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Page 232 Table I-11: Survey question 1 results for Clark County respondents Rank based on Frequency 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Frequency (Proportion of Total Responses) n = 1 gastritis low stomach acid generic 1mg doxazosin with amex,378 Safe gastritis diet íîâàÿ discount doxazosin 1 mg overnight delivery, affordable housing Access to gastritis red wine cheap 4 mg doxazosin overnight delivery physical gastritis diet uric acid generic doxazosin 2 mg without prescription, mental, and/or oral health care Low crime/safe neighborhoods Good daycare and preschools Good schools Access to healthy, affordable food Clean environment Good jobs to reach a healthy economy Healthy behaviors and lifestyles Welcoming of diverse communities/people Parks and recreation Supportive and happy family life Safe, nearby transportation Good place to raise children Participating and giving back to the community Religious or spiritual values Low level of child abuse Good job training opportunities Physical accommodations for people with disabilities Arts and cultural events Low deaths and disease rates 10. Responses 1-4 and 6 were the top five choices for total four-county respondents, although in a different order. Clark County was the only Page 233 population within the regional survey respondents to have "Good daycare and preschools" within the most frequently selected responses. Survey question 2: Issues affecting community health (needs) the second question on the survey asked respondents about the biggest health needs in their community. Table I-12: Survey question 2 results for Clark County respondents Rank based on Frequency 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Frequency (Proportion of Total Responses) n = 1,220 Homeless/lack of safe, affordable housing Unemployment/lack of living wage jobs Mental health challenges. These were the same five most frequently selected community needs as the total four-county respondents. Table I-13: Survey question 3 results for Clark County respondents Frequency (Proportion of Total Responses) n = 750 1 2 3 4 5 6 Drug use/abuse Alcohol abuse/addiction Lack of exercise Dropping out of school Social isolation/loneliness Poor eating habits 19. Unlike the previous three questions, respondents were directed to only give one response to this question. Table I-14: Survey question 4 results for Clark County respondents Proportion of Responses from Clark County Respondents n = 259 Rating Proportion of Responses from Entire Survey Population n = 3,075 Very healthy Healthy Somewhat unhealthy Unhealthy Very unhealthy 0. The data sources include: Population data on health behaviors, morbidity, and mortality Hospital admissions data for people who were uninsured or self-pay and were diagnosed with select conditions Community data from an online survey, listening sessions in all four counties, and a qualitative metaanalysis of community engagement projects from the last 3 years Each data set has its own specific limitations, which can be found in the Health Status Assessment and Community Themes and Strengths Assessment sections of this report. These data come from engagement with diverse communities across the four county region and represent the strengths in the community ­ the things that are working. This model describes how the drivers of health influence health conditions and outcomes. The yellow boxes across the top represent different pathways for intervention, while the grey arrows show the dynamic relationships between health behaviors, social determinants of health (such as food or housing), and health problems. The data in this model come from different sources with different methods, research questions, and Page 238 prioritization processes. For more information on methodology, sources, and limitations, see the Health Status and Community Themes and Strengths assessments. Data analysts identified three chronic conditions diagnosed separately among adults and children as the priority health issues. The regional Priority Health Issues Model includes Medicaid data for the tricounty Oregon region only. Similarly, we were able to examine mortality data for heart disease, but not morbidity. Limitations: the data from the survey and listening sessions were collected through small convenience samples. However, the people that participated in the survey and listening sessions do not represent the full range of diverse experiences in the region. The community health needs were identified through a comprehensive study of population, hospital, Medicaid, and community data. Community Themes and Strengths 10) Online survey about quality of life, issues affecting community health, and risky health behaviors. Key Findings for Multnomah County, Oregon Demographics Approximately 777,000 people lived in Multnomah County in 2014, having increased 11. Although the racial and ethnic population is predominantly white, non-Hispanic/Latino, the demographics of the county continue to diversify. Approximately 19% of individuals were living in poverty in Multnomah County in 2014 (the highest rate in the region), including 24. Multnomah County residents have been affected by increased housing costs and growing rates of homelessness, which are highest in the four-county region. Health behaviors Population health data from state surveys show that risky health behaviors, such as binge drinking, cigarette smoking, and not eating enough healthy foods are prevalent in Multnomah County. For teenagers specifically, the assessment identified lack of exercise, alcohol use, and marijuana use as common behaviors. Access to health care was identified as a priority health issue for adults, specifically lack of dental care, lack of access to preventive services. People with Medicaid, whose incomes are below 139% of the Federal Poverty Level, make up 26% of the population in Multnomah County, the highest percentage in the region. Emergency department admissions for uninsured residents Utilization data from local hospitals were analyzed for people who were uninsured or self-pay and were admitted to the Emergency Department for a condition that could have been treated in primary care. The most common conditions for adults were diabetes, hypertension, skin infections, and kidney/urinary infections.

