HTC Mega is a Smart Phone b

The initial type of programs to bear in mind in regards to increasing your living output is apps linked to operating and obtaining your path around. These are GPS applications, and they primarily turn your cell phone into a little lightweight GPS device. These programs enable you to only select in your local area and you will have a way to see nearby eateries as well as the addresses of your pals and family. Google Routes Navigation is a great program that can help you accomplish only that. This is generally an intelligent telephone edition of the very popular web site on the web that enables persons plug in recommendations and look for locations. Google’s Routes Program presents satellite and street opinions that different portable applications do not provide. Business applications for the LG Joy will also be very important because they could support us remain arranged and make living much easier for us. Organizational programs may include apps that allow you to with scheduling and conference appointments and deadlines, in addition to apps at that help you add up calendars and also create your personal to accomplish lists through the touch screen and writing performance of the phones. It is now more challenging to remain on top of things these days in contemporary life, because so many individuals have so many different obligations to have a tendency to, so when you can change your cell phone into an friend to help you remain related and up to date with modern living, then it’s worth taking advantage of. Cellular Buying has also become remarkably popular and that is why there are numerous shopping programs for sale in the App Market. These kinds of apps can provide you with recommendations and addresses and entries to the closest centers, sites, food markets, and other aspects of modern living that you could be interested in finding in the real world. You can even use such programs to learn a number of opinions of shops that can help you find out which store you’re thinking about visiting or buying things from. As you can see, you will find numerous aspects concerning the LG Thrill may be beneficial to day-to-day coping with several programs, including apps for operating, shopping, and work. On the way, it may perhaps not be considered a poor thought to appear into some extras such as a information wire, a case, monitor guard, and a Bluetooth headset. With a information cable you will have the ability to transfer documents from your own PC to your telephone and the Wireless headset allows you talk hands-free while you travel which can be really advantageous to your safety.  Shycocan their property to review if the garage home closed. Acquire some bit of mind and don’t worry about turning every thing down before you leave. You can change every thing down without even being there. Connect with an individual screen, shut garage door and check every other components you may have forgotten. A good house will also support keep you on-time. Simplify your property and work the House Theater audio, movie, and various other components all from remote control. One remote control is an easy and convenient method to enjoy audio in virtually any room at anytime. If you prefer music, utilize the multi-room music feature and balance out the acoustics in your home. You can be eco-friendly and enjoy the right feel in every room with lighting control. Dimming your lights employs less energy, therefore helping you save money. Appreciate get a handle on from anywhere with a good phone or net connection. Get some bit of brain and monitor your house security while on the road.

6 Most readily useful PC Games That You Can Perform

If you are looking to find the best games to play on your own PC, you might browse the list of games given in this article. With the proper design card in your PC, you are able to deploy and play all these games at optimum settings. So, let’s browse the list of games. 1. Call of Duty: Contemporary Combat This really is one of the finest new PC games on our list. Though this sequel doesn’t reinvent the wheel, you might have a more aged but richer tone the game offers. But, the campaign mode has some controversy. Even though you don’t utilize the campaign mode, you are able to however have a significantly simpler and stronger experience. And the good thing is that the overall game is gorgeous. 2. The Witcher 3: Wild Search Though the game is not on the list of just produced ones, it’s however on the list of most readily useful open world games. The game features an extraordinary open world environment. It gives the unapologetic degree of Skyrim and the amazing range of Grand Theft Car V. That jam-packed sport is on top of our list. In fact, it will not be an exaggeration to express that this sport is one of the finest games of time. login pkv games 3. Dark Souls 3 Dark Souls 3 presents substantial improvement on the Souls line by providing special elements that Bloodborne offers. Though it’s easier compared to past titles, it’s every thing you might have liked in the earlier installments. The game is simple but you’ll die numerous times while playing. You will have to bear patience to acquire a greater perception in to the complex overcome system. Aside from this, it supplies a good gameplay, which makes it a great choice for informal gamers as well. Thus, they can take part in the bleak, great world of the game. 4. Control There is grounds why this sport has taken the planet of gambling by storm. Also, the developers at the Solution Entertainment has packed the game with lots of enjoy and elaborate details. That cinematic, action-adventure sport features excellent activities, lovely atmosphere design and staggering visuals. Besides, it supplies a considerably gratifying battle experience. When the game begins, you’re required to look for The Earliest House, which is a framework in New York City. After found, your following move is to look for your missing brother. 5. Monster Hunter World Monster Hunter is just a big title in the gambling franchise. While playing, you are able to quest bigger, stronger enemies applying bigger armor. That easy sport is among the most rewarding and engaging games you are able to have a look at these days. At Capcom, the developers of the overall game bring lots of free DLC. If you are searching of an addictive fun sport, you are able to have a look at this title. 6. Grand Theft Car V Grand Theft Car V is a favorite system sport which was introduced for PC. The game enables you to explore the interactive and step by step world of Los Santos. That sequel presents exciting knowledge, richer design and a significantly simpler gameplay.

