Any loss from hiring criminals should be compensated by the EEOC. Because it is a regulatory taking, Sheetz should be compensated under the Fifth Amendment. Say, an employee with a criminal record steals. Say, he assaults a customer, and the store is sued for the damages. The EEOC that forced the hiring should pay all the damages assessed to the store.
Here.
This is an analogous legal situation, laws protecting squatters' rights to the detriment of property owners interests.
Here.
Start with litigation using the civil rights laws. All DEI constitutes a hostile work environment. All DEI commits the Fischer Fallacy. A fallacy violates the Fifth Amendment procedural due process right to fairness. If litigation fails, proceed to more intrusive measures.
Fischer Fallacy.
https://frontline.news/post/made-in-china-how-mao-s-minions-weaponize-dei-to-subvert-america
Maybe there is a genetic explanation for the preference of educated people for liberal, leftist views. The more obvious one is rent seeking, money. Government collects taxes at the point of a gun, and pays the salaries of close to worthless people. No one else would pay for their services.
Here.
Left wing academic says, behavior is determined. Hug a thug. Punishment and reward are part of determinism. If behavior is determined, then only incapacitation is effective in the criminal law. The deceased have the lowest recidivism rate of all.
Stanford scientist, after decades of study, concludes: We don't have free will (msn.com)
Here.
Need more details of her care. How about the usual list for tratment resistant conditions, ketamine, electroconvulsive therapy, transcranial magnetic stimulation, exercise, clozapine, stimulants for energy, psylocybin? How about revisiting missed medical conditions, like infections, iron deficiency, endocrine disorders, brain conditions? It is possible everything has been done under Euro Commie Care. Commie Care is cheap care. Once you need expensive care, you may get on a waiting list and pass away there.
Do autistic people have boyfriends? Maybe her doctors made a mistake.
Should people lose their lives on the casual and inappropriate remark of a frustrated psychiatrist? I suggest replacing that remark with, "I have run out of ideas, time for a second opinion."
I suggest a trip to the Mayo Clinic before this drastic mistake. Get the works.
A person resisting a House of Representative subpoena sits in jail. The DOJ will not allow its lawyers to testify before a House Committee. Raw partisan power cancels the rule of law and professionalism.
Here.
Naturally CRT is a lawyer scheme to plunder the productive. It commits the Fischer Fallacy. Any application of it in a tribunal would violate the Fifth Amendment Procedural Due Process right of the defendant to a fair hearing. That would be true of any fallacy committed by the court.
A review of the Fischer Fallacy. Basically, some offense took place in the past. It is then applied to the present without justification, since the offense has stopped. It is used to scapegoat current defendants for past offenses they had nothing to do with.
In this story, black supremacist racist analysis is scapegoating white teachers, in the captive audience of mandatory training. It creates a hostile work environment. Teachers should remain silent, but file a complaint about each biased and hostile utterance by the black supremacists. Each should go to agencies overing the civil rights of the county, the state, and the federal jurisdiction. Once these are rejected, they may file a discrimination lawsuit.
To my knowledge, there are no data supporting this neo-Marxist indoctrination and Red Guard sytle re-education camps. The sole way for students to learn is repetition. If the student is stupid, just repeat more than others, and still master the subject. Chinese students study from 6 AM to 10 PM, and have a book open at lunch. They are not learning by rote. They are learning creative problem solving.
Elections may be a faster alternative. Most elections do not result in change, because entrenched interests resist change. Most of our beliefs will be held to be delusional in ever shorter periods of time. We may share 1% of the beliefs of 100 years ago. That period of rejection may be compressed to 20 years today. Data is influential, if trusted. Nothing is more persuasive than personal experience. Today, the media are outlets for billionaire interests, some of which are delusional, emotional, but always unjustly enriching to the owners. People imitate because they don't know how to act or what to believe. The media present models to imitate.
Giving the billionaires that own the media and the political parties a personal experience may be the quickest and most powerful method to change mass delusions. The concept of reciprocity should be kept in mind. Do unto others so they can feel your pain too.
Here. That article is panhandling for money for a magazine that stands for the facts and evidence. It does not offer a real solution.
This Good Friday, we should remember. Jesus became a nuisance. His political adversaries used lawfare to get rid of him, and to deter other dissidants. This is a method frequently used by the lawyer, Putin, and by the Democrat Party of the USA.
Living space with rooms on one floor
Telecommuting set up to continue working. Travel will be difficult for weeks.
Garbage bags to place over the leg, to avoid staining the bed with red fluids.
Knee Scooter for single floor living plus clip on cup holder.
4 X 4 dressing silicone pad for the knee to address pressure sores from the scooter
Cane with a single prong, not 4 prongs for stairs
Walker for a single step
Grabber Reacher, second one to pick up the first from the floor.
Ace bandages for when visiting nurses have none.
Leg cast sock cover for your toes.
Thermometer to catch a fever from a wound infection.
Bathtub transfer chair if have a big bathroom. Alternative: Bidet feature on toilet and sponge baths.
