#Chronic Disease Management Ohio

[outsource-medical-billing]

Upcoming Changes in DME Billing for Chronic Disease Management

Chronic disease management significantly benefits from Durable Medical Equipment (DME) as it offers necessary medical devices that patients need to track and uphold their health. The Centers for Medicare & Medicaid Services (CMS) started making substantial revisions to DME billing procedures for 2025 as healthcare policies continue changing. These billing system updates strive to unite healthcare providers to improve patient care, simplify payment processing, and reward value-based care approaches. The modifications require complete understanding from healthcare providers working with patients who manage chronic diseases.

Key Changes in DME Billing for 2025

1. Elimination of HCPCS Code G0511 for Care Coordination Services

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) applied HCPCS code G0511 throughout history to submit bills for their Chronic Care Management (CCM) services. The Centers for Medicare and Medicaid Services (CMS) will discontinue its use of code G0511 starting January 1, 2025, as they plan to introduce individual CPT and HCPCS codes for improved billing specificity. The transition brings greater clarity about the services that lead to precise reimbursement payments.

2. Transition to Individual CPT Codes

The removal of G0511 requires healthcare providers to use specific Clinical Procedure Terminology codes for Chronic Care Management documentation and accurate reimbursement processes:

CPT Code 99490 – Non-complex Chronic Care Management services requiring at least 20 minutes of clinical staff time per month.

CPT Code 99439 – Additional time spent on Chronic Care Management beyond the initial 20 minutes.

This change aligns payments with the complexity and duration of care coordination activities, ensuring fair compensation for RHCs and FQHCs.

3. Introduction of Advanced Primary Care Management (APCM) Services

Under the 2025 Medicare Physician Fee Schedule (PFS) the Centers for Medicare & Medicaid Services (CMS) introduces Advanced Primary Care Management (APCM) services. APCM organizes multiple healthcare management services to support primary care physicians in their mission to provide organized patient-centric care.This initiative integrates elements of:

Principal Care Management (PCM)

Transitional Care Management (TCM)

Chronic Care Management (CCM)

The strategy proves to be beneficial for patient care by assisting primary care doctors in creating improved treatment organizations for patients who have prolonged health concerns. Through APCM, CMS intends to unite different care management systems while eliminating unnecessary office work so providers can provide more attention to patient assessment.

To facilitate the implementation of APCM, CMS has introduced three new HCPCS G-codes:

G0556: For patients with a single chronic condition requiring ongoing management.

G0557: For patients with two or more chronic conditions requiring active care coordination.

G0558: For patients with multiple chronic conditions who are also Qualified Medicare Beneficiaries (QMBs), meaning they are eligible for additional financial assistance.

Through these codes administrators no longer need to use time-based restrictions which decreases administrative workloads. APCM payment systems adjust financial compensation based on patient health requirements to allow for personalized long-term care administration.

4. Impact on RHCs and FQHCs

APCM services present an excellent opportunity for both RHCs and FQHCs to enhance their patient care practices. The centers can engage in APCM services by using the national non-facility PFS payment rates when they submit claims containing suitable APCM codes.

The coding shift delivers dual benefits to healthcare facilities since it both strengthens their financial status and allows better coordination between services and improved patient oversight with better health outcomes. An organized payment system enables RHCs and FQHCs to maximize resources for enhancing their premium healthcare services to underserved communities.

5. Six-Month Transition Period

The Centers for Medicare & Medicaid Services (CMS) provides a six-month transition period from January 1, 2025, up to at least July 1, 2025, to ease the implementation of this change. The six-month planning period requires healthcare practitioners to modify their billing procedures and train their teams while incorporating new CPT and HCPCS codes into their operational workflow.

The transition timeframe serves as the paramount factor in maintaining legal compliance and uninterrupted insurance claim processing. The transitional period provides healthcare entities with a chance to review billing procedures, identify errors, and enhance documentation systems.

6. Enhancements in Telehealth Services

Starting January 1, 2025, CMS proposes allowing real-time, two-way audio-only telehealth services when:

A distant-site physician has access to video technology.

The patient is unable or unwilling to use video conferencing.

Patients in rural locations or areas with limited technology experience now receive better medical care through this system modification.CMS seeks to improve medical care delivery for patients with chronic diseases through their expansion of telehealth services which combines reduced hospital visits and better medical access.

7. Integration of Remote Patient Monitoring (RPM) with CCM

The 2025 PFS Final Rule emphasizes the integration of Remote Patient Monitoring (RPM) with Chronic Care Management (CCM) services. Key points include:

Providers can offer RPM alongside CCM.

RPM supports its own CPT billing codes, allowing dual reimbursement.

RPM service and time requirements must be met separately from CCM.

This integration enables providers to bill separately for both services, provided that RPM requirements are met independently. By leveraging wearable devices, smart sensors, and continuous data tracking, healthcare professionals can proactively adjust treatment plans and prevent complications, leading to improved patient outcomes and reduced emergency visits.

Emphasis on Value-Based Care

These changes reflect CMS’s commitment to advancing value-based care by:

Implementing APCM services for personalized care.

Expanding telehealth services for improved accessibility.

Integrating RPM with CCM for real-time patient monitoring.

Refining billing codes for streamlined reimbursements.

Value-based care reimbursements are tied to the quality of services provided, incentivizing healthcare providers to invest in better care models, reduce inefficiencies, and prioritize patient well-being. The updated payment method provides healthcare organizations with enhanced capabilities regarding long-term illness management.

Conclusion

The upcoming DME billing changes for chronic disease management in 2025 signify a transformative shift toward more personalized, coordinated, and value-based care. Healthcare providers operating within RHCs and FQHCs need to implement these modifications as they will help maximize reimbursements while delivering better patient care.

The updated knowledge and utilization of these modifications enable healthcare providers to maintain simplified billing operations which results in better care outcomes for chronic disease patients. Healthcare providers should consider using medical and billing services provider company 24/7 Medical Billing Services as their outsourced partner to navigate complex changes and meet billing regulations.

FAQs 

Q1. What is the billing code for chronic disease?

Healthcare practitioners primarily rely on CPT 99490 for Chronic Care Management (CCM) and CPT 99439 for additional time to invoice chronic disease management services.

Q2. What is the DME code range?

Medical Durable Equipment (DME) has its billing codes located between E0100–E9999 in Level II of the HCPCS system to represent multiple types of durable medical equipment.

Q3. How to identify a DME code?

The explicit list of DME codes exists in the HCPCS Level II manual where each code begins with an “E” while following specific equipment types.

Q4. What is the limit of DME?

Medicare typically covers 80% of the approved amount for DME after the deductible, with limitations based on medical necessity, frequency, and lifetime restrictions for certain equipment.

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[localscannabis]

Navigating Ohio’s Medical Marijuana Program with Locals Cannabis: Your Guide to Healing and Wellness

Ohio’s journey into medical cannabis began in 2016, marking a turning point for patients in search of effective, natural alternatives to traditional medicine. Since then, thousands across the state have turned to medical cannabis to help manage chronic pain, neurological conditions, and more—legally and safely. At the heart of this movement is Locals Cannabis, a trusted dispensary dedicated to patient care, education, and access to top-quality products.

Whether you're exploring medical cannabis for the first time or simply looking to stay informed, this comprehensive guide will walk you through the essentials of Ohio’s medical cannabis program—and show you how Locals Cannabis is making a difference in patients’ lives.

Ohio’s Legal Framework for Medical Cannabis In 2016, House Bill 523 laid the foundation for what is now known as the Ohio Medical Marijuana Control Program (OMMCP). This law legalized the use of cannabis for medical purposes and set up a regulatory framework that includes oversight of dispensaries, physicians, cultivators, and patients.

Unlike recreational marijuana (still illegal in Ohio), medical cannabis is strictly regulated and accessible only to qualifying patients with a physician's recommendation and a valid medical marijuana card. The state maintains high standards for safety, product testing, and patient care—something Locals Cannabis takes seriously.

