DOCSLIB.ORG

Erectile Dysfunction in Family Practice: The

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Erectile Dysfunction in Family Practice: The ERECTILE DYSFUNCTION IN FAMILY PRACTICE: THE PREVALENCE AND CLINICAL CORRELATES AMONG ADULT MALE PATIENTS PRESENTING AT THE GENERAL OUTPATIENTS DEPARTMENT, UNIVERSITY COLLEGE HOSPITAL, IBADAN. A DISSERTATION SUBMITTED TO THE FACULTY OF FAMILY MEDICINE OF THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE FELLOWSHIP IN FAMILY MEDICINE BY ADEBUSOYE, LAWRENCE ADEKUNLE MB;BS(Ibadan) MAY 2008 ETHICAL APPROVAL 2 DEDICATION This dissertation is dedicated to Almighty God, my darling and supportive wife Adekemi and my children: Oluwadamilola, Oluwafemi and Oluwatobi. 3 CERTIFICATION We certify that this study has been carried out by Dr. LAWRENCE ADEKUNLE ADEBUSOYE in the General Outpatients’ Department, University College Hospital, Ibadan, Nigeria. Supervisors: ___________________________________ Dr M.M.A. Ladipo MB;BS (Ib), FMCGP (Nig), FWACP (FM). Consultant Family Physician Head, General Outpatients’ Department University College Hospital, Ibadan, Nigeria. _______________________________ Mr E.O. Olapade-olaopa FWACS, FRCS Consultant urologist Department of Surgery University College Hospital, Ibadan, Nigeria. 4 DECLARATION I do hereby declare that this work has not been presented to any other College or a body for examination purposes or elsewhere for publication. _________________________________ ADEBUSOYE, LAWRENCE ADEKUNLE MB,BS (Ibadan) 5 ACKNOWLEDGEMENT My gratitude goes to the Almighty God who sustained me through the Postgraduate programme in Family Medicine. I wish to express my sincere gratitude to my supervisors Dr M.M.A. Ladipo, trainer, mentor, and the Head of General Outpatients’ department of the University College Hospital, Ibadan and Mr E.O. Olapade-Olaopa for their support, guidance and encouragement. I acknowledge with gratitude Drs E. Ibeneme, I. Ajayi and A. Irabor for their support, training, guidance and assistance. My sincere appreciation goes to the resident doctors and the nursing staff of the General Outpatients’ department of University College Hospital, Ibadan for their support. Finally, I express my utmost appreciation for the encouragement, understanding and support of my wife and children throughout the period of this study. 6 TABLE OF CONTENTS PAGES TITLE PAGE ………………. ……………………i ETHICAL APPROVAL…………….. ……………ii DEDICATION……………………… ……………iii CERTIFICATION………………….. ……………………..iv DECLARATION…………………… ………….…...v ACKNOWLEDGEMENT……….. ..……….………….vi TABLE OF CONTENTS………… ..…………………..vii LIST OF TABLES……………….. …….……………...ix LIST OF FIGURES……………… …….………………...x LIST OF ABBREVIATIONS………. …………….xi ABSTRACT……………………. …………………..….xiii CHAPTER ONE - INTRODUCTION ……... 1 CHAPTER TWO - LITERATURE REVIEW …….7 CHAPTER THREE - SUBJECTS AND METHODS ……33 CHAPTER FOUR - RESULTS ……43 CHAPTER FIVE - DISCUSSION …….65 7 CONCLUSION - ………77 RECOMMENDATIONS - ………79 LIMITATIONS OF THE STUDY - ……… 80 REFERENCES - ………81 APPENDICES - ………....94 8 LIST OF TABLES PAGES Table 1 Sociodemographic characteristics of respondents 45 Table 2 Sociodemographic characteristics of respondents by severity of erectile dysfunction. 53 Table 3 Severity of erectile dysfunction by BMI 54 Table 4 Severity of erectile dysfunction by physical activities 55 Table 5 Severity of erectile dysfunction by chronic medical illnesses 57 Table 6 Severity of erectile dysfunction by medications use 59 Table 7 Severity of erectile dysfunction by lifestyle habits 61 Table 8 Severity of erectile dysfunction by sexual life and partner(s) satisfaction 62 Table 9 Severity of erectile dysfunction by frequency of sexual activities 63 9 LIST OF FIGURES PAGES FIGURE 1 Age distribution of respondents 46 FIGURE 2 Social class of respondents 47 FIGURE 3 BMI of respondents 48 FIGURE 4 Prevalence of erectile dysfunction 49 FIGURE 5 Prevalence of erectile dysfunction by Age group 50 10 LIST OF ABBREVIATIONS ADL - Activities of Daily Living AMD - Age- related Macular Degeneration BMI - Body Mass Index BPH - Benign Prostatic Hyperplasia. CDC - Center for Disease Control CED - Chronic Energy Deficiency COPD - Chronic Obstructive Pulmonary Disease DASH - Dietary Advice to Stop Hypertension DNA - Deoxyribonucleic Acid ED - Erectile dysfunction FBG - Fasting Blood Glucose GOPD - General Outpatients’ Department HIV/AIDS - Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome IIEF - International Index of Erectile Function JNC - Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure 11 NIDDM - Non Insulin Dependent Diabetes Mellitus NPTR - Nocturnal penile tumescence and rigidity testing RNA - Ribo-Nucleic Acid UCH - University College Hospital USA - United States of America WHO - World Health Organization Wonca - World Organization of Family Doctors (Formerly World Organization of Colleges and Academia of Family Medicine) 12 ABSTRACT BACKGROUND: The prevalence of erectile dysfunction (ED) is high globally, and it is increasing. Erectile dysfunction causes immense psychological distress in the sufferer which could lead to strained relationships, which lead to separation in the family and tense interpersonal relations with family and friends. ED causes mental stress, which leads to fearfulness, anxiety, depression, loss of self image and suicide in the sufferer. Erectile dysfunction is therefore an important public health problem which needs to be studied. This study among male patients presenting in a frontline hospital, will help the Family Physicians appreciate the magnitude of the problem among their male patients and ascertain the clinical correlates that exist in this environment. OBJECTIVES: The objectives of this study was to determine the prevalence of erectile dysfunction in this catchment area, and described its relationship to the physical characteristics, medical and psychosocial factors of the individuals, as well as its effect on the family relationship. MATERIALS AND METHODS: This was a descriptive cross-sectional study of four hundred and fifty adult male patients aged 18 to 70 years who presented at the General Outpatients’ Department of the University College Hospital, Ibadan between February 2005 and April 2005. They were interviewed with the International Index of Erectile Function (IIEF) questionnaire. 13 RESULTS: The overall prevalence of ED was 55.1%. The prevalence of the mild ED was 32.6%, moderate ED was 17.8%, whilst severe ED was 4.7%. The prevalence of ED increased significantly with age (p = 0.008) and its severity also worsened with increasing age. The prevalence of ED was found to be significantly associated with an increase in the social class of respondents (p = 0.011). The low level of physical activities was significantly associated with an increase in the prevalence of erectile dysfunction (p = 0.025). There was a significant association between the prevalence of erectile dysfunction and increase in BMI of the respondents (p = 0.012). Among the diabetic respondents, the prevalence of ED was 72.7%, while among the hypertensive, peptic ulcer disease and depressed respondents; it was 70.6%, 70.4% and 59.2% respectively. Additionally, the prevalence of ED in men taking medications for the treatment of chronic medical illnesses such as oral hypoglycemic agents, antidepressants, antihypertensive and peptic ulcer drugs was 87.5%, 83.3%, 57.1% and 50.0% respectively. As expected, the respondents’ dissatisfaction with sexual life was found to increase significantly with the severity of erectile dysfunction (p = 0.000). Partner(s) dissatisfaction with the respondents also increased significantly with the severity of erectile dysfunction (p = 0.000). The frequency of sexual activities was found to have a significant inverse association with the severity of erectile dysfunction in the respondents (p = 0.000). 14 CONCLUSION: The prevalence of erectile dysfunction was high among males in this setting. It was easily diagnosed in the primary care setting with the use of the IIEF questionnaire and clinical assessment. Efforts should be made by the Family physicians to detect this condition, find the possible aetiology or clinical correlates and institute management promptly to alleviate the social and psychological problems that result. 15 CHAPTER ONE 1.0 INTRODUCTION Traditionally, the term impotence had been used to describe the inability of the male to attain and maintain erection of the penis sufficient to permit satisfactory sexual intercourse1. The United States of America (U.S.A) National Institute of Health Consensus Development Panel on Impotence in 1992 identified the confusion in the definition and suggested a more precise term “erectile dysfunction”2. This is defined as the inability of the male to achieve an erect penis as part of an overall multifaceted process of male sexual function. This definition takes a variety of physical aspects with important psychological and behavioural overtones into consideration. The term erectile dysfunction is useful for practical diagnosis, and in the design of clinical trials with a high degree of objectivity2, 3. The aetiology of erectile dysfunction could be psychological, organic, or of mixed aetiology with both factors present2. The psychological causes are more common in young men less than 35 years of age and elderly men starting a new relationship2. These psychological aetiological factors include; problems in a relationship, anxiety about sexual performance, depression, bereavement, tiredness and stress, guilt about sex, unresolved homosexual feelings and an unattractive partner2, 3. Though, psychological factors