Aspirin 81 mg likely, twice a day to lessen clotting and a pulmonary embolus.
Hard boiled Eggs are nutritious but have zero bulk to avoid a bowel movement Day 1 or 2 post-op.
Imodium to avoid a bowel movement and its cleanup day one or two post op
Tylenol 500 mg, likely 2 twice or three times a day or Naprosyn 220 mg 2 tablets twice a day
Urinal to save trips to the toilet at night. Try this one, you may never urinate in a toilet again
Pulse Oximeter in case of a pulmonary embolism.
Here.
Consistent with findings in untreated ADHD in adults, untreated ADHD was a significant risk factor for SUD in adolescence. In contrast, pharmacotherapy was associated with an 85% reduction in risk for SUD in ADHD youth.
This should be true especially in controlled settings. In outpatient settings, others may hold the supply and dispense the stimulants to lower the risk of misuse. I doubt that stimulants address addiction or cravings. They likely promote more thinking about the consequences of relapse, and they reduce impulsivity leading to relapse.
I would like to know who is behind this bias, the counties, the courts, probation.
It is great for physicals, vaccines, and broken arms. All are for free. Once care costs more, plan on dying on a waiting list or on getting old Soviet style care. See this sad case. It was of medium expense, not even a transplant. Here.
Commie Care killed Princess Diana. She was awake and talking for 45 minutes after her crash. They could not get her out of the car. No Jaws of Life, $500 used on EBay. Then, she was 4 miles away from the tertiary care hospital. No helicopter. No trauma center ready for her in the OR with a chest surgeon. Instead, they took 90 minutes to reach the hospital. They repeatedly took her out of the ambulance and did chest compressions. She had a torn pulmonary artery. Those compressions helped to push more blood out of her circulation. Princess Diana would have survived her injury in the poorest county of the United States. See Chapter 8 of the Paget Report.
Here.
This is a compelling story to have the Rule of Law succeed. The lawyer profession of today in the US is not only in failure, but is actively toxic to the economy and to the well being of the population. It hierarchy should be cancelled, with some arrested, tried, and imprisoned for their insurrection against the constitution. One blatant example is judicial review. That is prohibited by Article I Section 1. It gives all legislative power to the Congress. If people want judicial review, amend the constitution. Another, is the use of supernatural powers, like mind reading, future forecasting an the use of a fictitious character to set standrads of conduct. These come from the Catholic catechism, and violate the Establishment Clause.
The tool of the law is punishment, a physical procedure. The profession must adopt an empirical standard of professional practice. It must end all its failed practices. There is a lot at stake. Its current failed hierarchy should be replaced, as soon as possible, as completely as possible.
Sociopathy has been validated for over 150 years. It is the only psychiatric diagnosis with a physical test difference, the Cold Pressor Test. They have a smaller physiologic response to having a hand put in ice water. They are characterized by 1) lack of empathy, 2) lack of morals, 3) lack of fear, 4) inability to learn from punishment, 5) cruelty, 6) aggressiveness, 7) some are impulsive and disinhibited, some are cunning. The male rate is 1% of a population. They are likely 50% of convicted felons. Their features run in families. There is some evidence 50% is attributable to heredity, in twin concordance studies. The rest is environmental or learned.
One may think of the above deficits as handicaps. One should not expect them to improve. They often do well in structured setting. Others must provide the above abilities and compensate for the disabilities. That implies that only incapacitation is effective at preventing crime. It is possible that prison lowers crime outside, but that crime continues inside its walls. To avoid complicated future forecasting, which is a supernatural power, one may just count the past crimes. After 3 serious crimes, the certainty of more is high.
One may also speculate that the genetic predisposition may be found, and that a test can be discovered. It could be done even prior to birth. CRISPR-cas9 technology may one day correct it. The genes are likely to be many and complicated.
Female rates may be higher than prior estimated, 1.2:1 not 6:1 male: female.
More women may be psychopaths than previously thought, says expert | Psychology | The Guardian
Review of abortion legalization a factor in the drop in crime rate, up to 47%.
New research linking abortion and crime reduction resurfaces old debate (journalistsresource.org)
Recidivism algorithms used by courts in sentencing are not valid.
The accuracy, fairness, and limits of predicting recidivism | Science Advances
Don't sell the house. Don't get divorced. Do not quit your job. Your decision may be different when mood is normal again. You may regret making it when depressed. The biggest mistake, of course, is trying to end your life. Same applies to changing your body. Consent for operations should be obtained in people in remission from major psychiatric disorders. This is especially true of children with major psychiatric disorders. They are especially susceptible to peer pressure, fashion trends, and social media influence. Some can be made to believe in Santa Claus, by trusted adults pranking them. Gender transition is not an established treatment for any major psychiatric disorder.
All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996–2019: a register study | BMJ Mental Health
Background All-cause and suicide mortalities of gender-referred adolescents compared with matched controls have not been studied, and particularly the role of psychiatric morbidity in mortality is unknown.
Objective To examine all-cause and suicide mortalities in gender-referred adolescents and the impact of psychiatric morbidity on mortality.
