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Click here to sign up for Daily Voice's free daily emails and news alerts.A man who allegedly used a fraudulent credit card to buy three generators worth $5,073 is wanted for third-degree grand larceny in both the Hudson Valley and on Long Island.Saekuan Smith, 29, said that he was an employee from a nearby building and remodeling company in Dickson, PA when he made the illegal purchase at a business in Sullivan County, in Calliccoon, according to State Police. Both the viagra for men price Town of Calliccoon Court and the Nassau County Police Department have issued warrants for his arrest. Smith stands at 5-foot-5, weighs 145 pounds and has black hair and brown eyes. Anyone with knowledge of his whereabouts is asked to contact New York State Police in Liberty at 845-292-6600 or via email at crimetip@troopers.ny.gov viagra for men price. Click here to sign up for Daily Voice's free daily emails and news alerts..

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NCHS Data where to buy women viagra Brief No Cheap farxiga. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for where to buy women viagra chronic conditions such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent where to buy women viagra cessation of menstruation that occurs after the loss of ovarian activity” (3).

This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and where to buy women viagra 22.1% are postmenopausal. Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 where to buy women viagra hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1).

Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period. Figure 1 where to buy women viagra. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant where to buy women viagra quadratic trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year where to buy women viagra ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure where to buy women viagra 1pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly where to buy women viagra one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week. Figure 2 where to buy women viagra.

Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, where to buy women viagra 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no where to buy women viagra longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for where to buy women viagra Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who where to buy women viagra had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women.

Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week. Figure 3 where to buy women viagra. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear where to buy women viagra trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer where to buy women viagra had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data where to buy women viagra table for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past where to buy women viagra week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week. Figure 4 where to buy women viagra. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status.

United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle.

Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion.

DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €. 2) “Do you still have periods or menstrual cycles?.

€. 3) “When did you have your last period or menstrual cycle?. €. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?. € Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis.

NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics.

The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report. ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF. Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon.

2016.Santoro N. Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al.

Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD. National Center for Health Statistics.

2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J. Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.

NCHS Data Brief No viagra for men price. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic viagra for men price conditions such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition.

Menopause is “the permanent cessation of menstruation that occurs after the loss of viagra for men price ovarian activity” (3). This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% viagra for men price are perimenopausal, and 22.1% are postmenopausal.

Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept viagra for men price less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

Figure 1 viagra for men price. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, viagra for men price 2015image icon1Significant quadratic trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if viagra for men price they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table viagra for men price for Figure 1pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in viagra for men price five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2 viagra for men price. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, viagra for men price 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago viagra for men price or less. Women were premenopausal if they still had a menstrual cycle. Access data viagra for men price table for Figure 2pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble viagra for men price staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

Figure 3 viagra for men price. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, viagra for men price 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no viagra for men price longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure viagra for men price 3pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who viagra for men price did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

Figure 4 viagra for men price. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 4pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5).

Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?.

€. 2) “Do you still have periods or menstrual cycles?. €. 3) “When did you have your last period or menstrual cycle?.

€. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less.

Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?.

€ Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS.

For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States. The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS.

Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report.

ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No.

141. Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF.

Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N. Perimenopause.

From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult.

A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software].

2012. Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286.

Hyattsville, MD. National Center for Health Statistics. 2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J.

Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J. Blumberg, Ph.D., Associate Director for Science.

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All of the viagra best price attachments viagra at cvs with the various levels are posted here. NEED TO KNOW PAST MEDICAID INCOME AND RESOURCE LEVELS?. Which household size applies?. The rules viagra at cvs are complicated. See rules here.

On the HRA Medicaid Levels chart - Boxes 1 and 2 are NON-MAGI Income and Resource levels -- Age 65+, Blind or Disabled and other adults who need to use "spend-down" because they are over the MAGI income levels. Box 10 on page 3 are the MAGI income levels -- The Affordable Care Act changed the rules for Medicaid income eligibility viagra at cvs for many BUT NOT ALL New Yorkers. People in the "MAGI" category - those NOT on Medicare -- have expanded eligibility up to 138% of the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a "spend-down." They have NO resource limit. Box 3 on page 1 is Spousal Impoverishment levels for Managed Long Term Care &. Nursing Homes and Box 8 has the Transfer Penalty rates for nursing home eligibility Box 4 has viagra at cvs Medicaid Buy-In for Working People with Disabilities Under Age 65 (still 2017 levels til April 2018) Box 6 are Medicare Savings Program levels (will be updated in April 2018) MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school.

42 C.F.R. § 435.4. Certain populations viagra at cvs have an even higher income limit - 224% FPL for pregnant women and babies <. Age 1, 154% FPL for children age 1 - 19. CAUTION.

What viagra at cvs is counted as income may not be what you think. For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained in this outline and these charts on income disregards. However, for the MAGI population - which is virtually everyone under age 65 who is not on Medicare - their income will now be determined under new rules, based on federal income tax concepts - called "Modifed Adjusted Gross Income" (MAGI). There are good changes and viagra at cvs bad changes. GOOD.

Veteran's benefits, Workers compensation, and gifts from family or others no longer count as income. BAD viagra at cvs. There is no more "spousal" or parental refusal for this population (but there still is for the Disabled/Aged/Blind.) and some other rules. For all of the rules see. ALSO SEE 2018 Manual on Lump Sums and Impact on Public Benefits - with viagra at cvs resource rules The income limits increase with the "household size." In other words, the income limit for a family of 5 may be higher than the income limit for a single person.

HOWEVER, Medicaid rules about how to calculate the household size are not intuitive or even logical. There are different rules depending on the "category" of the person seeking Medicaid. Here are the 2 basic categories viagra at cvs and the rules for calculating their household size. People who are Disabled, Aged 65+ or Blind - "DAB" or "SSI-Related" Category -- NON-MAGI - See this chart for their household size. These same rules apply to the Medicare Savings Program, with some exceptions explained in this article.

Everyone else -- MAGI - All children and adults under age 65, including people with disabilities who are not yet on Medicare -- this is the new "MAGI" population viagra at cvs. Their household size will be determined using federal income tax rules, which are very complicated. New rule is explained in State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010 (PDF) pp. 8-10 of the PDF, This PowerPoint by NYLAG viagra at cvs on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size. See slides 28-49.

Also seeLegal Aid Society and Empire Justice Center materials OLD RULE used until end of 2013 -- Count the person(s) applying for Medicaid who live together, plus any of their legally responsible relatives who do not receive SNA, ADC, or SSI and reside with an applicant/recipient. Spouses or legally responsible for one another, and viagra at cvs parents are legally responsible for their children under age 21 (though if the child is disabled, use the rule in the 1st "DAB" category. Under this rule, a child may be excluded from the household if that child's income causes other family members to lose Medicaid eligibility. See 18 NYCRR 360-4.2, MRG p. 573, NYS viagra at cvs GIS 2000 MA-007 CAUTION.

Different people in the same household may be in different "categories" and hence have different household sizes AND Medicaid income and resource limits. If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband's household size for Medicaid is determined under Category 1/ Non-MAGI above and his wife's is under Category 2/MAGI. The viagra at cvs following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid. Prenatal Care Assistance Program (PCAP) was Medicaid for pregnant women and children under age 19, with higher income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% FPL). Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household.

It was viagra at cvs sometimes known as "S/CC" category for Singles and Childless Couples. This category had lower income limits than DAB/ADC-related, but had no asset limits. It did not allow "spend down" of http://infonet.sonnenwelt.at/?page_id=198 excess income. This category has now been subsumed under viagra at cvs the new MAGI adult group whose limit is now raised to 138% FPL. Family Health Plus - this was an expansion of Medicaid to families with income up to 150% FPL and for childless adults up to 100% FPL.

This has now been folded into the new MAGI adult group whose limit is 138% FPL. For applicants between 138%-150% FPL, they will be eligible for a new program where Medicaid will subsidize their purchase of Qualified viagra at cvs Health Plans on the Exchange. PAST INCOME &. RESOURCE LEVELS -- Past Medicaid income and resource levels in NYS are shown on these oldNYC HRA charts for 2001 through 2019, in chronological order. These include Medicaid levels for MAGI and non-MAGI populations, Child Health Plus, MBI-WPD, Medicare Savings Programs and other public viagra at cvs health programs in NYS.

This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.A huge barrier to people returning to the community from nursing homes is the high cost of housing. One way New York State is trying to address that barrier is with the Special Housing Disregard that allows certain members of Managed Long Term Care or FIDA plans to keep more of their income to pay for rent or other shelter costs, rather than having to "spend down" their "excess income" or spend-down on the cost of Medicaid home care. The special income standard for housing expenses helps pay for housing expenses to help certain nursing home or adult home residents to viagra at cvs safely transition back to the community with MLTC. Originally it was just for former nursing home residents but in 2014 it was expanded to include people who lived in adult homes. GIS 14/MA-017 Since you are allowed to keep more of your income, you may no longer need to use a pooled trust.

KNOW YOUR RIGHTS - FACT SHEET on THREE ways to Reduce viagra at cvs Spend-down, including this Special Income Standard. September 2018 NEWS -- Those already enrolled in MLTC plans before they are admitted to a nursing home or adult home may obtain this budgeting upon discharge, if they meet the other criteria below. "How nursing home administrators, adult home operators and MLTC plans should identify individuals who are eligible for the special income standard" and explains their duties to identify eligible individuals, and the MLTC plan must notify the local DSS that the individual may qualify. "Nursing home administrators, nursing home discharge planning staff, adult home operators and MLTC viagra at cvs health plans are encouraged to identify individuals who may qualify for the special income standard, if they can be safely discharged back to the community from a nursing home and enroll in, or remain enrolled in, an MLTC plan. Once an individual has been accepted into an MLTC plan, the MLTC plan must notify the individual's local district of social services that the transition has occurred and that the individual may qualify for the special income standard.

The special income standard will be effective upon enrollment into the MLTC plan, or, for nursing home residents already enrolled in an MLTC plan, the month of discharge to the community. Questions regarding viagra at cvs the special income standard may be directed to DOH at 518-474-8887. Who is eligible for this special income standard?. must be age 18+, must have been in a nursing home or an adult home for 30 days or more, must have had Medicaid pay toward the nursing home care, and must enroll in or REMAIN ENROLLED IN a Managed Long Term Care (MLTC) plan or FIDA plan upon leaving the nursing home or adult home must have a housing expense if married, spouse may not receive a "spousal impoverishment" allowance once the individual is enrolled in MLTC. How much is the viagra at cvs allowance?.

The rates vary by region and change yearly. Region Counties Deduction (2020) Central Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, Tompkins $436 Long Island Nassau, Suffolk $1,361 NYC Bronx, Kings, viagra at cvs Manhattan, Queens, Richmond $1,451 (up from 1,300 in 2019) Northeastern Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington $483 North Metropolitan Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester $930 Rochester Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, Yates $444 Western Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming $386 Past rates published as follows, available on DOH website 2020 rates published in Attachment I to GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates 2019 rates published in Attachment 1 to GIS 18/MA015 - 2019 Medicaid Levels and Other Updates 2018 rates published in GIS 17 MA/020 - 2018 Medicaid Levels and Other Updates. The guidance on how the standardized amount of the disregard is calculated is found in NYS DOH 12- ADM-05. 2017 rate -- GIS 16 MA/018 - 2016 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards Attachment 12016 rate -- GIS 15-MA/0212015 rate -- Were not posted by DOH but were updated in WMS.

2015 Central $382 Long Island $1,147 NYC $1,001 Northeastern $440 N. Metropolitan $791 Rochester $388 Western $336 2014 rate -- GIS-14-MA/017 HOW DOES IT WORK?. Here is a sample budget for a single person in NYC with Social Security income of $2,386/month paying a Medigap premium of $261/mo. Gross monthly income $2,575.50 DEDUCT Health insurance premiums (Medicare Part B) - 135.50 (Medigap) - 261.00 DEDUCT Unearned income disregard - 20 DEDUCT Shelter deduction (NYC—2019) - 1,300 DEDUCT Income limit for single (2019) - 859 Excess income or Spend-down $0 WITH NO SPEND-DOWN, May NOT NEED POOLED TRUST!. HOW TO OBTAIN THE HOUSING DISREGARD.

When you are ready to leave the nursing home or adult home, or soon after you leave, you or your MLTC plan must request that your local Medicaid program change your Medicaid budget to give you the Housing Disregard. See September 2018 NYS DOH Medicaid Update that requires MLTC plan to help you ask for it. The procedures in NYC are explained in this Troubleshooting guide. NYC Medicaid program prefers that your MLTC plan file the request, using Form MAP-3057E - Special income housing Expenses NH-MLTC.pdf and Form MAP-3047B - MLTC/NHED Cover Sheet Form MAP-259f (revised 7-31-18)(page 7 of PDF)(DIscharge Notice) - NH must file with HRA upon discharge, certifying resident was informed of availability of this disregard. GOVERNMENT DIRECTIVES (beginning with oldest).

