By B. Ernesto. Westminster Theological Seminary.

Several of the more well known indicator initiatives are sum- marized below generic azulfidine 500mg without a prescription. Minimum Data Set The idea of creating a small set of indicators that captures the essential aspects of any healthcare experience is very appealing discount azulfidine 500 mg fast delivery. As healthcare has become more complex generic azulfidine 500mg with mastercard, the idea of a minimum data set (MDS) has gained even more appeal than it had when it was first introduced in the late 1960s azulfidine 500 mg online. What started as a general concept has emerged buy azulfidine 500 mg with amex, over time, into a variety of specific data sets. MDSs have been proposed for everything from inpatient services to ambulance services. The basic idea behind an MDS is that a The Search for A Few Good Indicators 91 small core set of indicators is defined and used for mandatory collection and reporting at the state, regional, or national level. The basic problem with implementing this concept, however, is that agreement on what con- stitutes a minimum set of indicators has been elusive. The other major challenge has been determining who will be the end user of the MDS. Providers have different data needs than policymakers, and both groups have different needs than the purchasing managers of large corporations or the public. In the long and interesting history associated with the development of MDSs, several key developments and structures deserve to be mentioned. In 1969, the National Committee on Vital and Health Statistics developed the first formal outline for an MDS for hospital discharge data elements. This led to the creation of the Uniform Hospital Abstract Minimum Data Set in 1973. The Uniform Hospital Discharge Data Set (UHDDS) emerged in the early 1970s as the standard MDS referent for hospital-based services. The 14 data elements contained in the original UHDDS were then used to create the first Uniform Bill (UB) for hospital services, popularly known as UB-82 (82 refers to 1982, when the structure of the UB was first accepted). This one-page form contains 86 fields, some of which allow for multiple entries or subcategories. While UB-92 is used primarily for pro- cessing Medicare claims, the format has been adopted by other groups (e. The elements included in UB-92 were determined by the National Uniform Billing Committee (NUBC),1 which was established in 1975. Each state has its own UBC that can recommend limited revisions to UB-92. In terms of physician billing, the CMS-1500 form (originally called HCFA-1500) is the standard reference. This form was last revised in 1992 and is accepted by nearly all insurance plans. An area that has been particularly active has been the nursing profession. Today, the Nursing Management Minimum Data Set is undergoing research and development (Huber et al. The most recent development in this area is being sponsored by the Agency for Healthcare Research and Quality (AHRQ). Department of Health and Human Services, has been charged by Congress to report annually on the status of healthcare quality in the United States. The National Healthcare Quality Report is the structure for reporting on a broad set of performance and 92 The Healthcare Quality Book outcome indicators believed to measure the current quality of healthcare services. Long-Term Care MDS CMS has been involved with the development of several MDSs that are tied directly to reimbursement and used to evaluate the quality of care. One of the better known of these data sets is the Long Term Care Resident Assessment Instrument (RAI) MDS (version 2. The four-page assessment form used to capture the core set of data elements contains more than 72 fields that have to be completed on every patient four times each year. While this data set is referred to as an MDS, ironically, the completion of these forms has placed additional data collection burdens on most facili- ties. Yet, Chapter 1 of the RAI manual states that The RAI should not be, nor was it ever meant to be, an additional burden for nurs- ing facility staff.

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Your mobility is ideal if your forearm forms a straight line with your upper arm cheap 500mg azulfidine overnight delivery. If you cannot quite straighten out your elbow cheap 500mg azulfidine amex, chances are you have a congenital condition that is very unlikely to be corrected cheap azulfidine 500 mg line. It is interesting that the powerlifting rules specify that a competitor who cannot lock out his elbows because of his bone structure is supposed to notify the officials before the meet cheap azulfidine 500mg on-line. Otherwise the lifter will get red lighted on the bench press for failing to lock out and complete the lift cheap azulfidine 500mg free shipping. If, on the other hand, your elbows bend back beyond a straight line with the upper arms, you have a problem that can and should be fixed. Strength exercises, for example pushups, various presses, and supports such handstands, will help. Lay your forearm flat on a table in front of you, a ninety-degree angle in your elbow. You should be able to lay your palm flat, then turn your forearm from inside out and rest the back of your palm on the surface. If you flex your wrist actively, that is only using muscular effort, without any pressure from the other arm or any other object, the hand should be perpendicular to the forearm. To check your wrist extension, or back bending, assume the pushup position. Your forearms should remain vertical while your palm is flat on the floor and your elbows are locked. Adduct your wrist, that is bend it toward the forearm on the little finger side while keeping your fingers straight. The first joint of the thumb should fall in line with the tip of the elbow. Lie on your back and flex your hip, that is bring your knee towards you chest. I believe this test to be unacceptably dangerous and propose that you test yourself seated on the floor instead. Spread your straight legs as wide as possible, then spread your arms and note how far out are the insides of your feet relative to your fingertips. Rotate your hip or turn your straight leg clockwise and then counterclockwise while standing in the snow or sand. Ideally a knee should straighten out to the point where the shin and the thigh form a straight line. Side to side movements of the shin relative to the knee and its rotation are normally very limited but still important to the health of your legs. Because the menisci and the ligaments are highly vulnerable in these planes of loading, Russian specialists such as Vladimir Petrov usually do not recommend direct mobility training. In place of specific mobility training— involving tibia rotation, adduction, and abduction—they encourage walking and jogging on uneven surfaces, especially barefoot. They also recommend games that require frequent change of direction such as soccer, squats and lunges with weights, cross-country skiing, and hiking with a backpack. Russian scientists warn that you cannot fix bowleggedness unless it was taken care of at an early age. People who suffer from it are especially prone to injuries from various jumps. Receiving expert coaching in depth jumping from a sky diving instructor is encouraged. Gentlemen, even though ladies generally have 20–25% percent better joint mobility than you, do not use this fact as an excuse to be stiff as an Apollo astronaut in a Moon suit. Do not bounce, especially when it concerns your spine; control your movements. If this is too ambitious for you add five a week for the first month and then start adding ten reps a week until the target number is reached. All the required repetitions do not have to be done back to back; you may reach you goal in multiple sets if you need the rest. Teenagers and pre-teens do not need to bother with these joint mobility drills; go straight to the Part Two exercises, Strength-Flexibility Plus More Joint Mobility. Spine rotation After these deceptively simple moves were featured in my first book Beyond Stretching I received many letters from grateful readers whose bad necks got a lot better. Tilt your head strictly to one side without twisting, then to the other side.

