在临床医学中课件

在临床医学中2HealthCareDeliverySystemsHistoryofMedicineandHealthcareDeliveryContinuumofCareHealthCareFacilityOwnershipHealthCareFacilityOrganizationalStructureLicensure,Regulation,andAccreditation3IntroductionHealthcaredeliveryhasbeengreatlyimpactedbyescalatingcosts,resultinginmedicalnecessityrequirements,reviewofappropriatenessofadmissions,andrequirementforadministrationofqualityandeffectivetreatments.4MRXO在臨床醫學中，進行手術時同時使用磁振造影並整合各種影像技術是目前最熱門的醫療概念。新式的「未來手術室」中，安裝有全球首套MRXO解決方案，即完全整合磁振造影(MR)、Ｘ光及電腦斷層掃描(CT)系統，大幅減少病患危險並簡化醫師的手續，可望提高手術成功率。這項由日本東海大學、飛利浦醫療系統事業部合力推動的「未來手術室」，已經由日本東海大學的松前教授、津具醫師、山本醫師共同在手術室同時使用MR(磁振造影)和X光影像技術，來進行神經外科手術。5MRXO在「未來手術室」中執行手術，可依執刀醫師與病患狀況，在數分鐘內將病患從手術台搬移到磁振造影、電腦斷層掃描或Ｘ光診斷系統，增加手術精密度與成功率。在磁振造影和電腦斷層掃描區域有拉門。6HistoryofMedicine&HealthCareDeliveryHistoryofmedicineEvolutionofhealthcaredeliveryintheUnitedStates7HistoryofmedicineIn1994,scientistsdiscoveredthegenesresponsibleformanycasesofhereditarycoloncancer,inheritedbreastcancer,andthemostcommontypeofkidneycancer.8EvolutionofhealthcaredeliveryintheUnitedStates1991TheWorkgrouponElectronicDataInterchange(WEDI)wascreatedtoreducehealthcareadministrativecoststhroughimplementationoftheelectronicdatainterchange(EDI),whichusesnationalstandardstotransmitdataforreimbursementpurposes.9EvolutionofhealthcaredeliveryintheUnitedStates1996TheHealthInsurancePortabilityandAccountabilityAct(HIPAA)waspassed.Itmandatesadministrativesimplificationregulationsthatgovernprivacy,security,andelectronictransactionstandardsforhealthcareinformation.10EvolutionofhealthcaredeliveryintheUnitedStates1996TheHealthcareIntegrityandProtectionDataBank(HIPDB)wascreatedwhichcombatsfraudandabuseinhealthinsuranceandhealthcaredeliverybyalertinguserstoconductacomprehensivereviewofapractitioner’s,provider’s,orsupplier’spastactions.11HealthcareIntegrityandProtectionDataBankAccesstoinformationintheHIPDBisavailabletoentitiesthatmeettheeligibilityrequirementsdefinedinSection1128EoftheSocialSecurityActandtheHIPDBregulations.Inordertoaccessinformation,eligibleentitiesmustfirstregisterwiththeDataBank.HIPDBinformationisnotavailabletothegeneralpublic.However,informationinaformthatdoesnotidentifyanyparticularentityorpractitionerisavailable.12HealthcareIntegrityandProtectionDataBank/Estimatesofannuallossesduetohealthcarefraudrangefrom3to10