Load more

Recommended publications
  • Understanding Icd-10-Cm and Icd-10-Pcs 3Rd Edition Download Free
    UNDERSTANDING ICD-10-CM AND ICD-10-PCS 3RD EDITION DOWNLOAD FREE Mary Jo Bowie | 9781305446410 | | | | | International Classification of Diseases, (ICD-10-CM/PCS) Transition - Background Palmer B. Manual placenta removal. A: Understanding ICD-10-CM and ICD-10-PCS 3rd edition International Classification of Diseases ICD is a common framework and language to report, compile, use and compare health information. Psychoanalysis Adlerian therapy Analytical therapy Mentalization-based treatment Transference focused psychotherapy. Hysteroscopy Vacuum aspiration. Every code begins with an alpha character, which is indicative of the chapter to which the code is classified. Search Compliance Understanding BC, resilience standards and how to comply Follow these nine steps to first identify relevant business continuity and resilience standards and, second, launch a successful While many coders use ICD lookup software to help them, referring to an ICD code book is invaluable to build an understanding of the classification system. Pregnancy test Leopold's maneuvers Prenatal testing. Endoscopy : Colonoscopy Anoscopy Capsule endoscopy Enteroscopy Proctoscopy Sigmoidoscopy Abdominal ultrasonography Defecography Double-contrast barium enema Endoanal ultrasound Enteroclysis Lower gastrointestinal series Small-bowel follow-through Transrectal ultrasonography Virtual colonoscopy. Psychosurgery Lobotomy Bilateral cingulotomy Multiple subpial transection Hemispherectomy Corpus callosotomy Anterior temporal lobectomy. While codes in sections are structured similarly to the Medical and Surgical section, there are a few exceptions. Send Feedback Do you have Understanding ICD-10-CM and ICD-10-PCS 3rd edition on the new website? Help Learn to edit Community portal Recent changes Upload file. D Radiation oncology. Stem cell transplantation Hematopoietic stem cell transplantation. The primary distinctions are:. Palmer Joseph C.
    [Show full text]
  • Laboratory Guide 2021 Valid from 1St January 2021 Cover: Daniel Odukoya, BMS, Laboratory Supervisor Within Molecular Pathology Handling PCR Samples
    Laboratory Guide 2021 Valid from 1st January 2021 Cover: Daniel Odukoya, BMS, Laboratory Supervisor within Molecular Pathology handling PCR samples. TAP4557/22-11-20/V3 Laboratory Guide 2021 Valid from 1st January 2021 TDL Customer Charter We are committed to being the most helpful pathology service in the UK. Our goal is always to provide a high level of service to our customers, who request pathology services, for their patients. This is a philosophy shared by all Sonic Healthcare Pathology practices. We are medically led, and patients are our first concern. We always try to look to improve our operational expertise, and we strive to provide professional leadership within our specialities. We promise to provide easy access to our pathology services • We will always provide a friendly, helpful service. • Our automated laboratory departments operate 24 hours a day, 7 days a week, and we aim to achieve, or improve, our published turnaround times. • Our medical consultants and laboratory teams are available to provide additional clarification, advice or information for tests or results. We promise to help you • We invest in technical and operational excellence, with an extensive test repertoire, to ensure access to a leading-edge laboratory service. • We return results using the reporting method choice, in an as organised and safe way as possible. We promise to support the communities we work in • We do our utmost to provide a service, even during extreme external disruptions beyond our control. • We are committed to our staff’s continued professional development. • We have an organised programme to provide young people with work experience.
