This document discusses follow-up care and tracking systems for preterm and low-birth weight infants in Virginia. It provides background on a study and workgroup convened by the Joint Commission on Health Care to examine the issue. Several state programs and initiatives that serve some preterm and low-birth weight infants are described. However, Virginia currently lacks a comprehensive statewide system for tracking these infants and the services they receive. The workgroup identified a need to strengthen tracking abilities across agencies to better coordinate services and evaluate outcomes.
As part of the Strong Start for Mothers and Newborns effort, the CMS Innovation Center hosted a webinar to discuss why it is important to reduce early elective deliveries and share best practices on how reducing early elective deliveries improves the health of mothers and newborns across the country. Individuals representing the American College of Obstetricians and Gynecologists, the March of Dimes, providers and payers conveyed examples of successes and how reducing early elective deliveries can be accomplished. All interested parties were invited to attend this event.
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CMS Innovations
http://innovations.cms.gov
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As part of the Strong Start for Mothers and Newborns effort, the CMS Innovation Center hosted a webinar to discuss why it is important to reduce early elective deliveries and share best practices on how reducing early elective deliveries improves the health of mothers and newborns across the country. Individuals representing the American College of Obstetricians and Gynecologists, the March of Dimes, providers and payers conveyed examples of successes and how reducing early elective deliveries can be accomplished. All interested parties were invited to attend this event.
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CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Innovation Center staff held a webinar on July 25, 2012 to provide guidance from experts for entities with limited experience identifying baseline data for comparison to an intervention population where care is changed. It is hoped that this webinar will assist prospective applicants and others in understanding baseline data and the potential sources for such data.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Child-health practitioners in Iowa must find better ways to address family, neighborhood and economic factors that shape children' health and well being, according to CFPC executive director Charles Bruner and Debra Waldron, director and chief medical officer of the Child Health Specialty Clinics at the University of Iowa. They presented at the Iowa Governor's Conference on Public Health in Ames on April 5.
Speaker presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 17-19, 2019 in Washington, DC. Find out more about this forum at www.usnewshot.com.
Speaker presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 17-19, 2019 in Washington, DC. Find out more about this forum at www.usnewshot.com.
According to the WHO, malnutrition is by far the biggest contributor to child mortality
Under-weight births and IUGR (intra-uterine growth restrictions) cause 3 million child deaths a year.
According to the Lancet, consequences of malnutrition in the first two years is irreversible.
Malnourished children grow up with worse health and lower educational achievements.
Malnutrition can exacerbate the problem of diseases such as measles, pneumonia and diarrhoea.
But malnutrition can actually cause diseases itself , and can be fatal in its own right
The term 'faltering growth' is widely used in relation to infants and young children whose weight gain occurs more slowly than expected for their age and sex.
In the past, this was often described as a ‘failure to thrive’ but this is no longer the preferred term :-
partly because ‘failure’ could be perceived as negative,
but also because lesser degrees of faltering growth may not necessarily indicate a significant problem but merely represent variation from the usual pattern when measured against the standardized growth charts (WHO Growth Charts
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Innovation Center staff held a webinar on July 25, 2012 to provide guidance from experts for entities with limited experience identifying baseline data for comparison to an intervention population where care is changed. It is hoped that this webinar will assist prospective applicants and others in understanding baseline data and the potential sources for such data.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Child-health practitioners in Iowa must find better ways to address family, neighborhood and economic factors that shape children' health and well being, according to CFPC executive director Charles Bruner and Debra Waldron, director and chief medical officer of the Child Health Specialty Clinics at the University of Iowa. They presented at the Iowa Governor's Conference on Public Health in Ames on April 5.
Speaker presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 17-19, 2019 in Washington, DC. Find out more about this forum at www.usnewshot.com.
Speaker presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 17-19, 2019 in Washington, DC. Find out more about this forum at www.usnewshot.com.
According to the WHO, malnutrition is by far the biggest contributor to child mortality
Under-weight births and IUGR (intra-uterine growth restrictions) cause 3 million child deaths a year.
According to the Lancet, consequences of malnutrition in the first two years is irreversible.
Malnourished children grow up with worse health and lower educational achievements.
Malnutrition can exacerbate the problem of diseases such as measles, pneumonia and diarrhoea.
But malnutrition can actually cause diseases itself , and can be fatal in its own right
The term 'faltering growth' is widely used in relation to infants and young children whose weight gain occurs more slowly than expected for their age and sex.
