An Evaluation of the ICD-10-CM System: Documentation Specificity, Reimbursement, and Methods for Improvement (International Classification of Diseases; 10th Revision; Clinical Modification)

The research project consists of three studies to identify the documentation specificity, reimbursement and documentation improvement for the upcoming International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system. A descriptive research study using quantitative methods was conducted for the first study, which focused on coding electronic documents across each major diagnostic chapter for ICD-10-CM. The coding was ranked according to the Watzlaf et al (2007) study where a ranking score was provided if the diagnosis was fully captured by the ICD-10-CM code sets. The ICD-10-CM codes were then compared to the current ICD-9-CM codes to evaluate the details on the descriptions of the codes. The rankings were determined by comparing the ICD-10-CM systems for the number of codes, the level of specificity and the ability of the code description to fully capture the diagnostic term based on the resources available at the time of coding. A descriptive research study using quantitative methods was conducted for the second study, which focused on evaluating the reimbursement differences in coding with ICD-10- CM with and without the supporting documentation. Reimbursement amounts or the MS-DRG (Medicare Severity Diagnosis Related Groups) weight differences were examined to demonstrate the amount of dollars lost due to incomplete documentation. Reimbursement amounts were calculated by running the code set on the CMS ICD-10 grouper. An exploratory descriptive research study using qualitative methods was conducted for the third study which focused on developing a documentation improvement toolkit for providers and technology experts to guide them towards an accurate selection of codes. Furthermore a quick reference checklist geared towards the physician, coders and the information technology development team was developed based on their feedback and documentation needs. The results of the studies highlighted the clinical areas which needed the most documentation attention in order to accurately code in ICD-10-CM and the associated potential loss of revenue due to absent documentation. Further, the results from the educational tool kit could be used in the development of a better inpatient Computer Assisted Coding (CAC) product

Clandestino: Latino Youth and Mental Health and Art as an Outlet for One’s Emotions

According to Lawrence Public Schools (2017), 64.9% of students are economically disadvantaged, meaning that many of these students may not be receiving the mental health treatment they need. For this project, a facilitate discussion on mental health and art as an outlet for one’s emotions occurred at Elevated Thought, a youth and social justice organization in Lawrence, Massachusetts. Altogether, the discussion brought up four themes: 1) Community & Institutions, 2) Lack of Access, 3) Mistrust & Stigma, 4) Art & Self. Through creative dialogue, the youth involved successfully reflected on their understanding of mental health, the stigma behind it, and how art can act as a positive outlet for emotions, primarily as a substitution for positive relationships with adults that they lack

Dexmedetomidine (Precedex) Induced Fever

Precedex is an intravenous, α-2 receptor agonist broadly used for analgesia, maintenance of sedation, and alcohol withdrawal treatment in the intensive care unit (ICU). The most commonly reported adverse effects associated with precedex are hypotension and bradycardia1. Fever has been reported with a 5-7% incidence rate. Our case shows a very impressive pyrexia in a 49 year old patient most likely associated to Precedex. When compared to the previously three reported cases his fever reached the largest value (T= 107ºF). As its use becomes more and more common in the ICU, clinicians should be aware of this adverse effect especially in patients whose fevers are refractory to acetaminophen and temperatures that are higher than 104ºF

Role of Extracellular Matrix-Mediated Interactions in Thymocyte Migration

Cell adhesion, migration, differentiation and survival or death is amongst a large spectrum of biological responses that can be elicited by ligation of extracellular matrix components to their corresponding receptors. As regards the physiology of the thymus, cell migration is a crucial event in the general process of T cell differentiation. Studies on the intrathymic distribution of ECM components revealed that fibronectin, laminin and type IV collagen, are not restrictedly located at typical basement membrane sites, also forming a thick network in the medullary region of the thymic lobules, whereas very thin ECM fibers are found within the cortex. These ECM components are essentially produced by thymic microenvironmental cells, which also drive thymocyte differentiation. Signals triggered by ECM are conveyed into thymocytes or microenvironmental cells through specific membrane receptors, and most of them belong to the integrin type, such as the VLA-3, VLA-4, VLA-5 and VLA-6. In vitro studies revealed that adhesion of thymocytes to thymic microenvironmental cells is mediated by extracellular matrix. Such an adhesion is preferentially done by immature thymocytes. Importantly, ECM-mediated interactions also govern the entrance and exit of thymocytes in the lymphoepithelial complexes named thymic nurse cells. Lastly, pathological conditions, including infectious and autoimmune diseases, in which changes of ECM ligands and receptors are observed, course with alterations in thymocyte migration and death. In conclusion, the fact that ECM can modulate traffic, differentiation, death and survival of normal thymocytes adds clues for understanding how ECM-mediated interactions behave in the thymus, not only in normal, but also in pathological conditions