    [Show full text]
  • Effective for Cases Diagnosed January 1, 2016 and Later
    POLICY AND PROCEDURE MANUAL FOR REPORTING FACILITIES May 2016 Effective For Cases Diagnosed January 1, 2016 and Later Indiana State Cancer Registry Indiana State Department of Health 2 North Meridian Street, Section 6-B Indianapolis, IN 46204-3010 TABLE OF CONTENTS INDIANA STATE DEPARTMENT OF HEALTH STAFF ............................................................................. viii INDIANA STATE DEPARTMENT OF HEALTH CANCER REGISTRY STAFF .......................................... ix ACKNOWLEDGMENTS ................................................................................................................................ x INTRODUCTION ........................................................................................................................................... 1 A. Background ..................................................................................................................................... 1 B. Purpose .......................................................................................................................................... 1 C. Definitions ....................................................................................................................................... 1 D. Reference Materials........................................................................................................................ 1 E. Consultation .................................................................................................................................... 2 F. Output ............................................................................................................................................
    [Show full text]
  • Tender Document for Selection of Implementation Support Agency (TPA) for Providing Support Services for the Implementation of Health Scheme (PM-JAY, AAUY and SGHS)
    Tender Document for Selection of Implementation Support Agency (TPA) For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand August 2021 Volume II: About Health Schemes (AB-PMJAY, AAUY and SGHS) Schedule of Requirements, Specifications, Scope of work and Allied Technical Details Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand Table of Contents Abbreviations ................................................................................................................................................ 5 Definitions and Interpretations .................................................................................................................... 6 Disclaimer................................... ................................................................................................................ 11 1. Name of the Scheme ............................................................................................................................. 13 2. Objectives of the Scheme ...................................................................................................................... 13 3. Health Scheme Beneficiaries and Beneficiary Family Unit .................................................................... 13 4. Benefit Cover and Benefit Limit ............................................................................................................
    [Show full text]
  • Program Book Welcome
    North Central Section of the AUA, Inc. 92nd Annual Meeting September 5 - 8, 2018 Fairmont Chicago, Millennium Park Chicago, Illinois PROGRAM BOOK WELCOME Table of Contents Schedule at a Glance 2 Hotel Directory 6 Promotional Partners 7 Exhibitors 8 Industry Satellite Symposium Events 9 CME Information 10 2017 - 2018 Board of Directors 13 2017 - 2018 Committee Listing 14 NCS Representatives to AUA Committees 17 Past Presidents and Annual Meeting Sites 18 Board of Directors and Committee Meetings 21 General Meeting Information 22 Evening Functions 23 Speaker Information 24 Program 25 Wednesday, September 5 25 Thursday, September 6 29 Friday, September 7 50 Saturday, September 8 67 Participant Index 78 Podiums 87 Posters 190 Annual Business Meeting Agenda 223 Membership Candidates and Transfers 224 Membership Summary Report 225 Proposed Bylaws Changes 226 Bylaws 228 In Memoriam 240 Award Recipients 241 NCS Urology Residency Programs 247 AUA Officers 250 AUA Foundation Research Scholars 250 POLICY: Filming, Photography, Audio Recording, and Cell Phones No attendee/visitor at the NCS 92nd Annual Meeting may record, film, tape, photograph, interview, or use any other such media during any presentation, display, or exhibit without the express, advance approval of the NCS Executive Director. The policy applies to all NCS members, nonmembers, guests, and exhibitors, as well as members of the print, online, or broadcast media. Back to Table of Contents 1 Schedule at a Glance WEDNESDAY, SEPTEMBER 5, 2018 7:00 a.m. - 5:30 p.m. Registration/Information Desk Hours: International Foyer 7:00 a.m. - 5:30 p.m. Speaker Ready Room Hours: Royal Room 7:30 a.m.
