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Set policies and procedures Established policies A comprehensive set Ultimately, a good All staff should sign and Any future amendments should be read As an alternative, team meeting minutes where all It must be In theory a new untrained staff member should It should be a Format should In addition, any leading published research, best practice, etc.An archiving system should be coordinated The content was authored by Brett McPherson, reviewed by Colleen Sullivan and Avant Mutual Group. You should seek legal or other professional advice before relying on any content, and practice proper clinical decision making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information.The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy wording and PDS, which is available at www.avant.org.au or by contacting us on 1800 128 268. Practices need to consider other forms of insurance including directors’ and officers’ liability, public and products liability, property and business interruption insurance, and workers compensation and you should contact your insurance broker for more information. Cover is subject to the terms, conditions and exclusions of the policy.

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Treating the Contamination Site. 124. Reporting the Incident. 124. Medical Records. 7 127. Requirements and Standards. 127. Advance Directives. 130. Information Confidentiality and Access to Records. 131. Releasing Confidential Records. 134. Confidentiality Agreement for Physician Office Employees. 136. Model Letter to a Patient Who Requests Withholding of Information from Disclosure138. Authorization to Transfer Medical Records. 140. Authorization for Release of Medical Information. 142. Privacy Complaints. 143. Mitigation of Privacy Breaches. 144. Review of Test Results. 149. Scanning Medical Records and 150. About Cardiology Medical Group Cardiology Medical Group opened on November 28, 2007 when the clinic was established. Cardiology Medical Group is located in San Diego, CA, and serves both metropolitan and rural areas. The area includes a culturally and age diverse population of about 3,000,000. Cardiology Medical Group includes six family physicians. The clinic hosts itinerant specialists and family practice residents and provides an urgent care clinic for the general public on evenings and weekends. The Office physicians estimate that almost 70% of the area's population is attached to their family practices, while their urgent care clinic serves the rest of the population for immediate care issues. Show more Ohio Department of Job and Family Services The Electronic Publishing Unit makes every attempt to publish accurate and current information, however, we disclaim any liability or responsibility for any The scenarios are narrowly focused to illustrate the “Airway Clearance and Techniques” 64 category and are not intended to be inclusive of all interventions that would be performed in clinical 65. General practices participating in the accreditation process will be required to have an appropriate policy and procedure manual.

CPGs should follow a sound, transparent methodology to translate best evidence into clinical practice for improved patient outcomes. Additionally, evidence-based CPGs are a key aspect of patient-centered care. The AAFP’s development process adheres to the following standards and principles: When these performance measures are incorporated into public reporting, accountability, or pay for performance programs, the strength of evidence and magnitude of benefit should be sufficient to justify the burden of implementation. The standards reflect best practices across the entire guideline development process, including attention to: Where possible, the standards outlined by the IOM (now the National Academies of Medicine) and CMSS are referenced in the corresponding sections below. When clinical practice guidelines address the issue of who should provide care, then recommendations for management, consultation, or referral should emphasize appropriate specific competencies rather than a clinician's specialty designation. The AAFP may participate with other medical organizations in the development of clinical practice guidelines (also known as practice parameters or clinical policies) when appropriate criteria are met. SCPG members and content experts assist in drafting and providing feedback on the key questions iii. Include collaborators for co-nomination (if applicable) Include one or more family physicians to serve on the technical expert panel (TEP) of the EPC. Often the TEP members will also serve on the guideline development panel. The draft report can be used to begin development of the draft CPG iii. When the final EPC evidence report is published and available, it is used to finalize the CPG. A COI has been defined as a set of conditions in which professional judgment concerning a primary interest (guideline recommendations), is unduly influenced by a secondary interest (financial or intellectual interests) (Norris et al 2012 and Thompson DF 1993).

Any advice here does not take into account your objectives, financial situation or needs. You should consider whether the product is appropriate for you before deciding to purchase or continuing to hold a policy with us. Updates to the manuals are done by Corporate Governance and Risk Management Branch as electronic amendments. A register of amendments accompanies the electronic version of each manual. An Ideal Clinic also collaborates with other government departments, theThe purpose ofOperation Phakisa for health was launched byA key step in the Operation Phakisa approach isFurther details onTherefore every province had to compile aTo further fast track the implementation of the programm, every district appointed a PerfectThe teams are responsible to conduct aVersion 18 isEach element on theThe average score according to the weights assigned toAn Ideal Clinic status is achieved when a clinicNote that a clinic can obtain a high average score example 80% butFor further details on the percentages per weight category required to. This indispensable guide sets the gold standard for nursing care, providing the procedures, rationale, and guidance required by qualified nurses to deliver clinically effective, patient-focused care with expertise and confidence. This helpful resource not only ensures you can provide your patients with the best care possible, but also simplifies the revalidation process with standard guidelines that drive professional development and establish a baseline to accommodate practice-based feedback and written reflection. The latest professional edition includes: Receive emails with top industry news and special discounts to keep you informed and up to date. Clinical practice guidelines are statements that include recommendations intended to optimize patient care. They are informed by a systematic review of evidence, and an assessment of the benefits and harms of alternative care options.

The librarian will use the same search criteria that were used in the AHRQ systematic review. Inclusion and exclusion criteria will be set a priori to determine which studies will be reviewed for quality. AAFP staff members review the updated search results and obtain articles relevant to the systematic review. The AAFP also uses this as a guide to ensure the systematic literature reviews we are performing or that we are using for guideline development are compliant with the best standards available. These standards include: establishing a team with appropriate experience and expertise to do the review, including those with content expertise; providing methodological expertise and other expertise as appropriate; ensuring any conflict of interest is managed with regard to the team; ensuring that there is user and stakeholder input as the review is designed and conducted; managing conflict of interest with regard to any individuals providing input into the review; and formulating the topic for review. This step will likely include: Here it is very important to include and exclude studies based on a priori specified criteria developed in the protocol. It is recommended that two or more people screen studies and that these reviewers are tested for accuracy and consistency in their reviews. If excluded, include the reason for exclusion. The IOM standards recommend that systematic review developers: The quality of the evidence should be linked to the strength of the recommendations in that guideline. Consistent with the IOM standards for systematic reviews, the AAFP uses a specified framework for assessing the quality of studies and providing strength for each recommendation. The GRADE system provides a transparent process and framework for developing evidence-based recommendations using the following system to rate the quality of evidence: Recommendations can be either for or against an intervention or testing modality.

This time-line will be distributed to GDG members during the first meeting of the GDG. Though this time-line is developed with the goal of adherence, it is recognized that circumstances during the development process may affect the time-line. Thus, this is a living document throughout the guideline process and should be updated as appropriate. GDG members will be asked to volunteer for certain tasks and may be assigned to subgroups to develop recommendations and write supporting evidence for those recommendations. However, as stated above, circumstances during the CPG development process may arise that warrant adjusting deadlines. The panel chair and staff members at the AAFP will work with the GDG on any changes in deadlines. The outline will include the key questions from the evidence report, the potential draft recommendations, key points for supporting text, and identification of potential information for shared decision-making tables and implementation algorithms. AAFP staff members will work with GDG members to ensure availability for calls. When a member cannot be present on a call, that member will be provided opportunities to provide any written comments prior to the call and feedback to the meeting summary after the call. Reasonable response times are expected for electronic communications and deadlines for requested action items will be clearly stated in the communications from AAFP staff members. All parties will agree to the publication plan. Dissemination activities should also be identified early on to facilitate work load and collaboration. These activities can include one or more of the following: Once the systematic review has been completed, a draft evidence report is published by AHRQ. The GDG reviews the draft evidence report to determine if applicable for development of a guideline. Systematic literature review performed by the AAFP. The GDG and AAFP staff members will work with the AAFP librarian to perform the updated review.

Recommendations made include an explanation of the reason for the recommendation; description of benefits and harms; a summary of the relevant available evidence; any explanation of values and preferences that went into the recommendation; a rating of the level of evidence and strength of recommendation; and differences in opinions of GDG panel members, if they exist, for that recommendation. iv. Recommendations made are specific and actionable and worded in a way that is clear that they are (1) strong recommendations, (2) weak recommendations, or (3) good practice points. When possible, GDG members will be asked for preferences regarding sections of the guideline they would like to write. Most often, staff members at the AAFP will compile all sections of the draft guideline and the chair will review the draft(s) before it is sent to other members of the panel. All reviewers are given four weeks to complete and return their review form to the staff members at the AAFP. (see Appendix A for an example of the review form). Upon receipt of the reviews, all comments will be recorded. Comments will be addressed when the chair determines that there is a need. A written record will be kept of the rationale for responding or not responding to all comments received. AAFP members who are identified as experts in the field may also be asked to participate in the review. All reviewer comments are collected and recorded. A record of how the comment was addressed is kept. Reviewers’ names are kept confidential unless a reviewer wants to be recognized for his or her review. Upon approval, a recommendation is made to the full commission, which upon approval makes a recommendation to the AAFP Board of Directors for approval. Any questions from the Board are addressed by the GDG, and staff at the AAFP. The collaborators will be sent the embargoed guideline, and given a month to decide upon endorsement.

The guideline manuscript undergoes independent editorial review, and a decision is made about publication. Due to the nature of journals, all supporting materials (such as tables with quality ratings of studies) may not be able to be published. All supporting materials that are relevant to the guideline that are not published will be made available on the AAFP website. Supporting documents that were not published with the original guideline will be available on the AAFP website as well. Any derivatives made relating to the guideline will also be publicized via a marketing plan. Whichever the case, when a guideline review is initiated, a preliminary search of the literature is completed and brought to the SCPG to determine if a new systematic review is necessary. If so, the topic will be nominated to AHRQ for a full systematic evidence update. If not, the SCPG will decide whether to reaffirm the guideline for additional time not to exceed five years, or sunset the guideline. The SCPG’s recommendation is then approved by CHPS and the Board of Directors. In certain cases, staff may review guidelines from selected organizations. Affirmation of Value to Family Physicians—the guideline does not meet the requirements for full endorsement, or the AAFP is not able to endorse all the recommendations, but feel the guideline is of some benefit for family physicians iii. Not Endorse—the AAFP does not endorse the guideline and the reasons are stated. The AAFP may also choose to remain silent. If substantial differences occur, the reviewers will discuss and determine if a consensus can be reached. Only guidelines with endorsement or affirmation of value will be placed on the website. Guidelines may be reviewed earlier if new evidence warrants an update. Clinical Practice Guidelines We Can Trust. Washington, DC. National Academies Press. 2011.. Accessed November 15, 2017. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC. National Academies Press.

The AAFP prefers the strength of the recommendation be consistent with the quality of the evidence such that strong recommendations are based on moderate to high quality evidence and weak recommendations are based on low to moderate quality evidence. Very low-quality evidence should be considered insufficient for a recommendation except when the benefits greatly outweigh the harms. Strong recommendations should be based on high quality evidence of improved patient oriented outcomes. Weak recommendations should be supported by some evidence of improvement in patient oriented outcomes; although, the evidence may be inconsistent, of lower quality, or rely on an indirect chain linking surrogate outcomes to patient oriented outcomes. These should be used sparingly in guidelines. Faulty randomization, such as lack of concealment at allocation to the study group; lack of blinding to the study group when assessing outcomes; large losses to follow-up; the failure to analyze everyone in the group to which they were randomized; stopping the study early when the benefit seems too great to ignore; or failure to report all outcomes. Were the interventions really the same. Were the samples very different. Inconsistencies that cannot be explained make it very difficult to assess the true effect of the treatment. Indirect comparisons are more difficult to interpret. Two types of indirectness exist. a. The first includes indirect comparisons.Investigators are more likely to submit studies for publication when the results are positive and journals may be more likely to accept them for publication. An effort should be made in a systematic review to uncover studies that have not been published. This is a particularly important issue when the studies are funded by industry This is one aspect of a finding that suggests an association based on cause and effect. 3.