Who Is Eligible for Medical Cannabis in Ohio? To qualify for medical cannabis in Ohio, a patient must be diagnosed with one or more conditions approved by the state. These include, but are not limited to:

Chronic or severe pain

Post-Traumatic Stress Disorder (PTSD)

Cancer

Glaucoma

Multiple sclerosis

Crohn’s disease

Epilepsy and seizure disorders

Parkinson’s disease

Alzheimer’s disease

HIV/AIDS

Fibromyalgia

Patients must be at least 18 years old, although minors can still qualify through a registered caregiver. Once certified, patients gain access to licensed dispensaries like Locals Cannabis.

Getting Your Ohio Medical Marijuana Card: A Step-by-Step Guide Obtaining your medical marijuana card may sound intimidating, but the process is relatively simple with the right guidance:

Meet with a Certified Physician Schedule an appointment with a doctor who is approved by the State Medical Board of Ohio. They’ll evaluate your condition and determine whether medical cannabis is an appropriate treatment.

Receive a Recommendation If approved, the physician will submit your information directly to the OMMCP system.

Complete Your Registration You’ll receive an email with instructions to complete your registration online. There is an annual registration fee of $50 (or $25 for caregivers).

Access Your Card Once approved, you can download your medical cannabis card through the state’s portal and begin purchasing products legally.

At Locals Cannabis, our team is happy to walk you through each step or connect you with certified doctors to simplify the process.

Why Ohio Patients Trust Locals Cannabis Locals Cannabis stands apart from the crowd—not just because of our extensive product selection, but because of our commitment to compassionate care. Here’s what makes us a go-to destination for Ohio patients:

Experienced and Friendly Staff Our team is trained to help you understand how different strains, products, and delivery methods can best address your symptoms.

Broad Range of Products From dry flower and vape cartridges to edibles, tinctures, and topicals, we stock a full spectrum of cannabis products sourced from Ohio’s top cultivators and processors.

Community Focused As a locally owned dispensary, we actively support Ohio communities through outreach, education, and job creation.

Safe and Legal Access Every product on our shelves is lab-tested for quality, potency, and purity—giving you peace of mind with every purchase.

What Kinds of Products Are Available in Ohio? Ohio’s medical cannabis laws permit the sale of several non-smokable cannabis formats, including:

Dry Flower (for vaporization only)

Edibles (capsules, gummies, chocolates)

Tinctures and Oils

Topical Creams and Lotions

Vape Products

Concentrates

Smoking cannabis is prohibited under Ohio law, so patients must use vaporizers or other approved methods. Unsure where to start? Locals Cannabis provides guidance to help you find the right form and dosage for your condition.

Understanding Dosage and Strains Each person reacts differently to cannabis, so it’s wise to start with a low dose and gradually increase as needed. Our staff can help you understand:

Strains – Whether you need a relaxing indica, energizing sativa, or balanced hybrid

Effects – From pain relief to improved sleep or anxiety reduction

Usage – The best time of day, method of consumption, and frequency

Staying Within the Law Ohio has clear rules for medical cannabis use. Keep these key points in mind:

Do not consume cannabis in public spaces.

Never operate a vehicle under the influence.

Only purchase from licensed dispensaries.

Renew your registration annually to remain compliant.

Locals Cannabis not only ensures compliance with all state laws—we actively help our patients stay informed through education and one-on-one consultations.

Supporting Ohio’s Wellness Future At Locals Cannabis, we see firsthand how medical cannabis improves lives. We believe access to this natural medicine should come with education, empathy, and community support. That’s why we’re committed to creating a safe, welcoming space for every patient.

Whether you’re looking for relief, reassurance, or reliable products, Locals Cannabis is here to support your journey toward better health. Stop by, meet our team, and discover how medical cannabis can make a meaningful difference in your life.

[nursingwriter]