percentofallhealthcareexpenditures--between$30

billionand$100

billionbasedonestimated1997expendituresofover$1trillionand2.5trillionfor2009.13ContinuumofCareAcompleterangeofprogramsandservicesiscalledacontinuumofcare,withthetypeofhealthcareindicatingthehealthcareservicesprovided.PrimarycareSecondarycareTertiarycare14PrimarycareservicesIncludepreventiveandacutecare,arereferredtoasthepointoffirstcare,andareprovidedbyageneralpractitionerorotherhealthprofessionalwhohasthefirstcontactwithapatientseekingmedicaltreatment,includinggeneraldental,ophthalmic眼科的,andpharmaceuticalservices.15PrimarycareservicesAnnualphysicalexaminationsEarlydetectionofdiseaseFamilyplanningHealtheducationImmunizationsTreatmentofminorillnessesandinjuriesVisionandhearingscreening16SecondarycareservicesProvidedbymedicalspecialistsorhospitalstaffmemberstoapatientwhoseprimarycarewasprovidedbyageneralpractitionerwhofirstdiagnosedortreatedthepatient.17TertiarycareservicesProvidedbyspecializedhospitalsequippedwithdiagnosticandtreatmentfacilitiesnotgenerallyavailableathospitalsotherthanprimaryteachinghospitalorLevelI,II,IIIorIVtraumacenters.18TraumacentersLevelI:providesthehighestlevelofcomprehensivecareforseverelyinjuredadultandpediatricpatientswithcomplex,multi-systemtrauma.LevelII:broadrangeofsub-specialistsareon-callandpromptlyavailabletoprovideconsultationorcare.19TraumacentersLevelIII:physiciansareadvancedtraumalifesupport(ATLS)trainedandexperiencedincaringfortraumaticallyinjuredpatients;nursesandancillarystaffarein-houseandimmediatelyavailabletoinitiateresuscitativemeasures.20TraumacentersLevelIV:criticallyinjuredpatientswhorequirespecialtycarearetransferredtoahigherleveltraumasystemhospitalinaccordancewithpre-establishedcriteria.1、病毒性肝炎：由病毒造成的肝炎按照其病毒系列不同分为甲、乙、丙、丁、戊和庚共六种类型病毒性肝炎。能引起肝脏细胞肿胀，是世界上流传广泛，危害很大的传染病之一。

1908年，才发现病毒也是肝炎的致病因素之一。1947年，将原来的传染性肝炎（infectioushepatitis）称为甲型肝炎（HepatitisA,HA）；血清性肝炎（serumhepatitis）称为乙型肝炎（HepatitisB,HB）。1965年人类首次检测到乙型肝炎的表面抗原。我国经济和科学技术日益发展，学术文化领域百家争鸣，（df高血压958心脏病983u6糖尿病87fr）特别是思想家的革新精神，为中医学理论的创新和突破性进展，提供了有利的文化背景。宋代陈无择著《三因极一病证方论》一书，（45传染病q566丙肝964jo乙肝28jgsx甲肝gh）提出三因学说；并产生了最具盛名四大学派，刘完素倡导火热论；张从正力倡“攻邪论”；李杲提出“内伤脾胃，百病由生”的理论；朱震亨创造性地阐明了相火的演变规律。编辑本段明清时期（df肺25s血液f369血小板t5172红血球gdf55m白血球fd2）是中医学理论综合汇编、深化发展，临床各科辨证体系丰富、提高阶段。如明代楼英的《医学纲目》和王肯堂的《证治准绳》，清代吴谦等编著的《医宗金鉴》和陈梦雷主编的《古今图书集成·医部全录》等。王清任著《医林改错》，注重实证研究，（df高血压958心脏病983u6糖尿病87fr）纠正了古医籍中关于解剖知识的某些错误，肯定了“脑主思维”，发展了瘀血理论。温病学说的形成和发展，标志着中医理论的创新与突破，吴有性著《温疫论》，叶天士著《温热病篇》，吴鞠通著《温病条辨》等，在药物学研究方面，（45传染病q566丙肝964jo乙肝28jgsx甲肝gh）李时珍著的《本草纲目》，总结了16世纪以前我国药物学研究的成就。医的诊察疾病能参考现代医学的微观分析，将辨证与辨病相结合，实现宏观与微观的统一，使中医诊断客观化，即把分析与综合相结合的方法引入中医理、法、方、药的研究，使二者有机结合，互相借鉴、补充，避免各自的片面性、局限性，这将有利于中西医学的优势互补，“和而不同”，多元发展。近年来，中医药在防治非典、禽流感和艾滋病方面发挥的独特作用也证实了二者的有机结合，具有肯定的临床疗效。编辑本段东西方医学交融不管是中医学还是西医学，从二者现有的思维方式的发展趋势来看，均是走向现代系统论思维，中医药学理论与现代科学体系之间具有系统同型性，属于本质相同而描述表达方式不同的两种科学形式。可望在现代系统论思维上实现交融或统一，成为中西医在新的发展水平上实现交融或统一的支撑点，希冀籍此能给中医学以至生命科学带来良好的发展机遇，进而对医学理论带来新的革命。编辑本段现代中医史上个世纪末,本世纪初，1996年,清华学界对中医气本质，经络实质，阴阳，五行，藏象，中医哲学观等都有了新的全面整体创造性的认识和解说。如，邓宇等发现的:气是流动着的‘信息－能量－物质’的混合统一体；分形分维的经络解剖结构；数理阴阳；中医分形集：分形阴阳集－阴阳集的分形分维数，五行分形集－五行集的分维数；分形藏象五系统－暨心系统、肝系统、脾系统、肺系统、肾系统；中医三个哲学观－新提出的第三哲学观：相似观－分形论等。还包括近代针灸经络的发展史,近代中医气的进展简史,中西医结合史,中医中药史等.六种类型的病毒性肝炎遗传因子不同，除乙型肝炎遗传因子是DNA外，其余几型肝炎遗传因子均为RNA。其中甲型肝炎的传播途径是粪口传播，乙型肝炎的传播途径是血液传播、性传播和母婴传播。疫苗。