All plausible confounding: In observational trials, it is particularly difficult to measure and control for all plausible confounding. When all unmeasured plausible confounders and biases in an observational study would result in an underestimate of an apparent treatment effect, then it is more likely that a finding is real rather than the result of unmeasured confounding. For instance, if only sicker patients receive an experimental intervention or exposure, yet they still fare better, it is likely that the actual intervention or exposure effect is even larger than the data suggest. This includes, but may not be limited to the appropriate users of the guideline, situations in which the guideline should be used, and appropriate patient populations for the guideline. It is worth noting that moving from examining the evidence to making a recommendation is where much of the disagreement happens in guideline development. Different groups that develop guidelines may disagree on how much weight they give to lower-level evidence; may not fully take into account benefits and harms, costs or burdens; and may give differing emphasis on patient or provider preferences and values. However, all of these factors should be considered when making recommendations. AAFP’s use of the GRADE system helps to systematically examine many of the factors mentioned to determine the quality of the evidence and strength of recommendations. ii. The AAFP strives to only make strong recommendations based on high-level evidence. However, there are few instances where strong recommendations can be made based on moderate or low-level evidence. In these instances, there must be certainty that benefits outweigh harms. iii.

2011.. Accessed November 15, 2017. Methods guide for effectiveness and comparative effectiveness reviews. Rockville, MD: Agency for Healthcare Research and Quality; 2014. AHRQ Publication No. 10(14)-EHC063-EF.. Accessed Nov. 1, 2016. These changes are for the duration of the COVID-19 PHE, and we will continue to review our policies as the situation evolves. For additional information, please see the link: (PDF) Section 3704 of the CARES Act authorizes RHCs and FQHCs to furnish distant site telehealth services to Medicare beneficiaries during the COVID-19 PHE. Medicare telehealth services generally require an interactive audio and video telecommunications system that permits real-time communication between the practitioner and the patient. RHCs and FQHCs with this capability can immediately provide and be paid for telehealth services to patients covered by Medicare for the duration of the COVID-19 PHE. Distant site telehealth services can be furnished by any health care practitioner working for the RHC or the FQHC within their scope of practice. Practitioners can furnish distant site telehealth services from any location, including their home, during the time that they are working for the RHC or FQHC, and can furnish any telehealth service that is approved as a distant site telehealth service under the Physician Fee Schedule (PFS). A list of these services can be found here. For additional information on payment, billing, and claims processing, see (PDF) Digital assessment services are non-face-to-face, patient-initiated, digital communications using a secure online patient portal. The digital assessment codes that are billable during the COVID-19 PHE are CPT code 99421 (5-10 minutes over a 7-day period), CPT code 99422 (11-20 minutes over a 7-day period), and CPT code 99423 (21 minutes or more over a 7-day period).

For claims submitted with HCPCS code G0071 on or after March 1, 2020, and for the duration of the COVID-19 PHE, payment for HCPCS code G0071 is set at the average of the national non-facility PFS payment rates for these 5 codes.Effective March 1, 2020 and for the duration of the COVID-19 PHE, the area typically served by the RHC is determined to have a shortage of home health agencies, and no request for this determination is required. RHCs must check the HIPAA Eligibility Transaction System (HETS) before providing visiting nurse services to ensure that the patient is not already under a home health plan of care. Payment for G0071 is set at the average of the national non-facility PFS payment rates for HCPCS code G2012 (communication technology-based services) and HCPCS code G2010 (remote evaluation services) and is updated annually based on the PFS national non-facility payment rate for these codes. See Virtual Communication Services Frequently Asked Questions (PDF) Check it often! See MM10989 (PDF). Other Provisions of the Final Rule - C. Payment for Care Management Services and Communication Technology-Based Services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Other Provisions of the Proposed Rule - A. New Care Coordination Services and Payment for Rural Health Clinics (RHCs) and Federally-Qualified Health Centers (FQHCs) For claims with dates of service on or after April 1, 2016, RHCs should follow the reporting requirements for modifier CG found in MLN Matters Article SE1611 (PDF). For additional information, see RHC Reporting Requirements FAQs (PDF). We are not accepting applications for this date and there is no waiting list.

Please note this situation may change depending on New Zealand's COVID-19 status Important note regarding employment opportunities Before you apply to sit NZREX Clinical, please note the following: The number of PGY1 roles is limited and priority is given to graduates from New Zealand and Australian medical schools. This is regardless of your previous experience. There is a possiblity that you will not obtain a PGY1 role within the 5 years that your NZREX pass is valid. Please note that this data does not provide information about when (in the 1-5 year timeframe of a valid NZREX pass) the doctor gained employment in New Zealand. If you are not eligible for registration under any other pathway, you must sit and pass NZREX Clinical, our registration examination. By passing the NZREX Clinical, we know you meet the required standard to be registered to practise in New Zealand. A pass in the NZREX Clinical is valid for 5 years from the date of your examination. To find out if you need to sit the NZREX Clinical as part of your pathway to gaining registration in New Zealand, use our Registration self assessment tool. Note: we do not cover student electives. We recommend you complete a minimum of 12-months postgraduate experience as a doctor in your own country before applying to sit the NZREX Clinical. This is not a requirement, but the experience will help you be better prepared to sit our examination. You will rotate through 16 stations during the 3-hour exam. All stations are weighted equally. You'll be examined on your: You may also be required to undertake a focused history, or present a preferred diagnosis, management plan, and investigations. Please refer to the sample questions below to see the marking scheme we use. Our sample questions and reading list will help with your examination preparation. These are organised by District Health Boards. Council only accepts certified copies of original documents.

Please do not submit any original documents with your application. If you’re paying the fee by cheque or bank draft you must include the full payment in New Zealand dollars with your application form. If you are paying with a credit card we will explain how to pay online once we’ve received and processed your application. Once you are sure you meet the application criteria, please send your completed application to us at: Professional Standards Coordinator (Examinations) Medical Council of New Zealand PO Box 10509 The Terrace Wellington 6143 New Zealand Once we receive your application, we'll send you an email within 5 working days, telling you we have it. It may take us up to 20 working days to process your application. If it's missing something, we may return it to you, or we may need more time to process it. Once it's processed, we will email you to tell you what the next steps are. If you are applying to sit the NZREX Clinical for the first time, please complete forms NZREX1 and NZREX3. Repeat candidates please complete only the NZREX4. Once you have a confirmed place on an exam, you are responsible for arranging your own transportation and accommodation. It's a good idea to wait for your confirmation email before making travel arrangements. Please note that examinations tend to fill well in advance of the closing dates, so don't delay in getting your application in. Exam and application closing dates are below. 31 October 2020 THIS EXAM IS NOW FULL 27 March 2021 THIS EXAM IS NOW FULL 19 June 2021 Council is intending to reopen applications in early 2021 for candidates to apply to sit NZREX. We are not accepting applications for this date and there is no waiting list. Please note that this situation may change if New Zealand moves from its current Level One COVID-19 status If there are too many applications for an examination date, we will let you know by email and offer you the next available examination date.

If possible, we will offer you a place on the waitlist for an earlier exam. This means that if a candidate withdraws from the exam and you are next on the waitlist, we will offer you the space. We compile waitlists in the order we receive complete applications, so the earlier we receive your application, the higher your place on a waitlist. A waitlist place is at our discretion; we do not provide updates on your status on the waitlist, even if you ask. We will only contact you regarding the waitlist to offer you a place on the exam, and this can happen at any time before it takes place. It's very unlikely, but in the event there are insufficient candidates, we reserve the right to cancel an examination. We will write to let you know if this happens. Marking for the NZREX Clinical is done electronically. Markers enter candidate marks on a tablet, which then calculates the results. The system supplier, MaxInity, is based in the United Kingdom and is highly-regarded, in delivering objective structured clinical examinations (OSCEs) electronically. We cannot give results over the telephone. Your result will show whether you achieved, or did not achieve, the required standard. If you have concerns about the examination process, your results, or you feel you have been disadvantaged due to a temporary impairment, please read our policy and refer to the NZREX Clinical Handbook. If your result is that you did not achieve the required standard, we'll give you some feedback to indicate the areas you need to improve for next time. This feedback will show you how you ranked overall against other candidates who sat the same exam as you. If you think that your exam results do not accurately reflect your performance in the examination, you may ask to have your results recounted. Please note that any recount looks only at whether your marks were correctly transcribed - there is no reassessment or alteration of the marks given to you by an examiner at an individual station.

clin check plus manual

According to the International Agency for Research on Cancer, in 2018.Please select channelTogether with leading industry partners, Getinge is showcasing innovative. First and only system to combine tissue acquisition, real-time imaging. First and only system to combine tissue acquisition, real-time imaging.It is clear that the COVID-19 crisis has been a boostAccess the future of healthcare While healthcare organizations across.International experts treating COVID-19 patients have concluded that.Questions to Wolfgang Heimsch, President Customer Service at Siemens HealthineeThe 175th president of the American Medical Association (AMA). As of May 4, Oliver Reichardt isDr. Sebastian Krolop, M.D., Ph.D., M. Sc. has recently been appointed the.The American Society for Parenteral and Enteral Nutrition (ASPEN) has.The 2017 Ethica Award, the highest honour of the European cardiovascular.Gamma Medica, a leader in molecular breast imaging (MBI) technology, announced.Please select channelPlease select channel. No guesswork. No waiting and seeing. It offers a fast and more comfortable experience and it’s more accurate, resulting in a more precise fit from your Invisalign aligners. Precision wings gradually move the lower jaw and are designed to improve the bite plus the appearance of the chin. Doctors with a star in their icon also treat teens with Invisalign clear aligners. The provider tiers and other designations used in this tool are not intended to reflect the quality or skill level of the provider nor be viewed as an endorsement or recommendation by Align of any provider. Forms and Certificates In-Service Training Tools Product Documentation Please try again later. An issue occurred on this form. Each is underlined in red. Or, the data inserted by you seems to be invalid. Thank you! An issue occurred on this form. The data inserted by you seems to be invalid.

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Sign in Forgot Password. My Bench Close Sign In Not A Member. Sign Up Join MedWrench OK name type Receive Summary Emails. Clin Check Plus is an interferential filter photometer, designed for a precise and fast execution of the most important tests of Clinical Chemistry and Hematology. The execution of the analyses and programming the instrument are simple and guided by the instructions shown on the display. It is possible to select a language among German, Italian, French, English. The light source of Clin Check Plus is a 2 W tungsten lamp: this enables the instrument to read in the UV range too. 5 interferential filters are incorporated: the proper wavelength of the Test is automatically selected by microprocessors. Iit is possible to add a sixth filter, upon request. The thermostat turns on automatically when the instrument is switched on. FORUMS View All (1) Ask a New Question 0 Replies -jad3a 6 years ago 6 years ago hello my dear By continuing to browse the site you are agreeing to our use of cookies. Please review our Privacy Policy for more details. All Rights Reserved. The laboratory photometer has 6 interferential filters and 2 positions in the 37?C incubator. Up to 40 tests can be programmed and these can be recalled at any time by keyboard. Either single cuvettes with prefilled reagents or traditional reagents in flasks can be used due to the open system. The spectral range is 320-750 nm. The Clin Check Plus works in fixed-time, end point, absorbance, kinetic or multistandard operating modes. It has interferential filter wavelengths of 340, 405, 505, 546, 578 and 630 nm. The device has dimensions of 27.5 x 21 x 9 cm and weighs 3.8 kg. It operates on an AC power supply or with rechargeable batteries.Larger-Scale. Lockdowns and other restrictive measures (e.g. travel curbs)As the respiratory disease COVID-19A recent report from McKinsey looks into the challengesFirst and only system to combine tissue acquisition, real-time imaging.

Education Overview Mayo Clinic College of Medicine and Science Mayo Clinic Graduate School of Biomedical Sciences Mayo Clinic Alix School of Medicine Mayo Clinic School of Continuous Professional Development Mayo Clinic School of Graduate Medical Education Mayo Clinic School of Health Sciences Alumni Center Visit Our Schools Educators at Mayo Clinic train tomorrow’s leaders to deliver compassionate, high-value, safe patient care. Choose a degree. For Medical Professionals Overview Provider Relations Referring Physician Portal AskMayoExpert Video Center Publications Continuing Medical Education Mayo Clinic Laboratories Professional Services Explore Mayo Clinic's many resources and see jobs available for medical professionals.John's wort Tea tree oil Thiamin Vitamin A Vitamin B-6 Vitamin B-12 Vitamin C Vitamin D Vitamin E Whey protein Zinc Advertising revenue supports our not-for-profit mission. All rights reserved. Its broad test menu comprises over 120 assays and applications that consolidate clinical chemistry with specific proteins, therapeutic drug monitoring and drug abuse testing. This compact tabletop analyzer offers maximum versatility to improve efficiency and reduce costs. It uses the convenient cobas c pack reagent format, which standardizes patient results across integrated laboratory networks.Please be aware that we do not take any responsibility for accessing such information which may not comply with any legal process, regulation, registration or usage in the country of your origin. Please update your browser to the latest version on or before July 31, 2020.What should I do? The red light is just the descaling reminder light. Follow the instructions for descaling; you can find the instructions in your manual or on this site. Once you have descaled with a white vinegar and water solution, it is important that you unplug the unit for several minutes. Then, plug it back in.

