This article summarizes an industrial rehabilitation company called Rehab At Work that offers both physical and occupational therapy services. It discusses the company's history starting in 1990 focusing only on occupational therapy, and expanding to add physical therapy in 1994. Currently they have 9 clinics across Maryland and Virginia treating a diverse population of injured workers. The CEO discusses the rewards and challenges of working in this specialty area of returning injured workers to their jobs.
Hospitals and health systems are taking a leading role in population health, by packaging
healthcare solutions — from employee wellness services to full-service health plan
management — and selling them to companies and businesses in their market area. This article details four healthcare systems – all succeeding with different employer programs.
Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Communique is created by Anesthesia Business Consultants (ABC), the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions.
Please send your email address to info [at] anesthesiallc [dot] com if you would like to join the Communique mailing list!
Visit www.anesthesiallc.com for more information!
Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Communique is created by Anesthesia Business Consultants (ABC), the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions.
Please send your email address to info [at] anesthesiallc [dot] com if you would like to join the Communique mailing list!
Visit www.anesthesiallc.com for more information!
Hospitals and health systems are taking a leading role in population health, by packaging
healthcare solutions — from employee wellness services to full-service health plan
management — and selling them to companies and businesses in their market area. This article details four healthcare systems – all succeeding with different employer programs.
Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Communique is created by Anesthesia Business Consultants (ABC), the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions.
Please send your email address to info [at] anesthesiallc [dot] com if you would like to join the Communique mailing list!
Visit www.anesthesiallc.com for more information!
Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Communique is created by Anesthesia Business Consultants (ABC), the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions.
Please send your email address to info [at] anesthesiallc [dot] com if you would like to join the Communique mailing list!
Visit www.anesthesiallc.com for more information!
The core of Telemecanique Sensors' offer in one place: limit switches, pressure switches, proximity sensors, inductive, ultrasonic, photoelectric sensors
Respond to 2 students DQ 275 words and 1 reference eachOriginal .docxmackulaytoni
Respond to 2 students DQ 275 words and 1 reference each
Original DQ... DUE 6-15-2016 7:00 p.m EST
Explain the difference between
pre
-service, point-of-service, and after-service. What elements are central to each? Provide an example of how an organization might create a competitive advantage in each of these areas...
(REMINDER) IN HEALTHCARE
Additional Topics (Team Meetings in a clinic) (Quality Improvement in Health Care) (National Health care Quality)
Student 1
he elements of p
re-service, point of service, and after service are
crucial
elements
in all lines of business. It is important for a business to
continuously
create an
experience
for the client in all stages of service. These stages are essential in not only
ensuring
organizational success but also ensuring that customer satisfaction is upheld. The largest factor In how successful an organization is depend on how happy their consumer base is with the experience received, prior to, during, and after the services were
comple
ted
. According an article in
Forbes
Magazine
, Customer
experience
has reached a level in which it is now more important than the products being sold and can even be a key factor in the marketing of a brand. (Newman, n.d.)
Pre
service care pertains to all planning stages of the organization.
This encompasses all aspects from
marketing, products and services provided, market research, understanding the client base as well as the area in which the products are to be provided. This is one of, if not, the most important
aspect of these elements. It is not only important to ensure that the products and or services provided are of the highest quality, but also that there is a need for them. This idea of a
competitive
advantage is a key
factor in the success of an organization and this is when the
pre
service planning come into play. According to the article
Startup Location Is Still A Critical Success Factor:
"
Even in this age of
globalization
and
virtualization
, the geographic area where you choose to live and work can still make or break your startup business."(
Zwilling
,
n.d.)
Meaning that it is important for a company to understand the market in which they
w
ish
to serve in order to assure that they are serving the correct client base and remain
competitive
in their market
.
P
oint
of service could translate to p
ost
service care which pertains to the care received at the time the patient is seen. This is reflected in the customers satisfaction with the experience received, a direct reflection of the customer service as well as the
techniques
that are used. Quality of care
provided by
healthcare
professionals, a
nd
thus
received
by patients, can be a make or break factor in the success of a firm. According to
Quality of Care Information Makes a
Difference,
"Quality
report cards are becoming increasingly more common and receive much publicity. They can have significant impact on competition among prov.
Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Communique is created by Anesthesia Business Consultants (ABC), the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions.
Please send your email address to info [at] anesthesiallc [dot] com if you would like to join the Communique mailing list!
Visit www.anesthesiallc.com for more information!
The core of Telemecanique Sensors' offer in one place: limit switches, pressure switches, proximity sensors, inductive, ultrasonic, photoelectric sensors
Respond to 2 students DQ 275 words and 1 reference eachOriginal .docxmackulaytoni
Respond to 2 students DQ 275 words and 1 reference each
Original DQ... DUE 6-15-2016 7:00 p.m EST
Explain the difference between
pre
-service, point-of-service, and after-service. What elements are central to each? Provide an example of how an organization might create a competitive advantage in each of these areas...
(REMINDER) IN HEALTHCARE
Additional Topics (Team Meetings in a clinic) (Quality Improvement in Health Care) (National Health care Quality)
Student 1
he elements of p
re-service, point of service, and after service are
crucial
elements
in all lines of business. It is important for a business to
continuously
create an
experience
for the client in all stages of service. These stages are essential in not only
ensuring
organizational success but also ensuring that customer satisfaction is upheld. The largest factor In how successful an organization is depend on how happy their consumer base is with the experience received, prior to, during, and after the services were
comple
ted
. According an article in
Forbes
Magazine
, Customer
experience
has reached a level in which it is now more important than the products being sold and can even be a key factor in the marketing of a brand. (Newman, n.d.)
Pre
service care pertains to all planning stages of the organization.
This encompasses all aspects from
marketing, products and services provided, market research, understanding the client base as well as the area in which the products are to be provided. This is one of, if not, the most important
aspect of these elements. It is not only important to ensure that the products and or services provided are of the highest quality, but also that there is a need for them. This idea of a
competitive
advantage is a key
factor in the success of an organization and this is when the
pre
service planning come into play. According to the article
Startup Location Is Still A Critical Success Factor:
"
Even in this age of
globalization
and
virtualization
, the geographic area where you choose to live and work can still make or break your startup business."(
Zwilling
,
n.d.)
Meaning that it is important for a company to understand the market in which they
w
ish
to serve in order to assure that they are serving the correct client base and remain
competitive
in their market
.
P
oint
of service could translate to p
ost
service care which pertains to the care received at the time the patient is seen. This is reflected in the customers satisfaction with the experience received, a direct reflection of the customer service as well as the
techniques
that are used. Quality of care
provided by
healthcare
professionals, a
nd
thus
received
by patients, can be a make or break factor in the success of a firm. According to
Quality of Care Information Makes a
Difference,
"Quality
report cards are becoming increasingly more common and receive much publicity. They can have significant impact on competition among prov.
Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Communique is created by Anesthesia Business Consultants (ABC), the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions.
Please send your email address to info [at] anesthesiallc [dot] com if you would like to join the Communique mailing list!
Visit www.anesthesiallc.com for more information!
The Sustainable Health Care Facility of the FutureTextbooks H.docxchristalgrieg
The Sustainable Health Care Facility of the Future
Textbooks:
Hayward, C. (2006). Healthcare Facility Planning: Thinking Strategically. Chicago, IL: Health Administration Press.
Vickery, C.G., Nyberg, G., & Whiteaker, D. (2015). Modern Clinic Design: Strategies for an Era of Change. Hoboken, NJ: Wiley.
Instructions: Please ensure to substantiate your response with scholarly sources and/or also a personal account of your own experience in the work place or personal life. Cite and reference work! Must be 150 -200 word count.
What reactions do you have to the ideas they presented? Include examples from the course readings or your own experience to support your perspective, and raise questions to continue the dialogue. 100 to 150 words for questions 1, 2, 6, 9, 10 & 11.