    [Show full text]
  • Laboratory Guide 2020 Valid from 1St January 2020 TAP4232/31-12-19/V1C Laboratory Guide 2020 Valid from 1St January 2020
    Laboratory Guide 2020 Valid from 1st January 2020 TAP4232/31-12-19/V1C Laboratory Guide 2020 Valid from 1st January 2020 TDL Customer Charter We are committed to being the most helpful pathology service in the UK. Our goal is always to provide a high level of service to our customers, who request pathology services, for their patients. This is a philosophy shared by all Sonic Healthcare Pathology practices. We are medically led, and patients are our first concern. We always try to look to improve our operational expertise, and we strive to provide professional leadership within our specialities. We promise to provide easy access to our pathology services • We will always provide a friendly, helpful service. • Our automated laboratory departments operate 24 hours a day, 7 days a week, and we aim to achieve, or improve, our published turnaround times. • Our medical consultants and laboratory teams are available to provide additional clarification, advice or information for tests or results. We promise to help you • We invest in technical and operational excellence, with an extensive test repertoire, to ensure access to a leading-edge laboratory service. • We return results using the reporting method choice, in an as organised and safe way as possible. We promise to support the communities we work in • We do our utmost to provide a service, even during extreme external disruptions beyond our control. • We are committed to our staff’s continued professional development. • We have an organised programme to provide young people with work experience. • We support our local community. We promise to listen • We acknowledge customer issues, and try to resolve them promptly and consistently.
    [Show full text]
  • Bates' Guide to Physical Examination and History Taking
    Bates’ Guide to Physical Examination and History Taking, 11th Edition Chapter 13: Male Genitalia and Hernias Multiple Choice 1. A 28-year-old musician comes to your clinic, complaining of a “spot” on his penis. He states his partner noticed it 2 days ago and it hasn't gone away. He says it doesn't hurt. He has had no burning with urination and no pain during intercourse. He has had several partners in the last year and uses condoms occasionally. His past medical history consists of nongonococcal urethritis from Chlamydia and prostatitis. He denies any surgeries. He smokes two packs of cigarettes a day, drinks a case of beer a week, and smokes marijuana and occasionally crack. He has injected IV drugs before but not in the last few years. He is single and currently unemployed. His mother has rheumatoid arthritis and he doesn't know anything about his father. On examination you see a young man appearing deconditioned but pleasant. His vital signs are unremarkable. On visualization of his penis there is a 6-mm red, oval ulcer with an indurated base just proximal to the corona. There is no prepuce because of neonatal circumcision. On palpation the ulcer is nontender. In the inguinal region there is nontender lymphadenopathy. What disorder of the penis is most likely the diagnosis? A) Condylomata acuminata B) Genital herpes C) Syphilitic chancre D) Penile carcinoma Ans: C Chapter: 13 Page and Header: 516, Table 13–2 Feedback: Primary syphilis causes a larger ulcer that is firm and painless. Syphilis is fairly uncommon but does occur in the highly promiscuous population, especially when coupled with illegal drug use.
    [Show full text]
  • Contact Acrin Protocol Development And
    AMERICAN COLLEGE OF RADIOLOGY IMAGING NETWORK ACRIN 6659 MR IMAGING AND MR SPECTROSCOPIC IMAGING OF PROSTATE CANCER PRIOR TO RADICAL PROSTATECTOMY: A PROSPECTIVE MULTI-INSTITUTIONAL CLINICOPATHOLOGICAL STUDY Principal Investigator Jeffrey C. Weinreb, MD PARTIAL PROTOCOL— Chief of MRI, Professor of Radiology CONTACT ACRIN Yale University School of Medicine PROTOCOL Department of Radiology DEVELOPMENT AND 333 Cedar St., Room MRC 147 REGULATORY New Haven, CT 06520 COMPLIANCE FOR A Phone: 203-785-5913 Fax: 203-785-3061 COMPLETE PROTOCOL E-mail: [email protected] Spectroscopy Advisor Co-Principal Investigator John Kurhanewicz, PhD Fergus V. Coakley, MB BCh Magnetic Resonance Science Center Chief, Abdominal Imaging Section Department of Radiology Department of Radiology University of California San Francisco University of California, San Francisco 1 Irving Street, AC109 Box 0628, L-308, 505 Parnassus Ave. San Francisco, CA 94143-1290 San Francisco, CA 94143-0628 Phone: 415-476-0312 Phone: 415-353-1786 Fax: 415-476-8809 Fax: 415-476-0616 E-mail: [email protected] E-mail: [email protected] Pathology Advisor Statistical Advisor Thomas Wheeler, MD Jeffrey Blume, PhD The Methodist Hospital Center for Statistical Sciences Deputy Chief / Pathology Service Brown University, Box G-H 6565 Fannin, MS 205 Providence, RI 02912 Houston, TX 77030 Phone: 401-863-9968 Phone: 713-394-6475 Fax: 401-863-9182 Fax: 713-793-1603 E-mail: [email protected] E-mail: [email protected] Version Date: July 16, 2003 Activation Date: June 23, 2003 Including amendments #1-5 This protocol was designed and developed by the American College of Radiology Imaging Network (ACRIN).
