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Plastic and Reconstructive Surgery.... Jul 2024Simply working hard is not enough to maintain a profitable clinical practice. Prompt and complete payment for services is just as critical. Revenue cycle management...
Simply working hard is not enough to maintain a profitable clinical practice. Prompt and complete payment for services is just as critical. Revenue cycle management (RCM) tracks the payment process from patient scheduling through treatment, coding, billing, and reimbursement. Even though reimbursement rates for service codes are preset, and the service is documented, this apparently straightforward process is complicated by insurance payors, negotiated contracts, coding requirements, compliance regulators, and an ever-changing reimbursement environment. Not typically trained in RCM, physicians struggle with its demands of timeliness, accuracy, paperwork, and the constant scrutiny for underpayment or unfulfilled reimbursements. Consequently, they often relent to the pressures and simply accept the decreased reimbursements as "cost of doing business" or else relegate RCM to others on the team. In either case, they leave significant amounts of money on the table. Using published work in health care and other allied sectors, we present a systematic method to understand and improve RCM processes. It also creates a strong partnership between clinicians and their administrative counterparts. Optimizing RCM improves patient experience, reduces the time between submission of claims and payment, eliminates fraud at both the coding and patient levels, and increases cash flow, all of which create a financially stable clinical practice.
PubMed: 38957721
DOI: 10.1097/GOX.0000000000005756 -
Plastic and Reconstructive Surgery.... Jul 2024Integration of artificial intelligence (AI), specifically with natural language processing and machine learning, holds tremendous potential to enhance both clinical...
Integration of artificial intelligence (AI), specifically with natural language processing and machine learning, holds tremendous potential to enhance both clinical practices and administrative workflows within plastic surgery. AI has been applied to various aspects of patient care in plastic surgery, including postoperative free flap monitoring, evaluating preoperative risk assessments, and analyzing clinical documentation. Previous studies have demonstrated the ability to interpret current procedural terminology codes from clinical documentation using natural language processing. Various automated medical billing companies have used AI to improve the revenue management cycle at hospitals nationwide. Additionally, AI has been piloted by insurance companies to streamline the prior authorization process. AI implementation holds potential to enhance billing practices and maximize healthcare revenue for practicing physicians.
PubMed: 38957712
DOI: 10.1097/GOX.0000000000005939 -
International Journal of Chronic... 2024Chronic obstructive pulmonary disease (COPD) stands as a predominant cause of global morbidity and mortality. This study aims to elucidate the relationship between...
BACKGROUND
Chronic obstructive pulmonary disease (COPD) stands as a predominant cause of global morbidity and mortality. This study aims to elucidate the relationship between pyroptosis-related genes (PRGs) and COPD diagnosis in the context of immune infiltration, ultimately proposing a PRG-based diagnostic model for predicting COPD outcomes.
METHODS
Clinical data and PRGs of COPD patients were sourced from the GEO database. The "ConsensusClusterPlus" package was employed to generate molecular subtypes derived from PRGs that were identified through differential expression analysis and LASSO Cox analysis. A diagnostic signature including eight genes (CASP4, CASP5, ELANE, GPX4, NLRP1, GSDME, NOD1and IL18) was also constructed. Immune cell infiltration calculated by the ESTIMATE score, Stroma scores and Immune scores were also compared on the basis of pyroptosis-related molecular subtypes and the risk signature. We finally used qRT - PCR to detect the expression levels of eight genes in COPD patient and normal.
RESULTS
The diagnostic model, anchored on eight PRGs, underwent validation with an independent experimental cohort. The area under the receiver operating characteristic (ROC) curves (AUC) for the diagnostic model showcased values of 0.809, 0.765, and 0.956 for the GSE76925, GSE8545, and GSE5058 datasets, respectively. Distinct expression patterns and clinical attributes of PRGs were observed between the comparative groups, with functional analysis underscoring a disparity in immune-related functions between them.
CONCLUSION
In this study, we developed a potential as diagnostic biomarkers for COPD and have a significant role in modulating the immune response. Such insights pave the way for novel diagnostic and therapeutic strategies for COPD.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Pyroptosis; Databases, Genetic; Predictive Value of Tests; Gene Expression Profiling; Lung; Male; Female; Middle Aged; Genetic Markers; Case-Control Studies; Transcriptome; Aged; Reproducibility of Results; Genetic Predisposition to Disease; Prognosis
PubMed: 38957709
DOI: 10.2147/COPD.S438686 -
Resuscitation Plus Sep 2024An 18-year-old drowning victim was successfully resuscitated using prehospital veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Despite 24 min of submersion...