1. I agree that the changes made with CMS (center for Medicare and Medicaid Services) how changed the guidelines for how providers can bill for services. One of the biggest changes was the upgrade of ICD codes which has expanded enormously to be more specific with diagnosis and services to bill for. I work for a program of hospice, called palliative care, and the change over from using ICD9 codes to ICD10 was a very large task that took time to switch over to but I have come to realize that changes in health care are inevitable and to be prepared for things to change constantly. With being a palliative care program I don't think the change was as big of an impact on us like I'm sure it was for a hospital. Our program provides education on disease progress for chronic illnesses such a chronic kidney disease, hypertension, diabetes, cancer, heart disease and so on. The amount of ICD 10 codes we use are minimal compared to what a hospital would see. Nonetheless the codes are way more specific now which can be challenging when trying to narrow down for accuracy.
2. I think training and feedback are two important aspects of implementing electronic medical records. The users are the most important stakeholders and they should be trained properly. Their feedback should be taken seriously as this helps with post implementation changes to the system. No one likes changes but change in any organization is essential. Technology has completely transformed the health care industry and from my experience resistance typically comes from the older generation who doesn't really understand the importance. Most are used to doing things manually. Most organizations are turning to the technology to transform their environment by cutting costs and ensuring that their revenues are coming in timely.
3. Open your web browser and search for videos, articles and other resources discussing the health care system in the United States. Look for new trends, current issues affecting the health care system, etc.
4. Discuss your findings with the class
5. As a healthcare leader, you will need to have a strong base with understanding healthcare systems. Where will health care be delivered in the future? ...
CBIZ's very own Todd Hanson is featured in the November edition of the Minneapolis St. Paul Business Journal. Read the panelists' expert opinions about current issues surrounding health care including benefits, mobile health, health education, aca compliance, and more!
Panelists include Todd Hanson, director of client services at CBIZ Benefits & Insurance Services; Jesse Berg, an attorney specializing in health care law at Gray Plant Mooty; John Soshnik, a partner in the health law group at Lindquist & Vennum; Becca Miller, director of employer solutions at Capella Education Co.; and Steven Rush, director of health literacy innovations at UnitedHealth Group Inc. Allison O’Toole, interim CEO at MNsure, served as moderator.
assignment 1IntroductionMidtown Neurology was started by a si.docxsalmonpybus
assignment 1
Introduction:
Midtown Neurology was started by a single physician who had been practicing in the community for nearly twenty years. As the practice grew, it evolved from a “mom-n-pop” operation to a more complex model. The founding physician recruited four new neurologists to join and continue to help build the practice. Subsequently, however, the new doctors took over and forced him out of the practice.
Tasks:
Case Study Six: From Nothing to Something: Defining Governance and Infrastructure in a Small Medical Practice
Read the above case study; your task would be to evaluate this case study utilizing the format below. Make sure to include at least two scholarly/peer-reviewed articles to help support your evaluation.
Case Study Evaluation
· Prepare a written report of the case using the following format:
· Background Statement: What is going on in this case as it relates to the identified major problem?
· What are (only) the key points the reader needs to know in order to understand how you will “solve” the case?
· Summarize the scenario in your own words—do not simply regurgitate the case. Briefly describe the organization, setting, situation, who is involved, who decides what, etc. Specifically identify the major problems and secondary issues.
· What are the real issues? What are the differences? Can secondary issues become major problems?
· Present an analysis of the causes and effects.
· Fully explain your reasoning. Declare your role in a sentence or a short paragraph explaining from which role you will address the major problem and whether you are the chief administrator in the case or an outside consultant called in to advise.
· Regardless of your choice, you must justify in writing as to why you chose that role. What are the advantages and disadvantages of your selected role? Be specific.
· Recognize the strengths and weaknesses of the organization.
· Identify the strengths and weaknesses that exist in relation to the major problem. Again, your focus here should be in describing what the organization is capable of doing (and not capable of doing) with respect to addressing the major problem. Thus, the identified strengths and weaknesses should include those at the managerial level of the problem. For example, if you have chosen to address the problem from the departmental perspective and the department is understaffed, that is a weakness worthy of mentioning. Be sure to remember to include any strengths/weaknesses that may be related to diversity issues.