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The children were between 4-14 years old buy 500 mg azulfidine mastercard, with an average age of nine years old cheap azulfidine 500 mg line. The course of disease was between six months Chinese Research on the Treatment of Pediatric Enuresis 129 and one year in 52 cases discount azulfidine 500mg overnight delivery, 1-3 years in 33 cases discount azulfidine 500mg line, and more than three years in three cases buy discount azulfidine 500mg on-line. In those with a long course of disease, the patient may also have had a devitalized essence spirit, poor appetite, and an emaciated body. One case had consumption of the lumbar vertebrae, and the other case had enuresis since suffering an injury to the spine. Treatment method: Acupuncture was given at Ji Men (Sp 11) located six inches above Xue Hai (Sp 10). The needles were retained for 30 minutes and restimulated every five minutes. This treatment was repeated every day for seven days which equaled one course of treatment. Yang says Ji Men has the abili- ty to regulate the latter heaven root or spleen as well as the ability to supplement the former heaven root or kidneys. From On Using Acupuncture Before Sleep to Treat 84 Cases of Stubborn Enuresis by Yang Yuan-de, Shan Xi Zhong Yi (Shanxi Chinese Medicine), 1989, #11, p. Twelve of these cases were between 5-7 years old, 29 cases were between 8-10 years old, 35 cases were between 11- 15 years old, and eight cases were between 16-18 years old. The 130 Treating Pediatric Bed-wetting with Acupuncture & Chinese Medicine course of disease ranged from 2–15 years. Patients were only included in this study if they had previously been treated with herbal medicine or acupuncture-moxibustion without success. Treatment method: The main acupoints in this protocol consisted of: Zhong Ji (CV 3) San Yin Jiao (Sp 6) Auxiliary points included: Da He (Ki 12) Bai Hui (GV 20) Tai Xi (Ki 3) Treatment was given 1-2 hours before sleep. The points were stimulated every five minutes using the supplementation method. Therefore, the total cure rate was 100% and there were no recurrences in any of these cases at six month and one year follow-up visits. Discussion: According to the Chinese author, the treatment principles that should be used to treat enuresis are to supplement and boost the kidney qi and secure and constrain the lower origin. The author recommended to not retain the needles for very long (10-15 min- utes) and to stimulate the needles once every five minutes. Zhong Ji is the intersection point of the conception vessel and the three yin channels of the legs and is also the alarm point of the bladder. Da He is an important point on the kidney channel locat- ed on the abdomen. If the patient felt a sensation radiate to the genital area when these points were stimulated, there was a bet- ter clinical effect. San Yin Jiao is an important point on the spleen channel but is also the intersection point of the three yin channels of the leg. This point is useful in treating diseases of the urinary system of both men and women and is frequently used in the Chinese Research on the Treatment of Pediatric Enuresis 131 treatment of stubborn enuresis. From Acupuncture of Chang Qiang (GV 1) as the Main Method for Treating Enuresis by Ye Chang-qing, Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine), 1991, #1, p. Treatment method: The main point in this protocol was Chang Qiang (GV 1). Additional points were divided into two groups which were used alternatingly. Ba Liao (Bl 31-34), Shen Shu (Bl 23), and San Yin Jiao (Sp 6) All points were stimulated with even supplementing-even draining technique or electroacupuncture. Treatment was given every day or every other day, and 7-10 days equaled one course of treatment. Study outcomes: After 1-3 courses of treatment, 90 cases were cured, 32 cases improved, and 14 cases did not improve. From Observations on & Results of Using the Method of Moxibustion to Treat 430 Cases of Pediatric Enuresis by Li Guo-shi et al. All 430 cases had enuresis for more than three months, and all cases manifested with scanty intake of food and fluids, emaciation, and poor memory. Treatment method: Acupoints moxaed in this protocol consisted of: Shen Shu (Bl 23) Pang Guang Shu (Bl 28) Ji Men (Sp 11) San Yin Jiao (Sp 6) The above points were moxaed with a moxa pole composed of: Ai Ye (Folium Artemisiae Argyii), 500g Chen Xiang (Lignum Aquilariae), 50g Ru Xiang (Olibanum), 50g Chuan Shan Jia (Squama Manitis), 50g Rou Gui (Cortex Cinnamomi), 50g Ren Shen (Radix Ginseng), 50g She Xiang (Moschus), a small, unspecified amount After the moxa pole was lit, it was held above the region of the acupuncture point. Moxibustion was done each night before bed, and five times equaled one course of treatment.

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