Learn How To Buy A Car And Car Insurance Without Breaking Your Budget

Would you ever wonder why different vehicles run you different amounts for automobile insurance premiums? Why is it that the new Corvette may run you $1,600 dollars per month in automobile insurance and an older Buick Noble may just run you $90 per month? The newest car insurance charge versus the previous car insurance charge is really a matter that you should evaluation before you buy any car. Review insurance costs before you buy and you won’t get found in a financial trap. New vehicles charge more to guarantee than previous vehicles for three reasons. First, an auto theft of a brand new and amazing car costs a lot more compared to the automobile theft of an older and normal type car. That is because of the big price difference of the newest car versus previous car. Like, a brand new Chevy Caprice is much more pricey to guarantee than an older Chevy Caprice. It really costs more cash to replace a brand new, costly car than an older, more affordable car. Second, the fee to repair a brand new car is much more than the fee to repair a classic car. As a result, that reality shall also boost your insurance premium charge for a brand new car. Like, in case a new Chevy Caprice is broken in an accident, the automobile mechanic shop can demand you significantly more cash for repairs than if the subject car were a ten-year previous Chevy Caprice. For this reason, your insurer can demand you a lot more insurance premiums on a brand new vehicle than an older vehicle due to such restoration costs. Third, the type and type of car also shall significantly affect the price of car insurance premiums your Car insurance organization can demand you. Insurance businesses use actuarial statistic platforms which demonstrate to them the past loss knowledge on particular models and forms of cars. They use these platforms, to simply help calculate what premiums to demand their clients in the future. Mathematical platforms display these insurance companies that homeowners of particular models and forms of vehicles, such as for instance activities vehicles, participate in more dangerous operating behavior than homeowners of vehicles which are of normal form and style. Like, insurance organization statistical platforms reveal that the insurer has experienced more failures with activities vehicles than with normal cars. It is because the master of a Corvette will probably push such car faster and riskier than the master of a Toyota Camry. With such rate and risk also comes along more failures for the insurance companies. With such risk and loss improve, the insurance organization must then improve their reunite and demand more for automobile insurance premiums. Another exemplory instance of how the type and type of vehicle may provide an insurance organization with increased risk is the off-road type cars such as the Hummer line of vehicles. These cars are made to accomplish in the off-road form environment. They’re increased up down the floor more than standard automobiles for less than carriage clearance. Moreover, they likewise have four-wheel push capability. With such style abilities, the statistical platforms reveal that the insurance organization has experienced more failures with these types of vehicles than standard cars. This is because the homeowners of such cars can participate in off-road operating which can be equally dangerous to the automobile and driver. Actually, some insurance businesses may club recovery for such injuries, when the master of the protected vehicle was broken while any participating in dangerous, off-road driving. Again, with increased risk, the insurance organization will increase reunite and ergo automobile insurance premiums. Now that you realize that particular models and forms of vehicles charge more to guarantee than others, you have to be wise about what sort of vehicle you are going to buy. As opposed to take a imagine at that which you feel a vehicle’s insurance costs are, call your vehicle insurance organization and question your insurance agent for a free of charge car insurance estimate for the actual type of vehicle that you will be thinking about buying. You will get a conclusive answer to your problem of if you can afford equally the car and the insurance premiums necessary to cover your vehicle against protected losses. Enough time to make such evaluation isn’t after you get a vehicle. At that time over time, it is also late. Enough time to make such evaluation is way prior to your getting an automobile. You definitely want to be ready to make equally car obligations in addition to insurance premium payments. Get a free of charge automobile insurance estimate in advance and avoid economic problems.