· Find out alternatives and recommend a solution.
· Describe the two to three alternative solutions you came up with. What feasible strategies would you recommend? What are the pros and cons? State what should be done—why, how, and by whom. Be specific. Evaluate how you would know when you’ve gotten there. There must be measurable goals put in place with the recommendations. Money is easiest to measure; what else can be measured? What evaluation plan would you put in plac.
assignment 1IntroductionMidtown Neurology was started by a si.docxbraycarissa250
assignment 1
Introduction:
Midtown Neurology was started by a single physician who had been practicing in the community for nearly twenty years. As the practice grew, it evolved from a “mom-n-pop” operation to a more complex model. The founding physician recruited four new neurologists to join and continue to help build the practice. Subsequently, however, the new doctors took over and forced him out of the practice.
Tasks:
Case Study Six: From Nothing to Something: Defining Governance and Infrastructure in a Small Medical Practice
Read the above case study; your task would be to evaluate this case study utilizing the format below. Make sure to include at least two scholarly/peer-reviewed articles to help support your evaluation.
Case Study Evaluation
· Prepare a written report of the case using the following format:
· Background Statement: What is going on in this case as it relates to the identified major problem?
· What are (only) the key points the reader needs to know in order to understand how you will “solve” the case?
· Summarize the scenario in your own words—do not simply regurgitate the case. Briefly describe the organization, setting, situation, who is involved, who decides what, etc. Specifically identify the major problems and secondary issues.
· What are the real issues? What are the differences? Can secondary issues become major problems?
· Present an analysis of the causes and effects.
· Fully explain your reasoning. Declare your role in a sentence or a short paragraph explaining from which role you will address the major problem and whether you are the chief administrator in the case or an outside consultant called in to advise.
· Regardless of your choice, you must justify in writing as to why you chose that role. What are the advantages and disadvantages of your selected role? Be specific.
· Recognize the strengths and weaknesses of the organization.
· Identify the strengths and weaknesses that exist in relation to the major problem. Again, your focus here should be in describing what the organization is capable of doing (and not capable of doing) with respect to addressing the major problem. Thus, the identified strengths and weaknesses should include those at the managerial level of the problem. For example, if you have chosen to address the problem from the departmental perspective and the department is understaffed, that is a weakness worthy of mentioning. Be sure to remember to include any strengths/weaknesses that may be related to diversity issues.
· Find out alternatives and recommend a solution.
· Describe the two to three alternative solutions you came up with. What feasible strategies would you recommend? What are the pros and cons? State what should be done—why, how, and by whom. Be specific. Evaluate how you would know when you’ve gotten there. There must be measurable goals put in place with the recommendations. Money is easiest to measure; what else can be measured? What evaluation plan would you put in plac ...
Running Head Organization and Management of a Health Care Facilit.docxtoltonkendal
Running Head: Organization and Management of a Health Care Facility
Running Head: Organization and Management of a Health Care Facility
Organization and Management of a Health Care Facility
Introduction
The organization that a health care facility can distinguish will determine its potential success and the longevity of that success because preparation, patience and organization are vital. Health care facilities are constantly changing, advancing and revamping. With this being a known unknown there is a major need for organization throughout the entire infrastructure of the organization. Organization is highly important because it allows for facilities to function and run smoothly with little to no confusion within each department acting as a well-oiled machine (Cruz, 2013 p.472). It is very difficult for a facility or organization to protect and flourish if there is no structure present. After witnessing first-hand the lack of proper structure and management take place, this caused a great deal of confusion from the upper management as they could not decipher the numerous departments’ primary responsibilities and this took a huge toll on their success. This particular lack of structure can and will decide an organizations fate if not fixed immediately. Healthcare facilities management must be in a sense bulletproof because of the many adversities which can and will arise as the healthcare realm changes. The healthcare realm changes and overlaps its previous methods for rules and regulations. This comes about due to the constant need for revitalization within the healthcare realm. If a facility lacks organization there is no structure and no sense of direction it will most likely fail. Of course there are spurts of success and lagging success for every healthcare facility today. But the elite healthcare facilities always find a way to revamp and restructure in order to flourish. The most important entity any facility or organization can acquire is the loyalty of its consumers. Loyalty has been proven to provide not only success but longevity of success for healthcare facilities and if health providers implement this type of atmosphere success is prominent.