Otitis Externa and Media: Diagnosis and Management Strategies Equine Veterinary Tech (Ohio University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Otitis Externa and Otitis Media Lynette K. Cole, DVM, MS, DACVD Professor of Dermatology and Otology The Ohio State University College of Veterinary Medicine Columbus, Ohio 43210 Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Introduction • Definition of otitis externa – Acute or chronic inflammation of the external ear canal – May involve the pinna • Definition of otitis media – Inflammation of the middle ear • Otitis externa is one of the most common ear diseases of the dog and cat Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Etiology of Otitis – The Three P’s Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Predisposing Factors for Otitis Externa • Facilitate the inflammation by permitting alteration of normal microenvironment • Establishment of secondary infections Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Predisposing Factors for Otitis Externa • Conformation – Stenotic ear canals – Chinese Shar Pei – Overgrowth of bacteria, yeast – Inhibit proper cleaning of ear Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Predisposing Factors for Otitis Externa • Conformation – Hair in canal – Impair ventilation – Impair clearance – Routine removal not recommended Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Predisposing Factors for Otitis Externa • Conformation – Pendulous pinnae – Restrict air flow – Higher risk for development of otitis externa Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Predisposing Factors for Otitis Externa • Moisture – Maceration of stratum corneum – Secondary infection – Swimming, bathing Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Predisposing Factors for Otitis Externa • Inappropriate Therapy – Cotton swabs (Q-tips) – Plucking of hair – Irritant ear cleaning solution – Improper topical antibiotic usage Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa • Conditions or disorders that initiate the inflammatory process • Epithelium of the ear canal is just an extension of the rest of the body • Most cases of otitis are associated with an underlying dermatologic condition Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa • Otodectes cynotis – Most common parasite – Life cycle completed on host – Irritate ceruminous glands – Diagnosis Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa • Demodicosis – Demodex canis/Demodex cati – Infrequent cause of otitis externa – Ceruminous otitis externa Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa • Foreign bodies – Plant material – Acute – Unilateral – Painful – Perforation of tympanic membrane Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa MOST COMMON CAUSE OF RECURRENT OTITIS EXTERNA IN THE DOG : ALLERGIC DISEASES! Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 CAFR/AD Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa • Atopic Dermatitis – Bilateral pruritic otitis externa –Otitis may be only clinical sign in 10% of atopic dogs – Early: pinna – Later: erythema, infections Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa • Cutaneous adverse food reaction – Bilateral pruritic otitis externa –Otitis may be the only presenting sign in 25% of food allergic dogs – Clinical signs similar to atopic Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa • Contact allergy – Rare –Non-haired portion of skin – May be caused by topical medications – Should be suspected if otitis fails to respond or worsens Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa • Juvenile Cellulitis • Affects puppies 3-16 weeks old • Etiology unknown • Papules, pustules, alopecia, swelling • Submandibular lymphadenopathy • Systemic illness Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa • Disorders of Keratinization – Sebaceous adenitis Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa • Endocrine disorders –Hypothyroidism –Hyperadrenocorticism Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa • Pemphigus foliaceus Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa • Ear tumors – Ceruminal gland adenoma, adenocarcinoma • More common in dog • Feline usually malignant – Histopathology Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa • Feline Inflammatory Polyps – Common – Otic • Purulent, ceruminous otitis externa – Nasal, Nasopharyngeal • Dysphagia, sinusitis Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Feline Inflammatory Polyps Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Primary Causes of Otitis Externa • Inflammatory Aural Polyps • Canine – Rare Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Tips for Work-up of Primary Causes • Age of onset • Species – Dog: CAFR, AD – Cat: Otodectes, polyp, allergic disease • Additional body sites affected – CAFR, AD – Hypothyroidism, hyperadrenocorticism – Juvenile cellulitis – Autoimmune diseases – Keratinization disorders Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Tips for Work-up of Primary Causes • Ears only – Otodectes – CAFR, AD – Foreign body – Tumor/polyp • Unilateral – Foreign body – Tumor/polyp – Otodectes – CAFR, AD Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Perpetuating Factors of Otitis Externa • Sustain and aggravate the inflammatory process • Prevents resolution or worsens an already present otitis externa Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Perpetuating Factors of Otitis Externa • Bacteria – Coccoid bacteria • Staphylococcus pseudintermedius – Rod bacteria • Pseudomonas aeruginosa – > 4 cocci/OIF considered abnormal – All rod bacteria considered abnormal Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Perpetuating Factors of Otitis Externa • Yeast – Malassezia pachydermatis – Candida spp. – > 4/OIF considered abnormal Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Perpetuating Factors of Otitis Externa: Progressive, Pathologic Changes Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Progressive pathologic changes • Edema • Stenosis • Epidermal hyperplasia • Fibrosis • Calcification Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Progressive Pathologic Changes • Thickening • Stenosis of lumen • Inhibit cleaning • Inhibit application of topical medications • Colonization, establishment of infection Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Progressive Pathologic Changes • Permanent changes in ear canal • Calcification of cartilage • Total ear canal ablation Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Perpetuating Factors of Otitis Externa • Infectious Otitis media • Route of Infection –Direct extension of otitis externa through a ruptured tympanic membrane • Intact tympanic membrane does not rule out – Through Eustachian tube Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Infectious Otitis Media • Dogs with chronic recurrent otitis externa – 89% had infectious otitis media – Intact tympanic membrane 73% • Dogs with acute otitis externa – 16% had infectious otitis media Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Infectious Otitis Media • Etiology – Bacteria • Staphylococcus pseudintermedius, Pseudomonas aeruginosa – Yeast alone isolated in 23.7% of ears – Trauma, polyps, neoplasms, foreign bodies Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Non-Infectious Otitis Media • Primary Secretory Otitis Media (PSOM) – Cavalier King Charles Spaniels – Head and neck scratching, neurological signs, hearing loss – Intact tympanic membrane, mucoid exudate – Diagnosis – Etiology? – Treatment Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Clinical Signs and Diagnosis Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Otitis Externa • Clinical signs of Otitis Externa – Head shaking – Scratching and rubbing ears – Pinnal alopecia – Excoriations – Exudation – Odor – Pain – Behavioral changes Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Otitis Media • Clinical signs of infectious otitis media – Recurrent otitis externa • May be only clinical sign exhibited – Discharge from ear canal – Pawing or rubbing ear – Head shaking – Pain Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Otitis Media • Neurological Signs • Facial Nerve Paralysis • Drooping of ear/lip • Drooling saliva • Absent palpebral reflex • Keratoconjuctivitis sicca Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Otitis Media • Neurological Signs • Horner’s Syndrome • Injury to sympathetic nerve • Ptosis – Drooping of upper lid • Miosis – Contraction of pupil • Enophthalmos – Backward displacement of eyeball into the orbit • Protrusion of nictitating membrane Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Otitis Interna • Neurological Signs • Horizontal nystagmus • Head tilt, falling, rolling to affected side • Asymmetric ataxia Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Otitis Interna • Neurological Signs • Horizontal nystagmus • Head tilt, falling, rolling to affected side • Asymmetric ataxia Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Otic Diagnostics Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Diagnosis • History • Physical examination • Dermatologic – Examination of the skin for generalized disease • Neurologic examination Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Diagnosis • Pinnal examination • Visual inspection • Palpation of the ear canals • Otic examination –Hand-held otoscope – Video otoscope Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Visually Inspect the Ear Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Palpate the Ear Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Otic Examination BASIC DIAGNOSTIC: PERFORMED AT EVERY APPOINTMENT WHETHER CLINICAL OR NOT Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Video Otoscopy Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Otic Diagnostics • Cytology – Rapid, inexpensive – Roll onto glass slide, heat fix – Modified Wright’s stain or gram stain – Scanning then oil-immersion –Number, type of organisms, inflammatory cells, other cells – Best diagnostic for identification of yeast – Performed at initial examination and all rechecks! Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Otic Diagnostics • Bacterial C/S –NOT NEEDED ON EVERY CASE! 1. Numerous rod bacteria on cytology 2. Need to identify the bacterial genus/species 3. Treating ear infections with ORAL ANTIBIOTICS – Middle ear infections Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Bacterial Culture and Susceptibility Testing • How to Interpret? • Systemic? Topical? • Susceptibility test results – Blood levels vs topical • 1000 times higher levels with topicals in ear – Prediction of response to treatment, not guarantee – Predictive value for a drug to fail is better than predictive value for success Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Otic Diagnostics • Mineral oil examination – Collect sample from ear – Roll on slide with mineral oil – Cover slip – Scanning power, condenser down – Parasites Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Additional Diagnostics • Diagnosis of primary disease – Skin scraping – Thyroid evaluation – Allergy testing, food trial – Biopsy – CBC, biochemical profile Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Radiography • Performed in animals suspected of otitis media • Visualize the bony integrity of the tympanic bullae; soft tissue changes in ear • Prognostic indicator for medical therapy • Normal findings do not rule out otitis media! • Abnormal findings: sclerosis, lysis of bulla; soft tissue density in bulla Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Plain Radiography • Views: • Dorsoventral • Right and left lateral obliques • Rostroventral-caudodorsal* Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Rostroventral-caudodorsal Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Left Lateral Oblique Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Right Lateral Oblique Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Dorsoventral Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Computed Tomography (CT) • Imaging method that uses x-rays to create pictures of crosssections of body • Better for bone Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Magnetic Resonance Imaging (MRI) • Allows distinction of soft-tissue components • Normal bulla: signal void • Fluid in bulla: – Hyperintense on T2-weighted Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Magnetic Resonance Imaging (MRI) • Allows distinction of soft-tissue components • Normal bulla: signal void • Fluid in bulla: – Isointense on T1 weighted Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Hearing Loss • Conductive – Wax accumulation/Stenosis/ Hyperplasia (otitis externa) – Infectious otitis media, PSOM – Medications (ointments, packing) – Mass/polyp • Sensorineural – Congenital hereditary deafness – Drugs – Noise-induced hearing loss – Presbycusis • Why Important to Distinguish? Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Brain-stem Auditory Evoked (BAER) Testing • Definition – Far-field recording of neuroelectrical activity of the auditory nerve and BS pathways in response to a sound stimulus • Components – 5 to 7 waves – Roman numerals – Intensity – Latencies – Threshold Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Brain-Stem AuditoryEvoked Response (BAER) • Subdermal needles • Click or tone burst stimulus • Don’t need sound-proof room • Level of consciousness Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Brain-Stem Auditory-Evoked Response (BAER) • Transducers – Insert earphones – Bone stimulation transducer Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Generator Sites • Wave I – Distal auditory nerve • Wave II – Proximal auditory nerve • Wave III – Cochlear nucleus • Wave IV – Nucleus of the lateral lemniscus (LL) • Wave V – Inferior colliculus (IC) Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 BAER Applications • Site-of-lesion diagnostic tool – Neural lesions of CN VIII, BS LESION Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Threshold Estimation Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Screening tool Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Bilateral Hearing Yellow Allen ID: 650684C Page: Acq Test Date: Apr. 20, 2023 DOB: Mar 02, 2023 Age: 6.9 weeks Report: Apr. 20, 2023 Acquisition Page 1-90L(B) Num Filename Int Ear Stim. Type Swps/Art Rate Mode PP Amp SNR RN Gain Filters 1 YALA90B.1 90nHL L Inst Click 256/18 11.1 Rare 4.08 0.52 1.54 100 100-1500Hz V I 2-90L(B) 2 YALA90B.2 90nHL L Inst Click 256/0 11.1 Rare 3.62 1.26 0.82 100 100-1500Hz 3-90R(A) 3 YARA90A.1 90nHL R Inst Click 256/6 11.1 Rare 3.44 1.41 0.65 100 100-1500Hz V I 4-90R(A) 0 1 2 3 4 5 6 7 8 9 10 11 12 ms 0 1 2 3 4 5 6 7 8 9 10 11 12 ms 4.08uV Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Bilateral Deaf Purple Allen ID: 650684G Page: Acq Test Date: Apr. 20, 2023 DOB: Mar 02, 2023 Age: 6.9 weeks Report: Apr. 20, 2023 Acquisition Page 1-90L(B) Num Filename Int Ear Stim. Type Swps/Art Rate Mode PP Amp SNR RN Gain Filters 1 PALA90B.2 90nHL L Inst Click 256/9 11.1 Rare 1.36 0.17 1.70 100 100-1500Hz 2-90L(B) 2PALA90B190HLLItClik256/1111R0640280411001001500H3-90R(A) 4-90R(A) 0 1 2 3 4 5 6 7 8 9 10 11 12 ms 0 1 2 3 4 5 6 7 8 9 10 11 12 ms 1.82uV Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Unilateral Deaf – Right Ear Red Allen ID: 650684A Page: Acq Test Date: Apr. 20, 2023 DOB: Mar 02, 2023 Age: 6.9 weeks Report: Apr. 20, 2023 Acquisition Page 1-90L(B) V I 2-90L(B) 3-90R(A) 4-90R(A) 4.61uV Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Read the full article