Are You Really the Patient? Medical Identity Theft Facts You Didn’t Know

The public has become more armed against the threats of identity theft. While identity thieves can steal individuals’ money, ruin their good credit and cause years of aggravation and stress, an alternative form of identity theft, medical identity theft, can actually threaten lives. Medical identity thieves steal and misuse other people’s personal information including their name and insurance card account numbers without the person’s consent and usually without their knowledge. The Scary Truth about Medical Identity Theft Your medical and insurance records follow you and when false information is added to your medical records, you can be at risk when you are treated in the future. Doctors may make decisions about your treatment and medications based on a fictitious medical history and this can put your health at risk. Not to mention that the insurance companies will have noted false “pre-existing conditions.” As more and more medical communities rely on electronic records, the information is more likely to follow you on a larger scale and some believe this trend makes it easier more medical records to be compromised. What can a thief do with your medical identity? Medical identity thieves may use other people’s information to obtain medical care, prescription items or to make fraudulent medical claims. A medical identity thief without insurance who wants a surgery or prescription drugs can use your information, get what they want and leave knowing you and your insurance company will get the bills. Some medical identity thieves are motivated purely by money. Thieves can collect large amounts of money, even millions of dollars, by making these false medical claims. Don’t Ignore a Medical Billing or Insurance Statements Don’t assume a medical bill or insurance statement for services you didn’t get is just a mistake. It could be the first sign that someone has stolen your medical identity. Joe Ryan, a Colorado resident, got a hospital bill for over $40,000 for surgeries and treatments he never received. This wasn’t a billing error. An ex-con had used Ryan’s medical identity to check into the hospital and obtain extensive medical care. Two years later, Ryan was still trying to undo the damage to his medical records. You may not learn about a medical identity theft from a bill. Brandon Reagan, who stationed in California, learned that his medical identity had been stolen and used in South Carolina when his mother called and told him he was the lead suspect in a car theft. Reagan had lost his wallet in South Carolina and a thief used his military i.d. and license to test drive cars and then steal them. In addition to getting Ryan on a wanted list, the thief also used Ryan’s medical identity to go the hospital on several occasions to get treatment for injuries and kidney stones. The medical bills were close to $20,000. Even though the identity thief was finally arrested, Reagan was left with a nightmare. His medical records in South Carolina were full of false information and his tax refund check was withheld due to the unpaid hospital bills still in his name. Sketchy Law and Statistics on Medical Identity Theft: Laws dealing with medical identity theft are still not thorough or consistent from state to state. Many Federal laws that were intended to protect confidentiality actually make it more difficult for you to access and correct your own medical records. Wide scale investigations into medical identity theft are just beginning but in 2005 there were over 8 million victims of identity theft and three percent, 249,000 of those involved medical identity theft. Pam Dixon, executive director of the World Privacy Forum warns, “Medical identity theft causes terrible harm, both financial and physical.” How can you protect yourself from medical identity theft? -Get a copy of your medical records for comparison in case they are compromised in the future. – Annually request a list of payments made for your medical services from your insurance company. -Review your Explanation of Benefits (EOB) as they are provided by your insurance carrier to determine their accuracy. -Check your credit report at least once a year for any unusual unpaid charges. -Research and report any suspicious medical bill or insurance statements.