Hospital Organizational Structure
In today’s’ world there is a major need for organizational structure, rules and regulations that not only govern the conduct within an organization but also protects customers’ rights and interests. The structuring of a hospital needs to be configured in a strategic way that will benefit all of its occupants regardless of what their economic and ethnic background might be. Without proper structure and legislation it’s highly difficult for a hospital to thrive within the healthcare realm. One will be able to recognize by the end of this reading a well-organized structured system for any hospital organization to thrive for many years to come and that is due to the proper planning, methods and steps that are outlined to const ...
Former police officer Don McMullin survived a gunshot to the head, persevered through intense rehabilitation, and became a physical therapist assistant.
The University of Scranton opens a state-of-the-art learning center to house its occupational therapy, physical therapy, and exercise science programs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. [ cover story ]
Maryland-based industrial
rehab company offers PT and
OT services under one roof
By Brian W. Ferrie
Maryland-based industrial
rehab company offers PT and
OT services under one roof
By Brian W. Ferrie
8 ADVANCE for Occupational Therapy Practitioners
3. W
hen therapists in other specialties think of indus-
trial rehab, a couple preconceived notions might
come to mind. First is a patient population com-
prised of burly blue-collar workers who have sus-
tained injury due to heavy lifting. Second is a perception those
patients could lack motivation to get back on the job because they’d
rather enjoy worker’s compensation benefits.
Julie Milanick Howar, OTR/L, CWA, CWT, CES, strongly dis-
putes both notions. And with more than 25 years of industrial
rehab experience, she has plenty of credibility on the matter. Howar
became an OT in 1981, started specializing in industrial rehab in
1985, then cofounded an OT practice focused on industrial rehab in
1990 in Germantown, MD.
“When my original partner and I founded that practice, it had no
outpatient physical therapy component,” she told ADVANCE. “Our
role in the continuum of care was confined to when a patient had
already received acute physical therapy and increased his strength
and flexibility, but it still wasn’t known whether he could go back
to work. We were the next piece of the puzzle for a person to return
to work full-time.”
Howar and her partner would evaluate patients at that point,
using the extensive space and distinctive equipment available in
their clinic to help make a determination.
“On-site we had cinder blocks, wheelbarrows, hand trucks, dry-
wall and all kinds of machinery to help rehabilitate a person back
to work, which most physical therapy offices didn’t have. So we
made a marketing decision in 1990 for that to be our niche because
there were already so many physician-owned physical therapy ser-
vices in the area. If we went to a physician to market that we could
take care of his patients, of course he’d just want to keep them in
his practice for acute rehab.”
Branching Out
By 1992, Howar and her partner moved to another space in near-
by Rockville, MD, outside Washington, DC. Then in 1994, a couple
pivotal developments occurred. The first was Howar’s partner de-
ciding she wanted to leave the business and become a full-
time mom. Second, Howar chose to add physical therapy to her
clinic’s services due to a changing economic climate. Thus, Rehab
At Work was born.
“In the four years since we started that practice, the number of
physician-owned PT clinics in the county had greatly decreased,”
Howar remembered. “Because of that, it made sense to offer PT so
we could take care of an injured worker through the whole con-
tinuum. From right after injury with physical therapy that would
look at function, then on to a functional capacity evaluation and
work hardening or work conditioning if needed.”
Explosive growth quickly followed. By 1995, Howar added a sec-
ond Rehab At Work location. Within another five years, the Rehab
At Work brand had grown to include nine total clinics, including
seven in Maryland and two in Virginia.
“The theory at that time was grow or go, because there were
large national competitors coming into the area,” Howar explained.
“And if you’re going to market to an insurance company or case
manager that you can take care of their injured worker, it makes
sense to say you can also take care of other injured workers who
live or work in other counties.”