2、酒精性肝炎：酒精性肝炎早期可无明显症状，但肝脏已有病理改变，发病前往往有短期内大量饮酒史，有明显体重减轻，食欲不振，恶心，呕吐，全身倦怠乏力，发热，腹痛及腹泻，上消化道出血及精神症状。体征有黄疸，肝肿大和压痛，同时有脾肿大，面色发灰，腹水浮肿及蜘蛛痣，食管静脉曲张。从实验室检查看，有贫血和中性白细胞增多，红细胞容积测定（MCV）大于95FL,血清胆红素增高，可达17.1μmoL/L或以上，转氨酶中度升高，常大于2.0，测定线粒体AST（mAST）及其与总AST（tAST）的比值，其升高可达12.5+5.2%。并有γ-GT，谷氨酸脱氢酶和碱性磷酸酶活力增高，凝血酶原时间延长。此外，病毒性肝炎还有丙型肝炎、丁型肝炎、戊型肝炎和庚型肝炎。过去被定为己型肝炎病毒的病毒现在被确定为乙型肝炎病毒的一个属型，因此己型肝炎不存在。在病毒肝炎的疫苗，A型、B型、D型的疫苗已研发成功；C型、E型、F型的目前无编辑本段宋金元时期精品课件文档，欢迎下载，下载后可以复制编辑。更多精品文档，欢迎浏览。22TertiarycareBurncentertreatmentCardiothoracicandvascularsurgeryInpatientcareforAIDSpatientsMagneticresonanceimaging(MRI)NeonatologylevelIIIunitservicesNeurosurgeryOrgantransplant23TertiarycarePediatricsurgeryPositronemissionstomography(PET)RadiationoncologyServicesprovidedtoapersonwithahigh-riskpregnancyServicesprovidedtoapersonwithcancerState-designatedtraumacentersTraumasurgery24Positronemissionstomography(PET)buildsimagesbydetectingenergygivenoffbydecayingradioactiveisotopes.Isotopesareatomsofanelementwiththesamenumberofprotons(positivelychargedparticles)inthenucleus,butadifferentnumberofneutrons(neutralparticles).Becauseradioactiveisotopesareunstable,astheydecay,theythrowoffpositronsthatcollidewithelectronsandproducegammaraysthatshootoffinnearlyoppositedirections.25PETPETsystemsusethepathsofthetwodetectedgammaraystodeterminetheoriginatingcollisionpoint,aprocesscalledelectroniccollimation(瞄準).Thescannersuseacircularseriesofgammaray-detectorstoenvelopethepatientsobothgammascanbedetectedsotheinstrumentcanuseelectroniccollimationtopredictwheretheenergysignaloriginated.Thissignalisthenconvertedintoathree-dimensionalimageslice.26台灣醫院分類診所地區醫院(497/2005)區域醫院(80/2005,65/2006,64/2007)醫學中心(23/2005,18/2006,19/2007,14/2009)27醫學中心在衛生局登記開放的急性一般病床與急性精神病床合計須達五百床以上至少應能提供家庭醫學、內、外、婦產、兒、骨、神經外、泌尿、耳鼻喉、眼、皮膚、神經、精神、復健、麻醉、放射線、病理、核醫、牙等十九科之診療服務。28醫學中心專任主治醫師人數(包括主任在內)每八床應有一名。專任護理人員每2床至少1名。加護病房：每床2.5名。手術室：每班每台2.5名。手術恢復室：每班每床0.5名。產房及待產室：每床2名。嬰兒室：每床0.4名。急診室：觀察室每床0.5名；診療室每12人次1名。門診：每班每診療室0.5名。血液透析室：每4人次1名。行政、教學、研究及其他護理人員(如院內感染控制、公衛、供應中心等護理人員)另計，應佔總人數百分之六。應有受過感染控制訓練之專任護理人員，每300床應設1名。29醫學中心藥事人員每40床至少1名。每60張門診處方至少1名。特殊藥品處方每15張至少1名。藥事人員總數至少四分之三為藥師。藥事人員至少有4名負責藥品管理諮詢及臨床等工作。30區域醫院應設置250床位以上急性病病床數每床所擁有的樓地板面積應在50平方公尺以上每9床至少應擁有一名主治醫師每2.5床至少應擁有一名護理人員等。至少應能提供家庭醫學、內、外、婦產、兒、骨、耳鼻喉、眼、精神、復健、麻醉、放射線、病理、牙等十四科之診療服務。31區域醫院Nurse加護病房：每床2名。手術室：每班每台2名。手術恢復室：每班每床0.5名。產房及待產室：每床1.2名。嬰兒室：每床0.4名。急診室：觀察室每床0.5名；診療室每12人次1名。門診：每班每診療室0.5名。血液透析室：每4人次1名。行政、教學、研究及其他護理人員(如院內感染控制、公衛、供應中心等護理人員)另計，應佔總人數百分之四。應有受過感染控制訓練之專任護理人員，每300床應設1名。32區域醫院藥事人員每50床至少1名。每70張門診處方至少1名。