In the past, this was often described as a ‘failure to thrive’ but this is no longer the preferred term :-
partly because ‘failure’ could be perceived as negative,
but also because lesser degrees of faltering growth may not necessarily indicate a significant problem but merely represent variation from the usual pattern when measured against the standardized growth charts (WHO Growth Charts
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Role of Mukta Pishti in the Management of Hyperthyroidism
Preterm Infants And Follow Up Care And Tracking Systems
1. Preterm Infants:
Follow-Up Care and Tracking Systems
Presented to the:
Joint Commission on Health Care
September 19, 2007 Stephen W. Bowman
Senior Staff Attorney/Methodologist
Agenda
Study History
Issue Overview
Virginia Initiatives and Programs
Policy Options
2
2. Study History
Study History
October 2005 - Dr. Susan Brown briefed JCHC
on the importance of providing follow-up
services for preterm and low-birth weight (LBW)
infants
Virginia does not do a good job of informing parents
of the developmental risks and resources available
No tracking system is available
November 2005 - JCHC requested staff study
preterm and LBW infants:
Availability and adequacy of follow-up services
Potential need for a tracking system
4
3. JCHC Preterm and LBW Infant
Study Group (2006)
Workgroup convened twice.
Findings:
Anecdotal evidence that families are having difficulty accessing
services for their preterm and low-birth weight infants. Important
factors included:
General lack of understanding regarding the importance of follow-up
services,
Cost of services particularly since reimbursement for services is low,
and
Restrictive eligibility criteria for public programs.
“It is difficult to determine the extent to which access to services is a
problem since data that is specific to preterm and low-birth weight
infants is lacking.”
Source: JCHC 2007 Report Document 96 “Follow-Up Care and Tracking Systems for Preterm and Low-Birth Weight Infants”
5
2006 Recommendations
November 2006 - JCHC recommended sending a
letter from the Chairman requesting that
representatives from invested associations and state
agencies participate in a JCHC staff-convened
workgroup
The focus was to assess amending existing data and
tracking systems to strengthen tracking abilities for:
Preterm and low-birth weight infants
Access to services
Utilization of services
Long-term outcomes
6
4. Workgroup to Strengthen Tracking of Preterm
and Low-Birth Weight Infants (2007)
Staff convened a workgroup with representatives from:
Department of Health (VDH)
Department of Education (DOE)
Medical Society of Virginia (MSV)
Virginia Association of Community Services Boards (VACSB)
Virginia Association of Health Plans (VAHP)
Virginia Hospital and Healthcare Association (VHHA)
Department of Medical Assistance Services (DMAS)
Department of Mental Health, Mental Retardation and Substance
Abuse Services (DMHMRSAS)
March of Dimes (MOD) *
Comprehensive Health Investment Project of Virginia (CHIP)*
* Organizations not named in Letter from Chairman 7
Issue Overview
5. Premature & Low-Birth Weight
Infants
Preterm - < 37 completed weeks of
gestation Full term - 38 to 42 weeks
Very Preterm< 32 completed weeks
of gestation
Normal Birthweight
Low-Birthweight (LBW) - < 2,500g - 4000g
2,500 grams or 5.5 lbs. 5.5 lbs - 8.8 lbs
Extremely Low-Birthweight -
< 1,000 grams or 2.3 lbs.
Source:* National Center for Health Statistics Website (2007)
9
Prevalence of Preterm & LBW
Births
2004 Virginia Preterm Births - 11,261 (10.9%)*
2004 Virginia LBW Infants - 8,587 (8.2%)*
Preterm and Low Birthweight Infants in
Virginia and the US (1994 & 2004)**
15.0%
12.5%
11.5% 12.1%
11.0%
VA LBW
10.0%
7.5%
7.3% 8.3% 8.1% US LBW
VA Preterm
5.0%
US Preterm
0.0%
1994 2004
Sources: *VDH Division of Health Statistics Data, **March of Dimes Peristats website accessed 7/27/07 10
6. LBW Infants have an Increased
Risk for Disabilities
% of School Identified Disabilities by
Birthweight
Overall 16.7%
Higher BW ( ≥ 4,000 g) 16.9%
Normal BW (2,500- 4,000 g) 16.0%
Low Birthweight (Under 2,500 g) 25.2%
Extremely Low Birthweight ( ≤ 1,000 g) 44.9%
0% 10% 20% 30% 40% 50%
11
Source: Avchen, Scott, Mason: Birth Weight and School-age Disabilities: A Population-based Study.
American Journal of Epidemiology 154:10, 895 (2001)
Developmental Delays
Delays may not be obvious to parent, but are
often recognized once the child enters school.
Types of delays include:
Communication
Personal social
Motor skills
Problem solving
Optimal time for providing services for the
most benefit is 0-5 years of age.
12
7. Importance of Follow-Up Services
Brain is especially receptive to the positive effects of
intervention services in first years of a child’s life.
Providing follow-up services soon after birth frequently
results in increased developmental scores.
If delays undetected until attending school, there is
an increased risk of:
academic failure
behavioral problems
socio-emotional disturbance
13
Virginia’s Initiatives and
Programs
8. Tracking Preterm and LBW
Infants in Virginia
No State data system specifically tracks
infants or children who were born preterm
or LBW.