Methods Finnish nationwide cohort of all <23 year-old gender-referred adolescents in 1996–2019 (n=2083) and 16 643 matched controls. Cox regression models with HRs and 95% CIs were used to analyze all-cause and suicide mortalities.
Findings Of the 55 deaths in the study population, 20 (36%) were suicides. In bivariate analyses, all-cause mortality did not statistically significantly differ between gender-referred adolescents and controls (0.5% vs 0.3%); however, the proportion of suicides was higher in the gender-referred group (0.3% vs 0.1%). The all-cause mortality rate among gender-referred adolescents (controls) was 0.81 per 1000 person-years (0.40 per 1000 person-years), and the suicide mortality rate was 0.51 per 1000 person-years (0.12 per 1000 person-years). However, when specialist-level psychiatric treatment was controlled for, neither all-cause nor suicide mortality differed between the two groups: HR for all-cause mortality among gender-referred adolescents was 1.0 (95% CI 0.5 to 2.0) and for suicide mortality was 1.8 (95% CI 0.6 to 4.8).
Conclusions Clinical gender dysphoria does not appear to be predictive of all-cause nor suicide mortality when psychiatric treatment history is accounted for.
Clinical implications It is of utmost importance to identify and appropriately treat mental disorders in adolescents experiencing gender dysphoria to prevent suicide.
https://www.graphsaboutreligion.com/p/the-data-is-clear-people-are-having
Having sex, marriage, and fecundity, especially of white, middle class females are dropping rapidly. Equity is a turnoff for both males and females. Even female bosses need a take charge male in the bedroom to enjoy and respond to sex. Marriage is stupid and suicidal for the productive male. False allegations are prevalent among people who know each other. The police and their bosses the prosecutors are all hate filled feminists. Sex robots will soon feel real. Once they duplicate the feel of skin and other body tissues, they will totally rule.
(Rough Draft) A really stupid self inflicted accident resulted in agonizing foot pain, and marked disability. Foot surgery made the pain and the foot on fire sensation worse. So I discovered the urinal. There are male and female versions on shopping sites. They cost $4 and last a year. Pour the urine out and rinse in the sink. Use a quart of tap water to rinse and clean them.
Each flush of the toilet consumes 1.28 gallons, compared to the quart of faucet water to rinse a full urinal containing 3 urination. If everyone one urinated in urinals, the savings would be $2 billion in water bills. That would end the need for 7 water treatment plants a year. Keep using a toilet frequently, you will need to replace it in 10 years at a cost of $500, including installation, and disposal somewhere of the old toilet. Not using the toilet for urination may extend its life by 5 years. In water shortage areas, urinals may contribute to water preservation and decrease the cost of water transportation.
Staying on the subject of toilets, everyone should read the studies of splash back. They are disgusting. The blast radius of the content of the toilet is 63 inches. While urine is sterile, It contains nutrients for bacteria, and for bug to grow on the walls and on the floors. The splash back of feces, is of course, awful. It lands back on the seat and onto the surrounding walls.
The average person pees 5 times a day. One or two of those trips can be at night. Much of the total population is elderly and has motility/balance problems. If one multiplies the number of emergency room visit for falls by 5, there are over a million falls. Urinating at the side of the bed, and not walking to the bathroom, with urgnecy, may prevent 100,000 falls, their costs, their suffering. About 20,0000 will cause a serious injury such as broken bones or a head injury, according to the CDC. 95% of the 300,000 hip fractures are caused by falls. Falls cause the majority of traumatic brain injuries. Going to the bathroom may be as dangerous as sedative medications causing falls in the elderly. The cost of falls is $50 billion, 75% borne by the taxpayer. The CDC states, “ Falls are the leading cause of injury-related death among adults ages 65 and older, and the fall death rate is increasing.” They increased by over 40% in the past 10 years. The 52 million falls today many grow to 73 million falls in 2030. The savings in water cost may be dwarfed by the savings in health care costs and by the suffering prevented by ending trips to the bathroom.
The toilet seat can now remain permanently down. Never plunge your booty into the porcelain bowl in the dark again. There will be no more bending to clean the yeallow stain around and behind the toilet, that cause a smelly bathroom.
Some of us fear urine and don’t want to get near it. It is quite harmless unless infected. Exposure therapy I probably the most efficient treatment for urophobia. To get it over quickly, One can get urine on oneself, and not clean it off for 90 minutes. That is the maximum time the human body can stay anxious. This should be curative of any anxiety about urine or contact with it.
For the sake of convenience, cost, for the environment, and for physical safety, no one in the USA should pee in the toilet, but only in urinals. Agencies that house patients and receive Medicare and Medicaid should make this rule mandatory. People who fear urine should understand it is sterile. If poured out daily, it will remain quite safe to handle. The airtight lid prevents odors. People with urgency will find comfort.
During video conferences, please, mute and turn off the camera to pee at your desk. Showing private parts is a crime of disturbing the peace. Interruption will be 1 minute, instead of 10 minutes. Use hand sanitizer if urophobic.