[bigbuckregistry]

Deer News - March 2025

In this edition of the Big Buck Registry's Deer News, we bring you twelve key stories every hunter should know as we head deeper into 2025. From Washington D.C. to the backwoods of Wisconsin, this roundup covers everything from sweeping conservation wins and poaching crackdowns to predator control, CWD outbreaks, and controversial legislation. Congress wraps up the Biden era with major investments in wildlife and outdoor access, while states wrestle with issues like buck limits, deer tag programs, and firearm restrictions. Whether you're in the tree stand, driving the backroads, or tuning in from camp, this is the news shaping the future of whitetail hunting across America.

ACE & EXPLORE Acts (Washington, D.C.) Congress passes two bipartisan bills funding CWD research, wetlands restoration, and outdoor access—plus mandates broadband in public rec areas and shooting range construction. 

ESA Reform & Fish & Wildlife Director Nominee (Washington, D.C.) Proposed changes to the Endangered Species Act stir debate, and Brian Nesvik’s nomination to lead the U.S. Fish & Wildlife Service raises concerns among environmental groups.

Wisconsin Poaching Crackdown Over 250 deer were illegally killed in one of the largest poaching crackdowns in state history. Offenders face jail time, steep fines, and decades-long license bans.

Texas Deer Smuggling Operation Texas Game Wardens file 1,200+ charges in a massive deer breeding and smuggling case. Violations include CWD testing failures and falsified records.

Maine Coyote Hunting Bill Rejected A bill aiming to restrict coyote hunting to a defined season is shot down. Officials say year-round control is vital to protect deer, pets, and livestock.

Ohio CWD Cases Increase Ohio reports 24 new cases of Chronic Wasting Disease this season. Wildlife officials expand surveillance zones and urge hunters to submit samples.

Oklahoma Buck Limit Proposal Lawmakers consider reducing the annual buck limit from two to one. Some hunters support the change; others want more data before backing the bill. 

 Florida Antlerless Deer Rule Changes Hunters in Deer Management Unit D2 can now harvest antlerless deer all season long on private land. The bag limit increases to better manage the herd.

Pennsylvania Deer Season Opener Debate A new bill seeks to shift the season opener back to Monday after Thanksgiving. The move would restore tradition but may limit access for some hunters.

Michigan Doe Tag Legislation Proposed legislation offers hunters two free antlerless tags with a base license, aimed at reducing herd size, crop damage, and deer-vehicle collisions.

Maryland Lead Ammo Ban Fails Efforts to phase out lead hunting ammunition stall in the state legislature. The debate over wildlife safety and affordability continues.

Colorado Gun Law Tightens Colorado passes a law restricting semiautomatic firearms with detachable magazines. Hunters express concern over how it may affect traditional sporting use.

DON'T MISS THIS ONE!

[nurseeden]

Enhancing Community Wellness: The Vital Role of Health Department Nurses in Public Health

Enhancing Community Wellness: Teh Vital Role of Health Department Nurses in public ⁣Health

In today’s fast-paced world, the significance of community ⁤wellness cannot be overstated.As the first‍ line of defense in public health, health department nurses play‍ a ‌crucial role in promoting and protecting the health of communities. This ​article‍ explores the multifaceted responsibilities of these‌ nurses and how their work⁢ is⁤ fundamental to enhancing community wellness.

the Role of Health Department Nurses

Health department⁣ nurses are ⁢highly skilled professionals who work in various settings, including community health centers, schools, and clinics. Their primary responsibilities include:

Health Education: ​Providing‍ valuable information ⁢on disease prevention, nutrition, and wellness.

immunization Programs: Administering vaccines to prevent outbreaks of contagious diseases.

Chronic Disease Management: Assisting individuals with conditions such as diabetes and hypertension.

Community Outreach: Engaging with community members to address health concerns and promote resources.

Emergency Preparedness: Preparing and responding to ⁢public health emergencies, such⁤ as pandemics or natural⁢ disasters.

Benefits of Health⁢ Department Nurses in Community Wellness

Health‍ department nurses ⁣contribute considerably to the well-being of their communities through various means:

Increased Access to Care: They⁣ provide essential health services in underserved‌ areas, reducing health⁤ disparities.

Education and Awareness: By​ educating the public, they empower individuals to make⁤ informed health decisions.

Public Health Advocacy: they advocate for policies that promote public health at local, state, and national⁤ levels.

Preventive Care: Their focus⁢ on ⁢prevention helps reduce the‍ prevalence of diseases and lowers healthcare costs.

Practical⁤ Tips for Community ‍Engagement

To enhance community wellness,⁤ health department nurses ⁢can employ⁣ several practical strategies:

Collaboration: Partner with community organizations to ‍extend outreach efforts.

Utilize Social Media: Leverage social platforms to share health tips, resources, and upcoming events.

Host Workshops: Organize educational‌ workshops covering various health topics‍ relevant to the community.

Gather⁢ Feedback: Regularly solicit feedback ​from community members to better address their needs.

Case Studies: Prosperous Initiatives Led by Health Department Nurses

Manny⁤ health department nurses have spearheaded⁤ successful ⁤public health initiatives. Here are a couple of noteworthy ‍examples:

Initiative

Location

Description

Impact

Childhood ‌Immunization Program

Texas

‌ ⁢A program aimed at increasing⁢ immunization rates for children.

Increased vaccination rates by ⁤30% over three years.

Nutrition Education Campaign

New York‌ City

Workshops⁣ teaching ‌families about nutrition and healthy eating.

Improved dietary habits for over‌ 2,000 families.

First-Hand Experience: Voices ⁤of health⁢ Department Nurses

Hearing directly from health department nurses about their experiences can ‌provide deeper insights into their roles.According​ to Jane doe, a public health nurse from ‌Ohio:

‍ ‍ ‌ ⁢ “Every day brings new challenges, but knowing ⁤that I’m making a difference in people’s lives keeps me‍ motivated. Whether it’s educating⁤ a parent on the importance‌ of vaccines or assisting a homeless individual in accessing healthcare, I feel a sense of fulfillment and purpose ⁢in my job.”

The Future ‍of⁢ Public Health Nursing

As we move forward,⁢ the role⁣ of health department nurses is expected to expand.Key trends in​ public⁤ health nursing include:

Telehealth Services: Increasing use of telehealth for consultations and guidance.

Focus on Mental Health: Expanding services​ to address mental health‍ issues exacerbated ⁢by social determinants of health.

Community​ Partnerships: Strengthening collaborations with other sectors (education, housing) to⁢ improve health outcomes.