An 18-year-old drowning victim was successfully resuscitated using prehospital veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Despite 24 min of submersion in water with a surface temperature of 15 °C, the patient was cannulated on-scene and transported to a trauma center. After ICU admission on VA-ECMO, he was decannulated and extubated by day 5. He was transferred to a peripheral hospital on day 6 and discharged home after 3.5 weeks with favorable neurological outcome of a Cerebral Performance Categories (CPC) score of 1 out of 5. This case underscores the potential of prehospital ECMO in drowning cases within a well-equipped emergency response system.
PubMed: 38957704
DOI: 10.1016/j.resplu.2024.100685 -
Ghana Medical Journal Sep 2023To determine the clinical presentation, imaging features and outcomes of children with adenoid hypertrophy in our setting.
OBJECTIVES
To determine the clinical presentation, imaging features and outcomes of children with adenoid hypertrophy in our setting.
DESIGN
A retrospective study.
SETTING
The paediatric clinic of a private hospital in Enugu.
PARTICIPANTS
51 children, aged 2 to 108 months, with suggestive clinical features and radiographic report of adenoid hypertrophy who presented over 3 years.
INTERVENTIONS
Clinical information was obtained from the patient's medical records. Data was analysed for the clinical characteristics of the patients, the relationship between the degree of airway narrowing on a postnasal space (PNS) radiograph and treatment outcomes.
MAIN OUTCOME MEASURES
Degree of airway narrowing as measured on a PNS radiograph, the type of and outcomes of treatment.
RESULTS
There was an almost equal male (54.7%): female (45.1%) ratio in the occurrence of adenoid hypertrophy, with a mean age of occurrence of 31.50 ± 3.64 months. Noisy breathing was the commonest symptom (94.1%); history of atopic rhinitis in 64.7% of cases and hyperactive airway disease in 45.1% more than 50% of cases with airway narrowing resolved with medical management only.
CONCLUSION
Adenoid hypertrophy should be considered in evaluating the upper airway in children under five. Paediatricians should be conversant with diagnosing and managing this common cause of upper airway obstruction.
FUNDING
None declared.
Topics: Humans; Adenoids; Male; Female; Nigeria; Retrospective Studies; Hypertrophy; Child, Preschool; Child; Infant; Treatment Outcome; Radiography; Adenoidectomy; Ambulatory Care Facilities; Airway Obstruction
PubMed: 38957679
DOI: 10.4314/gmj.v57i3.7 -
Ghana Medical Journal Sep 2023The study objective was to evaluate the prescription pattern and use of anti-seizure medications (ASMs) in patients with a seizure disorder and to evaluate if a change...
OBJECTIVE
The study objective was to evaluate the prescription pattern and use of anti-seizure medications (ASMs) in patients with a seizure disorder and to evaluate if a change in the ASM dose had a beneficial effect on seizure control, observed through Therapeutic Drug Monitoring [TDM] level of ASMs.
METHODS
Details of anti-seizure medications with their therapeutic levels in the blood of patients with seizure disorder were analysed.
DESIGN
Hospital-based retrospective analysis of patient case records.
SETTINGS
Therapeutic Drug Monitoring OPD of a tertiary care public teaching hospital.
PARTICIPANTS
Case records of 918 patients with seizure disorder from 2016-2021.
RESULTS
Data of men (53%) and women (47%) aged between 18-75 years was assessed About 62% (566/918) of patients were on levetiracetam, the most frequently prescribed anti-seizure medication. Whenever the ASMs dose was increased or decreased based on TDM levels, it was associated with a significant increase in the frequency of break-through seizures [OR- 5 (95% CI: 1.28-19.46)]. However, significant seizure control was observed when the patients were on the same maintenance dose of the anti-seizure medication [OR- 0.2 (95% CI: 0.06-0.63)]. Whenever an additional new anti-epileptic drug was prescribed or removed from the pre-existing anti-epileptic medications, it did not significantly impact seizure control.
CONCLUSION
Individualising drug therapy and therapeutic drug monitoring for each patient, along with patient factors such as medication compliance, concomitant drug and disease history, and pharmacogenetic assessment, should be the ideal practice in patients with seizures for better seizure control.
FUNDING
None declared.
Topics: Humans; Anticonvulsants; Male; Female; Middle Aged; Adult; Retrospective Studies; Aged; Adolescent; Drug Monitoring; Young Adult; Levetiracetam; Seizures; Tertiary Care Centers; Practice Patterns, Physicians'; Hospitals, Public; Epilepsy
PubMed: 38957674
DOI: 10.4314/gmj.v57i3.5 -
Ghana Medical Journal Sep 2023The study sought to determine clinical characteristics and histologic subtypes of a cohort of lung cancer patients in a tertiary facility.
OBJECTIVE
The study sought to determine clinical characteristics and histologic subtypes of a cohort of lung cancer patients in a tertiary facility.
DESIGN
Retrospective review of the medical records of histology-confirmed lung cancer cases at the respiratory clinic over a 3-year period.
SETTING
Respiratory Clinic, Korle-Bu Teaching Hospital, Accra, Ghana.