特殊藥品處方每15張至少1名。藥事人員總數至少四分之三為藥師。藥事人員中，至少有2名負責藥品管理諮詢及臨床等工作。33地區醫院在衛生局登記開放的急性一般病床需20床以上，急性一般病床及急性精神病床合計249床（含）以下。34地區醫院專任員工總人數每床應有1名。專任主治醫師人數以及專任護理人員應符合醫療機構設置標準。藥事人員每50床至少1名。每80張門診處方至少1名。每增加100張處方應增加1名。應有藥師1人以上。35評鑑分級設施總樓地板面積病房設施安全設備及一般設備保險病床比率36評鑑分級人員員工總人數醫師總數麻醉科醫師放射線科醫師核醫科醫師病理科醫師復健科醫師精神科醫師護理藥事醫事檢驗醫用放射線技術復健技術精神科社會工作營養師病歷管理37評鑑分級醫療業務及設備醫療業務急性病床數診療科別急診業務手術及麻醉作業產房嬰兒室加護病房藥事作業檢驗作業輸血作業放射線診療作業病理作業復健醫療作業精神科核子醫學牙科特殊醫療服務醫務社會服務工作營養部門病歷部門社區衛生服務員工健康檢查38評鑑分級品質保證醫療品質審查感染控制人體試驗藥事作業品質護理服務品質檢驗作業品質管制輸血作業品質管制病理作業品質管制放射線診療品質管制核子醫學品質管制病歷管理醫院管理業務醫病關係之促進39評鑑分級指定項目評估住院診斷處置用藥手術病歷寫作40評鑑分級教學訓練教學師資教學訓練與研究設備教學訓練活動與其他醫院(醫學院)交流合作情形研究情形及論文發表教學進修研究經費41新制教學醫院評鑑基準教學資源教學訓練計畫與成果研究執行與成果臨床師資培育及繼續教育學術交流與社區功能及角色管理行政42財團法人醫院評鑑暨醫療品質策進會.tw/Identify.asp?catid=2343HealthCareFacilityOwnershipGovernment(not-for-profit)25%Proprietary(for-profit)15%Voluntary(not-for-profit)60%44MedicalStaffIntern:aphysicianinthefirstyearofgraduatemedicaleducation,whichordinarilyimmediatelyfollowscompletionofthefour-yearmedicalcurriculum.Resident:aphysicianwhohascompletedaninternshipandisengagedinaprogramoftrainingdesignedtoincreasehisorherknowledgeoftheclinicaldisciplinesofmedicine,surgery,oranyoftheotherspecialfieldsthatprovideadvancedtraininginpreparationforthepracticeofaspecialty.45MedicalStaffChiefresident:aphysicianwhoisinhisfinalyearofresidencyorintheyearaftertheresidencyhasbeencompleted.VisitingStaff(VS):主治醫師46HealthCareFacilityOrganizationalStructureGoverningboardAdministrationMedicalstaffDepartments,services,andcommitteesContractedservices47GoverningboardThegoverningboard(boardoftrustees,boardofgovernors,boardofdirectors)serveswithoutpay,anditsmembershipisrepresentedbyprofessionalsfromthebusinesscommunity.48AdministrationServesasliaisonbetweenthemedicalstaffandgoverningboardandisresponsiblefordevelopingastrategicplanforsupportingthemissionandgoalsoftheorganization.CEO:chiefexecutiveofficeCFO:chieffinancialofficerCIO:chiefinformationofficerCOO:chiefoperatingofficer49MedicalstaffConsistsoflicensedphysiciansandotherlicensedprovidersaspermittedbylaw(e.g.,nursepractitionersandphysicianassistants)whoaregrantedclinicalprivileges.50physicianassistantsExamine,diagnose,andtreatpatientsunderthedirectsupervisionofaphysician.51MedicalstaffmembershipcategoriesActive:deliversmosthospitalmedicalservices,performssignificantorganizationalandadministrativemedicalstaffdutiesAssociate:advancementtoactivecategoryisbeingconsideredConsultingCourtesy:admitsanoccasionalpatienttothehospitalHonorary5253Hospitaldepartments,Services,andCommittees54HealthInformationDepartmentDepartmentadministrationCancerregistryCodingandabstractingImageprocessingIncompleterecordprocessingMedicaltranscriptionRecordcirculationReleaseofinformationprocessing5556CodingInvolvesassigningnumericandalphanumericcodestodiagnoses,procedures,andservices;thisfunctionisusuallyperformedbycredentialedindividuals.CodersassignICD-9-CMcodestoinpatientcasesandCurrentProceduralTerminology(CPT),HealthCareProcedureCodingSystem(HCPCS)LevelII(National),andICD-9-CMcodestooutpatient,emergencydepartment,andphysicianofficecases.57CancerregistryPerformedbyindividualswhoarecredentialedascertifiedtumorregistrarsandincludeusingcomputerizedregistrysoftwaretoconductlifetimefollow-uponeachcancerpatient,electronicallytransmitdatatostateandnationalagenciesforuseatlocal,regional,state,andnationallevels,andgeneratereportsandinformationforrequestingentities.58CurrentProceduralTerminology(CPT)PublishedannuallybytheAmericanMedicalAssociationandcodesare5-digitnumbersassignedtoambulatoryproceduresandservices.E.g.90663Influenzavirusvaccine,pandemicformulation59ICD-9-CMTheInternationalClassificationofDiseases,Ninthrevision,ClinicalModificationisusedintheUnitedStatestocollectinformationaboutdiseasesandinjuriesandtoclassifydiagnosesandprocedures.NationalCenterforHealthStatistics(NCHS).60/1.INFECTIOUSANDPARASITICDISEASES(001-139)TUBERCULOSIS(010-018)Includes:infectionbyMycobacterium分枝桿菌tuberculosis(human)(bovine牛)Excludes:congenitaltuberculosis(771.2)lateeffectsoftuberculosis(137.0-137.4)Thefollowingfifth-digitsubclassificationisforusewithcategories010-018:0unspecified1bacteriologicalorhistological組織學的examinationnotdone2bacteriologicalorhistologicalexaminationunknown(atpresent)3tuberclebacilli結核桿菌found(insputum)bymicroscopy4tuberclebacillinotfound(insputum)bymicroscopy,butfoundbybacterialculture5tuberclebacillinotfoundbybacteriologicalexamination,buttuberculosisconfirmedhistologically6tuberclebacillinotfoundbybacteriologicalorhistologicalexamination,buttuberculosisconfirmedbyothermethods[inoculation預防接種ofanimals]61/010PrimarytuberculousinfectionRequiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.011PulmonarytuberculosisRequiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.Useadditionalcodetoidentifyanyassociatedsilicosis矽肺病(502)012OtherrespiratorytuberculosisRequiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.Excludes:respiratorytuberculosis,unspecified(011.9)013Tuberculosisofmeninges

腦脊膜andcentralnervoussystemRequiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.62/014Tuberculosisofintestines

腸,peritoneum

腹膜,andmesentericglands

腸系膜腺Requiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.015TuberculosisofbonesandjointsRequiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.Useadditionalcodetoidentifymanifestation,as:tuberculous:Arthropathy關節病(711.4)Necrosis壞死ofbone(730.8)Osteitis骨炎(730.8)Osteomyelitis骨髓炎(730.8)Synovitis滑膜炎(727.01)Tenosynovitis腱鞘炎(727.01)63/016Tuberculosisofgenitourinary

泌尿生殖器的systemRequiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.017TuberculosisofotherorgansRequiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.018Miliary

粟粒狀的tuberculosis

Includes:tuberculosis:Disseminated彌散性Generalized全身性的miliary,whetherofasinglespecifiedsite,multiplesites,orunspecifiedsitePolyserositis漿膜炎ICD-10TheInternationalStatisticalClassificationofDiseasesandRelatedHealthProblems10thRevisionisacodingofdiseasesandsigns,symptoms,abnormalfindings,complaints,socialcircumstancesandexternalcausesofinjuryordiseases,asclassifiedbytheWHO.Thecodesetallowsmorethan14,400differentcodesandpermitsthetrackingofmanynewdiagnoses.Usingoptionalsubclassifications,thecodescanbeexpandedtoover16,000codes.64USICD-10CMTheInternationalversionofICDshouldnotbeconfusedwithnationalClinicalModificationsofICDthatincludefrequentlymuchmoredetail,andsometimeshaveseparatesectionsforprocedures,sothenewUSICD-10CMhassome155,000codes.6566HCPCSTheHealthCareProcedureCodingSystemiscomprisedofLevelI(CPT)andLevelII(National)codes.LevelIIHCPCScodesaredevelopedbytheCentersforMedicare&MedicaidServices(CMS)andusedtoclassifyreportproceduresandservices.67CPT(CurrentProceduralTerminology)anumericcodingsystemmaintainedbytheAmericanMedicalAssociation(AMA).TheCPTisauniformcodingsystemconsistingofdescriptivetermsandidentifyingcodesthatareusedprimarilytoidentifymedicalservicesandproceduresfurnishedbyphysiciansandotherhealthcareprofessionals.68LevelIoftheHCPCS,theCPTcodes,doesnotincludecodesneededtoseparatelyreportmedicalitemsorservicesthatareregularlybilledbysuppliersotherthanphysicians.69LevelIIHCPCSCodesarereportedtothird-partypayers(e.g.,insurancecompanies)forreimbursementpurposes.70LevelIIHCPCSLevelIIoftheHCPCSisastandardizedcodingsystemthatisusedprimarilytoidentifyproducts,supplies,andservicesnotincludedintheCPTcodes,suchasambulanceservicesanddurablemedicalequipment,prosthetics假體,orthotics矯形器,andsupplies(DMEPOS)whenusedoutsideaphysician'soffice71LevelIIHCPCSLevelIIalphanumericHCPCSprocedureandmodifiercodes,theirlongandshortdescriptions,andapplicableMedicareadministrative,coverage,andpricingdata.TheLevelIIHCPCScodes,whichareestablishedbyCMS'sAlpha-NumericEditorialPanel,primarilyrepresentitemsandsuppliesandnon-physicianservicesnotcoveredbytheAmericanMedicalAssociation'sCurrentProceduralTerminology-4(CPT-4)codes;Medicare,Medicaid,andprivatehealthinsurersuseHCPCSprocedureandmodifiercodesforclaimsprocessing.72/MedHCPCSGenInfo/A1001007DRESSINGFORONEWOUNDDressingforonewoundC2002070120020701N