Conclusion

Health department nurses are indispensable to enhancing community wellness. Their dedication to education,preventive⁣ care,and advocacy not ⁢only creates healthier environments but also empowers individuals to take charge of their health.⁢ As‍ the landscape of public health evolves,the vital role ‍of these nurses​ will continue to be paramount,ensuring that communities thrive and flourish.

https://nursingcertificationcourses.com/enhancing-community-wellness-the-vital-role-of-health-department-nurses-in-public-health/

[toughgirlchallenges]

Risa August - Removing limiting beliefs, shifting her perspective, and embracing an expansive life…. Author of 'The Road Unpaved: Border to Border with a Brain Tumor and a Bike’.

In this episode, we delve into the extraordinary life and inspiring journey of Risa August, a multifaceted individual based in Colorado, USA. Risa wears many hats - she's a Gestalt practitioner, a captivating speaker, an author, and a passionate patient advocate. Her story is one of resilience, marked by her decade-long battle with a pituitary tumour and a rare disease, Acromegaly.

Risa shares candidly about her experiences, offering profound insights into overcoming adversity and embracing life with unparalleled vigour.

Risa's journey into the realm of personal transformation began with her participation in Ironman races, a testament to her fierce determination and love for physical challenges. However, her path took an unexpected turn when she started noticing troubling symptoms, eventually leading to a diagnosis that altered her life trajectory. Despite facing daunting health challenges, Risa's spirit remained unyielding as she navigated through surgeries, treatments, and the complexities of managing a chronic condition.

In her book, The Road Unpaved: Border to Border with a Brain Tumor and a Bike, Risa eloquently chronicles her courageous cross-country bicycle journey, symbolising her refusal to let adversity define her. 

Throughout our conversation, Risa reflects on how her perspective on life and adventure has evolved, emphasising the importance of embracing new experiences and pushing beyond perceived limits. Her insights into removing limiting beliefs and fostering a positive mindset resonate deeply, offering profound lessons for anyone navigating their own challenges.

Join us as Risa shares her story of resilience, adventure, and the transformative power of embracing life fully, no matter the obstacles. Get ready to be inspired by her unwavering spirit and her profound wisdom gained through living a life unleashed.

***

Don't miss out on the latest episodes of the Tough Girl Podcast, released every Tuesday at 7am UK time! Be sure to hit the subscribe button to stay updated on the incredible journeys and stories of strong women.

 By supporting the Tough Girl Podcast on Patreon, you can make a difference in increasing the representation of female role models in the media, particularly in the world of adventure and physical challenges. Your contribution helps empower and inspire others. Visit www.patreon.com/toughgirlpodcast to be a part of this important movement. 

Thank you for your invaluable support!

***

Show notes

Who is Risa

Based in Colorado, USA

Working as a gestalt practitioner, speaker, author and patient advocate

Her passion for learning

‘CANI’ - Constant And Never-ending Improvement 

The connection with Tony Robbins 

Growing up in Cleveland Ohio and her early years

Taking herself on adventures 

Being inspired by her dad and a buffalo head nickel

How the meaning of adventure has changed over the years

Why adventure means - learning and experiencing something new 

Setting out a timeline

2011 - completing her first Ironman race 

Starting to notice changes in her body 

Fast forward 7 years and training for another Ironman.

Not being able to recover and not being able to keep the weigh off

Plus dealing with severe headaches and lack of sleep

Pushing for an MRI of her brain

Being diagnosed with an enlarged pituitary and a brain tumour 

Looking at brain surgery and being diagnosed with a rare disease - Acromegaly.

Processing and working through the diagnosis 

Having a mindset of getting it done and moving on with her life

Waiting 3 months for surgery 

Acromegaly is a rare condition where the body produces too much growth hormone, causing body tissues and bones to grow more quickly. 

Being very conscious of what goes into her body

Radiation or medication?

Feeling very lonely even while being supported

Battling orthorexia in her 20s

Not being able to exercise and spend time in the outdoors

Deciding to ride her bicycle down the Pacific Coast Highway (PCH)

Looking back on her adventurous life and remembering what it felt like

Starting to paint and how it became an outlet 

Instead of focusing on what she couldn’t do - focusing on what she could do

What can I do now?

Small steps, one thing at a time.

Stopping judging herself and blocking out the noise from other people

Getting back to the CrossFit gym

Acceptance around her identity and how it’s changed

Signing up for a semi supported tour on the PCH

SAG - Support And Gear

Book: The Road Unpaved: Border to Border with a Brain Tumor and a Bike 

Reflecting back on the ride and some of the magical moments 

Trying to control situation and outcomes and how the universe has a completely different plan for you

Being open to what’s possible

To be open to letting go of limiting beliefs 

Why it was a massive learning experience 

Being present and spending time in the moment

Naming her brain tumour and the reason behind it

Being kind to her body

Louise Hay Book: Heal Your Body: The Mental Causes for Physical Illness and the Metaphysical Way to Overcome Them. 

Adding humour to her situation and how it can change perspective - especially during dark moments

Her prognosis and being on medication to control the tumour 

Dealing with the uncertainty of her future 

Making big changes in her life

Divorcing after an 18 year marriage

Letting go of people and things in her life, that no longer felt in alignment

Creating a list of all the things she wanted to do, or try

Stepping more into who she wants to be

Being unpolished, unapologetic and unleashed 

Getting up, getting back in the saddle and doing it. 

Taking it each day at a time

Choosing to cycle the Camino de Santiago in Spain

The realities of the camino and why it wasn’t like she imagined

Why it was a spiritual journey 

Challenges on the journey and wanting to quit

What do I need to do, to make this work

Finding moment of joy even through she physically struggled 

Wanting to be alive 

Being realistic about adventures and challenges

Handing the frustrations and challenges 

The next adventure…. And having multiple options

Recovery after the camino

How to connect with Risa

Final words of advice and wisdom for other women who are going through a tough time

Ask yourself ‘what CAN (Capable - Able - Now) I do’

  Social Media

Website: www.risaaugust.com

Instagram: @risaunleashed

Facebook: @risaunleashed

Linktree: https://linktr.ee/risaaugust

Substack: @risaunleashed

Book: The Road Unpaved: Border to Border with a Brain Tumor and a Bike.

  Check out this episode!

[pennsylvaniamedicalcard]

How to Apply for a Medical Marijuana Card in Pennsylvania: Benefits and Key Information

In Pennsylvania, medical marijuana has been legal since 2016, providing relief for patients with qualifying conditions. However, recreational marijuana remains illegal, which means if you're an adult resident seeking to use cannabis for therapeutic reasons, you'll need to apply for a medical marijuana card in Pennsylvania. This card opens the door to legal cannabis access in the state, and understanding how to apply can make the process smoother.

In this article, we'll break down the steps to apply for a medical marijuana card in Pennsylvania and highlight the many benefits of doing so, especially since recreational marijuana remains off-limits.

Recreational Marijuana vs. Medical Marijuana in Pennsylvania While neighboring states such as New Jersey, Delaware, Maryland, Ohio, New York, and Virginia have legalized recreational cannabis, Pennsylvania is yet to join the ranks. Adult-use marijuana is still illegal in Pennsylvania, and it's important to note that transporting marijuana across state lines, even from states where it is legal, is a federal offense. This leaves medical marijuana as the only legal pathway to access cannabis in Pennsylvania.

Benefits of a Medical Marijuana Card in Pennsylvania Acquiring a medical marijuana card in Pennsylvania provides several important benefits:

Legal Access to Medical Cannabis: With a medical marijuana card, you can legally purchase cannabis products from any licensed dispensary in Pennsylvania. This access allows you to obtain various forms of cannabis, including tinctures, oils, pills, and vaporizable forms of flower.

Higher Potency Products: Medical marijuana patients have access to cannabis products that are typically more potent and effective than those found on the black market. This ensures you get the proper dosage and the right strain to manage your symptoms.

Access to Expert Guidance: Dispensaries in Pennsylvania employ trained staff who can offer advice on the best strains, forms, and dosages for your specific medical condition. This type of guidance is essential for first-time users or those new to medical cannabis.

Legal Protection: Holding a valid medical marijuana card offers legal protection against penalties for possession and use of cannabis within state limits. As long as you follow the state’s guidelines, you won’t face legal repercussions.