PARTICIPANTS
All adult patients with histologically diagnosed lung cancer were enrolled.
MAIN OUTCOME MEASURES
Lung cancer histological types.
RESULTS
The proportion of lung cancer cases was 12.4%. The majority were women (57.8%) and the mean age at diagnosis was 55.8±16.0 years. The patients were predominantly non-smokers (61%). Common symptoms were chronic cough and chest pain. More than two-thirds of the cases presented in clinical stages III and IV with the predominant histological subtype being adenocarcinoma in smokers and non-smokers. Genetic testing for epidermal growth factor receptor (EGFR) and Anaplastic Lymphoma kinase (ALK) mutations were largely absent.
CONCLUSIONS
The majority of lung cancer patients presented late with advanced disease. Adenocarcinoma was the predominant histological subtype in a predominantly non-smoking population, with an increased prevalence among women less than 60 years. This should encourage testing for genetic mutations to improve patient survival.
FUNDING
None declared.
Topics: Humans; Lung Neoplasms; Female; Middle Aged; Male; Retrospective Studies; Tertiary Care Centers; Aged; Adult; Ghana; Smoking; Adenocarcinoma; Neoplasm Staging; Cough; ErbB Receptors; Aged, 80 and over; Chest Pain
PubMed: 38957673
DOI: 10.4314/gmj.v57i3.2 -
Ghana Medical Journal Sep 2023To explore the prevalence of prostate cancer screening among Ghanaian men and interrogate why some individuals screen for the disease and others do not.
OBJECTIVE
To explore the prevalence of prostate cancer screening among Ghanaian men and interrogate why some individuals screen for the disease and others do not.
DESIGN
A cross-sectional questionnaire survey based on the Health Belief Model was used to collect data from 356 men aged 40 years and above. Data were collected between February and March 2021.
SETTING
The study was conducted in the Accra metropolitan area of the Greater Accra region of Ghana.
PARTICIPANTS
Convenience sampling was used to recruit participants for the study.
RESULTS
Although 86% of the respondents had heard about prostate cancer, only 23% had ever screened for it. Logistic regression analysis suggested that knowledge of the disease (OR = 1.19, CI 95% = 1.03 -1.38) and barriers to screening (OR = .87, CI 95% = .83 -.91) were statistically significant predictors of screening behaviour.
CONCLUSION
HBM has limited predictive power as far as our study is concerned. We suggest increasing public education on prostate cancer and its screening methods. The cost of screening should also be made more affordable so as not to become a barrier.
FUNDING
None declared.
Topics: Humans; Male; Prostatic Neoplasms; Ghana; Middle Aged; Cross-Sectional Studies; Early Detection of Cancer; Adult; Health Belief Model; Health Knowledge, Attitudes, Practice; Surveys and Questionnaires; Aged; Mass Screening; Logistic Models; Patient Acceptance of Health Care
PubMed: 38957671
DOI: 10.4314/gmj.v57i3.10 -
Ghana Medical Journal Sep 2023
Topics: Humans; COVID-19 Vaccines; COVID-19; Health Knowledge, Attitudes, Practice; Female; Male; Adult; Vaccination Hesitancy; SARS-CoV-2; Middle Aged; Patient Acceptance of Health Care; Public Opinion
PubMed: 38957669
DOI: 10.4314/gmj.v57i3.14 -
Transplant International : Official... 2024Current scientific literature is deficient in detailing the optimal timing for conducting bariatric surgery in relation to kidney transplantation. In this study, we...
Current scientific literature is deficient in detailing the optimal timing for conducting bariatric surgery in relation to kidney transplantation. In this study, we performed a retrospective evaluation of kidney transplant recipients with BMI >35 kg/m. It aimed to provide data on those who received both sleeve gastrectomy (SG) and kidney transplantation (KT) simultaneously, as well as on patients who underwent SG and KT at different times, either before or after. In addition, the acceptance levels of the bariatric surgery among different scenarios were assessed. Our findings demonstrated that combined KT and SG led to successful weight loss, in contrast to undergoing kidney transplant alone, while maintaining comparable rates of graft and patient survival. Weight loss was similar between recipients who had a combined operation and those who underwent SG following the transplant. Additionally, over a median time frame of 1.7 years, patients who underwent SG before KT exhibited a statistically significant reduction in BMI at the time of the transplant. Notably, our study highlights that patients offered the combined procedure were significantly more likely to undergo SG compared to those for whom SG was presented at a different operative time than the transplant.
Topics: Humans; Kidney Transplantation; Gastrectomy; Retrospective Studies; Female; Male; Middle Aged; Adult; Body Mass Index; Weight Loss; Bariatric Surgery; Time Factors; Graft Survival; Obesity, Morbid; Treatment Outcome; Operative Time
PubMed: 38957660
DOI: 10.3389/ti.2024.12690