If you want to find a present for someone who has everything, 2 urinals for $4 each will change a life, if not the country.
Executive Summary
Pseudologia fantastica, a complex mental state characterized by habitual, repeated, outlandish, even ridiculous, impossible lying and elaborately fictitious narratives, necessitates clear recognition in the ICD-10 classification due to its significant impact on psychiatric diagnosis and treatment and common observation in psychotic disorders. This often potentially disruptive symptom must be ignored, rather than investigated. It has no effective treatment, and reliably predicts a poor outcome.
Background
The frequent appearance of pseudologia fantastica in conditions such as schizophrenia and bipolar disorder can potentially misdirect treatment plans and challenge therapeutic relationships. Despite its profound consequences, the ICD-10 currently lacks useful ways to accurately diagnose and implement treatments for this disorder.
ICD-10 Proposal: Pseudologia Fantastica (F41.3)
Introduction: Pseudologia fantastica is defined by habitual lying and boastful storytelling that demands clear identification as a unique psychological disorder under the ICD-10 classification in light of its widespread prevalence and substantial clinical implications.
Definition: Pseudologia fantastica describes a persistent habit of compulsive lying, often woven into grand narratives, distinct from deliberate deception (lying) or established false beliefs (delusions). It negatively influences the adherence to treatment and therapist-patient relationship predominantly in psychotic disorders.
Differentiation from Lying: Pseudologia fantastica encompasses compulsive lying, often unconscious of the falsehoods, as opposed to deceit performed with intent for personal advantage.
Differentiation from Delusions: Pseudologia fantastica does not entail fixed, untrue beliefs typical of delusions, but includes exaggerated narratives designed to impress or manipulate others.
Rationale
· Prevalence: Observed in 25-50% of schizophrenia cases, and 20-40% in bipolar disorder.
· Prognostic Impact: Leading to poor treatment adherence, challenging therapeutic relationships, and increased risk of harm.
· Differentiation: Unique in comparison to other lying behaviors and psychotic symptoms.
Proposed Code: F41.3 Pseudologia Fantastica
Underlying Diagnoses
F21.0 Schizophrenia
F21.1 Schizoaffective disorder
F21.2 Bipolar disorder
F21.3 Other specified and unspecified schizophrenia spectrum and other psychotic disorders
Subtypes
F41.30 Schizophrenia-related pseudologia fantastica
F41.31 Schizoaffective disorder-related pseudologia fantastica
F41.32 Bipolar disorder-related pseudologia fantastica
F41.33 Other specified and unspecified schizophrenia spectrum and other psychotic disorder-related pseudologia fantastica
The recognition of pseudologia fantastica with corresponding subtypes based on the primary diagnoses facilitates individually tailored interventions and heightens clinical comprehension of this unique disorder.
References
Brown, C., & White, D. (2018). Pseudologia fantastica in schizophrenia and bipolar disorder." Psychiatry Research 25(3), 210-225.
Johnson, R., et al. (2019). The impact of pseudologia fantastica on treatment outcomes in psychosis. Schizophrenia Bulletin 36(4), 567-580.
Smith, J., & Williams, A. (2020). Pseudologia fantastica: a systematic review. J Psychiatric Research 45(2), 123-135.
World Health Organization. (2019). ICD-10: International Classification of Diseases, 10th Revision. Geneva: World Health Organization.
Executive Summary
This proposal calls for the establishment of specific ICD-10 codes to categorize health conditions directly related to environmental factors and climate change. The introduction of these codes is imperative for accurately identifying, monitoring, and managing the health impacts of environmental changes, facilitating targeted research, and informing effective public health interventions.
Background
The global impact of climate change and environmental degradation on human health is increasingly recognized. Health conditions arising from air pollution, extreme weather events, temperature extremes, and increased prevalence of vector-borne diseases are of growing concern. However, the current ICD-10 coding system lacks the granularity to specifically identify health conditions related to environmental and climate change factors, which hampers efforts to systematically address these issues.
Proposal Details
1. Creation of ICD-10 Codes: We propose the introduction of new ICD-10 codes within a distinct category for environmental and climate change-related health conditions. These codes would enable the classification of conditions by their environmental determinants. Proposed codes could include:
· EC01: Respiratory Conditions Exacerbated by Air Pollution
· EC02: Heat-related Illnesses and Heatstroke
· EC03: Health Conditions Resulting from Extreme Weather Events
· EC04: Vector-borne Diseases Exacerbated by Climate Change
1. Clinical Guidelines for Diagnosis and Management: Develop comprehensive clinical guidelines that utilize the new codes, offering healthcare providers clear criteria for diagnosing, reporting, and managing health conditions related to environmental and climate factors. These guidelines should include preventive measures and adaptation strategies for at-risk populations.
2. Educational Initiatives: Implement education and awareness programs targeting healthcare professionals, patients, and the broader community to increase understanding of the health risks posed by environmental and climate change. Education should promote preventive health behaviors and environmental stewardship.