Purchase Limits and Supply: Medical marijuana patients in Pennsylvania can legally purchase and possess up to a 30-day supply of cannabis at any given time, ensuring you have enough medication without frequent trips to the dispensary.

How to Apply for a Medical Marijuana Card in Pennsylvania The process of obtaining a medical marijuana card in Pennsylvania is straightforward, but you need to follow each step carefully to ensure approval. Here’s what you need to do:

Register with the Pennsylvania Medical Marijuana Program To start the process, you’ll need to visit the official Pennsylvania Medical Marijuana Program website and create an account. Make sure to have a valid PA driver’s license or state ID on hand, as this information will be required to confirm your residency. During registration, you’ll also be asked to provide some basic personal information, including your contact details.

Get Evaluated by an Approved Physician Once you’ve registered, the next step is obtaining a certification from a physician approved by the Pennsylvania Department of Health. You must have a qualifying medical condition to receive this certification, and the doctor will review your medical history to determine if medical marijuana is appropriate for you.

Some qualifying conditions include:

Chronic pain

PTSD

Anxiety disorders

Cancer

Epilepsy

Crohn’s disease

Multiple sclerosis

Make sure to ask your doctor any questions you might have about cannabis treatment to better understand how it can benefit your specific condition.

Pay for Your Medical Marijuana Card Once your physician submits your certification, you’ll need to return to the online patient portal and complete the application by paying the annual fee. Currently, the fee is $50, although discounts are available for patients who participate in Medicaid, PACE/PACENET, CHIP, or other state assistance programs.

Receive Your Pennsylvania Medical Card After your payment is processed, your medical marijuana card will be mailed to you. You can then use this card to purchase medical cannabis from licensed dispensaries throughout the state.

Key Considerations for Medical Marijuana Cardholders in Pennsylvania While holding a medical marijuana card in Pennsylvania gives you access to legal cannabis, there are still some restrictions you need to keep in mind:

You Cannot Transport Marijuana Across State Lines: Even though recreational marijuana is legal in nearby states such as New Jersey, New York, and Maryland, crossing state lines with cannabis remains illegal under federal law.

No Smoking: In Pennsylvania, smoking marijuana is not permitted. However, patients can use vaporization products, tinctures, oils, or edibles to receive their medication.

Employment Protections: Employers in Pennsylvania are not permitted to discriminate against employees solely based on their status as a medical marijuana patient, although certain positions may require adherence to drug-free policies.

Why Now is the Time to Apply for a Medical Marijuana Card Given that recreational cannabis remains illegal in Pennsylvania, and crossing state lines with cannabis from states where it's legal could lead to serious legal consequences, applying for a medical marijuana card is the best option for legal access to cannabis. With this card, you can safely obtain the products you need to manage your medical conditions without fear of prosecution.

If you are considering applying, make sure to do so through the proper channels and with the guidance of a certified physician. You’ll not only benefit from legal protection but also gain access to a wide range of cannabis products that can significantly improve your quality of life.

[mypositiveoutlooks]

6 natural ways to improve your gut health and enhance your well-being

If you frequently experience stomachaches, tiredness, or skin issues, it could be a sign that you need to improve your gut health. Gut health involves good digestion, a balanced mix of beneficial bacteria, and a strong immune system. According to Forbes, it impacts overall health, stress management, and chronic disease. Ohio State University Wexner Medical Center experts note that diet, behavior,…

[outsource-medical-billing]

Upcoming Changes in DME Billing for Chronic Disease Management

Discover key DME billing changes for 2025, including new CPT codes, APCM services, telehealth expansion, and RPM integration for better care.

[ohiopsychiatricservices121]

Dr. Raj Fatehchand MD, FACP Physician-Primary Care, Internal Medicine and Addiction Medicine

Many primary care visits in the United States are related to behavioral health needs, and many common medical problems seen in primary care involve poor health habits that may initiate excessive weight, all perpetuating symptoms and poor functioning.

Dr Raj Fatehchand, MD, Board-certified and trained is now available by appointment at Ohio Psychiatric Services for our registered patients, should they require urgent primary healthcare services.

Dr Raj Fatehchand serves to provide consultation visits for our patients and to answer questions regarding medical clearance for TMS and Esketamine (Spravato) services if needed. He is available to assist, navigate and educate our patients on good health; preventing diseases by identifying risk factors, coordinating with our patients’ regular primary care physician on managing chronic diseases and maintaining optimal health and advocating for patients by coordinating the use of the entire healthcare system to benefit them.

[nursingwriter]

