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By: I. Kulak, M.B. B.A.O., M.B.B.Ch., Ph.D.
Program Director, Texas Tech University Health Sciences Center School of Medicine
When warming a mirror muscle relaxant recreational buy cheap methocarbamol 500mg online, the physician should always test the back side of the mirror for proper warmth against his wrist or face so that the patient will not fear being burned muscle relaxant vitamin methocarbamol 500mg without a prescription. The nasopharyngeal mirror may be slipped into the nasopharynx alongside of the uvula and may even touch the tip muscle relaxant chlorzoxazone side effects cheap methocarbamol 500 mg amex, but touching the base of the tongue should be avoided muscle relaxant esophageal spasm methocarbamol 500 mg for sale. When holding the tongue for the laryngeal examination, the under surface should be wrapped with cotton gauze to protect it from the sharp edges of the teeth. If the patient sits up straight and brings his head and chin forward, the larynx is more fully visible. Often the vocal cords can be seen without touching the soft palate, but if necessary, contact should be positive and firm, with little or no movement after contact is made. If a patient is unable to breathe through his mouth when requested, it may be necessary to have him hold his nose closed. These examinations should last only 10 to 15 seconds because of salivation, anxiety, and discomfort. For patients with hyperactive gag reflexes, mild mucosal anesthetics such as Chloraseptic or Benadryl Elixir can be tried first. Since apnea, caine reactions, or cardiac arrest are always a definite danger with these drugs, resuscitative equipment should be at hand. Since the advent of antibiotics, thrush, formerly seen chiefly in children, is now being seen in adults when the normal flora is altered. The usually white mucosal lesions are scraped for microscopic diagnosis of the characteristic yeast cells. It is swished around in the mouth for a full five minutes daily, for seven or more days. Fever blisters and cold sores caused by the herpes simplex virus begin with a vesicle that, unlike the aphthous ulcer, usually involves the gingiva; the vesicle breaks and forms an irregular ulcer. These lesions are most common after a febrile illness, trauma, actinic exposure, or stress. Treatment is symptomatic with nonirritating mouthwashes and oral irrigations; mild anesthetic ointments and solutions may be helpful. Recurrent canker sores are found most often as multiple, well-delineated shallow ulcers on the buccal and labial mucosa, tongue, soft palate (including tonsillar pillars), and pharynx; occasionally, there is only a single lesion. These yellow-gray, membrane-covered ulcers heal spontaneously in one to two weeks. Longer relief can often be obtained by cleaning the lesion off and applying Kenalog in Orabase, while it is still dry this may be repeated three or four times daily. Aphthous stomatitis should be differentiated from the herpetic gingival stomatitis by lack of bleb or vesicle formation or associated systemic disease, before cortisone treatment is started. Treatment usually provides only temporary relief, but 50 percent potassium iodide, 10 gtt. It is sometimes difficult to determine if a pathogen is responsible for an infection in the nose or throat, or which pathogen is responsible. Many organisms such as Streptococcus veridans Neisseria, anaerobic streptococci, Staphylococcus albus, or yeast are always present and termed normal flora. Although a culture, which takes 24 to 48 hours to grow, may be helpful in treatment and should be obtained, it should be remembered that staphylococci can be obtained from 60 to 80 percent of the population, and beta-streptococci are often isolated from patients with a viral infection. Furthermore, pathogens may become established in the host and remain for months without causing disease. In treatment, the physician must make an intelligent "guess" about the etiology of the infection, using the most important clinical picture, a smear from the infected area for pus cells and predominant organisms, and then correlate this information with the bacteriological findings. Acute bacterial tonsillitis or pharyngitis is most often caused by betahemolytic streptococci, Group A. The mucosa is grossly inflamed, with white or yellow exudate on the lymphoid follicles. If the exudative tonsillar tissue becomes necrotic, it is termed necrotizing tonsillitis. The antibiotic treatment of choice is penicillin, most often given orally, 250 mgm, q. Hot throat irrigations hourly or at least four times daily, coupled with analgesics, such as Empirin Compound #3, Ascodeen - 30, or Tylenol #3, are necessary for both comfort and a more rapid recovery. Infection of the lingual tonsils at the base of the tongue, often not properly diagnosed without the aid of the laryngeal mirror, may cause considerable dysphagia. Occasionally, a physician may see a patient who appears toxic and febrile, with pressure or pain in the ears, a severe headache, or retrobulbar pain.