I hereby consent to the processing of my above given personal data by the Siemens Healthineers company referred to under Corporate Information and for the purpose described above. Further information concerning the processing of your data can be found in the Data Privacy Policy. I am aware that I can partially or completely revoke this consent at any time for the future.If you requested more information, a Siemens Healthineers representative will be contacting you shortly. Please try again or contact us. We apologize for the inconvenience caused. Try again Contact Us Would you like to provide detailed feedback. Add sample and the analyzer does the rest. Provides results in 1 minute. No waiting for lab results. Eliminates error sources Accurately times test for you—no watching the clock. Automates and removes subjectivity of result interpretation. Automatically transmits test results to minimize transcription errors (when interfaced). Operator lockout prevents use by unauthorized users. Future-ready—ask about our upgrade kit for adding connectivity and bar-coding. This is not a standard part that comes with the analyzer. Product availability may vary from country to country and is subject to varying regulatory requirements. Would you like to provide detailed feedback. Our smart Solution Finder will get you started on how, together, we can reimagine your lab! Click here to register or try again.Just fill in the form. We are trusted by hospitals, hospital networks, blood banks, and labs around the world. Ortho Clinical Diagnostics, publishes this site and is solely responsible for its content. The availability of the products is subject to compliance with the regulatory requirements of each market. Click here to register or try again. Just fill in the form. Explore now.

It’s a good idea to keep your computer tidy, too. For instance, using an external hard drive or cloud-based storage can declutter your computer while helping to keep valuable data safe and secure. Remove any fingerprints on the screen. If you want to use a cleaning fluid, visit a computer store to find one that’s specifically designed for your monitor type. Instead, gently wipe your screen with a soft cloth. A microfiber cloth is great for this purpose. Plain water usually works, too, but filtered or distilled water will help you avoid streaks. If you’re having trouble removing sticky dirt, try using a cotton swab dipped in rubbing alcohol, or the cleaning mixtures mentioned above. If your keyboard is acting up, you may need to open it in order to “deep clean.” Check your computer or keyboard manual for instructions on how to open and clean this component safely. With a can of compressed air (available at any computer store), clean the dust buildup out of the fan and the case. Put the case back together and use cotton swabs to pick up any lingering dirt on the fan vents or other small crevices on the outside of the case. The tool will scan for and repair issues such as file system errors or bad sectors. If you haven’t done this scan before, run a full scan, which enables automatic repairs. The process may take a few hours. Did you know surge protectors can lose their protection after undergoing just one power surge. Even if they still appear “on,” they may not be providing the protection you need. So it’s a good idea to check them from time to time, especially after a notable power surge. Make sure you have at least three inches of space on either side of your PC that’s free of obstructions such as other computers, papers, or walls. Also make sure your room is large enough or well-ventilated enough to facilitate good air flow. If your processor keeps overheating and forcing your PC to shut down, you may need to upgrade your CPU fan.

Lock your Blending Bowl(s) in to place (Listen For Click) press down on arrows at the top of your lid to assure your lid is locked, and then PRESS and HOLD the steam button down for 30 seconds to reset the cycle counter. The steam button will turn white again. Should you ever notice your steam cycles running shorter than usual or there is water remaining in the reservoir after the steam cycle completes, it is time to descale your machine. We also do not suggest inserting a foreign object into the reservoir as this could also damage the Stainless Steel finish. For instructions on how to clean your Babycook reservoir with lemon juice, please click here. Keeping the reservoir clean is much easier than trying to remove stubborn build-up. Keeping the reservoir clean is much easier than trying to remove stubborn build-up. Why is it not heating? Why is that? What is it? What is wrong. This product is designed to clean the most difficult instruments (i.e. orthopaedic, laproscopic) yet is safe for use on the most delicate (i.e. ophthalmic, microsurgical). Low-sudsing, neutral pH Endozime AW Triple Plus was developed for universal applications eliminating the need for all other cleaners and detergents. That’s plenty of time for dust buildup inside and outside your device. Regular cleaning protects your investment and your data. When you wipe off the screen and empty crumbs from your keyboard, you’re helping your equipment perform better and you reduce the risk it will break down. By regularly cleaning dust out of the fan vents and case, you can help protect the system from overheating and causing permanent damage to the internal parts of your computer and the information you store on it. If you don’t want to hurt your PC’s performance and lifespan with the added stress and heat, give it a good cleaning at least every six month to a year. Antivirus software and regular program updates help ensure viruses, malware, and cybercriminals stay out of your system.

Do not use any other cleaning or disinfecting solutions, as it could result in damage to the lancing device. This does not affect the functionality of the device. Here's how: Make sure that no liquid enters any opening, as it could damage the lancing device. Make sure that no solution is seen in any opening. Please be aware that we do not take any responsibility for accessing such information which may not comply with any valid legal process, regulation, registration or usage in the country of your origin. All rights reserved. Last updated on Jul 1, 2020. There are two different types of pregnancy tests: those that check the blood and those that check the urine. The pregnancy blood (serum) test must be performed at a doctor’s office or clinic, but the urine test can be performed at home or in a clinic. Home pregnancy tests are very accurate (if used properly), inexpensive and easily available at the pharmacy. Most only take about 10 minutes to see the results. Other early symptoms of pregnancy or signs of pregnancy might be: The hCG hormone is usually only present in blood or urine if a woman is pregnant. The egg usually implants into the wall of the uterus about six days after fertilization, but in about 10% of women implantation may not occur until after the first day of the missed period. The levels of hCG rise in the body early in pregnancy after implantation occurs. This test may be the most accurate option if a woman needs a pregnancy test very early. Women should contact their physician if they prefer the beta hCG blood test. If a negative pregnancy result occurs with a home urine test, the test should be repeated in a few days to a week to confirm the negative result. Women with positive pregnancy tests should contact their doctors for an appointment to discuss next steps. If the expiration date is passed, do not buy or use the pregnancy test. Store unopened tests in a cool, dry place. Be sure to read and follow the instructions exactly.

It is important to wait the correct number of minutes instructed on the package before the results are read. When this line or other symbol appears in the control window it ensures that the test is working properly. If a control window does not show a line or other symbol as indicated by the package instructions, then the test is not working properly. A new pregnancy test should used the next morning. For positive results, the woman should contact her physician to make an appointment as soon as possible to start prenatal care. However, it is best to confirm the results of a negative test by repeating it in a few days. If a woman is concerned about a faint line on a pregnancy test, it is best to wait a few days and repeat the test, or contact a physician for a confirmatory blood test. Digital pregnancy tests may not have a control window, but may show a flashing symbol in the window prior to the result. If you use insurance for your pregnancy test in a doctor's office or clinic, it may be more expensive than at-home tests. You might want to call your county health clinic or local Planned Parenthood. Also, ask your nurse or doctor for recommendations. All home pregnancy tests should give accurate results if not expired and the directions are followed closely. Many home tests claim to be 99% accurate on the first day of the missed period, but some studies refute this claim. However, other studies have found a greater than 90% accuracy for the ClearBlue tests. If you receive a negative pregnancy test, it's always best to test again in a few days to confirm the results. A false negative pregnancy test is when the results of the test indicate that the woman is not pregnant, but she actually is pregnant. A false-negative is much more likely to occur than a false-positive. Other circumstances that can lead to a false positive include: There are several other medical conditions that may lead to loss of a period, such as heavy exercise or thyroid problems. Clin Chem Lab Med.

Here’s how to keep your computer’s “mind” as clean as its “body” to possibly extend its longer lifespan. A laptop or tablet can be replaced, but the information inside it may be irreplaceable. Paid and free versions of antivirus software are available, and most programs can be set to work automatically in the background. Outdated software can be vulnerable to malware, because most updates are created to keep software safe from threats. Downloading and installing the latest versions of your programs might not only protect your PC, but can keep it working quickly. Decluttering helps ensure that your computer doesn’t get bogged down with unnecessary data. It also limits the number of programs malware might “hijack” to gain access to the system. Keep in mind that this may not make your device operate more efficiently. Your PC boot may work faster or maybe not. Making sure it’s clean is worth considering. But proceed with caution. If you make an error while cleaning your registry, you’ll need to reinstall your operating system. Be sure to back up your registry to be safe. Here are three examples to consider. It cleans out junk and duplicate files along with unnecessary apps, widgets and other extensions to free up space. Here are some of the options to consider: To launch it, click on the Windows key, type in Disk Cleanup, and press enter. To address this, Windows has a disk defragmenter tool that is built into the system and can run automatically. NortonLifeLock offerings may not cover or protect against every type of crime, fraud, or threat we write about. Our goal is to increase awareness about cyber safety. Please review complete Terms during enrollment or setup. Remember that no one can prevent all identity theft or cybercrime, and that LifeLock does not monitor all transactions at all businesses. NortonLifeLock, the NortonLifeLock Logo, the Checkmark Logo, Norton, LifeLock, and the LockMan Logo are trademarks or registered trademarks of NortonLifeLock Inc.

Firefox is a trademark of Mozilla Foundation. Android, Google Chrome, Google Play and the Google Play logo are trademarks of Google, LLC. Mac, iPhone, iPad, Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Alexa and all related logos are trademarks of Amazon.com, Inc. or its affiliates. Microsoft and the Window logo are trademarks of Microsoft Corporation in the U.S. and other countries. The Android robot is reproduced or modified from work created and shared by Google and used according to terms described in the Creative Commons 3.0 Attribution License. Other names may be trademarks of their respective owners. Learn more. A new lancet can be chosen by pushing the lancet lever back and forth. Insert a new drum—white end first—until it clicks into place. Replace the cap on the lancing device. The first lancet is ready to use. It contains 6 preloaded lancets, so there are no individual lancets to see or handle. The tip of a new needle is sharp and precisely formed to ensure gentle lancing, but the tip can become dull or bent if used more than once. What's more, a new lancet is sterile and hygienic. If you drop a drum, always pick it up at the red-striped end and dispose in a sharps container. Place the device firmly against the skin. Press the lancing device up and down in a slow pumping motion to assist the flow of blood. Do not be afraid to apply pressure to the area with the lancing device to assist the flow of blood. Continue to press the cap against the site for a few seconds to allow blood to come to the surface. The more blood you require, the higher the setting you'll need. Dial to a higher setting until blood volume is right.For this reason, it is important to keep the lancing device clean and disinfected. Do not allow anyone else to use your lancing device to obtain their blood sample.

2011;49(8):1317-1322.Accessed July 1, 2020 at Available for Android and iOS devices. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.

clinical documentation and case report writing manual

Case report, as a research design, describes important scientific observations that are encountered in a clinical setting to expand our knowledge base. Preparing a case report is far easier than conducting any other elaborative research design. Case report, with its main components, should be focused and delivers a clear message. In this article, the key components of a case report were described with the aim of providing guidance to novice authors to improve the quality of their reporting. Case reports have now been developed and accepted as a scholarly publication to disseminate knowledge to a wide medical audience. GENERAL PRINCIPLES OF CASES REPORT The case report is a research design where an unexpected or novel occurrence is described in a detailed report of findings, clinical course, and prognosis of an individual patient, which might be, but not mandatory, accompanied by a review of the literature of other reported cases. This approach might generate an idea or hypothesis, but it will not be confirmed unless we conduct further confirmatory quantitative experimental or observational study designs such as clinical trials or cohort studies. Despite that, case report provides the medical community with information which cannot be picked up by any other designs. The case report might be in the tail of the hierarchy of evidence-based medicine but if properly selected and appropriately reported it might stand a better chance of publication in high impact journals than even a clinical trial. However, if we have to categorize it; when we consider all research approaches in medicine, it can be classified into exploratory or confirmatory; then, case reports definitely will be considered an exploratory research approach. Case report can be classified as a single case report, two case reports or case series, which aggregate more than two cases in a report.