The years since have been dedicated to growing those nine clin-
ics, each with its own distinctive patient population.
“We get different kinds of occupations at different centers,”
Howar explained. “For example, when you think of Washington,
DC, which Rockville is suburban to, you don’t think of factory
workers. You think of attorneys, lobbyists and more sedentary jobs.
On the other hand, our office in Alexandria, VA, gets a lot of air-
line workers because it’s very close to Ronald Reagan Washington
National Airport. Our Frederick, MD, office tends to see many cli-
ents from a nearby hospital, such as injured nurses or nurse assis-
tants. The Rockville clinic also has a good working relationship
with the police and firemen in Montgomery County. Baltimore
is more of an industrial city so our Baltimore clinic tends to see
many of those types of injuries. There really is quite a mix based
on where the center is and that local economy.”
PT Perspective
Nathan Paraska, MPT, director of physical therapy services for
Rehab At Work, echoed Howar’s sentiments about patient diversity.
“I can honestly say there isn’t one type of injury or worker that
we see all the time,” he told ADVANCE. “We see it all. And when
I come into work tomorrow, I’ll probably see something I’ve never
seen before.”
Paraska has been with Rehab At Work since becoming a PT in
2001.
“I was actually looking for an outpatient orthopedic position
when I first came out of PT school,” he related. “But I graduated in
2001 and at that time, I think anybody in the field would remember
there weren’t a huge number of jobs available. So I found a posi-
tion with this company. I was intrigued by the specialty but hadn’t
learned much about it in school. Since then, I’ve really enjoyed it.
Either it fits you or it doesn’t, but the people who really like this
type of work tend to stick around and make a profession out of
it. You really do have to be an expert to work with this popula-
tion on a regular basis. But once you become an expert, it can be
very satisfying.”
Paraska has certainly proven himself worthy, rising in short
order from staff PT to a management role overseeing one clinic and
then a regional management role supervising two clinics. His pro-
motion to director of PT services for the entire company occurred
about a year ago. 8
Rehab At Work CEO Julie Milanick Howar, OTR/L, CWA, CWT, CES,
and Kristina Kline, OT, work with patient Marion Sterrett. With nine
clinics in Maryland and Virginia, Rockville, MD-based Rehab at Work
specializes in treating injured workers throughout the continuum of
care and returning them to work.
KyleKielinski
9ADVANCE for Occupational Therapy Practitioners
4. [ Cover Story ]
“That’s my new fancy title,” he laughed. “Basically I have a qual-
ity assurance role with respect to our clinical services. So my job
is to maintain appropriate company standards and our license
requirements for all nine clinics. To make sure we’re doing the
best we can on a clinical level.”
Overall, Rehab At Work employs about 50 people, Howar said.
That includes 13 physical therapists, three occupational thera-
pists, eight PTAs and three exercise physiologists, as well as office,
human resources and financial staff. Howar estimated that 70 per-
cent of the business comes from worker’s compensation/injured
worker cases and the other 30 percent from outpatient orthopedic
physical therapy.
Specialty Appeal
So what attracted Howar to this specialty in the first place?
“At one point in my life, I sustained a head injury and had diffi-
culty working,” she related. “That made me realize how important
work is to a person. Second, industrial rehab really pulls together
both parts of occupational therapy—the psychosocial/behavioral
aspect as well as the physical disability. Third, I think it offers a
little more variety in terms of interaction. For example, an OT in
a hospital or school system might work with an on-site team that
only includes a PT and speech therapist, with an occasional call to
a physician.”
Whereas in the industrial rehab setting, Howar communicates
on a daily basis with case managers, vocational rehabilitation
counselors, insurance adjusters, primary-care physicians, specialty
physicians such as orthopedists, insurance-company attorneys, as
well as the employers or supervisors of injured workers.
“So we’re able to work with many distinctive layers of team
members who are external,” she explained. “That requires us to
be very experienced and well-versed in communication, includ-
ing written documentation that has to be timely because it
affects the worker’s compensation case, as well as verbally relay-
ing our findings and the person’s progress to all the people
involved in this injured worker’s life. It can be very complex but I
like those layers.”