Virginia Department of Health is the only
agency that collects LBW or preterm
information on a consistent basis.
Preterm and LBW children receive State
services but are not identified as such
15
Programs that Serve Some
Preterm or LBW Infants
DMAS provides services such as:
Early and Periodic Screening, Diagnosis, and Treatment Services
(EPSDT)
Baby Care
IDEA Part B
IDEA Part C
Head Start
16
9. Programs that Serve Some
Preterm or LBW Infants (cont)
VDH offers several programs that assist children
with developmental delays including:
Early Hearing Detection and Intervention Program
Care Connection for Children
Child Development Services Program
VDH is conducting an evaluation of the Family
Planning Waiver
Includes merging the electronic birth certificate
information and DMAS information
17
Developmental Disability
Tracking Programs
Information on children who have
disabilities or documented delays are
tracked to some extent by various
agencies.
Virginia Congenital Anomalies Reporting and
Education System (VaCARES)
Early Hearing Detection and Intervention Program
Part C Early Intervention Services
18
10. PRAMS Can Track Some LBW
Infants
Pregnancy Risk Assessment Monitoring System
(PRAMS)
Administered through VDH
1,200 mothers randomly selected each year
600 Low-Birth Weight Infants
600 Normal-Birth Weight Infants
50 surveys are distributed monthly to each
population
Wide range of topics addressed
Follow-up surveys possible
19
Workgroup Themes
Workgroup convened twice
Four intergovernmental meetings occurred
Most state developmental services
provided are based on the child’s need
Virginia has limited to no ability to track
state services provided to a specific child.
20
11. Workgroup Themes
The ability to track the services to children across
agencies need to improve in order to determine:
Provision of services for specific children’s
Coordination of children’s services
Overall effectiveness of services
Obstacles for improving tracking abilities include:
Lack of common identifiers across agencies
Lack of a coordinated interagency approach to be able to follow
a child through different state agencies
Family Educational Rights and Privacy Act (FERPA)
21
Policy Options
12. Policy Options
Option 1: Take no action.
Option 2: Request by letter of the Chairman that
the Virginia Department of Health report to
JCHC in 2008 on the status of the PRAMS
follow-up survey including the proposed
timeline and information the survey results will
provide regarding the type, frequency and
providers of developmental services.
23
Policy Options
Option 3: Request by letter of the Chairman that VDH and
DMHMRSAS report to JCHC in 2008 on the status of an
automated referral system that includes a unique
identifier between the Virginia Infant Screening and
Infant Tracking System (VISITS) and the Infant and
Toddler Connection.
Option 4: Introduce a budget amendment that provides
additional funding for DMHMRSAS to make LBW and
preterm information mandatory data fields when local
Part C early intervention systems electronically submit a
Part C eligible child’s initial evaluation. (amount to be
determined)
24
13. Policy Options
Option 5: Request by letter of the Chairman that VDH report
to JCHC in 2008 regarding the status of the pilot for linking
birth certificate information to DMAS child records.
Option 6: By letter from the JCHC Chairman request that the
Secretaries of Health and Human Resources, Education,
and Technology in consultation with the Office of the
Attorney General conduct a demonstration project to track
a small group of children receiving services through state
agencies and through other state-funded organizations as
deemed appropriate. The purpose of this project would be
to determine the Commonwealth’s ability to track across
agencies the services provided to specific children. The
letter would include the request to report to JCHC in 2008.
25
Policy Options
Option 7: Introduce a budget amendment that provides
additional funding (amount to be determined) for the
DMHMRSAS Part C program to follow-up with LBW and
preterm children who were not initially eligible for
services.
Option 8: By letter from the JCHC Chairman request that
VDH and DMHMRSAS explore the feasibility of VDH
studying outcome data on LBW and preterm infants that
receive Part C services. Restrictions on VDH’s ability to
access educational records protected by the Family
Educational Rights and Privacy Act (FERPA) are the
primary obstacle. The letter would include the request for
VDH to report to JCHC in 2008.
26
14. Public Comments
Written public comments on the proposed
options may be submitted to JCHC by close of
business on October 10, 2007. Comments may
be submitted via:
E-mail (sareid@leg.state.va.us)
Facsimile (804/786-5538) or
Mail to Joint Commission on Health Care
P.O. Box 1322
Richmond, Virginia 23218
Comments will be summarized and presented to
the JCHC during its October 17th meeting.
27
Internet Address
Joint Commission on Health Care website
http://jchc.state.va.us
Contact Information
sbowman@leg.state.va.us
900 East Main Street, 1st Floor West
P O Box 1322
Richmond, VA 23218
804-786-5445 Fax 804-786-5538