NYS DOH 12- ADM-05 - Special Income Standard for Housing Expenses for Individuals Discharged from a Nursing Facility who Enroll into the Managed Long Term Care (MLTC) Program Attachment II - OHIP-0057 - Notice of Intent to Change Medicaid Coverage, (Recipient Discharged from a Skilled Nursing Facility and Enrolled in a Managed Long Term Care Plan) Attachment III - Attachment III – OHIP-0058 - Notice of Intent to Change Medicaid Coverage, (Recipient Disenrolled from a Managed Long Term Care Plan, No Special Income Standard) MLTC Policy 13.02. MLTC Housing Disregard NYC HRA Medicaid Alert Special Income Standard for housing expenses NH-MLTC 2-9-2013.pdf 2018-07-28 HRA MICSA ALERT Special Income Standard for Housing Expenses for Individuals Discharged from a Nursing Facility and who Enroll into the MLTC Program - update on previous policy. References Form MAP-259f (revised 7-31-18)(page 7 of PDF)(Discharge Notice) - NH must file with HRA upon discharge, certifying resident was informed of availability of this disregard. GIS 18 MA/012 - Special Income Standard for Housing Expenses for Certain Managed Long-Term Care Enrollees Who are Discharged from a Nursing Home issued Sept. 28, 2018 - this finally implements the most recent Special Terms &.

Conditions of the CMS 1115 Waiver that governs the MLTC program, dated Jan. 19, 2017. The section on this income standard is at pages 26-27. In these revised ST&C, this special income standard applies to people who were in a NH or adult home paid by Medicaid and "who enroll into or remain enrolled in the MLTC program in order to receive community based long term services and supports" and to those in a NH who were required to enroll into MLTC because of "...the mandatory Nursing Facility transition, and subsequently able to be discharged to the community from the nursing facility, with the services of MLTC program in place." September 2018 DOH Medicaid Update - explains this benefit to medical providers (nursing homes, MLTC plans, home care agencies, adult home operators, and requires them to identify potential individuals who could benefit and help them apply - described here..

65, Does not have Medicare)(OR has official source Medicare and has dependent viagra for men price child <. 18 or <. 19 in school) 138% FPL*** Children <. 5 and viagra for men price pregnant women have HIGHER LIMITS than shown ESSENTIAL PLAN For MAGI-eligible people over MAGI income limit up to 200% FPL No long term care.

See info here 1 2 1 2 3 1 2 Income $875 (up from $859 in 201) $1284 (up from $1,267 in 2019) $1,468 $1,983 $2,498 $2,127 $2,873 Resources $15,750 (up from $15,450 in 2019) $23,100 (up from $22,800 in 2019) NO LIMIT** NO LIMIT SOURCE for 2019 figures is GIS 18 MA/015 - 2019 Medicaid Levels and Other Updates (PDF). All of the attachments with the various levels are posted here. NEED TO KNOW PAST MEDICAID INCOME AND RESOURCE LEVELS? viagra for men price. Which household size applies?.

The rules are complicated. See viagra for men price rules here. On the HRA Medicaid Levels chart - Boxes 1 and 2 are NON-MAGI Income and Resource levels -- Age 65+, Blind or Disabled and other adults who need to use "spend-down" because they are over the MAGI income levels. Box 10 on page 3 are the MAGI income levels -- The Affordable Care Act changed the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers.

People in the "MAGI" category - those NOT on Medicare -- have expanded eligibility up to 138% of viagra for men price the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a "spend-down." They have NO resource limit. Box 3 on page 1 is Spousal Impoverishment levels for Managed Long Term Care &. Nursing Homes and Box 8 has the Transfer Penalty rates for nursing home eligibility Box 4 has Medicaid Buy-In for Working People with Disabilities Under Age 65 (still 2017 levels til April 2018) Box 6 are Medicare Savings Program levels (will be updated in April 2018) MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school. 42 C.F.R viagra for men price.

§ 435.4. Certain populations have an even higher income limit - 224% FPL for pregnant women and babies <. Age 1, 154% FPL for children age 1 viagra for men price - 19. CAUTION.

What is counted as income may not be what you think. For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as viagra for men price before, explained in this outline and these charts on income disregards. However, for the MAGI population - which is virtually everyone under age 65 who is not on Medicare - their income will now be determined under new rules, based on federal income tax concepts - called "Modifed Adjusted Gross Income" (MAGI). There are good changes and bad changes.

GOOD viagra for men price. Veteran's benefits, Workers compensation, and gifts from family or others no longer count as income. BAD. There is no more "spousal" or parental refusal for this population (but there still is for the Disabled/Aged/Blind.) and some other rules viagra for men price.

For all of the rules see. ALSO SEE 2018 Manual on Lump Sums and Impact on Public Benefits - with resource rules The income limits increase with the "household size." In other words, the income limit for a family of 5 may be higher than the income limit for a single person. HOWEVER, viagra for men price Medicaid rules about how to calculate the household size are not intuitive or even logical. There are different rules depending on the "category" of the person seeking Medicaid.

Here are the 2 basic categories and the rules for calculating their household size. People who are Disabled, Aged 65+ or Blind viagra for men price - "DAB" or "SSI-Related" Category -- NON-MAGI - See this chart for their household size. These same rules apply to the Medicare Savings Program, with some exceptions explained in this article. Everyone else -- MAGI - All children and adults under age 65, including people with disabilities who are not yet on Medicare -- this is the new "MAGI" population.

Their household size will be determined using federal income viagra for men price tax rules, which are very complicated. New rule is explained in State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010 (PDF) pp. 8-10 of the PDF, This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size. See slides 28-49 viagra for men price.

Also seeLegal Aid Society and Empire Justice Center materials OLD RULE used until end of 2013 -- Count the person(s) applying for Medicaid who live together, plus any of their legally responsible relatives who do not receive SNA, ADC, or SSI and reside with an applicant/recipient. Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21 (though if the child is disabled, use the rule in the 1st "DAB" category. Under this rule, a child may be excluded from the household viagra for men price if that child's income causes other family members to lose Medicaid eligibility. See 18 NYCRR 360-4.2, MRG p.

573, NYS GIS 2000 MA-007 CAUTION. Different people in the same household may viagra for men price be in different "categories" and hence have different household sizes AND Medicaid income and resource limits. If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband's household size for Medicaid is determined under Category 1/ Non-MAGI above and his wife's is under Category 2/MAGI. The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid.

Prenatal Care Assistance Program (PCAP) was Medicaid for pregnant women and children under viagra for men price age 19, with higher income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% FPL). Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household. It was sometimes known as "S/CC" category for Singles and Childless Couples. This category had lower income limits than DAB/ADC-related, but had no viagra for men price asset limits.

It did not allow "spend down" of excess income. This category has now been subsumed under the new MAGI adult group whose limit is now raised to 138% FPL. Family Health Plus - viagra for men price this was an expansion of Medicaid to families with income up to 150% FPL and for childless adults up to 100% FPL. This has now been folded into the new MAGI adult group whose limit is 138% FPL.

For applicants between 138%-150% FPL, they will be eligible for a new program where Medicaid will subsidize their purchase of Qualified Health Plans on the Exchange. PAST INCOME viagra for men price &. RESOURCE LEVELS -- Past Medicaid income and resource levels in NYS are shown on these oldNYC HRA charts for 2001 through 2019, in chronological order. These include Medicaid levels for MAGI and non-MAGI populations, Child Health Plus, MBI-WPD, Medicare Savings Programs and other public health programs in NYS.

This article was authored by the Evelyn Frank Legal viagra for men price Resources Program of New York Legal Assistance Group.A huge barrier to people returning to the community from nursing homes is the high cost of housing. One way New York State is trying to address that barrier is with the Special Housing Disregard that allows certain members of Managed Long Term Care or FIDA plans to keep more of their income to pay for rent or other shelter costs, rather than having to "spend down" their "excess income" or spend-down on the cost of Medicaid home care. The special income standard for housing expenses helps pay for housing expenses to help certain nursing home or adult home residents to safely transition back to the community with MLTC. Originally viagra for men price it was just for former nursing home residents but in 2014 it was expanded to include people who lived in adult homes.

GIS 14/MA-017 Since you are allowed to keep more of your income, you may no longer need to use a pooled trust. KNOW YOUR RIGHTS - FACT SHEET on THREE ways to Reduce Spend-down, including this Special Income Standard. September 2018 NEWS -- Those already enrolled in MLTC plans before they are admitted to a nursing home or adult home may obtain this budgeting upon discharge, if they meet viagra for men price the other criteria below. "How nursing home administrators, adult home operators and MLTC plans should identify individuals who are eligible for the special income standard" and explains their duties to identify eligible individuals, and the MLTC plan must notify the local DSS that the individual may qualify.

"Nursing home administrators, nursing home discharge planning staff, adult home operators and MLTC health plans are encouraged to identify individuals who may qualify for the special income standard, if they can be safely discharged back to the community from a nursing home and enroll in, or remain enrolled in, an MLTC plan. Once an individual has been accepted into an MLTC plan, the MLTC plan must notify the individual's local district of social services that the transition has occurred and that the individual may qualify viagra for men price for the special income standard. The special income standard will be effective upon enrollment into the MLTC plan, or, for nursing home residents already enrolled in an MLTC plan, the month of discharge to the community. Questions regarding the special income standard may be directed to DOH at 518-474-8887.

Who is eligible for this special income standard?. must be age 18+, must have been in a nursing home or an adult home for 30 days or more, must have had Medicaid pay toward the nursing home care, and must enroll in or REMAIN ENROLLED IN a Managed Long Term Care (MLTC) plan or FIDA plan upon leaving the nursing home or adult home must have a housing expense if married, spouse may not receive a "spousal impoverishment" allowance once the individual is enrolled in MLTC. How much is the allowance?. The rates vary by region and change yearly.

Region Counties Deduction (2020) Central Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, Tompkins $436 Long Island Nassau, Suffolk $1,361 NYC Bronx, Kings, Manhattan, Queens, Richmond $1,451 (up from 1,300 in 2019) Northeastern Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington $483 North Metropolitan Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester $930 Rochester Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, Yates $444 Western Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming $386 Past rates published as follows, available on DOH website 2020 rates published in Attachment I to GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates 2019 rates published in Attachment 1 to GIS 18/MA015 - 2019 Medicaid Levels and Other Updates 2018 rates published in GIS 17 MA/020 - 2018 Medicaid Levels and Other Updates. The guidance on how the standardized amount of the disregard is calculated is found in NYS DOH 12- ADM-05. 2017 rate -- GIS 16 MA/018 - 2016 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards Attachment 12016 rate -- GIS 15-MA/0212015 rate -- Were not posted by DOH but were updated in WMS.

2015 Central $382 Long Island $1,147 NYC $1,001 Northeastern $440 N. Metropolitan $791 Rochester $388 Western $336 2014 rate -- GIS-14-MA/017 HOW DOES IT WORK?. Here is a sample budget for a single person in NYC with Social Security income of $2,386/month paying a Medigap premium of $261/mo. Gross monthly income $2,575.50 DEDUCT Health insurance premiums (Medicare Part B) - 135.50 (Medigap) - 261.00 DEDUCT Unearned income disregard - 20 DEDUCT Shelter deduction (NYC—2019) - 1,300 DEDUCT Income limit for single (2019) - 859 Excess income or Spend-down $0 WITH NO SPEND-DOWN, May NOT NEED POOLED TRUST!.

HOW TO OBTAIN THE HOUSING DISREGARD. When you are ready to leave the nursing home or adult home, or soon after you leave, you or your MLTC plan must request that your local Medicaid program change your Medicaid budget to give you the Housing Disregard. See September 2018 NYS DOH Medicaid Update that requires MLTC plan to help you ask for it. The procedures in NYC are explained in this Troubleshooting guide.

NYC Medicaid program prefers that your MLTC plan file the request, using Form MAP-3057E - Special income housing Expenses NH-MLTC.pdf and Form MAP-3047B - MLTC/NHED Cover Sheet Form MAP-259f (revised 7-31-18)(page 7 of PDF)(DIscharge Notice) - NH must file with HRA upon discharge, certifying resident was informed of availability of this disregard. GOVERNMENT DIRECTIVES (beginning with oldest). NYS DOH 12- ADM-05 - Special Income Standard for Housing Expenses for Individuals Discharged from a Nursing Facility who Enroll into the Managed Long Term Care (MLTC) Program Attachment II - OHIP-0057 - Notice of Intent to Change Medicaid Coverage, (Recipient Discharged from a Skilled Nursing Facility and Enrolled in a Managed Long Term Care Plan) Attachment III - Attachment III – OHIP-0058 - Notice of Intent to Change Medicaid Coverage, (Recipient Disenrolled from a Managed Long Term Care Plan, No Special Income Standard) MLTC Policy 13.02. MLTC Housing Disregard NYC HRA Medicaid Alert Special Income Standard for housing expenses NH-MLTC 2-9-2013.pdf 2018-07-28 HRA MICSA ALERT Special Income Standard for Housing Expenses for Individuals Discharged from a Nursing Facility and who Enroll into the MLTC Program - update on previous policy.