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The CARE guidelines (for CA se RE ports) were developed by an international group of experts to support an increase in the accuracy, transparency, and usefulness of case reports. View and download the CARE checklist here. The CARE guidelines have been endorsed by multiple medical journals and publishers and have been translated into multiple languages. Articles about the CARE guideline development process and a “manual” for writing case reports have been published in 2013 and 2017 in the Journal of Clinical Epidemiology. The CARE guidelines support the Equator Network’s mission to improve health research reporting. Online training to write case reports following the CARE guidelines is available from Scientific Writing in Health and Medicine (SWIHM), which also provides access to CARE-writer, an online application for writing case reports as preprints or for submission to a scientific journal. Why case reports? Accurate and transparent data collection from episodes of care informs the delivery of high-quality individualized healthcare. “Good case reporting demands a clear focus, to make explicit to the audience why a particular observation is important in the context of existing knowledge” (Vandenbroucke 2001). The CARE guidelines for case reports help authors reduce risk of bias, increase transparency, and provide early signals of what works, for which patients, and under which circumstances. Case reports following the CARE guidelines support the measurement of (1) clinician- and patient-assessed outcomes, (2) effectiveness of Clinical Practice Guidelines (CPGs), and (3) the return on investment (ROI). What is CARE-writer. CARE-writer is an online application that helps authors follow the CARE guidelines as they organize, format and write systematic and transparent case reports and case report preprints. Case reports written with CARE-writer can be posted on preprint servers such as SSRN’s HSCaseRepRN or submitted to scientific journals.

Once you have reviewed the literature and improved your knowledge on the topic, use the patient's note to record the key points in history, examination findings, relevant data results and interpretation, treatment (including operational findings), and outcomes. Delete all patients’ personal information, identifiers or contact detailed from the prepared report, including the radiological or histopathological images before you copy them into your article. Save the prepared report on a password protected hospital computer. The last step would be checking the journal which is most appropriate for your case report. Those journals provide you with the required criteria and appropriate format to prepare your report, to enhance their acceptability for publication. Many journals are interested in published case reports, but not all. The general format adopted for most case reports is detailed in the following subsection and summarized as a checklist in Table 2. Table 2 Checklist for writing a case report Topic Item description Title page 1. Title: “case report” should be added in the title 2. Authors name: Should not exceed more than six authors 3. Affiliation: The names of organizations for each author 4. Corresponding author: Write the full name of the corresponding author and all contact details including email and mobile number Abstract 5. Background: what does this case report add to the medical literature? 6. Case summary: chief complaint, diagnosis, intervention, and outcome 7. Conclusion: what is the main “take-away” lesson from this case. Keyword Introduction Patient information 8. 4-7 key words-include “case report” as one of the key words 9. Briefly summarize the background and context of this case report (1-2 paragraphs) 10. De-identified demographic and other patient or client specific information 11. Chief complaint 12. Relevant history including past surgeries, family history, and medication history Physical examination Diagnostic assessment 13.

Once a potential case is identified, and the patient is in hospital, follow him through hospitalization until discharge. Give the case an appropriate time frame in the course of the disease to observe the development over time. Wait for 6 months during multiple visits, before you start writing a case report to allow adequate time to complete the clinical course. Once you have a potential case, how would you know if this is an appropriate for reporting or not. Especially if you are a novice physician, once you encounter a possible case and you are suspecting if this patient fulfills one of those criteria which are described in Table 1. The first step is a high index of suspicion; keep your eyes open for every case, once you suspect a case then ask your colleagues either directly or in a group related to the same discipline, locally, to confirm that this could be a case report. The next step would be asking an expert from the national or international medical community about this case scenario, get their opinion and feedback, including the appropriateness of reporting this case. Once the feedback is positive, perform extensive literature search, through PubMed, Embase, Google Scholar, and databases for case reports to ensure that you retrieve all available information on this topic. Do not forget to look at popular case reports which are not indexed in PubMed and read through previously published case reports that will enhance your understanding of the subject and gives you a general scaffold to prepare your own report. Once the decision was made to report this case, obtain an informed consent from the patient; otherwise, it will not be accepted for publication. Moreover, take a permission from consultant in-charge of the case before writing your report.

Cover letter Open in a separate window Title This is the most commonly read part of your article; therefore, it should be relevant, concise, informative, descriptive, and appealing enough to attract readers to your report. It is placed in the first page of the manuscript, but some journal might request you to specify a separate file from the manuscript, labeled as a “title page” file. In preparing the title, avoid unnecessary words, wordplay, double meaning, cute wording, and never uses abbreviations in the title. It is always advisable to add “case report” in your title. Beneath the title, list all authors and their affiliations on the same page including their E-mails account. Most of the case reports are not prepared by a single author, but it should not exceed more than six authors; otherwise, the journal might not accept your case report for publication. Finally, under the subsection of corresponding author, assign one author to communicate with the journal and include all details of communication, such as institutional address, E-mail, and phone numbers. Who should be the corresponding author. Any person who will submit the article to the journal to get the feedback from the editor of the journal and should be one of the article's authors. Abstract It is the most important part of your article as it will be freely accessible for others to read when retrieved from any medical databases during the relevant search. However, it is the last part written in your article. It should include a brief summary that gives a general idea of the content of the case report. It should not include any references or abbreviations and should not exceed 350 words, preferably Keyword This is quite important for indexing your article, and it should be from three to ten words, and you should be very careful in your selection, as it would help in retrieving your paper during the search.

Relevant physical examination findings 14. Evaluations such as laboratory testing and imaging 15. Diagnostic reasoning including other diagnosis considered and challenges 16. Consider tables or figures linking assessment, diagnosis and interventions 17. Prognostic characteristic where applicable Interventions 18. Intervention type 19. Intervention detailed methods and duration 20. Explanation to intervention outcome 21. Other concurrent interventions Follow-up and outcomes 22. Clinician assessment 23. Important follow-up diagnostic evaluations 24. Assessment of intervention adherence and tolerability, including adverse events Discussion 25. Strengths and limitations in your approach to this case 26. Compare your results with previous reported cases (optional) 27. Specify how this case report informs practice or guidelines 28. How does this case report suggest a testable hypothesis. Conclusion 29. State clearly the main conclusion of the case report and provide a concise statement and explanation of the importance and relevance Patient perspective Informed consent Additional information 30. When appropriate report the patient experience in his own word and his message 31. Informed consent from the person who is the subject of this case report is required by most journals 32. List of abbreviation 33. Competing interest 34. Author contribution 35. Author information 36. Acknowledgement and 37. References Plagiarism Supplementary material 38. Check for plagiarism 39. Table: Use Microsoft word, avoid creating tables using spaces or tabs, expand all abbreviations in the legend. Each table must be submitted as a separate file 40. Figures: Number each consecutively, expand all abbreviations in the caption. Each figure must be submitted as a separate file 41. Images: Digital images must be high resolution, JPEGS all images must be cited in the text and numbered in order of appearance 42.

Criteria of qualification to be an author should be strictly followed and explicitly stated for each author, separately. The first criterion is being a part of the conceptual development, data acquisition or analysis, then involvement in drafting part of the manuscript, and finally approving the final version of the manuscript. If those criteria are not fulfilled, then those individuals should be acknowledged in the next section. Be cautious from excessive authorship as this might lead to rejecting your article. References You need to mention around 15 references if possible, and few of them should be within the past 5 years, but do not exceed more than 25 references. Cover letter This is an optional supplementary document, addressed to the editor-in-chief, in a formal letter. Explain why this report is important and why it should be published in this journal. JOURNAL EVALUATION FOR A CASE REPORT Writing a case report varies from one physician to another, depending on the expertise of the author who prepared the report. This variation is influenced by many factors ranging from the author's knowledge base to his writing skills. The Peer review process will detect this variation to assure the quality of reporting through critical appraisal. It will assess the report, provide a valuable, supposedly constructive, feedback and helps the editor in a decision regarding the publication. This assessment should be as objective as possible to reach an unbiased decision. Therefore, several schemes were formulated to evaluate the quality of the case report. One of which is the Piersons 5-component scheme which relays on five major components, each component is scored from 0 to two, with a possible total score of 10 and lowest score of zero. A score from 6 to 8, indicate possible publication with caution about validity. Any score Table 3.

Table 3 Matrix of case report evaluation Components Points 0 1 2 Documentation Insufficient data provided with incomplete references for documentation Most information is available with some missing data, images and references Information is complete and accurate with supplemented with enough images and tests with relevant references Uniqueness Well reported and documented in the literature Reported before but not in the same field or journal or few cases It was never reported before Educational values Case is incomplete with weak instructional content, and irrelevant outdated references Case described missing, atypical or contradictory feature with incomplete discussion of the topic and less ideal references Complete description with appropriate and comprehensive discussion on selected topic which provides an opportunity to learn Objectivity Clear selective reporting, author’s bias toward the subject matter is evident with insufficient or inadequate presentation and reporting the evidence supporting the author’s idea only Data are presented in appropriate format but uncertain completeness, with selective or subjective reporting. Contradicting theories are omitted with incomplete references of those opposing to the authors All data is complete with appropriate format and no evidence of selective reporting. All alternative explanation is discussed, and atypical features are presented.

Introduction In this section, the definition and brief description of the pathology, including common presentations and disease progression is discussed, explaining the background of the selected topic. Followed by a brief description of what is about to be reported and the importance of reporting such case. The content should be clear, focused, concise, and attract the reader's attention and interest. Case presentation Provide a clear picture of the patient's condition and presentation, and it is best presented in chronological order with sufficient detail and explanation. Describe the relevant demographic information of the patient censoring any details that could lead to the patient being identified. Start with the current medical condition and primary complaint with detailed history including relevant family history, occupational and social history, medication, and allergy. Findings of physical examination should be briefly reported with all relevant investigation, laboratory results and images, and its analysis. Describe the differential diagnosis and the rational of the management approach, including follow-up results and final diagnosis. Avoid any extensive interpretation or defense for the approach you took. This section can be broken up into small subsections if needed, and it should be supplemented with necessary images and tables to facilitate reader's understanding of the case. Discussion Probably, this is an optional section, but it is preferable if reported, as it would explain more of your rational and approach with added additional relevant information about the uniqueness of this case. Compare your findings with what is known in the literature and why you think this case is different. Only discuss what is relevant to your case and do not provide any unproven and unsupported speculation. Acknowledge and explain any ambiguity or unexpected features occurred even if it is contradicting your concept.

Explain how this case would contribute to the literature and suggest justifiable recommendations. Conclusion The section should include a concise and brief statement, explaining the importance and relevance of your case and it should relate to the purpose of the paper. Patient's perspective This new section is an optional, but it adds a new dimension to your paper, as it gives the chance to patients with their own perspective to write and describe their experiences throughout the disease process. Make sure that any patient's identifiers are removed, and his identity is managed appropriately with confidentiality, removing all irrelevant information to the case report. Consent Before submission, make sure that the patient gave his informed consent for publication, and statement indicating that should be clearly narrated in the report. You do not need to send the consent form on submission, but it should be available if requested. In case of the child, the parent or legal guardian should be consented instead, and if the child is a teenager then both patient and his parent should be consented. Many journals will not proceed with the peer review process unless a statement like “written informed consent was obtained from the patient for publication” is clearly stated. This statement could be in a separate section, as indicated here, or within the content of the report. If the patient is incapacitated or deceased, obtain the consent from the next-of-kin, and this should be stated clearly in the report. If the patient is deceased and next-of-kin is unreachable, you should exhaust all reasonable attempts to obtain the consent. If you fail, then you should state that in your report. If none, then, a statement like “the authors declare that they have no competing interests” should be clearly stated. Author contribution In this section, you need to credit all individuals who made a substantial contribution to the production of this study.

No evidence of author advocacy or bias related to conflict of interest Interpretation Extrapolation of conclusions about mechanisms or interventions well beyond the data presented Some conclusions went further than what is acceptable of the data presented Conclusions and recommendation were conservative, compatible with the data provided Open in a separate window The calculated total score: Score of 9-10: Excellent report and most likely will add new information to the medical literature, Score of 6-8: Can be published but reader should be caution of validity and clinical value, Score of 5 or Less: Report is considered inadequate and inappropriate for publication CONCLUSION Case report remains an important source of information and common method in knowledge dissemination among physicians due to its simplicity in design. It will continue providing new research ideas through hypotheses generation. Publish it, place it on permanent record as a short, concise note. Such communication is always of value.” Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgment You need to mention and acknowledge the source of the research fund if any. Moreover, acknowledging all people who helped you, supervised you, or assisted you in finalizing this report, if they are not fulfilling the criteria to be an author. REFERENCES 1. Jenicek M. Clinical case Reporting in Evidence-Based Medcine. A preliminary communication on extensively disseminated Kaposi's sarcoma in young homosexual men. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. London: Routledge; 2011. Ilfeld BM, Wright TW, Enneking FK, Vandenborne K. Total elbow arthroplasty as an outpatient procedure using a continuous infraclavicular nerve block at home: A prospective case report. Gopikrishna V. A report on case reports. This article has been cited by other articles in PMC.