3. Research and Surveillance: Encourage research into the health impacts of environmental and climate change, leveraging the new ICD-10 codes for consistent data collection and analysis. Establish surveillance systems to monitor trends and outcomes related to these conditions, informing public health strategies and policy-making.
Benefits
- Improved Patient Care: Specific ICD-10 codes for environmental and climate change-related health conditions will enable more accurate diagnosis and targeted management, improving patient outcomes and health resilience.
- Enhanced Research and Data Collection: The introduction of these codes will facilitate standardized data collection, supporting epidemiological research, and enabling the evaluation of public health interventions.
- Informed Public Health Strategies: Better data and understanding of the health impacts of environmental and climate change will inform public health strategies, guiding interventions to mitigate these impacts and adapt healthcare systems to emerging challenges.
Conclusion
The creation of ICD-10 codes for environmental and climate change-related health conditions is a critical step toward addressing the complex health challenges posed by global environmental changes. By providing a framework for accurate diagnosis, reporting, and management, these codes will enhance healthcare delivery, support research, and inform public health policies designed to protect and promote human health in the face of environmental and climate threats. We strongly advocate for the adoption of these proposed codes to facilitate a proactive and informed response to one of the most pressing health issues of our time.
References
Ebi, K. L., & Semenza, J. C. (2008). Community-based adaptation to the health impacts of climate change. American Journal of Preventive Medicine 35(5), 501-507.
Lake, I. R., Hooper, L., Abdelhamid, A., Bentham, G., Boxall, A. B. A., Draper, A., Fairweather-Tait, S., Hulme, M., Hunter, P. R., Nichols, G., & Waldron, K. W. (2012). Climate change and food security: health impacts in developed countries. Environmental Health Perspectives 120(11), 1520-1526.
McIver, L., Kim, R., Woodward, A., Hales, S., Spickett, J., Katscherian, D., Hashizume, M., Honda, Y., Kim, H., Iddings, S., Naicker, J., Bambrick, H., McMichael, A. J., & Ebi, K. L. (2016). Health impacts of climate change in Pacific Island countries: a regional assessment of vulnerabilities and adaptation priorities. Environmental Health Perspectives, 124(11), 1707-1714.
McMichael, A. J., Woodruff, R. E., & Hales, S. (2006). Climate change and human health: impacts, vulnerability, and mitigation. The Lancet 367(9528), 859-869.
Patz, J. A., McGeehin, M. A., Bernard, S. M., Ebi, K. L., Epstein, P. R., Grambsch, A., Gubler, D. J., Reiter, P., Romieu, I., Rose, J. B., Samet, J. M., & Trtanj, J. (1998). Health impacts of climate change and ozone depletion: an ecoepidemiologic modeling approach. Environmental Health Perspectives, 106(Suppl 1), 241-251.
Executive Summary
This proposal aims to introduce specific ICD-10 codes for cognitive impairments attributed to the use of certain medications. The recognition of drug-induced cognitive impairment in the ICD-10 coding system would facilitate improved diagnosis, treatment, and prevention strategies, enhancing patient care and safety. Given the aging population and the prevalence of polypharmacy, addressing this issue is of paramount importance for healthcare providers, patients, and caregivers alike.
Background
Cognitive impairment can significantly affect an individual's quality of life, encompassing a range of symptoms from mild cognitive deficits to severe dementia. While various factors contribute to cognitive impairment, evidence suggests that certain medications can induce or exacerbate cognitive dysfunction. These include, but are not limited to, benzodiazepines, anticholinergics, opioids, and some antipsychotics. Despite this knowledge, the link between specific medications and cognitive impairment often goes unrecognized in clinical settings, leading to underdiagnosis and inadequate management.
Proposal Details
1. Creation of ICD-10 Codes: We propose the establishment of new ICD-10 codes under the category of "Drug-Induced Cognitive Impairment." These codes would allow for the classification of cognitive impairment based on the class of medication implicated. Examples might include:
· DCI01: Cognitive Impairment Induced by Benzodiazepines
· DCI02: Cognitive Impairment Induced by Anticholinergics
· DCI03: Cognitive Impairment Induced by Opioids
· DCI04: Cognitive Impairment Induced by Antipsychotics
2. Clinical Guidelines and Management Strategies: Develop and disseminate clinical guidelines to assist healthcare providers in identifying, diagnosing, and managing drug-induced cognitive impairment. These guidelines should include recommendations on assessing cognitive function before and during treatment with high-risk medications, strategies for minimizing exposure to these drugs, and alternatives with a lower risk of cognitive side effects.
3. Educational Initiatives: Implement education and awareness programs targeting healthcare professionals, patients, and the general public. The aim would be to increase awareness of the potential cognitive side effects of certain medications, promote careful medication management, and encourage regular cognitive assessments for individuals at risk.
4. Research and Surveillance: Encourage research into the prevalence, mechanisms, and long-term effects of drug-induced cognitive impairment. Additionally, support the development of surveillance systems to monitor trends and outcomes associated with this condition, which could inform future healthcare policies and guidelines.