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Nurse midwives erythematous gastritis definition 1mg doxazosin sale, nurse practitioners gastritis acid diet discount 4 mg doxazosin, and physician assistants are authorized to gastritis uti best doxazosin 1 mg issue routine or standard pregnancy profiles for the duration of the pregnancy gastritis diet indian doxazosin 2mg line. However, if this is not feasible, the profiling officer must complete the occupational history. After review of the occupational history, the profiling officer (physician, nurse midwife/practitioner, or physician assistant), in conjunction with the occupational health clinic as needed, will determine whether any additional occupational exposures, other than those indicated in the paragraphs below, should be avoided for the remainder of the pregnancy. Examples include but are not limited to hazardous chemicals, ionizing radiation, and excessive vibration. If the occupational history or industrial hygiene sampling data indicate significant exposure to physical, chemical, or biological hazards, then the profile will be revised to restrict exposure from these workplace hazards. This includes establishing liaison with the occupational health clinic and requesting site visits by the occupational health personnel if necessary to assess any work place hazards. Upon termination of pregnancy, a new profile will be issued reflecting revised profile information. Physical profiles will be issued as follows: (2) Under factor "P" of the physical profile, indicate "T­3. Excessive vibrations occur in larger ground vehicles (greater than 1 1/4 ton) when the vehicle is driven on unpaved surfaces. Pregnant and postpartum Soldiers must be cleared by their health care provider prior to participating in physical fitness training. Wearing of individual body armor and/or any other additional equipment is not recommended and must be avoided after 14 weeks gestation. The Soldier is exempt from participating in swimming qualifications, drown proofing, field duty, and weapons training. Her workweek should not exceed 40 hours and the Soldier must not work more than 8 hours in any 1 day. A woman who is experiencing a normal pregnancy may continue to perform military duty until delivery. Only those women experiencing unusual and complicated problems (for example, pregnancy-induced hypertension) will be excused from all duty, in which case they may be hospitalized or placed sick in quarters. A pregnant Soldier will not be placed sick in quarters solely on the basis of her pregnancy unless there are complications present that would preclude any type of duty performance. Convalescent leave after a termination of pregnancy (for example, miscarriage) will be determined on an individual basis by the attending physician. Prior to commencing convalescent leave, postpartum Soldiers will be issued a postpartum profile. If a Soldier decides to return early from convalescent leave, the temporary profile remains in effect for the entire 45 days. Soldiers will receive clearance from the profiling officer to return to full duty. After receiving clearance from their health care provider to resume physical fitness training, postpartum Soldiers will take part in the postpartum physical fitness training element of the Army. The above guidance will only be modified if, upon evaluation of a physician, it has been determined the postpartum Soldier requires a more restrictive or longer profile because of complicated or unusual medical problems. Record medical conditions and/or physical defects in common usage, nontechnical language that a layman can understand. For example, "compound comminuted fracture, left tibia" might simply be described as "broken leg. Code designations (defined in table 7-2) are limited to permanent profiles for administrative use only and are to be completed by the profiling officer. A Soldier may have a permanent profile for one condition and a temporary profile for another. If the profile is permanent, the profiling officer must assess if the Soldier meets retention standards of chapter 3 (Item 7). These functional activities are the minimum requirements to be considered medically qualified for military duties worldwide and under field conditions.