The study of Oh[15] that the reason for making the agency claim is due to the time loss and complicated administrative procedures experienced when making the exclusive claim spasms right side abdomen buy 500mg methocarbamol with visa. Moreover spasms right upper abdomen generic methocarbamol 500mg on line, it is also needed to provide special expertise to dental hygienists because there are many views that dental hygienists are the most suitable people for the professional management of health insurance claim work and self-examination work in dental care institutions[16] bladder spasms 4 year old buy discount methocarbamol 500 mg. This is the same result as the study of Yoo[4] that insurance claims were not made properly due to lack of time muscle relaxant for dogs order methocarbamol 500 mg on line, workforce and lack of knowledge of health insurance in dental institutions. In the study of Park [17], it was described that dental clinics emphasized the need for systematic education of not only the claimants but also employees with explaining the difficulties of claim Discussion As hospital management deteriorated recently, the number of hospitals which rely on health insurance claims rather than non-payment medical treatment or surgery increased [9]. As the coverage of insurance benefits gradually increases by expanding the insurance coverage of tooth sealant, which was previously a nonpayment treatment item, and applying the dentures, one-time tooth scaling a year, and dental implants of the elderly as insurance benefits, health insurance treatment is recognized as a factor that can enhance the competitiveness of dental management [10]. As a dental health insurance claim work is not just a job, but establishes a credible trust with patients and provides medical services, and further affects hospital management performance, need for intensive insurance claim education is required [17]. Thus, as dental hygienists are in a position to calculate accurately the medical expenses, the role of dental hygienists is emphasized to prevent any possible revenue cuts, and with awareness of the insurance fee system of dental hygienist, to claim promptly the medical services provided to patients by the hospital without errors and omissions [18]. Therefore, as suggested in the study of Ahn[19], it is necessary to consider being able to exert their abilities after employment in the hospital by selecting professional dental hygienists for dental insurance claims with introducing the dental health insurance claim professional qualification system as a national qualification system. The introduction of the qualification system can reduce the burden on insurance claims by dental institutions, and it is considered that the dental hygienists can exert their abilities to enter into the Health Insurance Review and Assessment Service later after building their clinical career as professional dental hygienists for dental insurance claims. The investigation of the degree of the request of the education about the claim for the medical expenses in the dentistry health insurance-mainly in the Daejeon, Chungcheong area. A study on the state of the claim of dental medical institutions for payment from the national health insurance corporation. Factors influencing the knowledge of health insurance standard and health insurance application. Analysis research about awareness of demanders of recuperation allowance for dental clinic health insurance in Daejun and Chunchung area. A study on recognition degree about the standard of health care insurance recuperation payment of dental sanitarian and the standard of dental treatment cost fee. Preference of dental insurance-related and dental health insurance professional qualifications. Conclusion the introduction of a qualification system for the dental health insurance claim professional can reduce the burden on insurance claims by dental institutions. Furthermore, it is considered that the efficiency of claim work will be inclined if professional dental hygienists are actively made to work in the field of dental insurance claims. Therefore, a foundation for cultivating claim professionals should be established, and it is believed that, for this purpose, it is necessary to introduce a private-centered claim professional qualification system as a national qualification system. A study on the survey by dental hygienists for payment under dental health insurance: the case of periodontal treatment. Original Article: Analysis of the knowledge and insurance screening review rates of health insurance claims in the dental hygienist. Measurement and Analysis of Exposure Dose According to Radiological Survey Films of Dental Hygiene Students in Oral Imaging Practice Kam Ji Young1, Yamaguchi Tokutaro2, Lim kun Ok3 1Professor, Medico-legal Update, January-March 2020, Vol. Method: We divided inside and outside of 8 exposure dosimeters into shielded ones and unshielded ones, performed irradiation 1,000 times, 2,000 times and 3,000 times respectively and compared and analyzed depth dose, shallow dose and accumulation dose. Findings: the accumulation dose of shielded ones examined 1,000 times, 2,000 times and 3,000 times was 0. All of the examinations were safe results regardless of frequency, and when they were unshielded, it was 1. Improvement: We intend to provide a basic resource that in the undergraduate course of the department of dental hygiene, learning radiologic examination technique through actual mutual practice rather than pandom practice in the irradiation practice is more effective and safer. Keywords: Department of dental hygiene, dental hygienist, oral imaging, examination practice, exposure dose, shield. Introduction According to Article 2, Clause 1, Section 6 of Enforcement Decree of the Act on Medical Articles, etc. Kim[3] claimed that dental hygienists play a main role at dental clinics as staff of radiography, and as the level of their knowledge and attitude is higher, the level of radiography defense behavior is higher.