Challenges and Rewards
What’s the greatest challenge of working in this setting?
“The belief among some people that everybody is faking it,”
Howar responded. “In fact, research says only about 15-20 per-
cent of patients involved in worker’s compensation cases are
truly presenting to get a secondary gain. So that’s number one,
in terms of the external perception. Internally, the greatest chal-
lenge is when injured workers come in very much not trusting the
process. Many times, patients have lost a lot physically and fi-
nancially, don’t have much familiarity with the system, so our
challenge is to help them increase their performance to the highest
level, work with the employer and insurance company, address
continued on page 22
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11ADVANCE for Occupational Therapy Practitioners
5. [ Cover Story ]
the patients’ fears and mistrust, while
also providing strategies to manage
their symptoms.”
And the most rewarding aspect of indus-
trial rehab?
“To me, it’s the client who visits us
months later and says, ‘Thank you so much
for getting me back to my job,’” related
Paraska. “‘I was in a desperate place, didn’t
think I’d be able to return to the profession
I love and you helped me do it.’ I’ll never
get tired of hearing that. I think it’s really
why everybody goes into the therapy busi-
ness. Even with the clients who have a dif-
ficult disposition at first, when you help
them out and show you’re on their side,
then they’re able to overcome some of their
issues and get back to more meaningful
lives, it’s very rewarding.”
Howar echoed the sentiment: “I find
it an honor to work with this popula-
tion. We’re assisting people during one of
the most challenging times of their life.
They’ve lost their occupation and physi-
cal ability, and in many cases are dealing
with an extremely altered financial situ-
ation. They’re in a very vulnerable place
and often don’t know what’s going on or
why. But we get to see them for as many
as eight hours a day and have an oppor-
tunity to help improve performance in all
aspects of their lives, really treating the
whole person.” n
Brian W. Ferrie is an ADVANCE contributing
editor.
continued from page 11
by providing alternates such as support-
ing the child: seated on caregiver’s lap, lay-
ing on caregiver’s chest, over caregiver’s
shoulder, in a football hold, lying
on caregiver’s lap with baby’s feet
in the air, laying on his/her side
while playing with toys, prone
with support from a towel roll
or boppy under baby’s chest, and
laying on his/her stomach with care-
giver on the floor at eye-to-eye level; and
5. ways to start early placement of the
infant in prone. Specifically, start with 5
minutes and gradually increase by 5-min-
ute intervals up to 30 minutes, twice a day,
to help the infant develop head, neck, arm
and upper-body strength.
These recommendations are espe-
cially important during the infant’s first
6 months of life; that is the period when
head molding, early bonding, social skills,
language, upper-body strength and eye-
hand coordination develop rapidly. n
References available at www.advanceweb
.com/OT or upon request.
Patricia Angermeier, OTR/L, has worked
with children with special needs for over 25
years and is co-creator of the FACES (Fun
Activities to Connect, Engage and Socially
Succeed) program for social-skills devel-
opment. She would like to thank
Tere Bowen-Irish, OTR/L, for
sharing her concerns and working
together to inform and educate fel-
low professionals as well as encour-
age AOTA to support an initiative on
infant positioning and development. Visit
www.advanceweb.com/OTFromPrint for a
complementary article by Ms. Bowen-Irish on
educating teachers to provide accommodations
in the classroom.
[ Children anD Youth ]
continued from page 13
More on the Web:
We’ve got much more pediatric content
online, including:
• A handout for caregivers on tummy time
• An exclusive article on educating teachers
to provide accommodations in the
classroom
• Pediatric OTs’ favorite therapy tools
Find it all at www.advanceweb.com/
OTFromPrint
GO TO: www.advanceweb.com/OT
EDUCATIONOPPORTUNITIES
24 ADVANCE for Occupational Therapy Practitioners ❘ January 7, 2013 ❘ www.advanceweb.com/OT
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22 ADVANCE for Occupational Therapy Practitioners