    [Show full text]
  • There Will Be No Printed Programmes at BAUS 2018
    There will be no printed programmes at BAUS 2018 Please download the BAUS 2018 App: To download the BAUS 2018 App please search ‘BAUS Annual Scientific Meeting’ on the Apple or Android app stores. Once in the portal app simply press the tile titled “BAUS 2018” to access this year’s app. IOS App Store Download Android App Store Download Web App There will be no printed programmes at BAUS 2018 Please download the BAUS 2018 App: To download the BAUS 2018 App please search ‘BAUS Annual Scientific Meeting’ on the Apple or Android app stores. Once in the portal app simply press the tile titled “BAUS 2018” to access this year’s app. IOS App Store Download Android App Store Download Web App ISSN 2051-4158 JCU Volume 11 Issue 1S June 2018 Journal of Clinical Urology Formerly British Journal of Medical and Surgical Urology An official publication of The British Association of Urological Surgeons Editor: Ian Pearce Abstracts of the BAUS 2018 Annual Scientific Meeting 25-27 June 2018 ACC Liverpool, Liverpool Volume 11 Number 1S June 2018 Contents President’s Introduction 2 Kieran O’Flynn Original Article A Series of Fortunate Events: Harold Hopkins 4 Jonathan Charles Goddard BAUS 2018 Abstracts 9 Funding statement: This work was supported by The British Association of Urological Surgeons Limited. 772797URO Journal of Clinical UrologyIntroduction Introduction Journal of Clinical Urology 2018, Vol. 11(1S) 2 –3 President’s Introduction © British Association of Urological Surgeons 2018 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI:https://doi.org/10.1177/2051415818772797 10.1177/2051415818772797 journals.sagepub.com/home/uro On behalf of BAUS Council I am delighted to welcome (Cleveland, Ohio, USA) and Dr Frank van der Aa (Leuven, you to the 2018 Annual Scientific Meeting.
    [Show full text]
  • The Massachusetts Register
    Issue: 1151, Date: 3/5/2010 The Massachusetts Register Published by: The Secretary of the Commonwealth, William Francis Galvin, Secretary $10.00 The text of the regulations published in the electronic version of the Massachusetts Register is unofficial and for informational purposes only. The official version is the printed copy which is available from the State Bookstore at http://www.sec.state.ma.us/spr/sprcat/catidx.htm. Issue: 1151, Date: 3/5/2010 THE COMMONWEALTH OF MASSACHUSETTS Secretary of the Commonwealth - William Francis Galvin The Massachusetts Register TABLE OF CONTENTS Page - THE GENERAL COURT Acts and Resolves 1 - Division of Health Care Finance and Policy Administrative Bulletin 10-05: 114.3 CMR 47.00: Freestanding Ambulatory 3 Surgical Facilities - ADMINISTRATIVE PROCEDURES Notice of Public Review of Prospective Regulations 10 Cumulative Table 25 Emergency Regulations 31 Permanent Regulations 35 MASSACHUSETTS REGISTER (THE) (ISSN-08963681) is published biweekly for $300.00 per year by the Secretary fo the Commonwelath, State House, Boston, MA 02133. Second Class postage is paid at Boston, MA. POSTMASTER: Send address chagne to: Massachusetts Register, State Bookstore, Room 116, State House, Boston, MA 02133.The text of the regulations published in the electronic version of the Massachusetts Register is unofficial and for informational purposes only. The official version is the printed copy which is available from the State Bookstore at http://www.sec.state.ma.us/spr/sprcat/catidx.htm. Page Emergency Regulations 211 CMR Insurance, Division of 43.00 Health Maintenance Organizations (HMOs) 31 The purpose of 211 CMR 43.00 is primarily to implement M.G.L.