Advocates for radioiodine treatment consider the following conditions: · Residual thyroid cancer is present or likely to be present in the remnant thyroid tissue after surgery muscle relaxant usa purchase 500mg methocarbamol otc. This is based on the incidence of multicentricity or multifocality of thyroid cancers which is generally quite high and there is always a possibility of a focus 110 · · · · of cancer being present in the remnant thyroid after surgery muscle relaxant drugs medication buy generic methocarbamol 500mg line. If there is pathological evidence of extra-thyroidal extension or capsular penetration of primary cancer then it would be prudent to consider the remnant to have residual thyroid cancer muscle relaxant rub methocarbamol 500 mg on line. Inadequate surgery has been performed spasms right side of back generic methocarbamol 500mg visa, and the surgeon informs that thyroid tissue has been deliberately left behind. The residual thyroid cancer or normal tissue concentrates radioiodine the treatment with radioiodine will deliver an effective radiation dose to the cancer or thyroid tissue without risk of major complications. In the presence of normal residual thyroid tissue, the detection of distant metastases is difficult and often missed. Uncertainty often arises in the interpretation of post-operative thyroid scans done with diagnostic doses of 131I, 4-6 weeks after thyroid surgery, especially when the uptake is in or near the thyroid bed. In the midline, the uptake is due to residual pyramidal lobe and/or thyroid cells in the distal thyroglossal duct and that immediately above the upper poles is due to residual tissue of the extension of the upper pole. However, if there is evidence of extracapsular or extra-thyroidal extension and there is uptake in that portion of the thyroid bed, then it can be presumed that this could have residual thyroid cancer and should be treated for the same. The presence of residual thyroid cancer is more obvious when there is an incomplete surgery for removal of the primary cancer in biopsy proven inoperable cancers and in recurrent invasive cancer in thyroid bed. It is because no randomized control trial is yet published in this field and there are many difficulties to realize this goal also in near future [11. The proponents for the use of 131I have shown evidence to suggest that 131I destroys residual tissue and microscopic thyroid cancer which is difficult to detect clinically. Secondly, its use greatly simplifies the follow-up evaluation for secondaries especially using serum thyroglobulin as a tumour marker. Papillary carcinoma of the thyroid tends to be bilateral, microscopically multicentric, metastasises to regional lymph nodes and has a higher incidence of persistent or recurrent disease. Both papillary and follicular cancers have a tendency to be invasive and locally infiltrate and this leads to a high probability for recurrence. In a retrospective analysis of 1599 patients with differentiated thyroid cancer, it was observed that 131I therapy was the single most important prognostic indicator by Cox proportional hazards regression model for prolonging "disease free survival" [11. The incidence of recurrence was reduced by 50% in the low risk given 131I for ablation of residual tissue. Similarly survival at 20 years was 90% in patients treated with 131I or external irradiation while it was 40% when only surgery was performed. Strong support for use of extensive initial surgery and post-operative 131I in papillary carcinoma with a tumour size more than 1 cm, showed a decreased risk of recurrence and death. Another supportive study showed that, patients given 131I to ablate normal residual thyroid tissue in low, intermediate and high risk groups, the incidence of recurrences was lesser in treated group as compared to those with only post-operative thyroid hormone therapy [11. It was estimated that even the modest increase in the life expectancy shown was comparable to the absolute gain obtained by accepted medical interventions like screening mammography and lowering cholesterol levels in the blood. In a 25 year prospective study, no patient died of cancer when complete 131I tumour ablation was achieved, whereas 70% died with incomplete ablation. Nevertheless, there are reservations expressed by some physicians who have shown no benefit arising from treatment with 131I of low risk group patients [11. However, one should take local recurrence as a warning for adverse outcome which may precede or accompany distant metastases. A report in an International symposium in which 160 surgeons, endocrinologists, pathologists and nuclear medicine physicians participated, suggested a total thyroidectomy with post-operative thyroid remnant ablation, for most differentiated thyroid cancer regardless of patients age. In another study of internationally recognized experts, total thyroidectomy was advised by 60% for papillary and 74% for follicular. Radioiodine for thyroid remnant ablation was recommended by 81% of respondents for papillary carcinoma and by 97% for follicular cancer [11. In a recent meta-analysis of published literature on remnant ablation, Sawka, et al.