A2001007DRESSINGFORTWOWOUNDSDressingfortwowoundsC02002070120020701NA3001007DRESSINGFORTHREEWOUNDSDressingforthreewoundsC02002070120020701N73AbstractingPerformedtoentercodesandotherpertinentinformationutilizingcomputersoftware.Togeneratestatisticalreportsanddisease/procedureindexes,whichareusedforadministrativedecision-makingandquality-managementpurposes.74IncompleterecordprocessingIncludestheassemblyandanalysisofdischargedpatientrecords.Afterapatientisdischargedfromanursingunit,therecordisretrievedandreportsareassembledaccordingtoahospital-andmedicalstaff-approvedorderofassembly.75MedicaltranscriptionInvolvestheaccurateandtimelytranscriptionofdictatedreports.76RecordcirculationIncludestheretrievalofpatientrecords,forthepurposeof:InpatientreadmissionScheduledandunscheduledoutpatientclinicvisitsAuthorizedquality-managementstudiesEducationandresearch77Licensure,RegulationandAccreditationCodeofFederalRegulations(CFR)FederalRegisterAlegalnewspaperpublishedeverybusinessdaybytheNationalArchivesandRecordsAdministration(NARA)inpaperform,microfiche,andonline.AccreditationStandardsandSurveys78RegulationAregulationisaninterpretationofalawthatiswrittenbytheresponsibleregulatoryagency.E.g.theConditionsofParticipation(CoP)areregulationswrittenbytheCentersforMedicare&MedicaidServices(CMS).Congresswritesandpassesanact,thePresidentsignstheactintolaw,andCMSinterpretsthelawcreatingaregulation.79AccreditationAvoluntaryprocessthatahealthcarefacilityororganizationundergoestodemonstratethatithasmetstandardsbeyondthoserequiredbylaw.80StandardsAccreditationorganizationsdevelopstandards,whicharemeasurementsofahealthcareorganization’slevelofperformanceinspecificareasandareusuallymorerigorousthanregulations.81SurveyAsurvey(evaluation)processisconductedbothoff-siteandon-sitetodeterminewhetherthefacilitycomplieswithstandards.82AccreditingOrganizationsAccreditationAssociationforAmbulatoryHealthCare(AAAHC)CommissiononAccreditationofRehabilitationFacilities(CARF)CommunityHealthAccreditationProgram(CHAP)83AccreditingOrganizationsJointCommissiononAccreditationofHealthCareOrganizations(JCAHO)NationalCommitteeforQualityAssurance(NCQA)NationalCommissiononCorrectionalHealthCare(NCCHC)84Bringinganewdrugtomarket5000compoundsevaluated5compoundsenterclinicaltrials1compoundapproved2345678910111213141516yearsDiscoveryandpreclinicaltesting:Compoundsareidentifiedandevaluatedinlaboratoryandanimalstudiesforsafety,biologicalactivity,andformulation.ReviewandapprovalbyFood&DrugAdministrationPhaseIII:Confirmseffectivenessandmon