Why You Need to Understand Medication Management

Early in my mom’s tenure in assisted living, I noticed her monthly bill had a significant expense labeled as “medication management.” As someone who rarely takes any medication, I realized I needed to understand the process better.  I’ll be dedicating several posts in near future to this topic, as I believe family involvement in medication management is critical. Medication is a Major Issue According to a 2006 study by the three leading non-profits – ACHA, NCAL and MEFC, medication is often a major component of an older person’s life, making it a major issue for assisted living facilities. The role of medication and medication assistance (called “medication management” by assisted living administrators) is surprising:   77.5% of residents needed assistance with medications Residents were taking an average of 13 medications   In an assisted living setting, residents rely heavily on staff to assist with the timely and correct delivery of medication.  But in the United States alone, nearly two million Americans experience adverse drug reactions from prescription medication each year. What can you do to protect your loved one? A better understanding of medication management can help. Where to Get Medications Families have several options for filling prescriptions on behalf of loved ones.  They are:   Mail order. Most health insurance and Medicare plans provide options for mail order delivery of medications.  Prescriptions are usually filled in 90-day quantities. Price discounts are usually offered over that of pick-up or local pharmacies. Unfortunately, mail order makes urgent medications challenging. Pick-up. You guessed it?!  You or a family member pick up prescriptions and deliver them to the facility. For a small number of medications, this may be feasible.  But it doesn’t work for multiple prescriptions on multiple delivery schedules. Local pharmacy delivery. Prescriptions are filled and delivered by a local pharmacy 1-2 times daily. Since assisted living facilities usually contract with a single pharmacy, rush orders and other conveniences are widely available. I recommend this option for all but the most hands-on families.   Introducing the Med Room So where do they store all that stuff? It’s called a “med room.”  The med room is a restricted-entry office that holds all resident medication, dosage records and prescription histories. If you’re looking into assisted living for the first time, you should ask to see the med room.  From an audit perspective, if you already have a loved on in assisted living, you should periodically ask to see the med room. Your goal in visiting the med room is to validate the following:   Medication is stored in a well-organized manner like that seen in hospitals Files are well-organized and clutter is at a minimum The staff can quickly share with you your loved one’s medication and prescription history There is a supply of pudding or apple sauce for those residents that have trouble swallowing pills Contact information for your loved one’s doctors is readily available The door is kept locked (verified by staff unlocking the door when they let you in)   Who Administers Medication Medications are provided to residents by a medical aide (called “med techs” by administrators).  Med techs are responsible for the maintenance of the med room and for administering medications correctly and in a timely manner. Med techs typically lay out all medications on a labeled delivery tray and deliver medication to each room. Their role is to ensure residents take their medications, although they will often leave medications with caregivers, if they are present. In the unfortunate event of hospitalization, the med tech will also provide a copy of all current medications to paramedics or the individual taking your loved one to the hospital. Keeping Track of It All As a family member, you should stay well informed of the medications your loved one is taking. The dosage record is the easiest way to do this. A dosage record is kept for each patient and resembles the graph paper we all used in grade school.  Along the left side of the page is a list of medications. Across the top are days of the month. Every time a medication is given, the med tech is required to sign the box corresponding to that medication and date. The best way to spot-check medication management is to randomly request copies of the dosage report.  Secondarily, ask the staff to notify you when medications are added or discontinued, so that you have a real-time understand of the medications being consumed.