References Form MAP-259f (revised 7-31-18)(page 7 of PDF)(Discharge Notice) - NH must file with HRA upon discharge, certifying resident was informed of availability of this disregard. GIS 18 MA/012 - Special Income Standard for Housing Expenses for Certain Managed Long-Term Care Enrollees Who are Discharged from a Nursing Home issued Sept.

Does viagra really work

Over the past 20 years, a large body of research has documented a relationship between higher nurse-to-patient staffing ratios and better patient outcomes, including shorter hospital stays, lower rates of failure to prevent mortality after an in-hospital complication, inpatient mortality for multiple types of patients, hospital-acquired pneumonia, unplanned extubation, respiratory failure and cardiac arrest.1–5 In addition, patients report higher satisfaction does viagra really work when they are cared for in hospitals with higher staffing levels.6 7To date, most studies have not identified an ‘optimal’ nurse staffing ratio,8 which creates a challenge for determining appropriate staffing levels. If increasing nurse staffing always produces at least some improvement in the quality of care, how does one determine what staffing level is best?. This decision is ultimately an economic one, balancing the benefits of nurse staffing with the other options for does viagra really work which those resources could be used. It is in this context that hospitals develop staffing plans, generally based on historical patterns of patient acuity.Practical challenges of nurse staffingHospital staffing plans provide the structure necessary for determining hiring and scheduling, but fall short for a number of reasons.

First, there are multiple ways in which patient acuity can be measured, which can have measurable effects on the staffing levels resulting from acuity models.9 Second, patient volume and acuity can shift rapidly with changes in the volume of admissions, discharges does viagra really work and transfers between units. Third, staffing plans provide little guidance regarding the optimal mix of permanent staff, variable staff and externally contracted staff.The paper by Saville and colleagues10 in this issue of BMJ Quality &. Safety addresses the latter two issues by applying a simulation model to identify the optimal target for baseline nurse staffing in order to minimise periods does viagra really work of understaffing. Included in this model is consideration of the extent to which hospitals should leverage temporary personnel (typically obtained through an external agency) to fill gaps.

The model acknowledges the likelihood that a hospital cannot realistically prevent all shifts from having a shortfall of nurses at all times, as well as the reality that hospital managers lack information about the best balance between permanent does viagra really work and temporary staff. In addition, the analysis includes a calculation of the costs of each staffing approach, drawing from the records of 81 inpatient wards in four hospital organisations.The application of sophisticated simulation models and other advanced analyticl approaches to analysis of nurse staffing has been limited to date, and this paper is an exemplar of the value of such research. Recent studies have used machine learning methods to forecast hospital discharge volume,11 a discrete event simulation model to determine nursing staff needs in a neonatal intensive care unit,12 and a prediction model using machine learning and hierarchical linear regression to link variation in nurse staffing with patient outcomes.13 This new study applied a unique Monte Carlo simulation model does viagra really work to estimate demand for nursing care and test different strategies to meet demand.The results of the analysis are not surprising in that hospitals are much less likely to experience understaffed patient shifts if they aim to have higher baseline staffing. The data demonstrate a notable leftward skew, indicating that hospitals are more likely to have large unanticipated increases in patient volume and acuity than to have unanticipated decreases.

This results in hospitals being more likely to have shifts that are understaffed than shifts that are overstaffed, which inevitably places pressure on hospitals to staff at a higher level and/or have access to a larger pool of temporary nurses does viagra really work. It also is not surprising that hospitals will need to spend more money per patient day if they aim to reduce the percent of shifts that are understaffed. What is surprising about the results is that hospitals do not necessarily achieve cost savings by relying on temporary personnel versus setting regular staffing at a higher level.Trade-offs between permanent and temporary staffThe temporary nursing workforce enables healthcare facilities to maintain flexible yet full care teams based on patient care needs. Hospitals can use temporary nurses to address staffing gaps during leaves does viagra really work of absence, turnover or gaps between recruitment of permanent nurses, as well as during high-census periods.

Temporary personnel are typically more expensive on an hourly basis than permanent staff. In addition, over-reliance on temporary staff can have detrimental does viagra really work effects on permanent nurses’ morale and motivation. Orientations prior to shifts are often limited, which leads to a twofold concern as temporary nurses feel ill-prepared for shifts and permanent staff feel flustered when required to bring the temporary nurse up to speed while being expected to continue normal operations.14 Agency nurses may be assigned to patients and units that are incongruent with their experience and skills—either to unfamiliar units, which affects their ability to confidently deliver care, or to less complex patients where they feel as if their skills are not used adequately.14 15 These issues can create tension between temporary and permanent nursing staff, which can be compounded by the wage disparity. Permanent staff might feel demoralised and expendable when working alongside temporary staff who does viagra really work are not integrated into the social fabric of the staff.16Hospital managers also must be cognisant of the potential quality impact of relying heavily on temporary nursing staff.

Research on the impact of contingent nursing employment on costs and quality have often found negative effects on quality, including mortality, and higher costs.17 18 However, other studies have found that the association between temporary nursing staff and low quality result from general shortages of nursing staff, which make a hospital more likely to employ temporary staff, and not directly from the contingent staff.19–21 Thus, temporary nurses play an important role in alleviating staffing shortages that would otherwise lead to lower quality of care.22Charting a path forward in hospital management and healthcare researchThe maturation of electronic health records and expansion of computerised healthcare management systems provide opportunities both for improved decision making about workforce deployment and for advanced workforce research. In the area of does viagra really work workforce management, nursing and other leaders have a growing array of workforce planning tools available to them. Such tools are most effective when they display clear information about predicted patient needs and staff availability, but managers still must rely on their on-the-ground understanding of their staff and their context of patient care.23 Integration of human resources data with patient outcomes data has revealed that individual nurses and their characteristics have important discrete effects on the quality of care.24 25 Future development of workforce planning tools should translate this evidence to practice. In addition, new technology platforms are emerging to does viagra really work facilitate direct matching between temporary healthcare personnel and healthcare organisations.

One recent study tested a smartphone-based application that allowed for direct matching of locum tenens physicians with a hospital in the English National Health Service, finding that the platform generated benefits including greater transparency and lower cost.26 Similar technologies for registered nurses could facilitate better matching between hospital needs and temporary nurses’ preparedness to meet those needs.Analytical methods that fully leverage the large datasets compiled through electronic health records, human resources systems and other sources can be applied to advance research on the composition of nursing teams to improve quality of care. As noted above, prior research has applied machine learning and discrete event simulation to analyses of healthcare does viagra really work staffing. Other recent studies have leveraged natural language processing of nursing notes to identify fall risk factors27 and applied data mining of human resources records to understand the job titles held by nurses.28 Linking these rapidly advancing analytical approaches that assess the outcomes and costs of nurse staffing strategies, such as the work by Saville and colleagues published in this issue, to data on the impact of nurse staffing on the long-term costs of patient care will further advance the capacity of hospital leaders to design cost-effective policies for workforce deployment.Guidelines aim to align clinical care with best practice. However, simply publishing a guideline rarely triggers behavioural changes to match guideline recommendations.1–3 We thus transform guideline recommendations into actionable tasks by introducing interventions that promote behavioural changes meant to produce guideline-concordant care.

Unfortunately, not much has changed in the 25 years since Oxman and colleagues concluded that we does viagra really work have no ‘magic bullets’ when it comes to changing clinician behaviour.4 In fact, far from magic bullets, interventions aimed at increasing the degree to which patients receive care recommended in guidelines (eg, educational interventions, reminders, audit and feedback, financial incentives, computerised decision support) typically produce disappointingly small improvements in care.5–10Much improvement work aims to ‘make the right thing to do the easy thing to do.’ Yet, design solutions which hardwire the desired actions remain few and far between. Further, improvement interventions which ‘softwire’ such actions—not guaranteeing that they occur, but at least increasing the likelihood that clinicians will deliver the care recommended in guidelines—mostly produce small improvements.5–9 Until this situation changes, we need to acknowledge the persistent reality that guidelines themselves represent a main strategy for promoting care consistent with current evidence, which means their design should promote the desired actions.11 12In this respect, guidelines constitute a type of clinical decision support. And, like all decision support interventions, guidelines require does viagra really work. (1) user testing to assess if the content is understood as intended and (2) empirical testing to assess if the decision support provided by the guideline does in fact promote the desired behaviours.

While the processes for developing guidelines have received substantial attention over the years,13–18 surprisingly little attention does viagra really work has been paid to empirically answering basic questions about the finished product. Do users understand guidelines as intended?. And, what version of a given guideline engenders the desired behaviours by does viagra really work clinicians?. In this issue of BMJ Quality and Safety, Jones et al19 address this gap by using simulation to compare the frequency of medication errors when clinicians administer an intravenous medication using an existing guideline in the UK’s National Health Service (NHS) versus a revised and user-tested version of the guideline that more clearly promotes the desired actions.

Their findings demonstrate that changes to guideline design (through addition of actionable decision supports) based on user does viagra really work feedback does in fact trigger changes in behaviour that can improve safety. This is an exciting use of simulation, which we believe should encourage further studies in this vein.Ensuring end users understand and use guidelines as intendedJones and colleagues’ approach affords an opportunity to reflect on the benefits of user testing and simulation of guidelines. The design and evaluation of their revised guidelines provides an excellent example of a careful stepwise progression in the development and evaluation of a guideline as a type of does viagra really work decision support for clinicians. First, in a prior study,20 they user tested the original NHS guidelines to improve retrieval and comprehension of information.

The authors produced a revised guideline, which included reformatted sections as well as increased support for key calculations, such as for infusion rates. The authors again user tested the revised guideline, successfully showing higher rates does viagra really work of comprehension. Note that user testing refers to a specific approach focused on comprehension rather than behaviour21 and is distinct from usability testing. Second, in the current study, Jones et al evaluated whether nurse and midwife end does viagra really work users exhibited the desired behavioural changes when given the revised guidelines (with addition of actionable decision supports), compared with a control group working with the current version of the guidelines used in practice.

As a result, Jones and colleagues verify that end users (1) understand the content in the guideline and (2) actually change their behaviour in response to using it.Simulation can play a particularly useful role in this context, as it can help identify problems with users’ comprehension of the guideline and also empirically assess what behavioural changes occur in response to design changes in the guidelines. The level of methodological control and qualitative detail that simulation provides is difficult to feasibly replicate with real-world pilot studies, and therefore simulation fills a critical gap.Jones et al report successful does viagra really work changes in behaviour due to the revised guidelines in which they added actionable decision supports. For example, their earlier user testing found that participants using the initial guidelines did not account for displacement volume when reconstituting the powdered drug, leading to dosing errors. A second error with the initial guidelines involved participants using the shortest infusion rate provided (eg, guidelines state ‘1 to 3 hours’), without realising that the shortest rate is not appropriate for certain doses (eg, 1 hour is appropriate for smaller doses, but larger doses should not be infused over does viagra really work 1 hour because the drug would then be administered faster than the maximum allowable infusion rate of 3 mg/kg/hour).

These two issues were addressed in the revised guidelines by providing key determinants for ‘action’ such as calculation formulas that account for displacement volume and infusion duration, thereby more carefully guiding end users to avoid these dose and rate errors. These changes to the guideline triggered specific behaviours (eg, calculations that account for all variables) that did not occur does viagra really work with the initial guidelines. Therefore, the simulation testing demonstrated the value of providing determinants for action, such as specific calculation formulas to support end users, by showing a clear reduction in dose and rate errors when using the revised guidelines compared with the initial guidelines.The authors also report that other types of medication-specific errors remained unaffected by the revised guidelines (eg, incorrect technique and flush errors)—the changes made did not facilitate the desired actions. The initial does viagra really work guidelines indicate ‘DO NOT SHAKE’ in capital letters, and there is a section specific to ‘Flushing’.

In contrast, the revised guidelines do not capitalise the warning about shaking the vial, but embed the warning with a numbered sequence in the medication preparation section, aiming to increase the likelihood of reading it at the appropriate time. The revised guidelines do not have a section specific to flushing, but embed the flushing instructions as an unnumbered step in the administration section. Thus, the value of embedding technique and flushing information within the context of use was not validated in the simulation testing (ie, no significant differences in the rates of these errors), highlighting precisely the pivotal role that simulation can play does viagra really work in assessing whether attempts to improve usability result in actual behavioural changes.Finally, simulation can identify potential unintended consequences of a guideline. For instance, Jones and colleagues observed an increase in errors (although not statistically significant) that were not medication specific (eg, non-aseptic technique such as hand washing, swabbing vials with an alcohol wipe).

Given that the revised guidelines were specific to the medication tested, it does viagra really work is unusual that we see a tendency toward a worsening effect on generic medication preparation skills. Again, this finding was not significant, but we highlight this to remind ourselves of the very real possibility that some interventions might introduce new and unexpected errors in response to changing workflow and practice6. Simulations offer an opportunity to spot these risks in advance.Now that Jones et al have seen how the revised guidelines change behaviour, they does viagra really work are optimally positioned to move forward. On one hand, they have the option of revising the guidelines further in attempts to address these resistant errors, and on the other, they can consider designing other interventions to be implemented in parallel with their user-tested guidance.