Abstract Case reports are a time-honored, important, integral, and accepted part of the medical literature. Both the Journal of Medical Case Reports and the Case Report section of BioMed Central Research Notes are committed to case report publication, and each have different criteria. Journal of Medical Case Reports was the world’s first international, PubMed-listed medical journal devoted to publishing case reports from all clinical disciplines and was launched in 2007. The Case Report section of BioMed Central Research Notes was created and began publishing case reports in 2012. Between the two of them, thousands of peer-reviewed case reports have now been published with a worldwide audience. Authors now also have Cases Database, a continually updated, freely accessible database of thousands of medical case reports from multiple publishers. This informal editorial outlines the process and mechanics of how and when to write a case report, and provides a brief look into the editorial process behind each of these complementary journals along with the author’s anecdotes in the hope of inspiring all authors (both novice and experienced) to write and continue writing case reports of all specialties. Useful hyperlinks are embedded throughout for easy and quick reference to style guidelines for both journals. Introduction: the importance of case reports Case reports are a time-honored tradition in the medical profession. The publication of case reports has indeed become a standard lexicon of the medical literature. The act of recording, discussion with colleagues, and publishing our clinical observations with patients remains essential to the art of medicine and patient care. Place it on permanent record as a short, concise note. Early case reports were little more than personal communications between colleagues about unique and interesting patients seen in their respective medical practices.

There are already many well-written published articles on how and when to write a good case report (please see Recommended further reading section at the end). I will not re-invent the wheel, but within this editorial I hope to provide an informal guide on how and when to write a case report for BioMed Central (BMC), in particular the Journal of Medical Case Reports ( JMCR ) and BioMed Central Research Notes ( BMCRN ). The utility of the newly created Cases Database will also be discussed. Relevant and useful website links will be used throughout to allow the reader easy access to further information on BMC requirements. I also hope to impart to the reader a brief overview of case report editorial flow in both JMCR and BMCRN along with the complementary relationship between both journals. I will also give anecdotes of how I personally approach things. Definitions What exactly is a case report. From peer-reviewed journals to Wikipedia (and yes, I read Wikipedia like we all do) definitions are readily available and generally agreed upon. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurrence. How to start: the patient Things start at the bedside or in the office with the most important person involved: the patient. Patients and their stories (including from their friends, coworkers, and family) are our portal to writing the case report. Patients (both in-patients and out-patients) are assessed, we confer with colleagues, appropriate investigations then follow, and treatment if possible begins. If I encounter an in-patient on call then I follow him or her throughout his or her hospitalization and, I hope, timely discharge. The patient is then followed and reexamined in the office over the course of time to see how the clinical course evolves. I usually wait 6 months over the course of multiple visits before I actually begin to write a case report so as to allow enough time for the clinical course to play out.

Of course if the patient is hospitalized with an acute and rapid illness then this time may be much shorter, but I still follow him or her with daily neurologic examinations. Collegial discussion and the Internet: our modern day water cooler When an interesting condition is encountered in either the hospital or the office setting, I discuss the case in person with both my local neurology colleagues and colleagues of other specialties to see if they have encountered before the clinical scenario that I am dealing with at the time. This is usually a quick face-to-face nursing station conversation. If the case is particularly challenging then I will contact my local university colleagues for their opinion (especially if an urgent transfer needs to be arranged). I then “hit the books”, or at least I used to. Nowadays I usually “hit the keyboards” which are plentiful at every hospital nursing station and in my office. Indeed, the Internet seems to have become our modern day replacement for office water cooler conversations. If I feel that a particular patient warrants a case report, then I continue to read more and more. There are also medical list servers and medical online communities to which one can post a case with de-identified images online and petition the advice of colleagues worldwide. Teaching grand rounds at one’s local university or hospital, poster presentations, and simple discussion with professors giving lectures at local seminars are also good (and previously “traditional”) places to start. I have always preferred an in-person encounter to discuss a case with a colleague or professor, but given the current day and age (daily workload, travel costs, time away from the office and family, and so on), I have found Internet-based discussion (keeping all patient information anonymous of course) very helpful.

The BMC series, JMCR, and BMCRN: a brief history The BMC series is a group of open access, peer-reviewed journals that spans most areas of biological and clinical research. There are currently 65 journals in the series, including (alphabetically) BMC Anesthesiology to BMC Women’s Health. JMCR is an online, open access journal under BMC auspices dedicated mainly to the publication of high quality case reports, and aims to contribute to the expansion of current medical knowledge (please see specific publication criteria below). It was created and founded by Michael Kidd and colleagues in 2007 and at the time was believed to be the world’s first international medical journal devoted to publishing case reports from all clinical disciplines. In the 5 years since its launch, JMCR has published over 2000 case reports. BMCRN is also an online, open access journal under BMC auspices publishing scientifically sound research across all fields of biology and medicine. The journal provides a home for short publications, case series, and incremental updates to previous work with the intention of reducing the loss suffered by the research community when such results remain unpublished. Please read on to see the complementary relationship of case reporting between the two journals, how they relate to other journals in the BMC series, and further information on editorial work flow including specific publication criteria. Cases Database: an invaluable resource Since the launch of JMCR in 2007 and the more recent introduction of case reports to the BMCRN, which aims to have a broader scope, BMC has acknowledged and continues to acknowledge the value of case reports to the scientific literature.

clinical chemistry quality control manual

This development together with the responsibility of the manufacturers for the measurement systems and reagents ( 18 ) creates the environment for re-orientation of laboratories of clinical chemistry to closer co-operation with their users. Total quality management (TQM) in clinical chemistry consists of efforts to establish and maintain a climate of continued improvements in the laboratory in order to deliver high-quality services to health care. Total quality management systems come in numerous variants forwarded by different organizations but are united by the following major cornerstones: 1) customer needs define quality, 2) continuous monitoring ( 19 ), systematic analysis and improvement of crucial work processes are needed, 3) the top leadership of the laboratory is responsible for the quality and quality improvements. The well-established principles of total quality management come in handy when optimizing the total testing chain. Quality assurance must be implemented, managed and maintained by the leadership of the laboratory. Procedures, processes and systems and not people represent the major obstacles to optimal quality. When physical staircases need cleaning, an appropriate cleaning process should start at the top since dust gravitates downwards. The initial efforts made by the laboratories to acquire accreditation are commonly the most rewarding as they engage all of the employees and the whole organisation in a goal-directed and concerted effort for improvements. As the years pass by, accreditation usually becomes the primary activity of a handful of persons in the laboratory who create a bureaucracy for the purpose. Standards and accreditation are important for quality assurance but in their basic nature they strive for status quo rather than for dynamic development with the inherent risks that changes invite. The avoidance of the risks of organisational changes is fundamentally not a property of the standards themselves.

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Summary Working in laboratories of clinical chemistry, we risk feeling that our personal contribution to quality is small and that statistical models and manufacturers play the major roles. It is seldom sufficiently acknowledged that personal knowledge, skills and common sense are crucial for quality assurance in the interest of patients. The employees, environment and procedures inherent to the laboratory including its interactions with the clients are crucial for the overall result of the total testing chain. As the measurement systems, reagents and procedures are gradually improved, work on the preanalytical, postanalytical and clinical phases is likely to pay the most substantial dividends in accomplishing further quality improvements. This means changing attitudes and behaviour, especially of the users of the laboratory. It requires understanding people and how to engage them in joint improvement processes. We need to use our knowledge and common sense expanded with new skills e.g. from the humanities, management, business and change sciences in order to bring this about together with the users of the laboratory. Quality control, quality assurance and total quality management in Clinical chemistry According to ISO 9000:2005, Clause 3.2.11, quality assurance is a part of quality management, providing confidence that quality requirements will be fulfilled. Quality control is monitoring to indicate needed corrective responses. Westgard, deVerdier, Groth and Aronsson ( 6, 7 ) addressed the important problem of false rejections of measurements introducing the use of multiple control rules. Importantly the introduction of ISO 15189 ( 16 ) broadened the scope of accreditation from the measurement process itself to the interaction of the laboratory with its clients and to the total testing chain, including the pre-and postanalytical processes. This is in tune with the widely practiced and well-established approaches of total quality management systems.

Research in the fields of pre- and post-analytical factors in laboratory medicine has seen exponential growth during recent years. However, since most of the economy of the laboratory is spent in the analytical phase, it still attracts the main focus of both the diagnostic industry and healthcare. Another important reason that pre- and postanalytical factors have been studied less than analytical factors is that other research- and administrative paradigms are needed than when studying analytical factors which can and should be addressed by sound principles of e.g. metrology. Optimal pre- and post-analytical procedures are frequently known and agreed on in professional circles. The analytical phase of the total testing chain The quality of the analytical phase of the total testing process has been and is being improved e.g. by the International Standardization Organization (ISO), e.g. through the ISO standard 17511:2003 detailing how the metrological traceability of values assigned to calibrators and control materials is established, The Joint Committee for Traceability in Laboratory Medicine (JCTLM) established in 2002 i.a. by the IFCC and the International Consortium for Harmonization of Clinical Laboratory Results (ICH-CLR) established by The American Association of Clinical Chemistry (AACC) in 2010. The Empower project ( 29 ) ( ) is a new promising and energetic newcomer in the field. Singleton measurement of control samples for quality control External quality control procedures in clinical chemistry traditionally focus on singleton- sample methods for quality control, which means that a control sample is measured only once before the result is reported. Singleton measurements are efficient for regulatory purposes since a minimum number of control samples (one) and measurements (one) are required. The drawback in some situations is that singletons are suboptimal for distinguishing between random error and bias as causes of the (total) error ( 31 ) ( Figure 2 ).

Accreditation according to ISO standards, as commonly practiced today, therefore risks becoming not only an obstacle but also a real enemy of the necessary paradigm shift in laboratory medicine made possible by advances in automation and information technologies. Flexible scope of accreditation ( 17, 20 ) may represent a partial solution to this challenge, but a more radical scheme of more intensive monitoring by the accreditation authorities during periods of major transitions for accredited laboratories may be needed in order to avoid the need to abandon forma accreditation when performing major restructuring. It also holds true for the total testing process in clinical chemistry e.g. as depicted in Figure 1. Open in a separate window Figure 1 The total testing chain in clinical chemistry involves several professionals and organizations in healthcare from the clinical decision to order a test through the pre-analytical, analytical and post-analytical phases to the value of the test result in the on-going clinical decisions and healthcare process. Uncertainty of the high-volume measurement methods in clinical chemistry has decreased substantially with the advent of highly automated measurement methods and reference measurement systems. The most substantial improvements have been accomplished in reducing the repeatability and reproducibility. Bias has also been decreased, but not to the same extent ( 28 ). The preanalytical, postanalytical and clinical phases (collectively known as extraanalytical phases ) of the testing processes have not been addressed nearly to the same extent as the analytical phase, probably because they involve multiple categories of professionals working in the clinic and are therefore outside of the boundaries of total control of the laboratory. In brief; it depends on whether the taking and handling of samples is under the auspices of the laboratory or not.

A laboratory represented by the yellow circle may preferably serve as a mentor for a certain measurand for the other laboratories in the conglomerate of laboratories serving a certain population ( 28, 34 ). The use of fresh split patient samples for quality control makes common sense for several reasons:Split sample methods are laborious in the absence of effective computerized systems, but convenient when properly implemented ( 34, 35 ). Most laboratory organizations that introduce split sample methods prefer to continue their participation in external quality control schemes for the purpose of being able to compare their results more widely. Traceability It is comforting when other laboratories measure approximately the same measurement result for the same measurand in the same sample. However, the absence of bias does not, in on its own, constitute a proof of trueness. Thus inter-laboratory comparisons by themselves do not provide traceability of the participants’ results. It is the task of the participants’ themselves task to ensure the traceability of their results ( 36, 37 ). Making sure there is traceability of measurement methods of the laboratory takes knowledge, skills and common sense of the engaged persons and makes especially good common sense when the results from the laboratory are to be used in studies involving several countries or when decision limits established in large population studies are implemented. Harmonization Only a minor portion of common methods in clinical chemistry are currently traceable. It is, however, possible to harmonize ( 38 ) the majority of all measurement methods using commutable sample materials, including patient samples ( 39, 40 ). It is not an easy undertaking, but potentially very valuable for the patients.