Evolution of a localized electron spin in a nuclear spin environment

Motivated by recent interest in the role of the hyperfine interaction in quantum dots we study the dynamics of a localized electron spin coupled to many nuclei. An important feature of the model is that the coupling to an individual nuclear spin depends on its position in the quantum dot. We introduce a semi-classical description of the system valid in the limit of a large number of nuclei and analyze the resulting classical dynamics. Contrary to a natural assumption, the correlation functions of electron spin with an arbitrary initial condition show no decay in time. Rather, they exhibit complicated undamped oscillations. This may be attributed to the fact that the system has many integrals of motion and is close to an integrable one. The ensemble averaged correlation functions do exhibit a slow decay (1/ln(t)) for t -> \infty.Comment: 11 pages, 11 figures, revtex4 styl

Nuclear Fuel Handling Device

The fuel handling device project is a solution to help the operators at Rhode Island Nuclear Science Center and Los Alamos National Laboratories ease the transportation and inspection of spent fuel rods. The objective is to have a device or pole that can remove spent fuel assemblies which sit in a 35 foot deep reactor. Which latches onto a small crossbar on top of the fuel assembly which transports it to another side of the reactor. In order to make sure it’s transported safely, there can’t be any errors where the fuel assembly would fall over. A device was created to meet the criteria that was laid out by the workers at RINSC and provide an optimal device for the workers to use. After 120 conceptual ideas and many hours of discussing these options, a final design has been chosen for the device. This includes specific dimensions and materials acceptable for use while also deciding to have an interchangeable end for multi use. Parts have been designed and printed to visualize the optimal end for the fuel handling before purchasing and manufacturing the final product

Peptides as potent antimicrobials tethered to a solid surface: Implications for medical devices

Medical devices are an integral part of therapeutic management; despite their importance, they carry a significant risk of microbial infection. Bacterial attachment to a medical device is established by a single, multiplying organism, leading to subsequent biofilm formation. To date, no preventative measures have impacted the incidence of device-related infection. We report the bidirectional covalent coupling of an engineered cationic antimicrobial peptide (eCAP), WLBU2, to various biological surfaces is accomplished. These surfaces included (i) a carbohydrate-based gel matrix, (ii) a complex polymeric plastic bead, and (iii) a silica-calcium phosphate nanocomposite associated with bone reconstruction. WLBU2-conjugated surfaces are shown to retain potent antimicrobial activity related to bacterial surface adhesion. This study provides proof of principle that covalently coating laboratory and bone-regenerating materials with eCAPs has the potential for decreasing infection rates of implanted devices. These findings have important consequences to the patient management component of our current health care technology

A Telehealth Privacy and Security Self-Assessment Questionnaire for Telehealth Providers: Development and Validation

Background: Telehealth is a great approach for providing high quality health care services to people who cannot easily access these services in person. However, because of frequently reported health data breaches, many people may hesitate to use telehealth-based health care services. It is necessary for telehealth care providers to demonstrate that they have taken sufficient actions to protect their patients’ data security and privacy. The government provided a HIPAA audit protocol that is highly useful for internal security and privacy auditing on health care systems, however, this protocol includes extensive details that are not always specific to telehealth and therefore is difficult to be used by telehealth practitioners.Objective: The goal of this study was to develop and validate a telehealth privacy and security self-assessment questionnaire for telehealth providers. Methods: In our previous work, we performed a systematic review on the security and privacy protection offered in various telehealth systems. The results from this systematic review and the HIPAA audit protocol were used to guide the development of the self-assessment questionnaire. The draft of the questionnaire was created by the research team and distributed to a group of telehealth providers for evaluating the relevance and clarity of each statement in the draft. The questionnaire was adjusted and finalized according to the collected feedback and face-to-face discussions by the research team. A website was created to distribute the questionnaire and manage the answers from study participants. A psychometric analysis was performed to evaluate the reliability of the questionnaire.Results: There were 84 statements in the draft questionnaire. Five telehealth providers provided their feedback to the statements in this draft. They indicated that a number of these statements were either redundant or beyond the capacity of telehealth care practitioners, who typically do not have formal training in information security. They also pointed out that the wording of some statements needed to be adjusted. The final released version of the questionnaire had 49 statements. In total, 31 telehealth providers across the nation participated in the study by answering all the statements in this questionnaire. The psychometric analysis indicated that the reliability of this questionnaire was high.   Conclusion: With the availability of this self-assessment questionnaire, telehealth providers can perform a quick self-assessment on their telehealth systems. The assessment results may be used to identify possible vulnerabilities in telehealth systems and practice or demonstrate to patients the sufficient security and privacy protection to patients’ data