At first glance, the errors that were resistant does viagra really work to change appear to be mechanical tasks that end users might think of as applying uniformly to multiple medications (eg, flush errors, non-aseptic technique). Therefore, a second intervention that has a more general scope (rather than drug specific) might be pursued. Regardless of what they decide to pursue, we applaud their measured approach and highlight that the key does viagra really work takeaway is that their next steps are supported with clearer evidence of what to expect when the guidelines are released—certainly a helpful piece of information to guide decisions as to whether broad implementation of guidelines is justified.Caveats and conclusionSimulation is not a panacea—it is not able to assess longitudinal adherence, and there are limitations to how realistically clinicians behave when observed for a few sample procedures when under the scrutiny of observers. Further, studies where interventions are implemented to assess whether they move the needle on the outcomes we care about (eg, adverse events, length of stay, patient mortality) are needed and should continue.

However, having end users physically perform clinical tasks with the intervention in representative environments represents an important strategy to assess the degree to which guidelines and other decision support interventions in fact does viagra really work promote the desired behaviours and to spot problems in advance of implementation. Such simulation testing is not currently a routine step in intervention design. We hope it becomes a more common phenomenon, with more improvement work following the example of the approach so effectively demonstrated by Jones and colleagues..

Over the past 20 years, a large body of research has documented a http://domainrealestatemanagement.com/best-prices-on-viagra-and-cialis/ relationship between higher nurse-to-patient staffing ratios and better patient outcomes, including shorter hospital stays, lower rates of failure to prevent mortality after an in-hospital complication, inpatient mortality for multiple types of patients, hospital-acquired pneumonia, unplanned extubation, respiratory failure and cardiac arrest.1–5 In addition, patients report higher satisfaction when they are cared for in hospitals with higher staffing levels.6 7To date, most studies have not identified an ‘optimal’ nurse staffing ratio,8 which creates a challenge for determining viagra for men price appropriate staffing levels. If increasing nurse staffing always produces at least some improvement in the quality of care, how does one determine what staffing level is best?. This decision is ultimately an economic one, balancing the benefits of nurse staffing with the viagra for men price other options for which those resources could be used. It is in this context that hospitals develop staffing plans, generally based on historical patterns of patient acuity.Practical challenges of nurse staffingHospital staffing plans provide the structure necessary for determining hiring and scheduling, but fall short for a number of reasons. First, there are multiple ways in which patient acuity can be measured, which can have measurable effects on the staffing levels resulting from acuity models.9 Second, patient volume and acuity can shift rapidly with changes in viagra for men price the volume of admissions, discharges and transfers between units.

Third, staffing plans provide little guidance regarding the optimal mix of permanent staff, variable staff and externally contracted staff.The paper by Saville and colleagues10 in this issue of BMJ Quality &. Safety addresses the latter two issues by applying a simulation model to identify the viagra for men price optimal target for baseline nurse staffing in order to minimise periods of understaffing. Included in this model is consideration of the extent to which hospitals should leverage temporary personnel (typically obtained through an external agency) to fill gaps. The model acknowledges viagra for men price the likelihood that a hospital cannot realistically prevent all shifts from having a shortfall of nurses at all times, as well as the reality that hospital managers lack information about the best balance between permanent and temporary staff. In addition, the analysis includes a calculation of the costs of each staffing approach, drawing from the records of 81 inpatient wards in four hospital organisations.The application of sophisticated simulation models and other advanced analyticl approaches to analysis of nurse staffing has been limited to date, and this paper is an exemplar of the value of such research.

Recent studies have used machine learning methods to forecast hospital discharge volume,11 a discrete event simulation model to determine nursing staff needs in a neonatal intensive care unit,12 and a prediction model using machine learning and hierarchical linear regression to link variation in nurse staffing with patient outcomes.13 This new study applied a unique Monte viagra for men price Carlo simulation model to estimate demand for nursing care and test different strategies to meet demand.The results of the analysis are not surprising in that hospitals are much less likely to experience understaffed patient shifts if they aim to have higher baseline staffing. The data demonstrate a notable leftward skew, indicating that hospitals are more likely to have large unanticipated increases in patient volume and acuity than to have unanticipated decreases. This results in hospitals being more likely to have shifts that are understaffed than shifts that are overstaffed, which inevitably places pressure on hospitals to staff at a higher level and/or have access to a viagra for men price larger pool of temporary nurses. It also is not surprising that hospitals will need to spend more money per patient day if they aim to reduce the percent of shifts that are understaffed. What is surprising about the results is that hospitals do not necessarily achieve cost savings by relying on temporary personnel versus setting regular staffing at a higher level.Trade-offs between permanent and temporary staffThe temporary nursing workforce enables healthcare facilities to maintain flexible yet full care teams based on patient care needs.

Hospitals can use temporary nurses to address staffing gaps during leaves of absence, viagra for men price turnover or gaps between recruitment of permanent nurses, as well as during high-census periods. Temporary personnel are typically more expensive on an hourly basis than permanent staff. In addition, over-reliance on temporary staff can have detrimental viagra for men price effects on permanent nurses’ morale and motivation. Orientations prior to shifts are often limited, which leads to a twofold concern as temporary nurses feel ill-prepared for shifts and permanent staff feel flustered when required to bring the temporary nurse up to speed while being expected to continue normal operations.14 Agency nurses may be assigned to patients and units that are incongruent with their experience and skills—either to unfamiliar units, which affects their ability to confidently deliver care, or to less complex patients where they feel as if their skills are not used adequately.14 15 These issues can create tension between temporary and permanent nursing staff, which can be compounded by the wage disparity. Permanent staff might feel demoralised and expendable when working alongside temporary staff who are not integrated into the social fabric of the viagra for men price staff.16Hospital managers also must be cognisant of the potential quality impact of relying heavily on temporary nursing staff.

Research on the impact of contingent nursing employment on costs and quality have often found negative effects on quality, including mortality, and higher costs.17 18 However, other studies have found that the association between temporary nursing staff and low quality result from general shortages of nursing staff, which make a hospital more likely to employ temporary staff, and not directly from the contingent staff.19–21 Thus, temporary nurses play an important role in alleviating staffing shortages that would otherwise lead to lower quality of care.22Charting a path forward in hospital management and healthcare researchThe maturation of electronic health records and expansion of computerised healthcare management systems provide opportunities both for improved decision making about workforce deployment and for advanced workforce research. In the area viagra for men price of workforce management, nursing and other leaders have a growing array of workforce planning tools available to them. Such tools are most effective when they display clear information about predicted patient needs and staff availability, but managers still must rely on their on-the-ground understanding of their staff and their context of patient care.23 Integration of human resources data with patient outcomes data has revealed that individual nurses and their characteristics have important discrete effects on the quality of care.24 25 Future development of workforce planning tools should translate this evidence to practice. In addition, new viagra for men price technology platforms are emerging to facilitate direct matching between temporary healthcare personnel and healthcare organisations. One recent study tested a smartphone-based application that allowed for direct matching of locum tenens physicians with a hospital in the English National Health Service, finding that the platform generated benefits including greater transparency and lower cost.26 Similar technologies for registered nurses could facilitate better matching between hospital needs and temporary nurses’ preparedness to meet those needs.Analytical methods that fully leverage the large datasets compiled through electronic health records, human resources systems and other sources can be applied to advance research on the composition of nursing teams to improve quality of care.

As noted above, prior research has applied machine viagra for men price learning and discrete event simulation to analyses of healthcare staffing. Other recent studies have leveraged natural language processing of nursing notes to identify fall risk factors27 and applied data mining of human resources records to understand the job titles held by nurses.28 Linking these rapidly advancing analytical approaches that assess the outcomes and costs of nurse staffing strategies, such as the work by Saville and colleagues published in this issue, to data on the impact of nurse staffing on the long-term costs of patient care will further advance the capacity of hospital leaders to design cost-effective policies for workforce deployment.Guidelines aim to align clinical care with best practice. However, simply publishing a guideline rarely triggers behavioural changes to match guideline recommendations.1–3 We thus transform guideline recommendations into actionable tasks by introducing interventions that promote behavioural changes meant to produce guideline-concordant care. Unfortunately, not much has changed in the 25 years since Oxman and colleagues concluded that we have no ‘magic bullets’ when it comes to changing clinician behaviour.4 In fact, far from magic bullets, interventions aimed at increasing the degree to which patients receive care recommended in guidelines (eg, educational interventions, reminders, audit and feedback, financial incentives, computerised decision support) typically produce disappointingly small improvements in care.5–10Much improvement work aims to ‘make the right thing to do the easy thing to do.’ Yet, design solutions which hardwire the viagra for men price desired actions remain few and far between. Further, improvement interventions which ‘softwire’ such actions—not guaranteeing that they occur, but at least increasing the likelihood that clinicians will deliver the care recommended in guidelines—mostly produce small improvements.5–9 Until this situation changes, we need to acknowledge the persistent reality that guidelines themselves represent a main strategy for promoting care consistent with current evidence, which means their design should promote the desired actions.11 12In this respect, guidelines constitute a type of clinical decision support.

And, like all decision support interventions, guidelines require viagra for men price. (1) user testing to assess if the content is understood as intended and (2) empirical testing to assess if the decision support provided by the guideline does in fact promote the desired behaviours. While the processes for developing guidelines have received substantial attention over the years,13–18 surprisingly little attention has been paid to viagra for men price empirically answering basic questions about the finished product. Do users understand guidelines as intended?. And, what version of a viagra for men price given guideline engenders the desired behaviours by clinicians?.

In this issue of BMJ Quality and Safety, Jones et al19 address this gap by using simulation to compare the frequency of medication errors when clinicians administer an intravenous medication using an existing guideline in the UK’s National Health Service (NHS) versus a revised and user-tested version of the guideline that more clearly promotes the desired actions. Their findings demonstrate that changes to guideline design (through addition of actionable decision supports) based on user feedback does in fact trigger changes in behaviour viagra for men price that can improve safety. This is an exciting use of simulation, which we believe should encourage further studies in this vein.Ensuring end users understand and use guidelines as intendedJones and colleagues’ approach affords an opportunity to reflect on the benefits of user testing and simulation of guidelines. The design and evaluation of their revised guidelines provides an excellent example of a careful stepwise progression in the development and evaluation of a guideline as a type viagra for men price of decision support for clinicians. First, in a prior study,20 they user tested the original NHS guidelines to improve retrieval and comprehension of information.

The authors produced a revised guideline, which included reformatted sections as well as increased support for key calculations, such as for infusion rates. The authors again user tested the revised guideline, viagra for men price successfully showing higher rates of comprehension. Note that user testing refers to a specific approach focused on comprehension rather than behaviour21 and is distinct from usability testing. Second, in the current study, Jones et al evaluated whether nurse and midwife end users exhibited the desired behavioural changes when given the revised guidelines (with addition of actionable decision supports), compared with a control group working with the current version viagra for men price of the guidelines used in practice. As a result, Jones and colleagues verify that end users (1) understand the content in the guideline and (2) actually change their behaviour in response to using it.Simulation can play a particularly useful role in this context, as it can help identify problems with users’ comprehension of the guideline and also empirically assess what behavioural changes occur in response to design changes in the guidelines.

The level of methodological control and qualitative detail that simulation provides is difficult to feasibly replicate with real-world pilot studies, and therefore simulation fills a critical gap.Jones et al report successful changes in behaviour due to the revised viagra for men price guidelines in which they added actionable decision supports. For example, their earlier user testing found that participants using the initial guidelines did not account for displacement volume when reconstituting the powdered drug, leading to dosing errors. A second error with the initial guidelines involved participants using the shortest infusion rate provided (eg, guidelines state ‘1 to 3 hours’), without realising that the shortest rate is not appropriate for certain doses (eg, 1 hour viagra for men price is appropriate for smaller doses, but larger doses should not be infused over 1 hour because the drug would then be administered faster than the maximum allowable infusion rate of 3 mg/kg/hour). These two issues were addressed in the revised guidelines by providing key determinants for ‘action’ such as calculation formulas that account for displacement volume and infusion duration, thereby more carefully guiding end users to avoid these dose and rate errors. These changes viagra for men price to the guideline triggered specific behaviours (eg, calculations that account for all variables) that did not occur with the initial guidelines.

Therefore, the simulation testing demonstrated the value of providing determinants for action, such as specific calculation formulas to support end users, by showing a clear reduction in dose and rate errors when using the revised guidelines compared with the initial guidelines.The authors also report that other types of medication-specific errors remained unaffected by the revised guidelines (eg, incorrect technique and flush errors)—the changes made did not facilitate the desired actions. The initial guidelines indicate ‘DO NOT SHAKE’ in capital letters, and there is a section specific viagra for men price to ‘Flushing’. In contrast, the revised guidelines do not capitalise the warning about shaking the vial, but embed the warning with a numbered sequence in the medication preparation section, aiming to increase the likelihood of reading it at the appropriate time. The revised guidelines do not have a section specific to flushing, but embed the flushing instructions as an unnumbered step in the administration section. Thus, the value of embedding technique and flushing information within the context of use was not validated in the simulation testing (ie, no significant differences in the rates of these errors), viagra for men price highlighting precisely the pivotal role that simulation can play in assessing whether attempts to improve usability result in actual behavioural changes.Finally, simulation can identify potential unintended consequences of a guideline.