Open in a separate window Figure 2 When a mean of a result is reported, the error of the mean is influenced both by bias and random error. The standard error of the mean is inversely related to the square root of the number of replicates and thus decreases quadratically with the number of replicates. As the number of replicates is increased, the contribution of the random error to the measurement error of the mean approaches zero, thereby improving the estimate of the bias. Bias is commonly estimated by participation in proficiency testing schemes (external quality control), using certified reference materials or by comparisons with reference methods ( 32, 33 ). Comparisons are commonly made by stabilized samples which do not necessarily exhibit all the properties of natural patient samples. Natural patient samples are commutable ( 34 ) by definition and in practice whereas stabilized control materials may or may not be commutable. If the main purpose of a quality control system is to minimize the overall measurement uncertainty of all measurement systems and methods in an organization or geographical area, the use of fresh split patient samples is more efficient in finding clinically important bias and thereby for minimizing measurement uncertainty, especially when replicate measurements are used for minimizing random error. Open in a separate window Figure 3 External quality control (ECQ) organizations send out stabilized quality control samples which are analyzed as singletons and evaluated centrally (depicted as dotted arrows). The use of split fresh patient samples (depicted as the solid black ring) including the use of replicate measurements facilitates finding bias and thereby minimization of measurement uncertainty in an organization or a geographical area.

In an environment of this kind, eliminating the contribution of the poorest performing measurement system (bias and random error) becomes particularly important. The extraanalytical phases of the total testing chain Academic organizations and producers of measurement systems and reagents are already heavily involved in improving the measurement part of the total testing process. The extraanalytical phases are also in need of substantial development. Current and future efforts in harmonizing measurement results in clinical chemistry are likely to include extensive cooperation between e.g. clinically active persons, the industry, standardization organizations, professional organizations and individual laboratories. They do also include all aspects of the process from the clinical decision to use the clinical chemistry laboratory in diagnosis through preparing the patient, taking- and transporting the samples ( 44 ), measuring the samples and reporting the results and including the interpretation of the results in the clinical ( Figure 1 ). Statistical and graphical methods are essential for quality control and for calculating measurement uncertainty in the analytical phase. Statistical methods can also be applied in the preanalytical phase, e.g. for monitoring the occurrences of different kinds of preanalytical errors ( 56 ). There are limits to the extent which uncertainty in the analytical phase can be reduced. In contrast sources of uncertainty in the preanalytical phase can be practically eliminated by optimizing practices for e.g. patient preparation, phlebotomy and sample transport. Sample transport practices can be improved by investments in e.g. vacuum tube systems or by contracting certified regional transporters of samples, regularly monitoring their performance through sensors regularly sent with the samples.

It is however, even more challenging to change the behavior of nurses, doctors and others responsible for patient preparation, phlebotomy and other preanalytical procedures outside the control of the laboratory. Different circumstances and individuals may also need different means of persuasion and education in order to minimize preanalytical errors. Time is well spent listening to the opinions of the users of the laboratory in different natural situations of co-operation. Advanced change management methods may be needed to accomplish the improvements needed. Neither of these technologies are amongst tools that have as yet been widely applied in clinical chemistry. Unfortunately there is no firm evidence as to the best methods to employ for the purpose of changing practices in healthcare ( 60 ). Studies investigating the components of tailoring (identification of the most important determinants, selecting interventions to address the determinants) are especially lacking. Eliminating preanalytical errors deserve to rank highest on the list of priorities when attempting to continue to reduce diagnostic uncertainty. Structured and persistent work in this area means that personnel from the laboratory need to allocate sufficient time and efforts to this purpose. The fact that laboratories are seldom reimbursed for work in the preanalytical field, commonly means that sufficient emphasis and time is not allocated. There are several valuable current developments for defining analytical quality specifications ( 64 ) and overall diagnostic uncertainty (the combined uncertainty of all uncertainty components involved when using the laboratory to support diagnosis). However, increased emphasis on changing behaviours in the preanalytical field promise to be even more important than developing methods for adding uncertainties arising in the preanalytical phase to the overall diagnostic uncertainty of laboratory results.

Routine laboratories of clinical chemistry with their abundance of patient samples are in an especially favourable position to participate in harmonization projects which optimally are done in co-operation with reference laboratories and with co-operation of the producers of the relevant measurement systems and reagents ( 41 ). Clinical chemistry pioneered in establishing the theoretical framework and practical routines for single sample-based external quality control (EQC) and batch-oriented routines for internal quality control. The total error of a measurement system estimated when measuring control samples is frequently the main emphasis of laboratories despite the fact that the total error only represents in the order of 20% of the diagnostic uncertainty related to laboratory medicine ( 30 ) ( Figure 4 ). Open in a separate window Figure 4 The diagnostic uncertainty of a measurement result in a patient sample is a property of the measurement result itself, influenced by several uncertainty components, including biological variation, preanalytical variation, analytical variation (including uncertainty of the calibration) and postanalytical variation. The total error of an external quality control sample, in contrast, is influenced by substantially fewer and smaller uncertainty components and therefore represents a property of the measurement system itself. The total error is commonly used for regulatory or accreditation purposes. Measuring the concentration of a measurand in a stabilized control sample in internal quality control or in proficiency testing involves much fewer uncertainty factors than being requested to prepare a patient, take a sample, process the sample, transport the sample, analyse the sample and interpret the results in a clinical context ( Figure 4 ). The uncertainty factors involved when measuring a stabilized control sample are mainly the sample handling and the uncertainty of the measurement system.

The total error estimated from singleton measurements of control samples has been found appropriate for regulatory purposes and an extensive theoretical and practical framework has been developed around its use ( 42, 43 ). According to a recent definition total analytical error (TAE) defines the interval that contains a specified proportion (usually 95% or 99%) of the distribution of analytical measurement differences between a measurement procedure operating in its stable incontrol state and a comparative measurement procedure that is either a definitive reference method or one that is traceable to one ( 43 ). Correspondingly allowable total error (ATE) is an analytical quality requirement that sets a limit for both the imprecision (random error) and bias (systematic error) that are tolerable in a single measurement or single test result. Regulatory issues are not of primary interest in many countries, certainly in the Nordic countries where the majority of labs are accredited according to ISO 15189. The laboratory organisation that the present writer belongs to caters for all laboratory services for 0,5 million inhabitants including point-of-care measurement methods. All laboratory services (including all specialties) are covered by the same accreditation. The total outcome is king in this environment, e.g. glycaemic control in the diabetic population, glycated haemoglobin and the contribution of the laboratory organization in optimizing treatment. It is a substantial challenge keeping the total CV% for HbA1c below 3% (total CV% for in the order of 100 measurement systems) as demanded by the diabetologists. This means that the performance of a single measurement system in external quality control systems has somewhat lower priority than the contribution of that measurement system to the overall CV% of HbA1c used for the entire population.

Postanalytical factors Co-operation with clinical disciplines on Health Technology Assessment (HTA), evidence- based medicine (EBM), guidelines etc.Hopefully this and other factors striving for excellence in healthcare can lead to projects aiming for harmonization and improvements of practice especially in the pre-and postanalytical parts of the total testing process. Important steps can be taken through many channels to improve the clinical use- and value of diagnostic procedures available through clinical chemistry. The laboratory and the clinicians are increasingly making co-operative projects in diagnostic guidelines and in the implementation of these guidelines. I personally believe joint projects of this kind may serve to facilitate other projects in the pre-and postanalytical areas ( 65 ). Motivation, knowledge and common sense Laboratory medicine performs a highly practical high-volume production, but its cornerstone is intellectual. Motivation is the mother of all intellectual pursuits. All measures that increase the motivation of the employed in the laboratory contribute to the overall quality of the services. The most important factor for creating and maintaining motivation is the intellectual and organisational environment of the laboratory. Active participation in research projects, organisational and quality improvement projects is motivational. Collaborative projects directly aimed at improving the quality of the services to the patients have especially strong motivational effects when done in collaboration with workers in other areas of healthcare. Research projects in the basic sciences are also important as they bring and maintain knowledge in scientific philosophy and methods, thereby increasing understanding of the meaning and proper interpretation of data.

It is a substantial challenge to maintain motivation throughout extended periods of time especially since demands for the reduction of costs and the number of workers are of regular occurrence. It is therefore important to regularly lift the focus from the mundane challenges of the laboratory and all its employees to the needs of the patients. External inspections of the quality assurance of the laboratory e.g. as part of ISO 15189 accreditation serves an important role in this context as it renews important commitments and focus on purpose. Common sense is especially important in the extraanalytical phases of the testing chain. Uncertainties in the preanalytical, postanalytical and clinical phases of the testing chain may be partially estimated as type A uncertainties ( 66 ) by calculating coefficients of variation. In contrast to imprecision in the analytical phase which cannot be eliminated the goal should be to eliminate uncertainty components in the extraanalytical phases, in order to as much as possible eliminate their contribution to the overall diagnostic uncertainty ( Figure 4 ). This is a lofty but not an unrealistic goal. As a matter of fact, any improvements in phlebotomy practices, sample treatment, sample transport, interpretation of the results in clinical and biologic variation contexts will decrease the contributions of the extraanalytical phases to the overall diagnostic uncertainty. Such crucial improvements will not happen by themselves. Conclusion Clinical chemistry is in the process of paradigm shift from a primary focus on optimizing the measurement methods themselves to more intense collaboration with persons engaged in clinical work in order to reduce preanalytical, postanalytical and clinical uncertainties thereby improving the clinical use of laboratory methods.

Manufacturers of measurement systems and reagents now shoulder the main responsibilities for the analytical process leaving time for optimizing preanalytical, postanalytical and clinical processes demanded e.g. by the accreditation standard ISO 15189. In order to shoulder these added responsibilities clinical chemistry needs to use its abundant common sense and learn from the humanities and from management-, business- and change sciences how to proceed in the interest of patients. Conflict of interest statement The authors stated that they have no conflicts of interest regarding the publication of this article References 1. Shewhart WA. Economic control of quality of manufactured product. The use of control charts in the clinical laboratory. Combined Shewhart-cusum control chart for improved quality control in clinical chemistry. Performance characteristics of rules for internal quality control: probabilities for false rejection and error detection. Ehrmeyer SS, Laessig RH. Has compliance with CLIA requirements really improved quality in US clinical laboratories. Plebani M, Sciacovelli L, Chiozza ML, Panteghini M. Once upon a time: a tale of ISO 15189 accreditation. Plebani M, Sciacovelli L, Aita A, Padoan A, Chiozza ML. Quality indicators to detect pre-analytical errors in laboratory testing. Plebani M, Astion ML, Barth JH, Chen W, de Oliveira Galoro CA, Escuer MI. et al. Harmonization of quality indicators in laboratory medicine. A preliminary consensus. Plebani M, Sciacovelli L, Marinova M, Marcuccitti J, Chiozza ML. Quality indicators in laboratory medicine: A fundamental tool for quality and patient safety. Sciacovelli L, O’Kane M, Skaik YA, Caciagli P, Pellegrini C, Da Rin G. et al. Quality Indicators in Laboratory Medicine: from theory to practice. Theodorsson E, Magnusson B, Leito I. Bias in clinical chemistry. De Grande LA, Goossens K, Van Uytfanghe K, Stockl D, Thienpont LM. Bonini P, Plebani M, Ceriotti F, Rubboli F. Errors in laboratory medicine.