Implementing the AMA’s Guidelines For Medical Tourism

In June 2007, the American Medical Association (“AMA”) released a report entitled “Medical Travel Outside the U.S.,” that tried to explain why people are going abroad for medical care. According to the AMA, the primary reasons that Americans are traveling for treatment are the ever escalating-cost of healthcare and the lack of affordable health insurance. On June 16, 2008 the AMA re-entered the conversation with Guidelines on Medical Tourism. These guidelines address important issues of patient safety, transparency, financial incentives, after care, and legal liability. The AMA’s contributions to the medical travel industry at such an early stage is notable and important. Many American doctors strongly disapprove of patients who seek care abroad and few will agree to provide follow-up care for returning medical travelers. Those doctors are understandably concerned about incurring liability for another physician’s malpractice. Widespread resistance in the medical community led many to believe that the AMA would either ignore or actively oppose the development of the medical travel industry. Instead, most were surprised by the AMA’s desire to get out in front of the issue and announce guidelines that some view as a traveling patient’s bill or rights. As the health insurance industry and employers begin to explore the cost savings and benefits of medical travel, the AMA’s contributions promote patient safety and protection. The AMA has legitimized a nascent industry with only limited support from mainstream healthcare networks. Since the AMA entered the discourse, more and more health insurers are evaluating whether medical travel makes sense today, tomorrow or sometime soon. At this stage, AMA does not seem intent to stamp out medical travel. This may be due in part to the movement’s consumer-driven nature and the reality of restricted resources at home. Instead, the organization of medical professionals will propose model legislation to all states that protects patients who go abroad for treatment. 2. The Guidelines and Who Will be Impacted The AMA’s Guidelines on Medical Tourism are enumerated below. Each addresses important components of patient decision-making, safety, protection and recovery. a. Medical care outside of the U.S. must be voluntary. b. Financial incentives to travel outside the U.S. for medical care should not inappropriately limit the diagnostic and therapeutic alternatives that are offered to patients, or restrict treatment or referral options. c. Patients should only be referred for medical care to institutions that have been accredited by recognized international accrediting bodies (e.g., the Joint Commission International or the International Society for Quality in Health Care). d. Prior to travel, local follow-up care should be coordinated and financing should be arranged to ensure continuity of care when patients return from medical care outside the US. e. Coverage for travel outside the U.S. for medical care must include the costs of necessary follow-up care upon return to the U.S. f. Patients should be informed of their rights and legal recourse prior to agreeing to travel outside the U.S. for medical care. g. Access to physician licensing and outcome data, as well as facility accreditation and outcomes data, should be arranged for patients seeking medical care outside the U.S. h. The transfer of patient medical records to and from facilities outside the U.S. should be consistent with HIPAA guidelines. i. Patients choosing to travel outside the U.S. for medical care should be provided with information about the potential risks of combining surgical procedures with long flights and vacation activities. Generally, these guidelines appear to be directed to health insurers and employers incorporating foreign providers into healthcare plans and to a lesser extent medical travel experts coordinating the patient travel experience. The Guidelines seek to protect patients from being pressured by healthcare payers to accept lower quality care without recourse in the event of a bad outcome. The AMA repeatedly stresses the importance of informing patients of their rights and recourse, the hospital and doctor’s credentials, and potential risks associated with combining travel activities with surgical procedures. 3. Implementing Key Guidelines a. Patient Safety The majority of the AMA’s Guidelines are aimed and ensuring patient safety. The Guidelines call for treatment abroad to be voluntary and for financial incentives to not restrict treatment options. This measure is meant to avoid patient coercion and withholding important information about available alternatives. The AMA also requires that institutions treating patients be accredited by recognized international accreditation bodies. This rule tries to ensure that patients are treated in safe and clean facilities that meet international standards of patient care, infection control and hygiene. The AMA also requires that patients be informed of the risks of combining surgical procedures with travel activities. The Guideline’s proscription against transferring patient medical records in violation of HIPAA aims to reassure patients that their privacy rights will continue to be safeguarded abroad.