For instance, Jones and colleagues observed an increase in errors (although not statistically significant) that were not medication specific (eg, non-aseptic technique such as hand washing, swabbing vials with an alcohol wipe). Given that the revised guidelines were specific to the medication tested, it viagra for men price is unusual that we see a tendency toward a worsening effect on generic medication preparation skills. Again, this finding was not significant, but we highlight this to remind ourselves of the very real possibility that some interventions might introduce new and unexpected errors in response to changing workflow and practice6. Simulations offer an opportunity to spot these risks in advance.Now that Jones et al have seen how the revised guidelines change behaviour, they are optimally positioned to viagra for men price move forward. On one hand, they have the option of revising the guidelines further in attempts to address these resistant errors, and on the other, they can consider designing other interventions to be implemented in parallel with their user-tested guidance.

At first glance, the viagra for men price errors that were resistant to change appear to be mechanical tasks that end users might think of as applying uniformly to multiple medications (eg, flush errors, non-aseptic technique). Therefore, a second intervention that has a more general scope (rather than drug specific) might be pursued. Regardless of what they decide to pursue, we applaud their measured approach and highlight that the key takeaway is viagra for men price that their next steps are supported with clearer evidence of what to expect when the guidelines are released—certainly a helpful piece of information to guide decisions as to whether broad implementation of guidelines is justified.Caveats and conclusionSimulation is not a panacea—it is not able to assess longitudinal adherence, and there are limitations to how realistically clinicians behave when observed for a few sample procedures when under the scrutiny of observers. Further, studies where interventions are implemented to assess whether they move the needle on the outcomes we care about (eg, adverse events, length of stay, patient mortality) are needed and should continue. However, having end users physically perform clinical tasks with the intervention in representative environments represents an important strategy to assess the degree to which guidelines and other decision viagra for men price support interventions in fact promote the desired behaviours and to spot problems in advance of implementation.

Such simulation testing is not currently a routine step in intervention design. We hope it becomes a more common phenomenon, with more improvement work following the example of the approach so effectively demonstrated by Jones and colleagues..

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Located in Zhuhai, China’s most livable city, the hospital not only enjoys tranquil and delightful scenery, but also boasts convenient transportation as it borders Macau to go to my site the south and faces Hong Kong to the east across the sea, with ferry female viagra prank terminals and an international airport nearby. Currently, the hospital offers 2,850 beds, covering a construction area of 290,000 ㎡ and a total area of 470,000 ㎡. The new surgical building in our hospital will be put into use soon, with a total construction area of 67,800 square meters.

19 standard wards and 43 operating rooms are planned to female viagra prank be built. It is designated as a center for international medical aid and the only therapy center of many foreign embassies and consulates in Zhuhai.Supported by SYSU and the Zhuhai government, the hospital has grown into a famous hospital on the west side of the Pearl River estuary with comprehensive disciplines, advanced medical technology, characteristic specialties and multidisciplinary strength. The hospital boasts a number of key specialties at provincial and municipal levels, and 5 predominant discipline clusters including medical imaging, infectious diseases, oncology, cardiovascular diseases, and organ transplantation.

Oncology Department, as a key clinical specialty in Guangdong Province, has the only comprehensive system female viagra prank for oncology treatment and prevention in Zhuhai. For years, it has been playing a supporting role in this field of the city. Infectious Diseases Department, as the only specialized center for infectious diseases, undertakes the diagnosis and treatment of most of the difficult, miscellaneous diseases in Zhuhai and neighboring areas.

It is also responsible for all the emerging, sudden and imported infectious diseases female viagra prank in Zhuhai.Currently, the hospital has a number of major research platforms, including Guangdong Key Laboratory of Biomedical Imaging, Guangdong Engineering Research Center for Molecular Imaging, Biological Function &. Molecular Imaging Platform as well as &. Immunization Platform (in preparation) included in the large scientific research platforms of SYSU under the construction of large research teams, large platforms and large projects.

These platforms provide a strong support female viagra prank for high-level medical research. In addition, there are also some other public platforms, such as Molecular Imaging Center, Biological Tissue Sample Bank, Experimental Animal Room, Central Lab, Fifth Affiliated Hospital – Zhongshan School of Medicine Tuberculosis Joint Lab, and Fifth Affiliated Hospital-BGI Joint Laboratory. Guangdong Key Laboratory of Biomedical Imaging covers an area of nearly 3,000㎡.

It is equipped with many first-class lab rooms for molecular biology, chemical synthesis, single-molecule and single-cell imaging, small animal in vivo imaging, nanomaterial and probes, genomics, female viagra prank proteomics and metabolomics, and bioinformatics. It has undertaken a number of national major projects including the National Key R&D Program, National Science and Technology Major Project, NSFC International Collaborative Study Key Project, NSFC Major Project, and NSFC-Guangdong Joint Fund Key Project. Since 2016, the hospital has introduced over 70 full-time and high-level talents from both home and abroad, including top ones that win the titles as experts of, “National high-level talents”, “Distinguished Professors under Zhujiang Scholar Program”, etc.

As a clinical teaching base for high-level medical talents of SYSU, the hospital has a complete medical education and training system, providing 13 doctoral degree programs, 29 master degree programs, and postdoctoral research female viagra prank centers. It also owns a national standardized training base for residents and a Guangdong teacher training base for general medicine.As the old year passed by, the hospital is now taking steps towards new goals. With an open and international vision, the hospital takes roots in Zhuhai, and serves the development strategy of international gateway cities and western core cities in the Guangdong-Hong Kong-Macau Greater Bay Area.

It strides toward the goal of evolving into a regional medical center female viagra prank at the national level that covers the city group on the west side of the Pearl River estuary and extends its influence to countries and regions along the Belt and Road.2. DisciplinesApplicants with the following background are welcomed:Research:Molecular imaging, genomics, molecular biology, vascular biology, molecular medicine, medical image processing, immunology, anti-infective immunity, infectious disease diagnosis research, oncology, cardiovascular and cerebrovascular diseases, cell biology, biochemistry, nanomaterial synthesis and application, materials science, bioinformatics, medical statistics, etc. Clinic disciplines.

Respiratory and critical care female viagra prank medicine, Cardiovascular Medicine, Gastroenterology, Nephorology, Hematology, Hematology&. Rheumatolog, Endocrinology&. Metabolism, Neurology, Rehabilitation Medicine, Psychology, Oncology,Infectious Disease Center, Emergency Medicine, Intensive Care Unit, General Practice, Geratology, Hepatobiliary Surgery, Thyroid &.

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For those who have made particularly significant achievements, the number of their female viagra prank works could be reduced to one. Be an outstanding doctoral student or postdoctor from a well-known domestic or international higher education institute or research institute.4. Remunerations and BenefitsSalary and Benefits.

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There are 10 SYSU female viagra prank affiliated hospitals that provide high-level healthcare service.Children Education. SYSU has constructed affiliated primary and secondary schools and kindergartens in Guangzhou, Zhuhai and Shenzhen campuses to provide high-quality elementary education for the children of faculty members.Employee Wellbeing. Provides "sports time".

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Http://www.zsufivehos.com/1. About UsZhongshan Ophthalmic Center (ZOC), Sun Yat-sen University is the only one of its kind ophthalmic hospital appointed by the National Health Commission. Its history can date back to 1835, when Peter Parker, missionary from the United States founded the oldest western hospital -the Ophthalmic Hospital in Canton.

In 1965, the Zhongshan Ophthalmic Hospital was officially established located on No 54, Xianlie South Road. In 1983, it was renamed as Zhongshan Ophthalmic Center combining clinical services, scientific research, healthcare service and preventative ophthalmology. ZOC has been entitled the State Key Laboratory of Ophthalmology, without any equivalent in China.

The head quarter of Asia Pacific Association of Ophthalmology (APAO) is also located at ZOC. ZOC has consecutively been ranked the first on two well-recognized Rankings in China, one being “Hospitals with Best Reputation by Specialty in China” for 10 terms, and another one being “Hospitals with Most Influence in Technology and Science in China” for 6 terms.ZOC is the largest eye care center in China, treating complicated eye diseases. With 185 ophthalmologists, ZOC has managed an annual workload of over 1,140,000 outpatient visits and more than 75,000 surgeries.ZOC is the China’s leading research institutes in the fields of Medical Science and Ophthalmology.

ZOC have 67 full time researchers. The researches in Stem Cell, Myopia Prevention, Biology Information and Artificial Intelligence, clinical researches in prevention and treatment of eye diseases have been published in Nature, JAMA, Lancet, Nature Methods, Nature Biomedical Engineering, Nature Communications, Lancet Global Health, Ophthalmology, JAMA Ophthalmology, IOVS, and etc.ZOC is the largest training base for ophthalmic talents in China. It currently has 80 doctoral tutors, and has brought up 500 PhD in Ophthalmology, over 250 department heads of domestic tertiary hospitals and 6 full-time professors working for the universities at foreign countries.

In May 2018, the Research Building and the Clinical Building of ZOC, located on No 7, Jinsui Road, Zhujiang New Town, the Central Business District of Guangzhou, were put into full use, which ushers ZOC into the new era of functioning with the Ouzhuang Campus in Yuexiu District and the Zhujiang New Town Campus in Tianhe District. Aiming to serve the national and regional healthcare strategies, Zhongshan Ophthalmic Center gears to a world class ophthalmic center with standardized operating procedures and high-level researches.2. DisciplinesApplicants with the following background are welcomed:Ophthalmology, Medicine, Biology, Computer Science or related fields, including but not limited to, Bioinformatics, Molecular Biology, Biochemistry, Biomedical Engineering, Vascular Biology, Microbial Groups, Structural Biology, Artificial Intelligence, Virtual Reality and Augmented Reality Technology and System, Neural Science, Material Science, Genetics, Immunology, Optical Imaging Technology and Optical Design3.

QualificationsHave comparatively great academic potentials and achieved comparatively great research results by publishing no less than two outstanding academic works in principle. For those who have made particularly significant achievements, the number of their works could be reduced to one. Be an outstanding doctoral student or postdoctor from a well-known domestic or international higher education institute or research institute.4.Remunerations and BenefitsSalary and Benefits.

The University provides generous salary, research start-up fee, talent allowance, and settlement allowance. Talents working in Zhuhai and Shenzhen campuses can enjoy subsidies of the local campuses.Housing Support. Talents can apply for the university's public rental housing.

There are 1,200 new apartments in the Guangzhou campus. More than 1,000 new apartments and 1,500 new shared property houses in the Zhuhai campus. And 3,600 new talent indemnificatory apartments in the Shenzhen campus.Quality Healthcare.

There are 10 SYSU affiliated hospitals that provide high-level healthcare service.Children Education. SYSU has constructed affiliated primary and secondary schools and kindergartens in Guangzhou, Zhuhai and Shenzhen campuses to provide high-quality elementary education for the children of faculty members.Employee Wellbeing. Provides "sports time".

Free use of sports facilities on campus. And annual health checkup. The Zhuhai campus provides meal subsidies.5.ContactContact Person:Mr.

Wu, Ms. Liang Email. Rencaiban@gzzoc.comTel.

Currently, the hospital offers 2,850 beds, covering a construction area of 290,000 ㎡ and a total area of 470,000 viagra for men price can u buy viagra over the counter ㎡. The new surgical building in our hospital will be put into use soon, with a total construction area of 67,800 square meters. 19 standard wards and 43 operating rooms are planned to be built. It is designated as a center for international medical aid and the only therapy center of many foreign embassies and consulates in Zhuhai.Supported by SYSU and the Zhuhai government, the hospital has grown into a famous hospital on the west side of the Pearl River estuary with comprehensive viagra for men price disciplines, advanced medical technology, characteristic specialties and multidisciplinary strength.

The hospital boasts a number of key specialties at provincial and municipal levels, and 5 predominant discipline clusters including medical imaging, infectious diseases, oncology, cardiovascular diseases, and organ transplantation. Oncology Department, as a key clinical specialty in Guangdong Province, has the only comprehensive system for oncology treatment and prevention in Zhuhai. For years, it viagra for men price has been playing a supporting role in this field of the city. Infectious Diseases Department, as the only specialized center for infectious diseases, undertakes the diagnosis and treatment of most of the difficult, miscellaneous diseases in Zhuhai and neighboring areas.

It is also responsible for all the emerging, sudden and imported infectious diseases in Zhuhai.Currently, the hospital has a number of major research platforms, including Guangdong Key Laboratory of Biomedical Imaging, Guangdong Engineering Research Center for Molecular Imaging, Biological Function &. Molecular Imaging Platform as well as viagra for men price &. Immunization Platform (in preparation) included in the large scientific research platforms of SYSU under the construction of large research teams, large platforms and large projects. These platforms provide a strong support for high-level medical research.