On the use of total error and uncertainty in clinical chemistry. Thienpont LM. Quality specifications for reference methods. Theodorsson E. Validation and verification of measurement methods in clinical chemistry. Braga F, Infusino I, Panteghini M. Role and responsibilities of laboratory medicine specialists in the verification of metrological traceability of in vitro medical diagnostics. De Bievre P. Do interlaboratory comparisons provide traceability. Greg Miller W, Myers GL, Lou Gantzer M, Kahn SE, Schonbrunner ER, Thienpont LM. et al. Roadmap for harmonization of clinical laboratory measurement procedures. Thienpont LM, Van Uytfanghe K, De Leenheer AP. Reference measurement systems in clinical chemistry. Stepman HC, Tiikkainen U, Stockl D, Vesper HW, Edwards SH, Laitinen H. et al. Measurements for 8 common analytes in native sera identify inadequate standardization among 6 routine laboratory assays. Westgard JO, Westgard SA. Quality control review: implementing a scientifically based quality control system. Westgard JO. Useful measures and models for analytical quality management in medical laboratories. Truchaud A, Le Neel T, Brochard H, Malvaux S, Moyon M, Cazaubiel M. New tools for laboratory design and management. Statland BE, Bokelund H, Winkel P. Factors contributing to intra-individual variation of serum constituents. 4. Effects of posture and torniquet application on variation of serum constituents in healthy subjects. Statland BE, Winkel P. Effects of preanalytical factors on the intraindividual variation of a nalytes in the blood of healthy subjects: consideration of preparation of the subject and time of venipuncture. Lippi G, Banfi G, Church S, Cornes M, De Carli G, Grankvist K. et al. Preanalytical quality improvement. Lippi G, Becan-McBride K, Behulova D, Bowen RA, Church S, Delanghe J. et al. Preanalytical quality improvement: in quality we trust. Lippi G, Chance JJ, Church S, Dazzi P, Fontana R, Giavarina D. et al.

Preanalytical quality improvement: from dream to reality. Lippi G, Simundic AM, Plebani M. Phlebotomy, stat testing and laboratory organization: an intriguing relationship. Lima-Oliveira G, Lippi G, Luca Salvagno G, Picheth G, Cesare Guidi G. Laboratory diagnostics and quality of blood collection. Plebani M, Sciacovelli L, Aita A, Chiozza ML. Harmonization of pre-analytical quality indicators. Corbin JM, Strauss AL. Denzin NK, Lincoln YS. Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S. et al. Tailored interventions to address determinants of practice. Fearing G, Barwick M, Kimber M. Clinical transformation: Manager’s perspectives on implementation of evidence-based practice. Bernhardsson S, Larsson ME, Eggertsen R, Olsen MF, Johansson K, Nilsen P. et al. Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial. Rousseau DM, Gunia BC. Evidence-Based Practice: The Psychology of EBP Implementation. Sandberg S, Fraser CG, Horvath AR, Jansen R, Jones G, Oosterhuis W. et al. Defining analytical performance specifications: Consensus Statement from the 1st Strategic Conference of the European Federation of Clinical Chemistry and Laboratory Medicine. Skeie S, Perich C, Ricos C, Araczki A, Horvath AR, Oosterhuis WP. et al. Postanalytical external quality assessment of blood glucose and hemoglobin A1c: an international survey. Joint Committee for Guides in Metrology; 2008. Our news promotes the best new methodologies in science. Our news promotes the best new methodologies in science. It involves systems that safeguard the accuracy, reliability, and timeliness of lab results by ensuring the early detection of results or measurement errors and the procedures to rectify them. It should be performed regularly and quality control materials should be treated the same as samples, from the beginning to the end of the run.

clinical coding training manual

The axis of the classification depends on the intended use of the compiled statistics. The tenth revision of the International Statistical Classification of Disease and Related Health problems famously known as ICD-10 is the latest in the series. The contents of ICD-10 have been divided into three major volumes. Volume 1 is a tabular list that contains reports of the 10th revision international conference, the classification at three and four character levels and classifications of neoplasm morphologies, a special tabulated list of morbidity and mortality, nomenclature regulations and definitions. Volume 3 contains an index with an introduction and more expanded instructions for its use. Each volume of the ICD has two sections. World Health Organization (WHO) brought out the 10th version of ICD-10 in 1993 for methodical coding of illness and death causes in the medical records of medical organizations to be used for reporting by the member states. The inclusion criteria included level of completeness of recorded mortality data. Also touted as a major source of error are incomplete or inaccurate code descriptions which vary from coder to coder or from one health professional to another. Training and awareness have been advanced as a remedy, yet trials of their effect are limited. Mama Lucy Kibaki County Hospital was selected as the control site while Mbagathi County and Referral Hospital was the intervention site based on the results of the baseline study. An initial baseline study was used to establish the gaps in the quality of clinical coding both for diseases and procedures in medicine coding; followed by intervention (training), and an after-training follow-up study.Data from the Clinical Coders who are Health Records and Information Officers was collected using a self-administered questionnaire containing both closed and open-ended questions for the level of training for the coders. A check list was used to audit the coded files.

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Keep up with special offers, product releases, and more: Our most popular brands include ADA, AHA, AMA, Optum 360, and PMIC. J Hosp Med Manage Vol.6 No.1:1 The objective of this research was to establish whether training could improve the quality of clinical coding in Nairobi City County Hospitals. A beforeand-after interventional design was used for the study. The study was conducted at Mbagathi County Referral Hospital and Mama Lucy Kibaki Hospital, with the latter acting as the control group. The study took the form of a baseline and two followup studies. The intervention was training on ICD-10. A sample of 612 subjects with 306 cases from each hospital was audited. Pretesting was conducted at Mama Lucy Kibaki Hospital. Data analysis was done using Statistical Package for Social Science (SPSS) Version 25. Fisher’s Exact and Paired T- test were conducted to establish the significance of differences between the two groups. The study revealed a low proportional (52%) of files were coded in MCRH than in MLKH (62%) therefore, biasing the intervention to MCRH. The difference in coding of external injury files between MLKH and MCRH prior to and after intervention was explicit. Coding of external injury files in the intervention arm improved to 100% from 97.3%. While that of control arm enhanced from 50% to 83.3%. The fisher exact p value was It includes an examination of specific cohorts and their overall well-being. The ICD tool is important in monitoring incidence or prevalence of specified diseases and other health related problems. Therefore, ICD provides an overall picture of the health status of people and countries. ICD is used widely in the health sector by health care providers, policy-makers and facilities. ICD is applicable in classification of diseases and other health related problems recorded in the different forms of health and vital records like health records and death certificates.

This infers that the clinical coding health records and information officers are well qualified to undertake the assigned roles and tasks. The respondents’ mean industry experience was eleven; however, period for working in the current station was less than five years.This finding affirms that credentialed health management professionals in the two facilities perform clinical coding. This finding resonates with Taiwo et al., which reported that ICD-10 coding and classification of diagnoses and procedures and the process is being managed by the right workforce (HIM professionals) which reassures effectiveness. Enhanced training improves documentation that in turn enables providers to analyze patient details, thereby lead to better care coordination and health outcomes. Coding performed by improperly trained or distracted clinical staff can cost an outlet in reimbursement, delayed billing and compliance risk.The understanding of ICD coding process was better in MLKH compared with MCRH. This means that the coders in MLKH were well informed than the colleagues in MCRH on the common language that health care providers utilize to code every possible medical injury, illness, or accident.The effect of training is well advanced by WHO. The mean speed of coding was better in MCRH than in MLKH. The findings may reveal that experience and education is not a good predictor for coding since coders in MLKH were more educated and experienced than MCRH.First is clarity, precision and completeness of documentation. Second is the accuracy and consistency of the coder.The many steps in the process of coding death or life-threatening conditions may trigger the emotional perspective of coders, therefore introducing numerous opportunities for error. Poor coding of cause of death files, the less knowledge on how to use ICU-10, and that of ICD coding biased the clinical coding training intervention to MCRH.

The research adopted both quantitative and qualitative techniques using questionnaires, focus group discussions and in-depth individual discussions for key informants. Data was analyzed using descriptive statistics. A composite index to assess quality of coding was generated from the auditing criteria, the index was compared between the two facilities both at baseline and in the follow-up, and the influence of independent factors was also analyzed. Data was analyzed using SPSS version 25. And hypothesis testing done at p-value cut off of 0.05. Quality of coding was measured using paired T-test. Considerable number of coders 15 (88.2%) were educated past certificate level. About three quarters of the clinical coding health records and information officers were, trained on ICD. The median years of experience were 11 as shown in Table 1. There was a slight mean difference in understanding of ICD coding.Coding of external injury files in the intervention arm improved to 100% from 97.3%. While that of control arm enhanced from 50% to 83.3%. The difference in coding of external injury files was statistically significant prior to intervention and after intervention. However, the strength of evidence reduced from p-value of Table 4. The variance was statistically significant after training but non-significant before. The difference was statistically significant at both surveys ends. The accuracy of coding external cause of injury varied from 64% to 85% Table 5. There was no wrongly coded file in the MCRH but 30 (13.2%) were wrongly coded lower from 23.3%. The net effect was increase of rightly coded file to 86.8% from 75.3%. There was slight improvement in MLKH. Rightly coded files increase by 0.5% to 72.2% as shown in Table 6.The results are discussed and compared with other similar studies in this chapter. The conclusion and recommendation are also provided. The education level of the coders resonates with level four hospitals in Kenya.

For example, injury-related deaths may be coded as unspecified because medical certifiers fail to report sufficiently detailed information on the death certificates to allow coders to assign specific codes. On the other hand, the cause of death is sometimes described in terms of symptoms, rather, than attributed to a specific underlying cause. More efforts should focus on training medical certifiers to report specific information relevant to injury prevention on death certificates. The difference was non-significant before and after the intervention. Completeness in medical abbreviations files was perfect at 100% before and after intervention. The study accepts the hypothesis that level of completeness of clinical coding differ before and after training of Health records and information officers in Nairobi City County Hospitals, Kenya. The two facilities shared similar traits in clinical coding diseases and injuries before intervention. The findings suggest that coders have similar understanding of ICD-10 codes. Nonetheless, accuracy of coding improved after the intervention in MCRH suggesting that the training was impactful. Rightly coded files increased to 86.8% from 75.3% while wrongly coded files decreased to 13.2% from 23%. There was slight improvement of 0.5% in MLKH of rightly coded files. The variance was statistically significant after training but non-significant before. Based on the results, coding is influenced by both coder awareness level, keenness in documentation and interpretation.Accurate coding was 33.3% and 67.5% in MLKH and MCRH respectively. However, accuracy improved to 94.6% from 67.5% in MCRH compared to that of MLKH that increased to 41.7% from 33.3%. The difference was statistically significant at both surveys ends. The accuracy of coding external cause of injury varied from 64% to 85% in a similar study.

Therefore, study accepts the hypothesis that Health records and information officers in Nairobi City County Hospitals, Kenya were not competent in clinical coding. However, files were completely coded after the intervention in MCRH. In general, incompleteness reduced from 2.6% to 0.2% after the training. Though this difference was not statistically significant, it provides a strong indication of significant return on investment for training time.Chongthawonsatid in a study on national health data of Thailand observed that records were often incorrect and incomplete even though there were standard coding guidelines available (Chongthawonsatid).However, the strength of evidence reduced after training. For example, the difference in coding of external injury files was 27.3% between MLKH and MCRH before training. Nonetheless, this reduced to 16.7% after the training. Coding of external injury files in the intervention arm improved to 100% from 97.3%. While that of control arm enhanced from 50% to 83.3%. The baseline survey may have triggered coders to start coding external injury files. A previous study found that external causes of injury were not coded in a reliable, complete and valid manner. The inconsistency in completeness in medical procedures have been reported Chongthawonsatid. Chongthawonsatid found that the discharge summaries had the most coding errors and incomplete spaces. The difference was statistically significant before training but insignificant after. Coding comorbidities files remains a challenge across. This is attributed to the need to differentiate between several codes for comorbidities during documentation. Added specification such as detailed description of laterality and location in the patient’s body have compounded the problem. The validation of the codes themselves, a key area of determining the optimal strategy for defining comorbid conditions is undefined.