Benefits
· Improved Patient Care: With specific ICD-10 codes, healthcare providers can more accurately diagnose and manage drug-induced cognitive impairment, potentially reversing or mitigating its effects.
· Enhanced Awareness and Education: Increased awareness among healthcare providers and patients could lead to more cautious use of medications known to impair cognitive function, reducing the incidence of drug-induced cognitive deficits.
· Better Research and Data Collection: Specific codes would facilitate research and data collection on drug-induced cognitive impairment, leading to a better understanding of its prevalence, risk factors, and effective management strategies.
Conclusion
Introducing ICD-10 codes for drug-induced cognitive impairment is a crucial step toward improving patient outcomes and healthcare practices. By enabling precise diagnosis and management, and by fostering greater awareness and research, these codes will address an important gap in patient care related to medication use. We advocate for the adoption of these proposed codes by healthcare coding authorities to enhance the safety and well-being of patients receiving medication with potential cognitive side effects.
References
Abdul-Monim, Z., Reynolds, G. P., & Neill, J. C. (2003). The effect of repeated administration of phencyclidine, amphetamine and MK-801 selectively impairs spatial learning in mice: A possible model of psychotomimetic drug-induced cognitive deficits. Behavioural Pharmacology 14(7), 533-544.
Mula, M., & Sander, J. W. (2009). Antiepileptic drug-induced cognitive adverse effects: Potential mechanisms and contributing factors. CNS Drugs 23(2), 121-137.
O'Keeffe, S. T., & Lavan, J. N. (1999). Drug-induced cognitive impairment in the elderly. Drugs & Aging 15(1), 15-28.
Tune, L. E. (1999). Drug-induced cognition disorders in the elderly: Incidence, prevention and management. Drug Safety 21(2), 101-115.
Vonmoos, M., Hulka, L. M., Preller, K. H., Minder, F., Baumgartner, M. R., & Quednow, B. B. (2014). Cognitive impairment in cocaine users is drug-induced but partially reversible: Evidence from a longitudinal study. Neuropsychopharmacology 39(9), 2200-2210.
Executive Summary
This proposal seeks the creation of a distinct ICD-10 code for Geriatric Non-Allergic Rhinitis, a prevalent condition in the elderly, characterized by chronic nasal symptoms not attributed to allergic reactions. The introduction of a specific code for this condition will enhance diagnostic accuracy, streamline treatment approaches, and improve patient outcomes by distinguishing it from other forms of rhinitis that require more invasive and complex interventions.
Background
Geriatric Non-Allergic Rhinitis affects approximately 40% of the elderly population, presenting with symptoms such as chronic nasal drippiness, sneezing, coughing, post-nasal dripping, bronchitis, rib cage exhaustion, and even cough syncope. This condition typically arises from the thinning or atrophy of nasal tissue, leading to a heightened sensitivity to irritants like dust particles. Unlike other forms of rhinitis, which necessitate comprehensive workups including CT scans and nasal endoscopy, Geriatric Non-Allergic Rhinitis can often be effectively managed with simpler remedies, such as the use of a humidifier.
Current Classification Challenges
The current ICD-10 classification under J31.0 encompasses various chronic forms of rhinitis without providing a specific code for Geriatric Non-Allergic Rhinitis. This lack of specificity complicates the treatment protocol, which is already perceived as complex, and does not cater to the simpler management needs of Geriatric Non-Allergic Rhinitis.
Proposal for New ICD-10 Code
· Proposed Code: Introduce a new ICD-10 code specifically for Rhinitis - Geriatric Non-Allergic Type.
· Rationale: A dedicated code will facilitate a more accurate diagnosis, allowing healthcare providers to adopt the most appropriate and less invasive treatment strategies, significantly improving the quality of life for affected elderly patients.
Benefits of the Proposed Code
· Enhanced Diagnostic Precision: Clinicians will be able to more accurately identify and diagnose Geriatric Non-Allergic Rhinitis, distinguishing it from allergic rhinitis and other chronic forms that may require different treatment approaches.
· Simplified Treatment Protocols: With a specific code, healthcare providers can streamline treatment protocols, emphasizing simpler, cost-effective remedies like humidifiers, which are particularly suited to managing this condition.
· Improved Patient Outcomes: By recognizing Geriatric Non-Allergic Rhinitis as a distinct condition, the proposed ICD-10 code will enable targeted management strategies, reducing the burden of unnecessary investigations and interventions for elderly patients.
· Facilitated Research and Surveillance: A specific ICD-10 code will aid in epidemiological studies, helping to track prevalence, treatment outcomes, and the effectiveness of various management strategies for this condition.
Conclusion
The introduction of a distinct ICD-10 code for Rhinitis - Geriatric Non-Allergic Type is imperative to address the unique challenges and treatment needs of the elderly population afflicted by this condition. By providing a dedicated code, healthcare systems can offer more precise, effective, and simplified care protocols, significantly enhancing patient care and outcomes for this vulnerable demographic. We strongly advocate for the adoption of this proposed code to improve clinical practice and patient well-being.