In addition, there are also some other public platforms, such as Molecular Imaging Center, Biological Tissue Sample Bank, Experimental Animal Room, Central Lab, Fifth Affiliated Hospital – Zhongshan School of viagra for men price Medicine Tuberculosis Joint Lab, and Fifth Affiliated Hospital-BGI Joint Laboratory. Guangdong Key Laboratory of Biomedical Imaging covers an area of nearly 3,000㎡. It is equipped with many first-class lab rooms for molecular biology, chemical synthesis, single-molecule and single-cell imaging, small animal in vivo imaging, nanomaterial and probes, genomics, proteomics and metabolomics, and bioinformatics. It has undertaken a number viagra for men price of national major projects including the National Key R&D Program, National Science and Technology Major Project, NSFC International Collaborative Study Key Project, NSFC Major Project, and NSFC-Guangdong Joint Fund Key Project.

Since 2016, the hospital has introduced over 70 full-time and high-level talents from both home and abroad, including top ones that win the titles as experts of, “National high-level talents”, “Distinguished Professors under Zhujiang Scholar Program”, etc. As a clinical teaching base for high-level medical talents of SYSU, the hospital has a complete medical education and training system, providing 13 doctoral degree programs, 29 master degree programs, and postdoctoral research centers. It also owns a national standardized training base for residents and a Guangdong teacher training base for general medicine.As the old year passed by, viagra for men price the hospital is now taking steps towards new goals. With an open and international vision, the hospital takes roots in Zhuhai, and serves the development strategy of international gateway cities and western core cities in the Guangdong-Hong Kong-Macau Greater Bay Area.

It strides toward the goal of evolving into a regional medical center at the national level that covers the city group on the west side of the Pearl River estuary and extends its influence to countries and regions along the Belt and Road.2. DisciplinesApplicants with the following background are welcomed:Research:Molecular imaging, genomics, molecular biology, vascular biology, molecular medicine, medical image processing, viagra for men price immunology, anti-infective immunity, infectious disease diagnosis research, oncology, cardiovascular and cerebrovascular diseases, cell biology, biochemistry, nanomaterial synthesis and application, materials science, bioinformatics, medical statistics, etc. Clinic disciplines. Respiratory and critical care medicine, Cardiovascular Medicine, Gastroenterology, Nephorology, Hematology, Hematology&.

Rheumatolog, Endocrinology& viagra for men price. Metabolism, Neurology, Rehabilitation Medicine, Psychology, Oncology,Infectious Disease Center, Emergency Medicine, Intensive Care Unit, General Practice, Geratology, Hepatobiliary Surgery, Thyroid &. Galactophore Surgery, Urology, Thoracic and Cardiovascular Surgery, Trauma&. Joint Surgery, Spinal Surgery, Neurosurgery, Burn wound repair surgery, Plastic surgery, Gynaecology, Obstetrics, Paediatrics, Ophthalmology, ENT-HN Surgery, Stomatology, Surgical anesthesiology, Dermatology, Interventional medicine, viagra for men price Radiology, Ultrasonography, Nuclear Medicine, Pathology, Blood Transfusion, Clinical Nutriology, Pharmacy, Fenghuang Medical Center, Nursing, etc.3.

QualificationsHave comparatively great academic potentials and achieved comparatively great research results by publishing no less than two outstanding academic works in principle. For those who have made particularly significant achievements, the number of their works could be reduced to one. Be an viagra for men price outstanding doctoral student or postdoctor from a well-known domestic or international higher education institute or research institute.4. Remunerations and BenefitsSalary and Benefits.

The University provides generous salary, research start-up fee, talent allowance, and settlement allowance. Talents working in Zhuhai and Shenzhen viagra for men price campuses can enjoy subsidies of the local campuses.Housing Support. Talents can apply for the university's public rental housing. There are 1,200 new apartments in the Guangzhou campus.

More than 1,000 new apartments and 1,500 new shared property houses in viagra for men price the Zhuhai campus. And 3,600 new talent indemnificatory apartments in the Shenzhen campus.Quality Healthcare. There are 10 SYSU affiliated hospitals that provide high-level healthcare service.Children Education. SYSU has constructed affiliated primary and secondary schools and kindergartens in Guangzhou, Zhuhai and Shenzhen campuses to provide high-quality elementary education for the children of faculty members.Employee Wellbeing viagra for men price.

Provides "sports time". Free use of sports facilities on campus. And annual how to order viagra health viagra for men price checkup. The Zhuhai campus provides meal subsidies.5.

ContactContact Person:Ms. Yao, Mr viagra for men price. Zhuang, Ms. Liu,Email.

Liulu58@mail.sysu.edu.cnTel. 86-756-2528762, 2526012, 2528862Website. Http://www.zsufivehos.com/1. About UsZhongshan Ophthalmic Center (ZOC), Sun Yat-sen University is the only one of its kind ophthalmic hospital appointed by the National Health Commission.

Its history can date back to 1835, when Peter Parker, missionary from the United States founded the oldest western hospital -the Ophthalmic Hospital in Canton. In 1965, the Zhongshan Ophthalmic Hospital was officially established located on No 54, Xianlie South Road. In 1983, it was renamed as Zhongshan Ophthalmic Center combining clinical services, scientific research, healthcare service and preventative ophthalmology. ZOC has been entitled the State Key Laboratory of Ophthalmology, without any equivalent in China.

The head quarter of Asia Pacific Association of Ophthalmology (APAO) is also located at ZOC. ZOC has consecutively been ranked the first on two well-recognized Rankings in China, one being “Hospitals with Best Reputation by Specialty in China” for 10 terms, and another one being “Hospitals with Most Influence in Technology and Science in China” for 6 terms.ZOC is the largest eye care center in China, treating complicated eye diseases. With 185 ophthalmologists, ZOC has managed an annual workload of over 1,140,000 outpatient visits and more than 75,000 surgeries.ZOC is the China’s leading research institutes in the fields of Medical Science and Ophthalmology. ZOC have 67 full time researchers.

The researches in Stem Cell, Myopia Prevention, Biology Information and Artificial Intelligence, clinical researches in prevention and treatment of eye diseases have been published in Nature, JAMA, Lancet, Nature Methods, Nature Biomedical Engineering, Nature Communications, Lancet Global Health, Ophthalmology, JAMA Ophthalmology, IOVS, and etc.ZOC is the largest training base for ophthalmic talents in China. It currently has 80 doctoral tutors, and has brought up 500 PhD in Ophthalmology, over 250 department heads of domestic tertiary hospitals and 6 full-time professors working for the universities at foreign countries. In May 2018, the Research Building and the Clinical Building of ZOC, located on No 7, Jinsui Road, Zhujiang New Town, the Central Business District of Guangzhou, were put into full use, which ushers ZOC into the new era of functioning with the Ouzhuang Campus in Yuexiu District and the Zhujiang New Town Campus in Tianhe District. Aiming to serve the national and regional healthcare strategies, Zhongshan Ophthalmic Center gears to a world class ophthalmic center with standardized operating procedures and high-level researches.2.

DisciplinesApplicants with the following background are welcomed:Ophthalmology, Medicine, Biology, Computer Science or related fields, including but not limited to, Bioinformatics, Molecular Biology, Biochemistry, Biomedical Engineering, Vascular Biology, Microbial Groups, Structural Biology, Artificial Intelligence, Virtual Reality and Augmented Reality Technology and System, Neural Science, Material Science, Genetics, Immunology, Optical Imaging Technology and Optical Design3. QualificationsHave comparatively great academic potentials and achieved comparatively great research results by publishing no less than two outstanding academic works in principle. For those who have made particularly significant achievements, the number of their works could be reduced to one. Be an outstanding doctoral student or postdoctor from a well-known domestic or international higher education institute or research institute.4.Remunerations and BenefitsSalary and Benefits.

The University provides generous salary, research start-up fee, talent allowance, and settlement allowance. Talents working in Zhuhai and Shenzhen campuses can enjoy subsidies of the local campuses.Housing Support. Talents can apply for the university's public rental housing. There are 1,200 new apartments in the Guangzhou campus.

More than 1,000 new apartments and 1,500 new shared property houses in the Zhuhai campus. And 3,600 new talent indemnificatory apartments in the Shenzhen campus.Quality Healthcare. There are 10 SYSU affiliated hospitals that provide high-level healthcare service.Children Education. SYSU has constructed affiliated primary and secondary schools and kindergartens in Guangzhou, Zhuhai and Shenzhen campuses to provide high-quality elementary education for the children of faculty members.Employee Wellbeing.

Provides "sports time". Free use of sports facilities on campus. And annual health checkup. The Zhuhai campus provides meal subsidies.5.ContactContact Person:Mr.

Wu, Ms. Liang Email. Rencaiban@gzzoc.comTel. 0086-20-66618946Website.

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Healthway Medical Corporation Limited (HMC), a private healthcare provider based in Singapore, cheap generic viagra has announced that its pediatric unit, Singapore Baby and Child Clinic has been onboarded onto its proprietary teleconsultation app. HMC said it will cheap generic viagra integrate further specialist clinics into the app in the months ahead. Island Orthopaedics and the Nobel Group of clinics will also be onboarded in the coming months. The Nobel Group encompasses specialist services such as Psychological Wellness, Gastroenterology and Cardiology.Since its official launch cheap generic viagra on 15 August 2020, the Healthway Medical app has onboarded 47 of its GP clinics located islandwide. HIMSS20 Digital cheap generic viagra Learn on-demand, earn credit, find products and solutions.

Get Started >>. HOW IT WORKSWith the app, patients can cheap generic viagra arrange a video consultation with a doctor up till 1030pm daily, with medication delivered to their doorstep. They can cheap generic viagra scan a QR code displayed at the registration counter of their regular GP clinic to confirm their details automatically.THE LARGER TRENDAs a result of the ongoing erectile dysfunction treatment viagra, healthcare providers have been ramping up their teleconsultation and telemedicine services. In May, IHH Healthcare, Asia’s largest privately owned healthcare group, rolled out telemedicine services in Singapore, Malaysia, Turkey, India and Hong Kong, Healthcare IT News reported.In Thailand, private healthcare provider Samitivej Hospital Group, which is owned by Bangkok Dusit Medical Services (BDMS), launched its Virtual Hospital app in March 2019 – the app includes teleconsultation and medicine delivery services. Dr Surangkana Techapaitoon, Deputy CEO of Samitivej cheap generic viagra and BNH Group of Hospitals &.

Director, Samitivej Children’s Hospital, said in the sixth episode of the HIMSS APAC Digital Dialogue Series that the number of patients using the cheap generic viagra Samitivej Virtual Hospital service increased six fold during the peak of the viagra. ON THE RECORD“The erectile dysfunction treatment viagra has accelerated the adoption and acceptance of telehealth services, particularly catering to those seeking medical assistance for non-erectile dysfunction treatment related concerns. While teleconsultations cannot replace the necessity of in-clinic cheap generic viagra care for a range of medical conditions, the provision of teleconsultation services facilitates more efficient doctor-patient interactions, especially when it comes to early diagnosis and preventive care. The ongoing digital transformation of traditional healthcare services will continue to play cheap generic viagra an important role in providing complementary holistic care for patients in tandem with in-clinic consultations,” said Dr Nelson Wee, Deputy Head of Primary Care of HMC.The U.S. Food and Drug Administration on Thursday convened a public meeting of its Patient Engagement Advisory Committee to discuss issues regarding artificial intelligence and machine learning in medical devices."Devices using AI and ML technology will transform healthcare delivery by increasing efficiency in key processes in the treatment of patients," said Dr.

Paul Conway, PEAC chair and chair of policy and global affairs of the American Association of Kidney Patients.As Conway and others noted during the panel, AI and ML systems may have algorithmic biases and lack transparency – potentially leading, in turn, to an undermining of patient cheap generic viagra trust in devices. Medical device innovation has already ramped up in response to the erectile dysfunction treatment crisis, with Center for Devices and Radiological Health Director Dr. Jeff Shuren noting that 562 medical devices have already been granted emergency use authorization by the FDA.It's imperative, said Shuren, that patients' cheap generic viagra needs be considered as part of the creation process."We continue to encourage all members of the healthcare ecosystem to strive to understand patients' perspective and proactively incorporate them into medical device development, modification and evaluation," said Shuren. "Patients are truly the inspiration for all the work we do.""Despite the global challenges with the erectile dysfunction treatment public cheap generic viagra health emergency ... The patient's voice won't be stopped," Shuren added.

"And if anything, there is even more reason for it to be heard."However, said Pat Baird, regulatory head of global software standards at Philips, facilitating patient trust also means acknowledging the importance of robust and accurate data sets."To help support oru patients, we need to become more familiar with them, their medical conditions, their environment and their needs and wants, to be able to better understand the potentially confounding cheap generic viagra factors that drive some of the trends in the collected data," said Baird."An algorithm trained on one subset of the population might not be relevant for a different subset," Baird explained. For instance, if a hospital needed a device that would serve its population of seniors at a Florida retirement community, an algorithm trained on recognizing healthcare needs of teens in cheap generic viagra Maine would not be effective – not every population will have the same needs. "This bias in the data is not intentional, but can be hard to identify," he continued. He encouraged the development of a taxonomy of bias types cheap generic viagra that would be made publicly available.Ultimately, he said, people won't use what they don't trust. "We need to use our collective intelligence to help produce better artificial intelligence populations," he said.Captain Terri Cornelison, chief medical officer and director of health of women at CDRH, noted that demographic identifiers can be medically significant due to genetics and social determinants of health, among other factors."Science is showing us that these are not just categorical identifiers but actually clinically relevant," Cornelison said.She pointed out that a clinical study that does not identify patients' sex may mask different results cheap generic viagra for people with different chromosomes.