Violence experienced by Turkish nursing students in clinical settings: their emotions and behaviors muscle relaxant benzo buy cheap methocarbamol 500mg on-line. Prevalence and characteristics of aggression and violence experienced by Western Australian nursing students during clinical practice spasms hands generic methocarbamol 500mg amex. Method/Statistical Analysis: the study was conducted in the survey of Korean dental medical institution workers spasms left upper quadrant quality methocarbamol 500mg. The chi-square test was conducted to analyse the difference according to the health insurance claim method and the difference in health insurance reception result spasms after surgery effective 500mg methocarbamol. A logistic regression analysis was conducted to verify the factors affecting the charge of health insurance claims. Findings: Compared to the case of the absence of a dental hygienist, in case of 2 people, the probability of being in charge of a claim increased by 8. Compared to the case of 1-4 employees, in case of more than 10 employees or more, the probability of being in charge of a claim is reduced by 0. In the work experience, the probability of being in charge of a claim in case of more than 5 years and less than 10 years was 1. Improvements/Applications: the introduction of a qualification system for the dental health insurance claim professional can reduce the burden on insurance claims by dental institutions. Keywords: Claim status, Dental institution, Health insurance, National Health Insurance, Korea. Introduction Health insurance system is a social security system that prevents an excessive burden on households due to disease or injury and ensures that appropriate medical services are provided and the people ordinarily pay an insurance fee, and the National Health Insurance Service that is the insurer manages and operates them and provides insurance benefits if needed [1]. The health insurance system adopts a third-party payment system where the medical provider does not request the full cost of medical treatment to the medical consumer but request it to Health Insurance Review and Assessment Service. For the payment method for medical expense, both Fee-for-service that is to pay a medical fee by setting a price for each medical treatment provided by a medical provider and case-payment that is a system that bears a predetermined amount of medical expenses for some disease groups such as payment implants and payment dentures have been applied [2]. In Dental Health Insurance, with the start of tooth sealant in 2009, the attention and knowledge on the criteria for calculating care benefits expense are required according to that the insurance coverage of resin dentures, partial dentures, metal dentures, scaling, dental Corresponding Author: Hye-Sook Choi Professor, Kyungdong University, Dept. Although the importance of accurate claims in insurance claims by medical institutions has been emphasized through various studies [3,5-7] related to the claim actual status and knowledge level for care benefits expense of claim professional workforce, the error in application continues to occur due to the unskilled knowledge of the work related to the health insurance claim. As the work importance of dental hygienists in charge of insurance claims is rising with the increase of the use of medical services due to the expansion of insurance coverage, alternatives on the provider side will be necessary for the quality of medical service and the efficient management of insurance claim work. Therefore, this study was performed to identify the causes that affect care benefits expense claim work of dental health insurance to provide basic data on an alternative for continuous and efficient dental health insurance claim professional workforce management. Result and Discussion the general characteristics of the study subjects are shown in Table 1. General characteristics of the study subjects Variables Seoul Working area Incheon/Gyeonggi-do Daejeon/Chungcheong-do Other Dental doctors Occupation Dental hygienists Nursing assistants other 29 Age 30-39 40 Work experience Number of employees Claim method Monthly claim amount 4 5-9 10 4 5-9 10 Exclusive claim Agency claim 499 500-899 900 N 121 91 106 15 7 276 36 14 198 94 41 131 105 97 104 142 83 265 68 109 115 109 % 36. The questionnaires, which had a total of 23 questions, consisted of 8 general questions and 13 questions for the actual status of the dental health insurance claim. For the survey, the questionnaire was revised and supplemented after a preliminary survey with 20 questionnaires. Health insurance claim method according to the characteristics of medical institution Claim Method Exclusive Claim Number of employees Number of Dental hygienists Monthly claim amount Total 4 5~9 10 None 1 2 3 499 500-899 900 72(69. After dividing the health insurance claims into two groups, Exclusive claim and agency claim, as a result of analyzing the difference according to the number of claims, the number of hospital workforce and the number of dental hygienists, all three items were statistically significant. Compared to the case of the absence of a dental hygienist, in case of 2 people, the probability of being in charge of a claim increased by 8. Additionally, as there are also a number of difficulties related with health insurance in dental institutions [12], to compensate for this, institutional review should be made to ensure that health insurance claim work can be performed independently and professionally [13], by recognizing the need for professional claimants with whom the effectiveness of treatment can be increased in the clinic, and by cultivating medical treatment claim professionals who are dedicated to health insurance claims to enhance the quality of medical services through coordinating the workforce[14]. Lee[4] revealed in the research on radiation safety management that the level of knowledge about radiation safety management is higher, the level of the attitude and behavior is higher, and the level of the attitude is higher, the degree of behavior is higher in the relation among the knowledge, attitude and behavior of radiation safety management. The exposure by dental radiation is remarkably lower than other diagnostic medical radiographic inspections, but the frequency is very high[6]. The clinical performance ability, an important performance index of the dental hygiene education, is a critical part to evaluate the performance ability as a dental hygienist after a student graduates. Thus, this study is intended to reveal dental hygiene students obey safety levels of exposure dose, perform safety regulations, and the accumulation dose is safe in their performance as radiation workers, and to provide a basic resource that in the undergraduate course of the department of dental hygiene, learning radiologic examination technique through actual mutual practice rather than pandom practice in the irradiation practice is more effective and safer.
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