respectively. There were no significant between-group age or sex differences. Patients in the EMCC group had more disease severity score and had the left main trunk identified as the culprit more frequently (12% versus 0.6%, P < 0.001) than those in the CICU group; however, the number of patients with multiple culprit vessels did not differ. The EMCC group had a longer door-to-reperfusion time (75 [60, 109] minutes versus 60 [40, 86] minutes, P< 0.001) and a higher in-hospital mortality (19% versus 4.5%, P < 0.001), especially from non-cardiac causes (10% versus 0.6%, P < 0.001), than the CICU group. However, peak myocardial creatine phosphokinase did not significantly differ between the groups. The EMCC group had a significantly higher 1-year post-discharge mortality than the CICU group (log-rank, P = 0.032); this trend was maintained after propensity score matching, although the difference was not statistically significant (log-rank, P = 0.094).AMI patients transferred to the EMCC exhibited more severe disease and worse overall in-hospital and non-cardiac mortality than those transferred to the CICU.

"Jest w tobie coś magicznego, moje dziecko!". Doświadczenia mikroagresji w autobiograficznych narracjach kobiet z niepełnosprawnością

The article explores manifestations and forms of microaggressions towards women with disabilities. The analysis is based on autobiographical-narrative interviews with women activists and (self-)advocates with disabilities. Microaggressions are defined as attitudes and behaviours, often subtle or unintentional but full of prejudices, that are expressed in seemingly meaningless and harmless ways. The ephemeral nature of microaggressions make them difficult to identify, both for the perpetrator and the person who experiences them. The author claims they are a form of violence, often invisible. They usually occur in a variety of everyday situations: in public spaces, in the street during a casual interaction, when using public transport, in institutions, or during a visitto a medical care center. They can manifest themselves in a variety of ways, from the asking of invasive questions about one's disability, to the physical incursion into one's private space - such as touching without warning, suddenly grabbing a person's arm, or pulling, etc. Continued exposure to this type of behaviour can have negative consequences in individuals lives. Cumulatively, they cause a drop in self-esteem, anger and frustration.

Role of Pain Clinics in Chronic Pain Management

A pain clinic is a medical care center that specializes in pain management and does not only provide nerve block therapy. Pain specialists diagnose the etiology of pain based on the biopsychosocial model of pain and develop individualized treatment goals for patients at the pain clinic. Appropriate treatment methods are selected and implemented to achieve these goals. The primary goal of treatment is not merely pain relief but improved activities of daily living/quality of life. Therefore, a multidisciplinary approach is important.

The Fermi problem: Estimation of potential Billing losses due to Undercoding of Florida Medicare data

Billing issues are more commonplace than most healthcare professionals, including pharmacists, even realize. Undercoding—or billing outpatient visits for a lower level of service than may be justified—leads to decreased reimbursement, but almost no data captures what is being sacrificed, especially at the state level. Using publicly available data from the National Ambulatory Medical Care Survey and Centers for Medicare and Medicaid Services, we attempt to approximate just how much Medicare reimbursement is lost annually to undercoding in Florida. We also discuss the hidden dangers of undercoding, including how it could hinder the ability of clinical pharmacists to build sustainable clinical services and contribute to the broader healthcare team.