    [Show full text]
  • Behavioral Science and Social Sciences
    ﻣﻨﺘﺪﻯ ﺍﻓﺮﻳﻘﻴﺎ ﺳﺎﺕ )) www.afriqa-sat.com ﺍﳌﻬﻨﺪﺱ : ﻋﺒﺪﺍﻟﻌﺰﻳﺰ ﺍﻟﻀﺎﻭﻱ ﻟﻠﻤﺮﺍﺳﻠﺔ ﻋﻠﻰ ﺍﻟﻔﻴﺲ ﺑﻮﻙ ﺍﻟﻀﺎﻭﻱ ﺳﺎﺕ )) www.facebook.com/aldawi.sat USMLE® Behavioral Science STEP 1 and Social Sciences Lecture Notes 2016 USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), neither of which sponsors or endorses this product. This publication is designed to provide accurate information in regard to the subject matter covered as of its publication date, with the understanding that knowledge and best practice constantly evolve. The publisher is not engaged in rendering medical, legal, accounting, or other professional service. If medical or legal advice or other expert assistance is required, the services of a competent professional should be sought. This publication is not intended for use in clinical practice or the delivery of medical care. To the fullest extent of the law, neither the Publisher nor the Editors assume any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. © 2016 by Kaplan, Inc. Published by Kaplan Medical, a division of Kaplan, Inc. 750 Third Avenue New York, NY 10017 Printed in the United States of America 10 9 8 7 6 5 4 3 2 1 Course ISBN: 978-1-5062-0775-9 All rights reserved. The text of this publication, or any part thereof, may not be reproduced in any manner whatsoever without written permission from the publisher. This book may not be duplicated or resold, pursuant to the terms of your Kaplan Enrollment Agreement.
    [Show full text]
  • Understanding Icd-10-Cm and Icd-10-Pcs 3Rd Edition Pdf, Epub, Ebook
    UNDERSTANDING ICD-10-CM AND ICD-10-PCS 3RD EDITION PDF, EPUB, EBOOK Mary Jo Bowie | 9781305446410 | | | | | Understanding ICD-10-CM and ICD-10-PCS 3rd edition PDF Book Hysterectomy B-Lynch suture. Fluoroscopy Dental panoramic radiography X-ray motion analysis. Craniotomy Decompressive craniectomy Cranioplasty. Guidance on usage will follow Learn More. PCS Tables are organized in alphanumeric order in a series by Section, which is the first character of a code. Lymphadenectomy Neck dissection Retroperitoneal lymph node dissection Lymph node biopsy. Tenotomy Tendon transfer. ICD refers to the tenth edition of the International Classification of Diseases, which is a medical coding system chiefly designed by the World Health Organization WHO to catalog health conditions by categories of similar diseases under which more specific conditions are listed, thus mapping nuanced diseases to broader morbidities. View Here. Gynecological surgery. CPT remains the procedure coding standard for physicians, regardless of whether the physician services were provided in the inpatient or outpatient setting. Vasectomy Vasectomy reversal Vasovasostomy Vasoepididymostomy. Guidance on usage will follow. Thalamotomy Thalamic stimulator Pallidotomy. The letters O and I are excluded to avoid confusion with the numbers 0 and 1. WHO assumed oversight of the International Classification of Diseases ICD in with the main intention of tracking—and helping to eliminate—diseases within various populations. Tests and procedures involving the urinary system. Many countries now use national variations of ICD, each modified to align with their unique healthcare infrastructure. HZ None. Quantum computing challenges and opportunities While quantum computing is still under development, IT leaders should know how they can use it today to stay on the competitive Why are we changing from ICD-9? This will make it easier to start your search for the main term.
    [Show full text]