"In many instances, AI and ML devices may be learning a worldview that is narrow in focus, particularly in the available training data, if the available training data do not represent a diverse set of patients," she said. "More simply, cheap generic viagra AI and ML algorithms may not represent you if the data do not include you," she said."Advances in artificial intelligence are transforming our health systems and daily lives," Cornelison continued. "Yet despite these significant achievements, most ignore the sex, gender, age, race [and] ethnicity dimensions and their contributions to health adn disease cheap generic viagra differences among individuals."The committee also examined how informed consent might play a role in algorithmic training. "If I give my consent to be treated by an AI/ML device, I have the right to know whether there were patients like me ... In the data set," said Bennet Dunlap, a health communications consultant cheap generic viagra.

"I think the FDA should not be accepting or approving a medical device that does not have patient engagement" of the kind outlined in committee meetings, he continued."You need to know what your data is going to be used for," he reiterated. "I have cheap generic viagra white privilege. I can cheap generic viagra just assume old white guys are in [the data sets]. That's where everybody starts. But that cheap generic viagra should not be the case."Dr.

Monica Parker, assistant professor in neurology and education core member of the Goizueta Alzheimer’s Disease Research cheap generic viagra Center at Emory University, pointed out that diversifying patient data requires turning to trusted entities within communities."If people are developing these devices, in the interest of being more broadly diverse, is there some question about where these things were tested?. " She raised the issue of testing taking place in academic medical centers or technology centers on the East or West Coast, versus "real-world data collection from hospitals that may be using some variation of the device for disease process.""Clinicians who are serving the population for which the device is needed" provide accountability and give the device developer a better sense of whom they're treating, Parker said. She also reminded fellow committee members cheap generic viagra that members of different demographic groups are not a monolith.Philip Rutherford, director of operation at Faces and Voices Recovery, pointed out that it's not just enough to prioritize diversity in data sets. The people in charge of training the algorithm must also not be homogenous."If we want diversity in our data, we have to seek diversity in the people that are collecting cheap generic viagra the data," said Rutherford.The committee called on the FDA to take a strong role in addressing algorithmic bias in artificial intelligence and machine learning. "At the end of the day, diversity validation and unconscious bias … all these things can be addressed if there's strong leadership from the start," said Conway.

Kat Jercich is cheap generic viagra senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.ChristianaCare this week announced the launch of its Home Care Coach, a HIPAA-eligible Alexa Skill aimed at meeting the needs of home health patients.The Home Health Coach, which the Delaware-based health system says was designed in collaboration with frontline caregivers, is a proactive care plan that patients can use through their Alexa smart speaker.WHY IT MATTERSHome healthcare acts as a major part of ChristianaCare's services. According to the organization website, ChristianaCare staff members performed nearly 300,000 home health visits in fiscal year 2019.Of course, the erectile dysfunction treatment viagra inevitably complicates home health care provision, especially because vulnerable members of the community are often the ones relying on it. The increasing prevalence of voice assistants and smart speakers makes them a natural complement, when available, with other medical treatments.The Home Care Coach's interface, according to ChristianaCare, allows providers to customize patient care plans.

The patient can then ask Alexa questions about prescribed medication, exercise, and more, and get personalized prompts.The skill is being launched to select groups of ChristianaCare patients, system representatives said, with plans to expand it in the coming months."Voice assistants are in millions of homes in the U.S.," said Randy Gaboriault, chief digital and information officer at ChristianaCare, in a statement. "By leveraging this technology, we are creating a new model of care within patients’ homes to support the best health outcomes possible."THE LARGER TRENDIntelligence-driven voice assistants have been increasingly leveraged in medical settings, with healthcare organizations relying on Alexa, as well as Apple's Siri and Google Home, to augment patient care.Recently, the Mayo Clinic added a erectile dysfunction treatment specific skill set to Alexa, offering users the latest information on the disease in response to voice commands."For Mayo Clinic, voice technologies allow us to deliver information and care when, where and how people wish to access it," explained Dr. Sandhya Pruthi, a Mayo Clinic physician and medical director for Mayo's health education and content services. "Accurate, easily accessible information is key to fighting this viagra, and voice technologies are another avenue to get information to the public."ON THE RECORD"Engaging patients digitally is more important than ever right now, as it will help them reach their health goals, improve their experience, and shape the future of health care as we know it," said ChristianaCare President and CEO Dr. Janice E.

Nevin in a statement."We have a bold vision of the future," she said. "All care that can be digital will be digital, and all care that can be done in the home or in the community will be done in the home or in the community." Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.In 2012, the state of Kentucky passed a law similar to those in many other states requiring physicians prescribing controlled substances to check their state’s prescription drug-monitoring program database. The database enables providers to view a patient’s controlled substance prescription history to identify potential signs of opioid use disorder or doctor shopping.THE PROBLEMKentucky has been particularly hard hit in the opioid epidemic.

More than 1,500 Kentuckians die each year from drug overdoses. A contributor is the state’s opioid prescribing rate, which is 55% higher than the rest of the U.S. HIMSS20 Digital Learn on-demand, earn credit, find products and solutions. Get Started >>. Norton Healthcare is the largest health system in Kentucky, with more than five hospitals and a total of 250 care locations.

Staff members say they have a medical and moral responsibility to serve as leaders in the state’s fight against this crisis.“We’re based in Louisville, which is right on the Indiana border, and serving patients in a metro area spanning two states often means that our physicians are tasked with querying both Kentucky’s PDMP, KASPER, and Indiana’s PDMP, INSPECT, before prescribing controlled substances,” said Dr. Steven Heilman, senior vice president and chief health innovation officer at Norton Healthcare.“This process used to require physicians to log out of our Epic electronic health record and separately open and search within each state’s web-based PDMP database, and then load the results into the patient’s chart.”"It has helped us much more easily understand and adjust our physicians’ prescribing behaviors so we can be part of the solution to reduce the availability of prescription opioids in the communities we serve."Dr. Steven Heilman, Norton HealthcareThis highly manual process took as long as 10 minutes per patient if checking both states’ PDMPs and was a major interruption to physicians’ workflows, so much so that Norton began to assign medical assistants to help with the process and save physicians’ time. Extracting data from these databases to study prescribing patterns among physicians also was time-consuming, but essential if Norton wanted to reduce the volume of opioids in its communities.PROPOSALAn Ohio physician demonstrated medication management and integration IT vendor Appriss Health’s PMP Gateway tool during an Epic users’ conference, and Heilman was immediately intrigued.“Gateway enables physicians to automatically query the PDMP database from within the EHR workflow when a controlled substance prescription is ordered or at any other time,” he said.“This alleviates the need to exit the EHR and log in to a separate application. I realized this would help us realize efficiencies.

For example, we would no longer need to delegate a medical assistant to query PDMP databases, as physicians would be able to manage this themselves during their workflow.”Another Appriss Health tool, NarxCare, uses advanced analytics to provide an immediate, point-of-care analysis of a patient’s risk for substance use disorder and other information in a visually interactive format that supports prescribers’ rapid comprehension and decision-making.“We also learned of the analytics tools that, due to the integration with Epic, would enable us to easily generate reports on physician-controlled substance prescribing behaviors, which can be used to support provider outreach and education,” Heilman explained.He presented the Appriss Health tools to Norton’s Narcotics Matrix Committee, which works to address and define Norton Healthcare’s prescribing levels and patterns and to identify areas for improvement.The committee members and other Norton Healthcare leaders understood that providing clinicians with access to the right data using Appriss Health solutions could impact overall prescribing levels and improve patient outcomes, he added.MARKETPLACEThere are various medication-management technologies on the health IT market today. Some of the vendors of these technologies include Appriss Health, BD, Cureatr, DrFirst, Kit Check, LogicStream Health, Medication Management Partners, Medisafe, Mediware Information Systems and Talyst.MEETING THE CHALLENGEAbout a year ago, Norton implemented Gateway and NarxCare in the departments where opioids are most often prescribed – primary care, emergency, orthopedics and pain management – as well as for the organization’s hospitalists.“Appriss Health had completed numerous successful PDMP integrations for other large health systems using the Epic platform, so the implementation was smooth,” Heilman recalled. €œNow our physicians can access PDMP data as well as actionable information on the patient’s substance use disorder risk at the point of care, just as they would any other EHR information.”This integration with the EHR has made it easier for providers to comply with Kentucky and Indiana mandatory-use laws and has eliminated the need to assign the task of checking PDMPs to a medical assistant, he said.RESULTSThe success metric Norton Healthcare is most proud of is the number of opioids prescribed by providers, which has decreased by 51% since last year.“We have achieved this significant volume reduction despite increasing the number of prescribers in our health system by 100 to 150 each year through acquisition, integration and other clinical staff growth,” Heilman noted.“Using the analytic and reporting tools, for example, we were able to identify protocols among care teams where physicians would prescribe 120 opioid tablets after certain surgical procedures, when only 90 or 60 would suffice,” he said.Reducing the number of prescribed tablets not only decreases the health and safety risks for the patients, it also reduces the availability of tablets that could be sold or stolen in the communities served, he added.“We’re also seeing that our prescribers check the PDMP more often using the Gateway tool,” he said. €œFor example, in June 2020, 850 prescribers accessed Gateway 9,861 times. Just two months later, in August, roughly the same number of prescribers accessed Gateway 12,248 times.”Norton has not yet quantified the time savings due to the integration of the PDMP data within the EHR, but because of the automation afforded by Appriss, Heilman is certain that staff is saving hours each week in time for medical assistants’ who were tasked with querying the PDMP databases.The previous process for accessing PDMP data took about four to five minutes per patient and involved creating a report that needed to be scanned to the patient’s chart.

Now, the process is automatic.ADVICE FOR OTHERS“Integrating PDMP access into providers’ EHR workflow has been a relatively simple and fast way to improve their workflow efficiency while complying with state mandates to check PDMP databases before prescribing or dispensing a controlled substance,” Heilman advised.“More important, though, it has helped us much more easily understand and adjust our physicians’ prescribing behaviors so we can be part of the solution to reduce the availability of prescription opioids in the communities we serve.”Heilman urges other health systems to consider such a solution to help providers identify patients with potential opioid use disorder, or those who are at risk for developing OUD, so they can align them with the appropriate care resources to achieve safe and better outcomes.Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication..

Healthway Medical Corporation Limited (HMC), a private healthcare provider based in Singapore, has announced that its pediatric unit, viagra for men price Singapore Baby low price viagra and Child Clinic has been onboarded onto its proprietary teleconsultation app. HMC said it will integrate further specialist clinics into the app in the months ahead viagra for men price. Island Orthopaedics and the Nobel Group of clinics will also be onboarded in the coming months. The Nobel Group encompasses specialist services such as Psychological Wellness, Gastroenterology and Cardiology.Since its official launch on 15 August 2020, the Healthway Medical app has onboarded 47 viagra for men price of its GP clinics located islandwide.

HIMSS20 Digital Learn on-demand, earn credit, find products viagra for men price and solutions. Get Started >>. HOW IT WORKSWith the app, patients can arrange a video consultation with a doctor up till 1030pm daily, with medication delivered to their viagra for men price doorstep. They can scan a QR code displayed at the registration counter of their regular GP clinic to confirm their details automatically.THE LARGER TRENDAs a result of the ongoing erectile dysfunction treatment viagra, healthcare providers have been ramping viagra for men price up their teleconsultation and telemedicine services.

In May, IHH Healthcare, Asia’s largest privately owned healthcare group, rolled out telemedicine services in Singapore, Malaysia, Turkey, India and Hong Kong, Healthcare IT News reported.In Thailand, private healthcare provider Samitivej Hospital Group, which is owned by Bangkok Dusit Medical Services (BDMS), launched its Virtual Hospital app in March 2019 – the app includes teleconsultation and medicine delivery services. Dr Surangkana Techapaitoon, Deputy CEO viagra for men price of Samitivej and BNH Group of Hospitals &. Director, Samitivej Children’s Hospital, said in the sixth episode of the HIMSS APAC Digital Dialogue Series that the number of patients using the Samitivej Virtual Hospital service increased six fold during the peak of viagra for men price the viagra. ON THE RECORD“The erectile dysfunction treatment viagra has accelerated the adoption and acceptance of telehealth services, particularly catering to those seeking medical assistance for non-erectile dysfunction treatment related concerns.