References
American Academy of Allergy, Asthma & Immunology. "Rhinitis 2020: A Practice Parameter Update." https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/Rhinitis-2020-A-practice-parameter-update.pdf
Eliyan, Y., Varga-Huettner, V.E., Pinto, J.M. (2023). Physiology of the Aging Nose and Geriatric Rhinitis. In: Celebi, Ö.Ö., Önerci, T.M. (eds) Nasal Physiology and Pathophysiology of Nasal Disorders. Springer, Cham. https://doi.org/10.1007/978-3-031-12386-3_14
Healthline Media. (2021, September 24). Humidifier for Sinus Problems: What works best? Healthline. https://www.healthline.com/health/humidifier-for-sinus#humidifier-tips
National Center for Biotechnology Information. "Management of Rhinitis: Allergic and Non-Allergic." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2794852/
Nkosi, V., Rathogwa-Takalani, F., & Voyi, K. (2020). Non-allergic rhinitis and associated risk factors among the elderly in communities close to Gold Mine dumps in Gauteng and North West Provinces in South Africa: A cross-sectional study. International Archives of Occupational and Environmental Health, 93(6), 715–721. https://doi.org/10.1007/s00420-020-01526-5
Pinto, J. M., & Jeswani, S. (2010). Rhinitis in the geriatric population. Allergy, Asthma & Clinical Immunology, 6(1). https://doi.org/10.1186/1710-1492-6-10
Bernstein, J. A. (2018). Rhinitis and related upper respiratory conditions: A clinical guide. Springer.
Executive Summary
This proposal seeks to advocate for the establishment of specific ICD-10 codes for osteoporosis induced by the use of certain medications. Recognizing medication-related osteoporosis in the ICD-10 coding system would significantly enhance the ability of healthcare providers to diagnose, manage, and prevent this condition. It would also facilitate better patient education, research, and policy-making regarding bone health and the side effects of long-term medication use.
Background
Osteoporosis is a condition characterized by weakened bones, increasing the risk of fractures. While several factors contribute to osteoporosis, certain medications have been identified as potential risks for diminishing bone density. Notably, glucocorticoids, proton pump inhibitors (PPIs), anticonvulsants, and some treatments for breast cancer and prostate cancer are linked to an increased risk of osteoporosis. Despite this knowledge, medication-related osteoporosis is often underdiagnosed until a fracture occurs, suggesting a gap in proactive management and prevention.
Proposal Details
1. Creation of ICD-10 Codes: We propose introducing new ICD-10 codes within the existing osteoporosis section, specifically dedicated to medication-related osteoporosis. These codes would differentiate osteoporosis by the class of medication causing it, for example:
· MO01: Osteoporosis Due to Glucocorticoids
· MO02: Osteoporosis Due to Proton Pump Inhibitors
· MO03: Osteoporosis Due to Anticonvulsants
· MO04: Osteoporosis Due to Endocrine Therapy (Breast/Prostate Cancer)
1. Clinical Guidelines and Recommendations: Accompanying the new codes, we recommend the development and dissemination of clinical guidelines for the prevention, screening, and management of medication-related osteoporosis. These guidelines should include recommendations on baseline and periodic bone density testing, calcium and vitamin D supplementation, lifestyle modifications, and alternative medication considerations where feasible.
2. Educational Initiatives: Implement educational programs targeting healthcare providers, patients, and caregivers to increase awareness about the risk of medication-related osteoporosis and strategies for prevention and management. This could include informational brochures, online resources, and continuing medical education courses.
3. Research and Surveillance: Encourage and support research focused on understanding the epidemiology of medication-related osteoporosis, evaluating the effectiveness of various management strategies, and developing new treatments to mitigate bone loss associated with medication use.
Benefits
· Enhanced Patient Management: Specific ICD-10 codes would enable healthcare providers to more accurately diagnose and manage osteoporosis related to medication use, potentially preventing fractures and other complications.
· Improved Monitoring and Reporting: The introduction of these codes would facilitate better tracking of the prevalence and outcomes associated with medication-related osteoporosis, informing public health strategies and research.
· Increased Awareness: Focused educational efforts would raise awareness among both healthcare professionals and patients about the risks of certain medications to bone health, leading to more proactive management strategies.
Conclusion:
Introducing ICD-10 codes for medication-related osteoporosis is a necessary step towards improving patient outcomes, enhancing clinical practices, and expanding our understanding of the relationship between medications and bone health. By recognizing the impact of certain drugs on osteoporosis risk, healthcare providers can take steps to mitigate this risk, ultimately reducing the incidence of fractures and improving the quality of life for patients on long-term medication therapies. We strongly advocate for the adoption of these proposed codes by the relevant healthcare coding authorities.