Medical Terminology – First Step on a New Career Path

In these days of economic uncertainty, career change is a hot button issue. As baby boomers retire and leave the work force, employers are concerned about the shortage of skilled workers. In addition, corporate cost cutting, off-shoring, layoffs, and forced career changes leave many workers with difficult choices. Gone are the days of one job and one employer for life. Following a career path today can mean maneuvering many twists and turns, setbacks, side roads, and blind alleys. Where is the roadmap to a new career that provides enrichment, stability and growth potential? One of the best ways to ease some of the uncertainty and increase your marketability quotient is to broaden your skill set. Since continuing education is often required to maintain licenses and certifications, make those education hours do double duty. The right training can mean more opportunities in your current field, and serve as a stepping stone to a new career. But which industries offer the best chance for job stability and advancement? It is predicted that expanding healthcare and healthcare-related industries will require many additional skilled workers in the coming decade. According to Forbes Magazine, “As well-heeled baby boomers age, look to the health care industry… (B)etween 2004 and 2014, seven of the 10 fastest-growing jobs in the U.S. will be in health care.” In addition to careers directly involved in patient care, demand for support professionals such as medical records and health information technicians, therapists, counselors, and medical transcriptionists will increase. A basic requirement for entry into almost any healthcare-related career is a command of medical terminology. The ability to recognize, understand, spell, and pronounce basic medical terms, identify medical abbreviations, and decipher unfamiliar words using roots, suffixes and prefixes is a necessary tool to perform well in any medical setting. Medical terminology courses are widely available in online, home study and instructor-led formats. Because medical technology advances rapidly, medical terminology evolves to keep pace. To stay on top of new terminology, consider taking the course again if you’ve taken it in the past. The Department of Labor database lists seven nontraditional careers that require medical terminology: Medical Transcriptionists – To understand and accurately transcribe dictated reports, medical transcriptionists must understand medical terminology, anatomy and physiology, diagnostic procedures, pharmacology, and treatment assessments. They also must be able to translate medical jargon and abbreviations into their expanded forms. Medical Records and Health Information Technicians – In addition to general education, coursework requirements for medical records and health information technicians includes medical terminology, anatomy and physiology, legal aspects of health information, health data standards, coding and abstraction of data, statistics, database management, quality improvement methods, and computer science. Surgical Technologists – Surgical technologists receive their training in formal programs offered by community and junior colleges, vocational schools, universities, hospitals, and the military. In 2006, the Commission on Accreditation of Allied Health Education Programs (CAAHEP) recognized more than 400 accredited training programs. Programs last from 9 to 24 months and lead to a certificate, diploma, or associate degree. Programs provide classroom education and supervised clinical experience. Students take courses in anatomy, physiology, microbiology, pharmacology, professional ethics, and medical terminology. Other topics covered include the care and safety of patients during surgery, sterile techniques, and surgical procedures. Students also learn to sterilize instruments; prevent and control infection; and handle special drugs, solutions, supplies, and equipment. Most employers prefer to hire certified technologists. Occupational Therapist Assistants and Aides – There were 126 accredited occupational therapist assistant programs in 2007. The first year of study typically involves an introduction to health care, basic medical terminology, anatomy, and physiology. In the second year, courses are more rigorous and usually include occupational therapist courses in areas such as mental health, adult physical disabilities, gerontology, and pediatrics. Students also must complete 16 weeks of supervised fieldwork in a clinic or community setting.