While much progress has occurred in the risk stratification of lesion suspicion scoring stress gastritis diet doxazosin 1mg low price, less is understood about how information can be combined from multiple lesions to gastritis heartburn buy doxazosin 2 mg on-line give patient-specific risk assessment gastritis diet amazon purchase 1 mg doxazosin fast delivery. One point was assigned for each of the following: Prostate volume 70ml gastritis upper right abdominal pain buy doxazosin 2 mg with visa, total depth of identified lesions (Cross-measure) 17mm, and the sum of all measures of the angle between two lines drawn through the midpoint of the urethra to the opposing edges of the identified lesions (Angle) 140°. Further validation studies are needed to determine the utility of this standardized system for the assessment, treatment, and outcomes of prostate cancer. However, the clinical impact of targeted biopsy accuracy vis-a-vis registration and targeting errors has not yet been systematically studied. A larger energy field may result in more controllable heating environment for larger sized ablations. Five ablations using the AveCure system were performed at an output power of 24 W, a set temperature of 106 oC, and irradiation time of 5 minutes. Using the Acculis system, five ablations at an output power of 180W were performed for 2 minute. Results: the curves for temperature change within the first 10 seconds for both systems were best fit to a power equation having the form T=a*t^b, where "T" is the change in temperature (C) measured in the tissue, "t" is the time into ablation (s), and "a" and "b" are equation parameters. The average values of these parameters, the R-squared value of the curve fits, and the maximum temperatures reached during the entire ablation are provided in the table. The large standard deviations in temperatures and equation parameters may be attributed to the variability in placement of the thermal sensor of up to 5mm away from the targeted location. Outcomes assessed were post transplant graft function and the measures of surgical process (anastomotic and ischemic times). Shewart-control charts analysis showed that functional outcomes were never compromised in group 1 and 2 patients. Further, functional rather than technical outcomes should be examined when evaluating new techniques. First port placement is a mandatory and crucial initial step which contributes to complications. Hence, today the need for a safe, reliable and cheap, reusable laparoscopic port placement system. Our system consists of a 2 mm diameter initial puncture needle with a safety mechanism; attached to a barometer. The needle is dissembled leaving behind a rod guided system for insertion of screw dilator, dilator, and port. An airlock valve allows for continuous peritoneal insufflation during the safe port placement. The water well design, markings on the components and endoscopic compatibility, helps confirmation of peritoneal entry of each component at various stages. The special tip design of part 3 facilitates blunt port placement by tissue separation through the "same site" of the initial puncture. Smooth peritoneal entry; eliminates the possibility of sharp injuries Results: Port placement system was evaluated in 5 cases. The port placement system demonstrated significantly lower port placement time and anxiety related to the initial port placement. Conclusion: Our port placement system is an efficient means of safe, seamless port placement. It provides peritoneal entry confirmation using barometrics and utilizes the same entry point for port placement (as the initial needle). Developing such systems would reduce the healthcare costs for laparoscopic urology. Following the final wait time, a post contrast scan was obtained for each triple bolus protocol. Desired thermal lesions may be achieved with lower output power, thus controlling the heating environment to minimize the risk of damage to healthy renal tissue. Five ablations were performed at quarter, half, three-quarter, and full output power for a total of twenty ablations. Power, current, voltage, and impedance were recorded during ablations using the Radionics Real-Time Graphics Software. Thermal damage was calculated based on the temperature data using the Arrhenius equation.