Cartwright advances that information on numerous codes that represent more specific anatomic sites, etiologies, comorbidities, and complications, and will improve the ability to demonstrate and code comorbidities.There was increase in the control site; however, not statistically significant. There was improvement in practice in both control and intervention. Whereas the improvement may be ascribed to intervention sites, the change in the control arm may be attributed to acquired syndrome courtesy of the baseline survey. The finding alludes that the existence of codes does not assure that the coders will use these codes consistently and accurately. The findings resonated with McKenzie et al., who alluded that the practice of coding episodes in hospitals differs and varies relative to personnel and social support. It is important to note that in coding injuries and disease episodes special rules apply (WHO). Although the ICD is primarily designed for the classification of diseases and injuries with a formal diagnosis, not every problem or reason for coming into contact with health services can be categorized in this way (WHO). To realize the objectives of the ICD- 10 injury classification scheme, a defined supervisory mechanism informing the consistent and accurately used of ICD-10 need to be developed. The mean increased by 0.65, which indicated an increase of 48.9% in intervention. While that control increased by 0.56 (5.9%). The discernible finding may be attributed to the fact that many potential errors originate with the coder. It is also important to note that the current study intervention centered on ICD-10 standards and not the coders work procedures. Therefore, appropriate code for medical procedure was the same before and after the intervention since work ambience was affected by the training. It is important to reiterate that the ICD-10 is one of the most vital epidemiologic tools. The t-test was statistical indifferent.

The current results of diagnosis reporting prior and after intervention are expected since the study participants did not change. Therefore, completeness and accuracy are the gold standard for effective and efficient quality coding. The study rejects the hypothesis that quality of clinical coding does not differ before and after training of health records and information officers in Nairobi City County Hospitals, Kenya. The study reveals therefore that short and specific tailored made education session is an effective strategy to change coders’ behaviour and improve the cording of the death, death certification, and indexing files. This study results are consistent with Esmaeili et al., as cited by Farzandipour et al., which proved educational intervention to be an effective means of improving providers’ behaviour regarding medical record documentation.I would submit that this single strategy of training intervention was not the most effective ways of encouraging coders to learn, understand and interpret medical abbreviations.Adequate training, planning and awareness as key ingredients for effective implementation of ICD-10. The study provides a strong indication of a significant return on investment for staff clinical coding training. The understanding of ICD coding and on how to use ICD-10 was high. The study reports variability of speed of coding. However, the current study could not validate the speed of coding relative to quality due to study methodology and insufficient sample size. There was absolute completeness in diagnosis reporting files. However, the external causes of injury were not coded in a reliable, complete and valid way. Coding for comorbidities, death certification and medical procedures were inconsistent and incomplete. Study revealed inaccuracy in coding diseases and injuries, external causes and file medical procedure before training. Medical procedure was dissimilar before and after the intervention in the two facilities.

However, Kirpich, Marsano, and McClain examined broader groups of codes using ICD-9-CM codes while this study used ICD-10 codes, which provide a more detailed approach to specify the type of maltreatment, the level of certainty of the cause of the injury, and the suspected perpetrator. This infers that coding practices are not uniform and are based on practices at individual hospitals. For example, practices for medical procedure were considerably efficient in MCRH after intervention. Rightly, coded files increased to 97.7% from 39.5%. While in MLKH, the accuracy increased to 40.7% from 25.9%. The difference was statistically significant before and after the intervention. A recurring issue found in this study is the positive impact of the intervention to coding including the appropriate coding of medical procedure. These results strengthen the theory that high-quality medical record documentation is best achieved when coders are informed, supervised or when responsibilities are shared.This may explain the inaccuracy in the baseline. There was no significant effect in coding and interpreting medical abbreviations before and after the training. We can deduce from this finding that the level of understand among coders in the two facilities is equal and alike. One factor discussed when examining coding accuracy is the use of Electronic Medical Records (EMR). This study was limited to manual coding since the facilities were using paper medical records during this time period. Based on the results, coding is influenced by both coder awareness level, keenness in documentation and interpretation. The study rejects the hypothesis that level of accuracy of clinical coding differ before and after training of health records and information officers in Nairobi City County Hospitals, Kenya. The t-test was statistically indifferent.

The certainty of a diagnosis depends upon multiple factors such as the participants (patient, clinician, and medical staff), disease type, current state of medical knowledge and technology, context within which the diagnosis is made, and translation of coding changes into practice by O’Malley et al. The current results of diagnosis reporting prior and after intervention are expected since the study participants did not change. The findings contrast with Farzandipour et al., who reported that coding in diagnosis reporting continues to be variable and those factors such as clarity of documentation, incomplete information in medical records and lack of attention to detail can lead to unreliable and inaccurate diagnosis coding. The present study was limited to effect of training among coders; however, there is need to undertake a research to address the role of other health providers in improving the quality of coding particularly in diagnostics. The paired t-test of the pre-test and post-test results of assigning the correct code for diseases and injuries was statistically significant in the intervention arm. But, this was insignificant in the control arm. Nonetheless, the quality of coding improved by 7.5% in the intervention arm. The training may improve the skills and enhance the attention of the coders in coding simple files.The proportion of well-coded complex files rose to 71%, representing one of the best improvements after training. The change in the mean of assigning the appropriate code for comorbidities between the pre-test and the posttest stage was 37.7%. The paired sample t-test was significant in intervention but not in control. The finding alludes that the training intervention heightened awareness in numerous codes representing comorbidities, and complications, which improved the coding in the intervention arm. Cartwright reported similar finding on a study titled ICD-9-CM to ICD-10-CM Codes: What. Why? How?

Nonetheless, accuracy of coding improved after the intervention. This infers that coding practices are not uniform and are based on practices at individual hospitals. The study also found statistical variation in accurately coding death certification files. There was no significant effect in coding and interpreting medical abbreviations before and after the training. This infers that training of health records and information officers significantly competence which in turn improve the quality of clinical coding. Quality of coding in improved in comorbidities files, simple files, complex files, coding causes of death, death certification, and indexing. However, the quality of coding in diagnosis reporting files was the same prior and after intervention. The proportion of well-coded complex files rose to 71%, representing one of the best improvements after training. Coding causes of death, death certification, and indexing increased by 19.5%. Grounded on the finding, undertaking clinical coding awareness is advanced for policy makers and practitioners in health management. The understanding of ICD coding and on how to use ICD-10 was high. The coders in this study benefited significantly on the key areas of ICD policy guideline, ICD-10 use and coding of cause of death. However, understanding on coding of complex, and comorbidities files were still key concern. A detailed training on the ICD-10 or new version is necessary to mitigate the shortcomings and enhance efficiency of ICD-10. The study revealed absolute completeness in diagnosis reporting files. However, the external causes of injury were not coded in a reliable, complete and valid way. Coding for comorbidities, death certification and medical procedures were inconsistent and incomplete. This finding implies that coders have differences skill and competencies to each coding standard. Skills difference may be due to exposure or education.

There is need therefore for training tailored for these specific coding challenges. The study also found statistical variation in accurately coding death certification files. This infers that, coding is influenced by coder awareness level, keenness in documentation and interpretation. There is therefore to raise awareness and importance of keenness in documentation. Supervisory roles should also be enhanced to reduce external cause of keenness. For example, to realize the objectives of the ICD-10 injury classification scheme, a defined supervisory mechanism informing the consistent, complete and accurate application of ICD-10 need to be developed. American J of Healt Res 3: 38-46. The HIM Journal 36: 20-30. The HIM Journal 34: 40-46. Healthcare Informatics Research 23: 293-303. Economic History Review, 69: 3-34. Global Journal of Health Science, 6: 11-18. World Health Organisation 2: 1- 252. AMIA Symposium 912-920. Sucralfate 10: 35-45. Health Info Manag 37: 25-37. Iranian J of Med Edu 9: 356-364. BMJ Open 6: 8. Clin Biochem 48: 923-930. Indian Journal of Public Health, 59: 68-9. BMC Healt Ser Res 12: 149. CHRISMED Journal of Health and Research 2: 186. Family Practice, 25: 213-214. BMC Health Services Research, 10. BMC Medical Research Methodology, 10. Health Services Research, 43: 1424-1441. Patricia Aalseth, RHIA, CCS. 2nd Edtn. Studies in Health Technology and Informatics 136: 479-83. Health Services Research 40: 1620-163 American Journal of Health Research 3: 38. British Journal of Hospital Medicine, 69: 372-3. Classification of Morbidity (Nosology) - Understanding and interpretations Classification of Morbidity (Nosology) - Understanding and interpretations from Ayurveda and Biomedicine, (January). MOLTE: a Modular Optimal Learning Testing Environment. Comparing paper-based with electronic patient records: Lessons learned during a study on diagnosis and procedure codes. Journal of the American Medical Informatics Association 10: 470-477.

Clinical coding procedures. Validation of clinical coded information. Clinical coding departmental structure and training. Communication in clinical coding. Security and confidentiality. Form A: Clinical coding staff training programme. Form B: OPCS-4 Implementation dates. Form C: Clinical coding information agreements with clinical staff. Form D: Details of local policies. Form E: Amendments to Clinical Coding instruction for Manuals, ICD-10 and OPCS4. ? Form F: Receipt of Coding Clinics. It is based on guidance from Connecting for Health and has been designed to incorporate the requirements of the Data Accreditation process to ensure information produced during the coding process is accurate and adheres to local and national policies. Policies and procedures provide the framework for decision making and completion of tasks. This policy sets the boundaries within which action will take place, and reflects the philosophy of the service. This policy should be supported by local procedures which are designed to accomplish specific tasks in specified chronological order. This Policy and associated procedures conform to national requirements already in existence and other local procedures which affect the coding process, such as patient administration, patient discharge, clinical record documentation, clinical record flow and filing, storage of records. A procedure is a series of related steps designed to accomplish a specific task in a specified chronological order should be explicit about who is responsible for what, how, when and where. 4 Accountability This Policy and Procedures Manual is the responsibility of: Name: Elaine Coulter Job Title: General Manager Acute Service Reform Date: Revised April 2012 The person specified above will ensure that all policy decisions detailed in this policies and procedures manual are reviewed regularly (at least annually) to ensure that this document is updated and maintained in line with current Clinical Coding Dept practices.

The person specified will also ensure that Clinical Coding Staff are made aware of the contents of this manual and their responsibility to adhere to its guidance and recommendations. Corporately the responsibility for this Policy and Procedure Manual for Clinical Coding Dept in the NHSCT lies with the Director of Acute Hospital Services. Through the line management structure they will ensure that all standards detailed in this policy and procedures manual are, as a result of joint collaboration and understanding between clinical coding staff and the persons involved in the creation or use of information used for coding purposes, fit for purpose and adhering to regional guidance, policy and target setting in respect of Clinical Coding standards. This policy will be reviewed annually or more often if required to ensure the policies and procedures are kept in line with current activities and central guidance. Once such coding algorithms or exceptions have been identified they should be documented (See FORM D) and this Policy and Procedure Manual updated. Copies of any locally agreed clinical coding processes should also be disseminated amongst Trust Clinical Coding staff by the person responsible for updating of the Policy and Procedure Manual. For Daycase activity, the above process above will also apply, excepting that in some instances the source data for clinical coding may be retrieved by the Clinical coder from electronic systems such as Endoscribe, in conjunction with paper records of care. Along with the approximate levels of annual discharges these account for. At present clinical coding staff are based at Antrim Area and Causeway Hospitals for Mid Ulster and Whiteabbey hospitals information is collected or posted to coding. The Clinical coding department manager will attempt to ensure coding is still met within regional targets; however given the limitations of cover for the current service this may not always be met.

In Causeway Hospital coders visit all wards except ICU each morning to obtain information from discharge letters. NIRADS and Histology systems enhance the information. It should be recognised that there are not clinical coding staff en situ at all hospital sites within the NHSCT, therefore for some sites clinical coding may not be achieved until a discharge letter and chart are received by coding staff from the appropriate secretary. 9 Clinical Staff responsibilities in relation to Clinical Coding There is an onus of responsibility on clinical staff at ward level to ensure that a discharge summary is completed for every patient on discharge. This includes patients who are being transferred to another facility outside of this trust and those who die. They should attempt to ensure that the discharge summary gives clear and specific information relating to the following: - Primary diagnosis Secondary diagnosis (co-morbidities) Primary procedures (with dates) Secondary procedures (with dates) Complications of treatment Other factors that may have delayed the patients discharge from hospital To assist clinical staff in the production of useful discharge summaries a Discharge proforma has been introduced in the trust and its use is supported by Clinical Coding Department staff. Electronic discharge summaries are being phased in, in certain specialties. For chemotherapy unit activity that currently takes place in Laurel House is recorded by Nursing and Clinical staff using a proforma, developed in conjunction with Clinical Coding Dept. Clinical staff can also assist the clinical coding staff in abstraction of relevant information and assignment of correct codes, by supplying advice and clarification on patient diagnosis and treatment when this is requested.