While teleconsultations cannot replace the necessity of in-clinic care for a range of medical conditions, the provision of teleconsultation services facilitates more efficient doctor-patient interactions, especially when it comes to early diagnosis and preventive viagra for men price care. The ongoing digital transformation of traditional healthcare services will continue to play an important role in providing complementary holistic care for patients in tandem with viagra for men price in-clinic consultations,” said Dr Nelson Wee, Deputy Head of Primary Care of HMC.The U.S. Food and Drug Administration on Thursday convened a public meeting of its Patient Engagement Advisory Committee to discuss issues regarding artificial intelligence and machine learning in medical devices."Devices using AI and ML technology will transform healthcare delivery by increasing efficiency in key processes in the treatment of patients," said Dr. Paul Conway, PEAC chair and chair of policy and global affairs of the American Association of Kidney Patients.As Conway and others noted during the panel, AI viagra for men price and ML systems may have algorithmic biases and lack transparency – potentially leading, in turn, to an undermining of patient trust in devices.

Medical device innovation has already ramped up in response to the erectile dysfunction treatment crisis, with Center for Devices and Radiological Health Director Dr. Jeff Shuren noting that 562 medical devices have already been granted emergency use authorization by the FDA.It's imperative, said Shuren, that patients' needs be considered as part of the viagra for men price creation process."We continue to encourage all members of the healthcare ecosystem to strive to understand patients' perspective and proactively incorporate them into medical device development, modification and evaluation," said Shuren. "Patients are truly the inspiration for all viagra for men price the work we do.""Despite the global challenges with the erectile dysfunction treatment public health emergency ... The patient's voice won't be stopped," Shuren added.

"And if anything, there is even more viagra for men price reason for it to be heard."However, said Pat Baird, regulatory head of global software standards at Philips, facilitating patient trust also means acknowledging the importance of robust and accurate data sets."To help support oru patients, we need to become more familiar with them, their medical conditions, their environment and their needs and wants, to be able to better understand the potentially confounding factors that drive some of the trends in the collected data," said Baird."An algorithm trained on one subset of the population might not be relevant for a different subset," Baird explained. For instance, if a hospital needed a device that would serve its population of seniors at a Florida retirement community, an viagra for men price algorithm trained on recognizing healthcare needs of teens in Maine would not be effective – not every population will have the same needs. "This bias in the data is not intentional, but can be hard to identify," he continued. He encouraged the development of a taxonomy of bias types that would be made viagra for men price publicly available.Ultimately, he said, people won't use what they don't trust.

"We need to use our collective intelligence to help produce viagra for men price better artificial intelligence populations," he said.Captain Terri Cornelison, chief medical officer and director of health of women at CDRH, noted that demographic identifiers can be medically significant due to genetics and social determinants of health, among other factors."Science is showing us that these are not just categorical identifiers but actually clinically relevant," Cornelison said.She pointed out that a clinical study that does not identify patients' sex may mask different results for people with different chromosomes. "In many instances, AI and ML devices may be learning a worldview that is narrow in focus, particularly in the available training data, if the available training data do not represent a diverse set of patients," she said. "More simply, AI and ML algorithms may not represent you if the data do not include you," she viagra for men price said."Advances in artificial intelligence are transforming our health systems and daily lives," Cornelison continued. "Yet despite these significant achievements, most ignore the sex, gender, age, race [and] viagra for men price ethnicity dimensions and their contributions to health adn disease differences among individuals."The committee also examined how informed consent might play a role in algorithmic training.

"If I give my consent to be treated by an AI/ML device, I have the right to know whether there were patients like me ... In the data set," said Bennet Dunlap, viagra for men price a health communications consultant. "I think the FDA should not be accepting or approving a medical device that does not have patient engagement" of the kind outlined in committee meetings, he continued."You need to know what your data is going to be used for," he reiterated. "I have white privilege viagra for men price.

I can just assume old white guys are in viagra for men price [the data sets]. That's where everybody starts. But that should not viagra for men price be the case."Dr. Monica Parker, assistant professor in neurology and education core member of the Goizueta Alzheimer’s Disease Research Center at Emory University, pointed out that diversifying patient data requires turning to trusted entities within communities."If people are developing these devices, in the interest of being more broadly diverse, is there some viagra for men price question about where these things were tested?.

" She raised the issue of testing taking place in academic medical centers or technology centers on the East or West Coast, versus "real-world data collection from hospitals that may be using some variation of the device for disease process.""Clinicians who are serving the population for which the device is needed" provide accountability and give the device developer a better order viagra from canada sense of whom they're treating, Parker said. She also reminded fellow committee members that members of different demographic groups are viagra for men price not a monolith.Philip Rutherford, director of operation at Faces and Voices Recovery, pointed out that it's not just enough to prioritize diversity in data sets. The people in charge of training the algorithm must also not be homogenous."If we want diversity in our data, we have to seek diversity in the people viagra for men price that are collecting the data," said Rutherford.The committee called on the FDA to take a strong role in addressing algorithmic bias in artificial intelligence and machine learning. "At the end of the day, diversity validation and unconscious bias … all these things can be addressed if there's strong leadership from the start," said Conway.

Kat Jercich is senior editor viagra for men price of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.ChristianaCare this week announced the launch of its Home Care Coach, a HIPAA-eligible Alexa Skill aimed at meeting the needs of home health patients.The Home Health Coach, which the Delaware-based health system says was designed in collaboration with frontline caregivers, is a proactive care plan that patients can use through their Alexa smart speaker.WHY IT MATTERSHome healthcare acts as a major part of ChristianaCare's services. According to the organization website, ChristianaCare staff members performed nearly 300,000 home health visits in fiscal year 2019.Of course, the erectile dysfunction treatment viagra inevitably complicates home health care provision, especially because vulnerable members of the community are often the ones relying on it.

The increasing prevalence of voice assistants and smart speakers makes them a natural complement, when available, with other medical treatments.The Home Care Coach's interface, according to ChristianaCare, allows providers to customize patient care plans. The patient can then ask Alexa questions about prescribed medication, exercise, and more, and get personalized prompts.The skill is being launched to select groups of ChristianaCare patients, system representatives said, with plans to expand it in the coming months."Voice assistants are in millions of homes in the U.S.," said Randy Gaboriault, chief digital and information officer at ChristianaCare, in a statement. "By leveraging this technology, we are creating a new model of care within patients’ homes to support the best health outcomes possible."THE LARGER TRENDIntelligence-driven voice assistants have been increasingly leveraged in medical settings, with healthcare organizations relying on Alexa, as well as Apple's Siri and Google Home, to augment patient care.Recently, the Mayo Clinic added a erectile dysfunction treatment specific skill set to Alexa, offering users the latest information on the disease in response to voice commands."For Mayo Clinic, voice technologies allow us to deliver information and care when, where and how people wish to access it," explained Dr. Sandhya Pruthi, a Mayo Clinic physician and medical director for Mayo's health education and content services.

"Accurate, easily accessible information is key to fighting this viagra, and voice technologies are another avenue to get information to the public."ON THE RECORD"Engaging patients digitally is more important than ever right now, as it will help them reach their health goals, improve their experience, and shape the future of health care as we know it," said ChristianaCare President and CEO Dr. Janice E. Nevin in a statement."We have a bold vision of the future," she said. "All care that can be digital will be digital, and all care that can be done in the home or in the community will be done in the home or in the community." Kat Jercich is senior editor of Healthcare IT News.Twitter.

@kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.In 2012, the state of Kentucky passed a law similar to those in many other states requiring physicians prescribing controlled substances to check their state’s prescription drug-monitoring program database. The database enables providers to view a patient’s controlled substance prescription history to identify potential signs of opioid use disorder or doctor shopping.THE PROBLEMKentucky has been particularly hard hit in the opioid epidemic. More than 1,500 Kentuckians die each year from drug overdoses.

A contributor is the state’s opioid prescribing rate, which is 55% higher than the rest of the U.S. HIMSS20 Digital Learn on-demand, earn credit, find products and solutions. Get Started >>. Norton Healthcare is the largest health system in Kentucky, with more than five hospitals and a total of 250 care locations.

Staff members say they have a medical and moral responsibility to serve as leaders in the state’s fight against this crisis.“We’re based in Louisville, which is right on the Indiana border, and serving patients in a metro area spanning two states often means that our physicians are tasked with querying both Kentucky’s PDMP, KASPER, and Indiana’s PDMP, INSPECT, before prescribing controlled substances,” said Dr. Steven Heilman, senior vice president and chief health innovation officer at Norton Healthcare.“This process used to require physicians to log out of our Epic electronic health record and separately open and search within each state’s web-based PDMP database, and then load the results into the patient’s chart.”"It has helped us much more easily understand and adjust our physicians’ prescribing behaviors so we can be part of the solution to reduce the availability of prescription opioids in the communities we serve."Dr. Steven Heilman, Norton HealthcareThis highly manual process took as long as 10 minutes per patient if checking both states’ PDMPs and was a major interruption to physicians’ workflows, so much so that Norton began to assign medical assistants to help with the process and save physicians’ time. Extracting data from these databases to study prescribing patterns among physicians also was time-consuming, but essential if Norton wanted to reduce the volume of opioids in its communities.PROPOSALAn Ohio physician demonstrated medication management and integration IT vendor Appriss Health’s PMP Gateway tool during an Epic users’ conference, and Heilman was immediately intrigued.“Gateway enables physicians to automatically query the PDMP database from within the EHR workflow when a controlled substance prescription is ordered or at any other time,” he said.“This alleviates the need to exit the EHR and log in to a separate application.

I realized this would help us realize efficiencies. For example, we would no longer need to delegate a medical assistant to query PDMP databases, as physicians would be able to manage this themselves during their workflow.”Another Appriss Health tool, NarxCare, uses advanced analytics to provide an immediate, point-of-care analysis of a patient’s risk for substance use disorder and other information in a visually interactive format that supports prescribers’ rapid comprehension and decision-making.“We also learned of the analytics tools that, due to the integration with Epic, would enable us to easily generate reports on physician-controlled substance prescribing behaviors, which can be used to support provider outreach and education,” Heilman explained.He presented the Appriss Health tools to Norton’s Narcotics Matrix Committee, which works to address and define Norton Healthcare’s prescribing levels and patterns and to identify areas for improvement.The committee members and other Norton Healthcare leaders understood that providing clinicians with access to the right data using Appriss Health solutions could impact overall prescribing levels and improve patient outcomes, he added.MARKETPLACEThere are various medication-management technologies on the health IT market today. Some of the vendors of these technologies include Appriss Health, BD, Cureatr, DrFirst, Kit Check, LogicStream Health, Medication Management Partners, Medisafe, Mediware Information Systems and Talyst.MEETING THE CHALLENGEAbout a year ago, Norton implemented Gateway and NarxCare in the departments where opioids are most often prescribed – primary care, emergency, orthopedics and pain management – as well as for the organization’s hospitalists.“Appriss Health had completed numerous successful PDMP integrations for other large health systems using the Epic platform, so the implementation was smooth,” Heilman recalled. €œNow our physicians can access PDMP data as well as actionable information on the patient’s substance use disorder risk at the point of care, just as they would any other EHR information.”This integration with the EHR has made it easier for providers to comply with Kentucky and Indiana mandatory-use laws and has eliminated the need to assign the task of checking PDMPs to a medical assistant, he said.RESULTSThe success metric Norton Healthcare is most proud of is the number of opioids prescribed by providers, which has decreased by 51% since last year.“We have achieved this significant volume reduction despite increasing the number of prescribers in our health system by 100 to 150 each year through acquisition, integration and other clinical staff growth,” Heilman noted.“Using the analytic and reporting tools, for example, we were able to identify protocols among care teams where physicians would prescribe 120 opioid tablets after certain surgical procedures, when only 90 or 60 would suffice,” he said.Reducing the number of prescribed tablets not only decreases the health and safety risks for the patients, it also reduces the availability of tablets that could be sold or stolen in the communities served, he added.“We’re also seeing that our prescribers check the PDMP more often using the Gateway tool,” he said.

€œFor example, in June 2020, 850 prescribers accessed Gateway 9,861 times. Just two months later, in August, roughly the same number of prescribers accessed Gateway 12,248 times.”Norton has not yet quantified the time savings due to the integration of the PDMP data within the EHR, but because of the automation afforded by Appriss, Heilman is certain that staff is saving hours each week in time for medical assistants’ who were tasked with querying the PDMP databases.The previous process for accessing PDMP data took about four to five minutes per patient and involved creating a report that needed to be scanned to the patient’s chart. Now, the process is automatic.ADVICE FOR OTHERS“Integrating PDMP access into providers’ EHR workflow has been a relatively simple and fast way to improve their workflow efficiency while complying with state mandates to check PDMP databases before prescribing or dispensing a controlled substance,” Heilman advised.“More important, though, it has helped us much more easily understand and adjust our physicians’ prescribing behaviors so we can be part of the solution to reduce the availability of prescription opioids in the communities we serve.”Heilman urges other health systems to consider such a solution to help providers identify patients with potential opioid use disorder, or those who are at risk for developing OUD, so they can align them with the appropriate care resources to achieve safe and better outcomes.Twitter. @SiwickiHealthITEmail the writer.

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