The robot has given me the tools I need to gastritis diet 7 up cake buy cheap doxazosin 1mg on line perform minimally invasive surgery on some of the most complicated and challenging patients gastritis acid reflux diet discount 4mg doxazosin with visa. By using the robot gastritis diet áàðáîñêèíû generic doxazosin 1mg free shipping, I have been able to gastritis what not to eat generic 2 mg doxazosin otc minimize their stays in the hospital and shorten recovery times. My understanding is that Medicaid does not pay any extra fees for robotic surgery on patients. The robot is considered a laparoscopic tool and therefore all cases are reimbursed as though they were straight laparoscopic. If this is the case, then I confused as to why the state would be concerned as to whether Robotic surgery is covered in their plans or not. And, patients benefit from robotics by avoiding large incisions that often lead to secondary complications such as infections, seromas, separations and longer healing times. It allows patients the opportunity to undergo minimally invasive surgery when there are no other reasonable alternatives except traditional open surgery at significantly greater cost due to longer hospital stay and recovery time. For prostatectomy, this may well be the case, but for some other procedures it is less clear. Robotic assisted surgery is clearly part of the "medical arms race" in that purchasing the equipment is driven by the desire on the part of hospital administrators to maintain their market share in a given community. Some surgeons have commented that the best business decision is to buy and market a robot, but to never use it. Clearly the push by the device manufacture to use a single port robotic approach to cholecystectomy is purely driven by profit. The likelihood that we could ever prove a single port robotic approach is safer and more cost effective than current laparoscopic approaches is extremely hard to imagine. Multiple other procedures fall in the middle including robotic gastrectomy, pancreatectomy, and colectomy to name a few. The safety, efficacy and cost benefits might favor the robotic approach, but would require considerable study. While the use of laparoscopy and other minimally invasive methods are now commonly accepted as the standard of care, at their inception, literature supporting their use was lacking. This makes meaningful comparison between techniques challenging especially at this early stage in adoption. This is related to increased time associated with gaining minimally invasive access to the body. An unmeasured advantage is the quicker return to work for patients which increases their productivity within their employment environment. I raise my concerns about the potential for a decision of refusal of reimbursement for minimally invasive robotic-assisted surgery when my own experience suggests excellent outcomes, overall cost effectiveness, and improve patient satisfaction. With robotics, surgery can be offered to a wider range of patients (obesity, prior abdominal surgery) with excellent outcomes. In kidney cancer, there is the benefit of preservation of kidney function with robotic partial nephrectomy and decreased long term possibility of renal failure and the potential health care cost related to this (esp. My belief is that within urologic surgery there is no going back to open surgery or traditional laparoscopy as the robotic approach is superior to those old techniques. It would be a great tragedy for Washington State Health Care Authority to declare urologic robotic surgery to be a non-covered procedure given the multiple medical studies suggesting equivalence and possible superiority to traditional open/laparoscopic techniques with the bonus of less morbidity and consistent excellent outcomes. Washington state has an impressive track record of building high technologies industries. This procedure improves outcomes in obese women, women with prior abdominal surgery and it shortens recover (decreases length of stay). I believe it would be a disservice to your patients to not offer this innovative procedure. I am writing you to strongly consider the benefits of robotic surgery for women patients with gynecologic malignancies. I used to perform over 80% of my endometrial cancer hysterectomies as an open procedure with 3-7 day hospital stay and 20-50% wound infection rate. The improved technological advances of robotic surgery has enabled me to now perform 70-80% of my patients with endometrial cancer with minimally invasive surgery as robotic assisted laparoscopy. They stay overnight in the hospital, have less infections, quicker recovery, less blood loss, less pain. I have less postoperative office visits for wound care and complications compared to open surgery. There are many studies now showing the benefit of robotic assisted surgery over open procedures.

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References:

• https://www.novartis.us/sites/www.novartis.us/files/beovu.pdf
• http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Carboplatin_monograph_1Jan2014.pdf
• https://cancerres.aacrjournals.org/content/early/2019/10/04/0008-5472.CAN-19-1166.full-text.pdf
• https://www.uwsuper.edu/shcs/upload/mrsa-at-home-care.pdf
• https://pdfs.semanticscholar.org/2b4c/5b8521f4b89cb89c9eec0ac74ee4adfecc96.pdf