Medical Transcription Introduction

Medical Transcription is the process of converting voice dictation (typically either cassette or digital format) into a permanent written record utilizing word processing equipment and software. Each day in hospitals all over the country, thousands of patients are admitted and discharged. Examinations are conducted, procedures are performed and recommendations are made. It is not uncommon for multiple physicians to be involved in a simple procedure for a single patient. Radiologists, Pathologists, Anesthesiologists, Surgeons, and a host of other medical specialists must all coordinate their efforts to ensure that patient care is both adequate and appropriate. Underpinning all of these activities is a complex web of medical and patient information. Each patient-related activity and procedure must be meticulously documented and then added to the patient’s permanent record. Physicians and medical record handlers alike must be extremely careful to ensure that detailed patient identification information accompanies each procedure and examination report to avert potentially disastrous mix-ups. Over time, all of this information accumulates in a centralized medical records repository where it serves as a critical resource for patient care – facilitating accurate diagnoses and appropriate treatments. Indeed, timely patient care often hinges on the ability of Radiology, Pathology, and other specialty departments to quickly conduct their examinations and report their findings. Evolution and History of Medical Transcription In the past, patient medical charts consisted of a series of abbreviated handwritten notes that were funneled into the patient’s file for interpretation by the primary physician responsible for diagnosing ailments and prescribing treatment. Ultimately, this hodge-podge of handwritten notes and typed reports was consolidated into a single patient file and physically stored along with thousands of other patient records in a wall of filing cabinets in the medical records department. Whenever the need arose to review the records of a specific patient, the patient’s file would be retrieved from the filing cabinet and delivered to the requesting physician. To enhance this manual process, many medical record documents were produced in duplicate or triplicate by means of carbon copy. In recent years things have changed considerably. Walls of filing cabinets have given way to desktop computers connected to powerful mainframe systems where patient records are prepared and archived digitally. This digital format allows for immediate remote retrieval by any physician who is authorized to review the patient information. Reports are stored electronically and printed selectively as the need arises. While the transition from a paper based to an electronic format will take years to complete, considerable progress has been made. Handwritten reports are largely a thing of the past. Verbal dictation is now by far the most common method for documenting and reporting the results of examinations and procedures. Physicians generally use either a cassette based voice dictation system or a digital voice dictation system to record their findings. Dictating reports verbally not only allows physicians to be more thorough in their reporting, it also saves them a great deal of time. The Wall Street Journal recently reported the results of a study conducted by the Association of Legal Administrators suggesting that verbal dictation is the fastest way to create a document. The study states that “a 245-word document takes 9.34 minutes to create with an electronic dictaphone, compared with 16.46 minutes on a personal computer and 16.49 minutes by hand.” (WSJ, Tuesday, October 22, 1996, page A1, column 5). Given the salaries of most physicians, the cumulative productivity savings associated with these technological enhancements is considerable. The process of converting voice dictation to a typewritten format is known as transcription. Traditionally a staff of skilled medical transcriptionists working in the medical records department of the hospital has accomplished the work of transcribing medical records. In the early years of medical transcription it was not uncommon for very large hospitals to have staffs of 40 or 50 medical transcriptionists working one or more shifts. A transcription supervisor, who in turn reported to the Medical Records Director, generally oversaw these transcriptionists. The Medical Transcription Outsourcing Trend Increasingly, traditional hospitals are coming under competitive attack by more efficient managed care organizations. In an effort to remain competitive, many hospitals have turned to outsourcing as a means of cutting costs. Many of the processes that were previously performed internally are now being contracted out to third parties. Medical transcription is no exception. The outsourcing of transcription and other functions relieves hospitals of the administrative headaches and overhead burdens associated with internal production and allows them to focus their attention on improving service and lowering costs. This new competitive climate has driven many hospitals out of business. Those organizations that have survived have done so by becoming more efficient and cost-conscious. There is considerable evidence to suggest that contracting out medical transcription is a much less costly alternative to producing reports internally. Most savvy healthcare providers today understand this and are responding appropriately. The significant cost-cutting pressures which continue to drive the industry toward consolidation, managed care and capitation virtually guarantee that the outsourcing trend will not only continue but accelerate in coming years. This proliferation of outsourcing agreements has spawned a new generation of small medical transcription companies intent on carving out a piece of the pie. Interestingly, in spite of its rapid growth, the medical transcription industry is still considered a cottage industry. While there are a few truly national players, the industry is at this point still dominated by the hundreds of small local transcription companies located wherever hospitals are found. Opportunities in Medical Transcription The outlook for quality medical transcriptionists have never been greater. Lucrative opportunities abound today in hospitals, clinics, HMO’s, and in the hundreds of Medical Transcription contracting companies located throughout the country.