Community Dementia Care and the Chronic Care Model End-Stage Dementia Evaluation Proposal Health Promotion Plan for Community End-Stage Dementia Care: The Chronic Care Model Health Promotion Plan for Community End-Stage Dementia Care: The Chronic Care Model. In 2013 an estimated 5.0 million Americans over the age of 65 suffered from Alzheimer's disease (Alzheimer's Association, 2013). Although the U.S. Centers for Disease Control and Prevention (CDC) considers dementia/Alzheimer's to be the fifth leading cause of death among adults 65-years of age or older, careful examination of Medicare claims data revealed that dementia is probably right behind cardiovascular disease as the second leading cause of death for this age group (Tinetti et al., 2012). Most of these patients would prefer to die at home, not only because of comfort concerns, but due to the higher quality of care that tends to be provided by informal and paid caregivers in this setting (reviewed by Teno et al., 2013). Unfortunately, nearly half (42.2%) of all dementia patients receiving Medicare coverage died in a hospice setting in 2009, compared to only 21.6% in 2000 (Teno et al., 2013). This may be good news for policymakers interested in increasing the use of hospice care, but not patients preferring to die in their own homes surrounded by loved ones. In addition to the increased reliance on hospice care, ICU admissions during the last 30 days of life increased during the same period. Improving the quality of the home-based palliative care experience may be one way to reverse this trend. Accordingly, a health promotion plan advocating the benefits of the Chronic Care Model (CCM) for home-based dementia care has been developed. What follows is a description of the intervention and the proposed outcome measures that will be used to evaluate the efficacy, efficiency, and quality of the intervention. Intervention The efficacy of CCM as an intervention for increasing the quality of home-based palliative care is currently being investigated by researchers (Brodaty & Donkin, 2009). The CCM has six core elements: (1) explicit protocols and policies, (2) emphasis on patient-centered care, (3) comprehensive services, (4) systematic attention to patient information and behavioral needs, (5) integrated multidisciplinary care, and (6) information systems to support clinical objectives. Preliminary research findings for a small, randomized Ohio sample (N = 80) provided trend data that supported the utility of CCM for reducing the number of unscheduled visits to hospitals and admissions to nursing homes (Radwany et al., 2013). A similar study, also with a small, randomized sample (N = 125), was completed in Finland, which revealed significantly lower rates of institutional care after 1.6 years and reduced healthcare spending (p = .03) (Eloniemi-Sulkava et al., 2009). What both studies reveal is that CCM can be implemented successfully and without substantially increasing overall healthcare spending. For these reasons, a health promotion plan for home-based dementia care has been proposed. Efficacy Evaluation Researchers have shown that individual elements of the CCM significantly delayed and/or prevented the use of institutional care during the last days of life (reviewed by Eloniemi-Sulkava et al., 2009). The CCM intervention implemented in Ohio incorporated a care manager who orchestrated healthcare services for both the patient and family members within a provider network (Radwany et al., 2013). This network consisted of the care manager, hospital-based geriatricians, primary care providers, and health care facilities. One of the expected benefits of the care network, for example, is seamless transitions between care settings. Another benefit would be a patient- and family-centered care orientation, such that the physical, psychological, and spiritual needs of the patient and family caregivers are addressed. The evaluation outcome measures for intervention efficacy should therefore include methods and instruments that can quantify how effective care transitions are being made and whether the quality of life for patients and family caregivers is improved compared to standard care. Eloniemi-Sulkava and colleagues (2009) reviewed the concerns of family caregivers when caring for dementia patients and among the most common were patient physical disability and the behavioral and psychological symptoms associated with dementia (BPSD). An effective intervention for home care of dementia patients would therefore need to quantify activities of daily living (ADL) and instrumental activities of daily living (IADL) (Radwany et al., 2013). In addition, the behavioral and psychological symptoms due to dementia should be followed during the study period using a clinical instrument (Eloniemi-Sulkava et al., 2009). Another essential measure of the quality of an intervention is the experiences of the care team. When Peyrot and colleagues (2006) examined provider perceptions of the chronic care model for diabetes care the results were mixed. Providers in the United States perceived the CCM to be mediocre with respect to organization and receiving compensation for services rendered. By comparison, patients being treated under CCM felt the ease of access and patient-provider collaboration was high, while provider collaboration was mediocre. Patents also tended to experience some financial limitations to receiving diabetes care through CCM. When combined, these findings seem to reveal a lower opinion of CCM by providers than by patients. This seems to contradict the emphasis on patient-centered care within CCM and may reflect provider resistance to CCM implementation or a poor fit between CCM and the health care system in existence at the time. Whether implementation of the Patient Protection and Affordable Care Act (ACA) of 2010 will improve these perceptions is unknown, it seems likely that these questions will be on the minds of researchers as the ACA becomes the norm. In summary, survey instruments and patient records will be used to quantify the effectiveness of the care provided under CCM, patient (PQOL) and family caregiver (FCQOL) quality of life, ADL, and BPSDs. In addition, provider experiences of the intervention will be gathered using a questionnaire. Evaluation Strategy As recommended by the CDC (n.d.), an evaluation strategy should be created prior to intervention implementation and become an integral component of the intervention going forward. While some of the evaluation methods proposed above may be too cumbersome for long-term and continuous evaluation of intervention effectiveness and quality, some would be amenable to long-term use. For the purposes of this proposal, however, the long-term feasibility of the evaluation measurement tools will not be considered here. The formative evaluation will depend on all of the above mentioned measurement tools, thereby providing objective information about the implementation process and its completeness, as well as information about how well the intervention is meeting its goals. The overall evaluation strategy will involve recruitment of patients and family caregivers into the study. Informed consent will be obtained from both patients (when possible) and family caregivers prior to gathering baseline data. The baseline data will be obtained from providers, medical records, and questionnaires filled out by patients, family caregivers, and providers. Eloniemi-Sulkava and colleagues (2009) utilized a 2-year study period because anything longer proved to be counter-productive due to patient attrition. The follow-up evaluation occurred at 6, 12, and 24 months following inclusion of the patient in the study; however, the 6 and 12-month follow-ups proved to be the most informative due to patient attrition. Follow-up evaluations will depend on patient, family, and clinician participation, because quality of life, physical disability, behavioral and psychological problems, and institutional care utilization data will be gathered from all these sources using questionnaires and patient medical records. CCM care managers will be responsible for collecting patient- and family-related information through questionnaires. Designated nurses working in the offices of geriatricians and primary care providers will be given the responsibility for gathering patient information from medical records. This information will be de-identified and assigned a case number prior to analysis. This data will then be collated and analyzed by researchers, who will produce a summative evaluation that can be used to quantify the efficacy and quality of home-based palliative care for dementia patients and family caregivers using CCM. The summative evaluation will be completed after the data gathering period in the study has been completed, which is expected to last a little over 2 years depending on the availability of patients and family caregivers. Instruments Eloniemi-Sulkava and colleagues (2009) evaluated patients at baseline using the Barthel Index and Neuropsychiatric Inventory (NPI) (see Appendix). The Barthel Index (Stone, Ali, Auberleek, Thompsell, & Young, 1994; University of Iowa Healthcare, n.d.) and NPI (Cummings et al., 1994) were administered again at 6 and 12 months into the study and will be used in the current study to track ADL and BPSDs using the same intervals. PQOL will represent a composite score obtained using the Color Analog Scale for pain (Santos & Castanho, 2013) and the Quality at the End of Life Scale (QUAL-E) (National Palliative Care Research Center, 2005) (see Appendix). In cases of severe cognitive impairment, completion of the QUAL-E may depend on family caregivers. FCQOL will be evaluated using the Zarit Burden Scale (Regional Geriatric Program Central, 2014) (see Appendix). The success of the intervention, as perceived by family caregivers and providers, will be assessed using the questionnaires developed by Morita and colleagues (2013). The goal of these questionnaires will be to evaluate how effective the community palliative intervention was in improving the knowledge and skills of palliative care, increasing access to specialized services, coordinating care services, and increasing deaths at home. This evaluation will be performed following the death of the patient or the end of the study period, whichever comes first. The validity and reliability of the questionnaires developed by Morita et al. (2013) have not been evaluated, but should prove informative and provide context for the other findings. Discussion A review of interventions designed to improve the quality of community palliative care has revealed mixed findings, but the trend is in the desired direction of reducing the number of patients dying in hospital wards, ICUs, and hospice facilities. CCM has garnered the interest of researchers interested in improving palliative care outcomes for patients, family caregivers, and providers alike, and have begun to study the efficacy and quality of interventions, including CCM. This proposal provides justification for implementing CCM for end-stage dementia patients residing at home and details an evaluation strategy that can be implemented to determine the efficacy, effectiveness, and quality of the care provided. In contrast to many other studies, however, this proposal places equal value on the experiences of patients, family caregivers, and providers alike, in addition to the more common outcome measures of BPSDs and institutional admissions. The methods of data gathering will involve the review of patient records and several instruments designed   https://www.paperdue.com/customer/paper/model-for-community-palliative-care-186123#:~:text=Logout-,ModelforCommunityPalliativeCare,-Length6pages Read the full article

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Transform Your Health with AnshulGuptaMD: Your Partner in Functional Medicine

At AnshulGuptaMD, we believe in a holistic approach to healthcare that addresses the root causes of disease, not just the symptoms. Dr. Anshul Gupta, a renowned Functional Medicine Doctor in Ohio, is dedicated to guiding you on a transformative journey toward optimal health and well-being. Functional Medicine Doctor OH

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Early Warning Signs of Diabetes to Look Out For

Type-2 diabetes is one of the most common chronic conditions affecting adults worldwide. It can increase the risk of heart disease, kidney disease, vision & hearing problems, nerve damage, and many more.

[bigbuckregistry]

DEER NEWS January 2025

In this episode, we explore the most pressing wildlife management issues across the United States, from record-breaking deer hunting seasons to groundbreaking conservation efforts. From Mississippi's legal battle over deer-dog hunting to Missouri’s fight against chronic wasting disease, we’re diving deep into the decisions shaping the future of hunting, wildlife preservation, and public safety. Whether you’re a hunter, conservationist, or just curious about how these topics affect your community, this episode has something for everyone.

Topics Covered

Mississippi’s Deer-Dog Hunting Debate: A tradition under scrutiny—can property rights and hunting heritage coexist?

Ohio’s Record Deer Harvest: What’s driving the highest deer harvest in 13 years?

Pennsylvania’s Proposed Hunting Rule Changes: How 2025 could redefine hunting across the Keystone State.

Missouri’s Chronic Wasting Disease Fight: Will new carcass disposal rules change the game for hunters and conservationists?

Montana’s Landfill Deer Culling Efforts: Why a landfill is at the center of the state’s disease containment strategy.

Maine’s Deer Dilemma: Lyme disease, car crashes, and the search for innovative solutions in Southwest Harbor.

Grand Rapids’ Urban Deer Hunt Proposal: Archery in city limits—could it work?

Ohio Poacher’s Record-Breaking Fine: The $43,000 trophy buck case shaking up the hunting community.

New York’s Venison Donation Program: Turning an illegal hunt into a win for families in need.

💬 Have thoughts on today’s stories? Share your opinions with us on social media using #BBR

Links and Resources

Mississippi Wildlife Regulations

Ohio Department of Natural Resources

Pennsylvania Game Commission

Missouri Department of Conservation

Montana Fish, Wildlife & Parks

Feeding New York State Venison Program

Big Buck Registry Links

Official Website: Big Buck Registry

Spotify: Deer Hunt - Big Buck Registry

Apple Podcasts: Big Buck Registry Podcast

iHeartRadio: Listen on iHeartRadio

TuneIn: Listen on TuneIn

Amazon Music: Listen on Amazon Music

Social Media Profiles

Facebook: Big Buck Registry on Facebook

Instagram: @bigbuckregistry2012

Twitter: @BigBuckRegistry

DON'T MISS THIS ONE!

[alliedcreation]

E-Textile Market Latest Industry Trend, Challenges, Strategy  2021 to 2030 

There have not been many commercial successes with e-textiles up to this point. This is attributed to the healthcare industry's unwillingness to invest in academic or research endeavors in favor of a wait-and-see attitude. Some manufacturers have substituted wellness/sports sector in its place, where repercussions of a false signal are significantly less severe.

However, with chronic diseases such as diabetes, heart disease, cancer, and respiratory disorders continuing to rise in many parts of the world, older populations living longer, and increase in the number of surgeries performed in important healthcare markets such as Europe and the U.S., e-textile developments are on the rise to utilize cutting-edge electronics and medical technology. In some clinical studies, smart clothing has demonstrated the ability to guard against infectious diseases, sense the wearer's health status, and aid in the prevention, treatment, and management of health.

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E-textiles must continue to evolve in terms of dependability, liability, and certification to overcome obstacles. Device producers and researchers face additional difficulties with regulatory approvals because getting FDA approval might take years. Then comes the challenge of receiving certification and permission from insurance companies. The development of the several smart clothing concepts that have been proposed would take three to five years. Many experts predict that this turning moment will occur around 2020.

University-level research shows great promise for the future of patient care technology among those creating e-textiles for the healthcare business.

The VTT Technical Research Center in Finland is working on an intriguing project where researchers have developed smart fabric that can be worn as clothing or blankets and determine whether a patient needs to be warmed or cooled based on initial data measured from person and environment. Thegear adapts to body's temperature during surgery, hence it might also be utilized by doctors who feel too warm during an operation.

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The ElectroScience Laboratory at Ohio State University is developing useful e-textiles that gather, store, or transmit digital information by weaving antennas into objects such as brain caps that sense brain activity to help treat conditions such as epilepsy or addiction. These antennas use platforms such as the Intel Edison development platform. Researchers are also developing a smart bandage that can communicate with a doctor about the state of surrounding tissue's healing without having to remove it.

While this is going on, researchers at the University of Bristol are developing soft robotic clothing that could prevent falls in people who are vulnerable by supporting them while they walk and provide bionic strength to people who need it to get from a sitting to a standing position or climb stairs. Nanotechnology, 3D printing, electrical stimulation, and full-body monitoring technologies are all used in creation of smart clothes. As per opinions of various researchers this technology could ultimately lead to potentially freeing wheelchair-bound people from having to use the devices.

The Empa research institute in Switzerland has developed a fitted cap that measures heart rates and is incorporating optical fibers into e-textiles to monitor skin circulation and avoid bed sores. Hospitals find the clothing to be perfect as it can endure a disinfecting wash cycle.

This technique, according to researchers, may one day be used to gauge tissue pressure, respiration rate, or oxygen saturation. To examine bodily fluids or gases, e-textiles could also be made into chemical or biological sensors such as those provided by Maxim Integrated. Based on a series of ultra-low power ARM�� Cortex®-M microcontrollers from Maxim, ultra-low power and secure development boards are available. These ARM Cortex-M4F 32-Bit MCUs combine ultra-low-power, high-efficiency signal processing functionality with user-friendliness, making them perfect for the growing category of wearable medical and fitness applications. The integrated pulse oximetry and heart-rate monitor module from Maxim, the MAX30102 Pulse Oximeter & Heart-Rate Sensor, has inbuilt LEDs, photodetectors, optical components, low-noise electronics with ambient light rejection, and it also has low-power electronics.

Even though many of these research projects are progressing and working toward commercialization, new developments in microelectronics and high-tech fabrics are expanding the potential applications for healthcare-related e-textiles.

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Some of these concepts and early pilot projects include t-shirts that treat chronic back pain, shirts with stretch sensors to track respiratory rates in people with chronic lung disease, soft all-day belly bands to track fetal heart rate and uterine contractions in pregnant women, pressure monitor stockings for people with diabetes, or even a shirt that shocks people with severe heart problems.

According to some experts, shirts that monitor heart rate, blood pressure, oxygen saturation, and other metrics will eventually totally replace bedside monitoring in hospitals.

With the Google-Levi Project Jacquard commuter jacket for cyclists, the concept of using gesture detection in smart clothing has recently gained prominence. There are currently much more affordable and well-established technologies that will be difficult to surpass in the next five years, despite the fact that many experts believe gesture recognition could find its way into clothing for healthcare—possibly for use by paraplegics, elderly who have suffered strokes or heart attacks, or elderly in the home who fall.

It can be easily shrunk and does not require moving mechanical elements, haptic feedback, or the use of touch in a user interface design, hence holds a lot of potential for e-textiles. To engage a patient's muscles, haptic feedback, which can be anything from a slight tickle to a powerful force input, is employed in electric muscle stimulation (EMS). To stimulate muscle movements or for rehabilitation, smart clothing with haptic feedback technology might be worn on any region of the body at any hour of the day. Prototypes of haptic feedback-based projects, like those from Novasentis, are now being created for use in medical apparel and should be available later this year.

The e-textile market is segmented on the basis of type, product, application, functionality, and region. On the basis of type, the E-Textile Industry is bifurcated into classic electronics and modern electronics. By product, it is classified into passive, active, and ultra-smart. On the basis of application, it is categorized into defense, sports & fitness, healthcare, household textiles, fashion & entertainment, transport, protection & military, architecture and others. On the basis of functionality, it is classified into sensing, energy harvesting, luminescence & aesthetics, thermoelectricity, and others. Region-wise, theE-Textile Market is analyzed across North America, Europe, Asia-Pacific and LAMEA.

The players operating in the global e-textile market have adopted various developmental strategies to increase their E-Textile Market Share, gain profitability, and remain competitive in the market. The key players included in the E-Textile Market Analysis are- CARRÉ TECHNOLOGIES Inc., Chronolife., E. I. DU PONT DE NEMOURS AND COMPANY , INTERACTIVE WEAR AG, Mitsufuji Corporation, Myant Health , Outlast Technologies GmbH , sanSirro GmbH , Schoeller Textile AG, SENSING TEX, S.L. , Sensoria Inc. , SunstarTaiwan ENT. CO., LTD. , Tex-Ray Industrial Co., Ltd., TORAY INDUSTRIES, INC., Vista Medical Ltd., Vulpés Electronics GmbH, Xenoma Inc.

Key findings of the study

On the basis of product type, the classic electronics segment is projected to witness the major E-Textile Market Growth with the CAGR of 6.5%, in terms of revenue, during the E-Textile Market Forecast period.

On the basis of product, the ultra-smart segment E-Textile Market Size is expected to dominate the market from 2022 to 2031.

On the basis of application, the defense segment has the high E-Textile Market Trends and is expected to grow at a significant CAGR during the forecast period and has myraid E-Textile Market Opportunity.

On the basis of functionality, the sensing functionality segment dominated the global market in the 2021, with a E-Textile Industry share of more than 30%.

Region wise, Europe dominated the global market in 2021. This is attributed to expansion of new wholesale fabrics companies and surge in E-Textile Market Demand for apparel and textile machinery exports for e-textiles.