The Dangers of Expired Medications

Expired medications are commonplace and inertia notwithstanding, many of us tend to rely on an intuitive sense of their value in continuing to store and use them. Such drugs can be harmful to health in several ways; they can be unpredictable in effectiveness, simply ineffective, or even toxic. The formal way of classifying a medication as having expired is through it’s labeled expiry date. This date is often set based on a combination of the common properties of the dosage form as well as the stability and expiration studies of the product that have been conducted by the manufacturer. Importantly, this expiry date is contingent on specific storage conditions of the product. Although a medication may pass it’s labeled expiry date, it may not necessarily be any less effective or dangerous to consume depending on the product itself, the storage conditions and the circumstances leading up to expiry. When most medications pass their expiry date under appropriate storage conditions, they are generally taken to have become so variable in effectiveness as to have become unsuitable for use. This often comes about as a result of the degradation of the active ingredients of the medication with exposure to physical, chemical or microbiological variables like temperature, pressure, humidity, light, bacteria as well as other components of the product known as excipients. Creams may “crack” once their expiry date is passed, leading to a separation of the components and hence provide a non-uniform delivery of active ingredients. This can lead to the poor control of conditions like eczema or acne. Tablet medications can mechanically “powder” off, change in consistency with exposure to water vapor or even experience the contained drug itself becoming ineffective on prolonged exposure to air as occurs with glyceryl trinitrate, an emergency medicine that can easily become ineffective in relieving acute symptoms of chest pain. With common injections, should the acidity change to fall outside a fairly narrow range, significant pain and tissue damage can result from use. With most eye drops, an expiry date of one month after opening is accepted to minimize the potential for dangerous bacterial contamination. With any medication, once a specific threshold of remaining active ingredient is passed, the medication can no longer be relied upon to deliver accurate doses. This loss of reliability is often exacerbated by the fact that the active ingredients can degrade into various combinations of active, inactive or toxic breakdown products. The common aspirin is for instance, known to react with moisture to breakdown into salicylic acid, which is active, and acetic acid, which is inactive and can lead to toxicity in excess. While the expiry date provides a useful gauge of when to stop using a medication, there are also many other factors that can informally accelerate the expiry of a medication and make it dangerous to use, chief among which is how the medication is stored. It is oftentimes not just the medication that is affected by storage conditions but also the storage container. Under inappropriate storage conditions, certain containers can leech material into liquid medication preparations, or medication particles can stick to the container rather than remain separated. On average, a 10 degree rise in temperature doubles the rate of chemical reactions that occur to a medication product and can accelerate the rate of bacterial contamination several fold. Just like an ice cream can simply melt or a loaf of bread becomes mouldy much quicker if not refrigerated, many medication products can easily expire much faster when not stored appropriately. With oral liquid and topical medications, potentially dangerous changes associated with expiry can at times be detected by color or consistency changes, component separations, altered smell or taste (oral preparations). Should a suspicion of expiry arise, a medication expert should be consulted regardless of whether or not the labeled expiry date has been passed. “Expiry” should also be understood to occur once a supply of medications is no longer used appropriately for it’s intended purpose. Consultation with a medication expert is always advised to prevent the inappropriate use of existing medication supplies. Inappropriate use can often occur with self-medication and is harmful. An unfinished supply of a previously used antibiotic may be tried to treat a new infection that is actually untreatable by or resistant to that antibiotic. This practice may not only delay recovery but can also encourage the proliferation of “super bugs” that have resistance to many antibiotics. Another incorrect purpose involves sharing medications and this can be especially harmful if another is allergic to the shared medication or a child or pet is medicated with an adult’s medication. Children often require dose adjustments to accommodate their size while many human drugs are often unsuitable for pets. Even a simple food like chocolate that we may enjoy can easily be toxic to a pet dog. Another mechanism whereby medication expiry is dangerous occurs when an unfinished supply is used despite new information that points to increased precautions associated with the medication or that has led to it’s recall. An example is obtaining pain relief from a previous supply of a painkiller like Vioxx (rofecoxib) or Celebrex (celecoxib) in spite of an existing heart condition that is now known to relate to an increased risk of fatality under those circumstances of consumption. Expired medications that are kept instead of discarded not only take up space but can actually discourage the appropriate use of new supplies in the treatment of illness. A medication cabinet, if not tended to regularly, could eventually contain more expired medications than viable ones and this can lead to the accidental consumption of an expired medication in place of a viable one. It is definitely advisable to clear the medication cabinet of expired medicaitons at least annually if not more often. A further danger however, lies in how expired medications are disposed of. Expired medications and pharmaceutical byproducts can be harmful to the environment especially when they end up in our rivers and drinking water supply. Hormonal compounds like estrogen from birth control pills and patches as well as antibiotics have been linked to being flushed by individuals and institutions into sewage, draining largely unchanged and collecting in rivers and streams, then returning in tiny amounts into drinking water. Traces of antibiotics could worsen bacterial resistance while estrogens and other steroids are known to change the reproductive characteristics of fish. Even trace amounts of chemotherapy medications have emerged in tap water and this could be severely detrimental to the unborn babies of pregnant women who drink such water. The long-term impact on human health of medications in our rivers and drinking water is as yet unknown but no one would want to wait to find out. We can all play our part by inquiring on and using pharmacy or state-run programs for the disposal of expired medications instead of sending them down the sink or the toilet bowl. A pharmacist is the expert of choice to approach in handling medication expiry and should be consulted if in doubt. As a general rule, it is always best to safeguard your own health and that of those around you by expeditiously and appropriately discarding all expired medications.