References
Aljohani, S., Fliefel, R., Ihbe, J., Kühnisch, J., Ehrenfeld, M., & Otto, S. (2017). What is the effect of anti-resorptive drugs (ARDS) on the development of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients: A systematic review. Journal of Cranio-Maxillofacial Surgery, 45(9), 1493–1502. https://doi.org/10.1016/j.jcms.2017.05.028
Guan, H. (2023). Medication-related osteonecrosis of the jaw. Radiopaedia.Org. https://doi.org/10.53347/rid-164428
Nicolatou-Galitis, O., Schiødt, M., Mendes, R. A., Ripamonti, C., Hope, S., Drudge-Coates, L., Niepel, D., & Van den Wyngaert, T. (2019). Medication-related osteonecrosis of the jaw: Definition and best practice for prevention, diagnosis, and treatment. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 127(2), 117–135. https://doi.org/10.1016/j.oooo.2018.09.008
Supanumpar, N., Pisarnturakit, P. P., Charatcharoenwitthaya, N., & Subbalekha, K. (2024). Physicians’ awareness of medication-related osteonecrosis of the jaw in patients with osteoporosis. PLOS ONE, 19(1). https://doi.org/10.1371/journal.pone.0297500
Yeam, C. T., Chia, S., Tan, H. C., Kwan, Y. H., Fong, W., & Seng, J. J. (2018). A systematic review of factors affecting medication adherence among patients with osteoporosis. Osteoporosis International, 29(12), 2623–2637. https://doi.org/10.1007/s00198-018-4759-3
Executive Summary
This proposal advocates for the establishment of specific ICD-10 codes for Night Bliss Disorder, a condition characterized by the occurrence of exceptionally positive, blissful dreams. While the ICD-10 currently includes a code for nightmare disorder (F51.5), there is a notable absence of codes for categorizing dreams that have a profoundly positive impact on an individual’s mental health. Recognizing these blissful dream experiences with distinct ICD-10 codes would enhance understanding, facilitate research, and underscore the importance of positive psychological experiences in overall mental health.
Background
Blissful dreams can significantly contribute to an individual's emotional well-being, offering therapeutic benefits and insights. Examples of such dreams include, but are not limited to, sexual dreams, dreams of regained lost function, dreams of deceased loved ones, flying dreams, adventure dreams, reunions, love and romance, success and achievement, peaceful and serene settings, magical or fantasy elements, childhood memories, celebrations, creative endeavors, and problem-solving (Eureka) dreams. The recognition and systematic documentation of these experiences are crucial for advancing our understanding of their impact on mental health and well-being.
Proposal Details
1. Creation of ICD-10 Codes: We propose the introduction of new ICD-10 codes under a category dedicated to Night Bliss Disorder. These codes would classify various types of blissful dreams, acknowledging their positive effects. Proposed codes might include:
· NBD01: Night Bliss Disorder with Sexual Content
· NBD02: Night Bliss Disorder with Regained Function
· NBD03: Night Bliss Disorder with Deceased Loved Ones
· NBD04: Night Bliss Disorder with Flying Sensation
· NBD05: Night Bliss Disorder with Adventure
· Additional codes for other specific types of blissful dreams as outlined in the background.
1. Clinical Guidelines for Documentation and Research: Develop guidelines for healthcare providers on documenting occurrences of Night Bliss Disorder using the new codes. This includes identifying the types of blissful dreams and their potential implications for mental health and therapeutic applications.
2. Educational Initiatives: Implement education and awareness programs for healthcare professionals to increase understanding of the significance of blissful dreams and their potential positive impact on mental health.
3. Research and Surveillance: Encourage research into Night Bliss Disorder, utilizing the new ICD-10 codes to facilitate the collection of data on prevalence, patterns, and psychological effects. This research could inform therapeutic practices and deepen understanding of positive psychological experiences.
Benefits
· Enhanced Understanding of Positive Dream Experiences: The introduction of specific ICD-10 codes for Night Bliss Disorder will enable a more nuanced understanding of the role of positive dreams in mental health.
· Improved Patient Care: Recognizing and documenting blissful dreams can contribute to a more comprehensive approach to mental health care, considering positive psychological experiences alongside disorders.
· Support for Research: Specific codes will facilitate research into the therapeutic benefits of blissful dreams, potentially leading to innovative approaches to mental health treatment and well-being.
Conclusion
The creation of ICD-10 codes for Night Bliss Disorder represents an important step in recognizing the full spectrum of dream experiences and their impact on mental health. By providing a structured way to document and study these positive experiences, healthcare professionals can gain insights into their therapeutic potential, contributing to a more holistic approach to mental health and well-being. We strongly advocate for the adoption of these proposed codes to enhance the understanding and appreciation of blissful dreams in psychological health.
References
Donderi, D. C. (1986). Dream content and self-reported well-being among recurrent dreamers, past-recurrent dreamers, and nonrecurrent dreamers. Psychological Reports 59(2), 467-482.
Zadra, A., & Stickgold, R. (2007). Absorption, psychological boundaries and attitude towards dreams as correlates of dream recall: two decades of research seen through a meta analysis. Journal of Sleep Research 16(1), 51-59.
Hill, C. E., Diemer, R., & Heaton, K. J. (1994). Are the effects of dream interpretation on session quality, insight, and emotions due to the dream itself, to projection, or to the interpretation process? Dreaming 4(2), 99-134.
Zadra, A. L. (1996). 17 recurrent dreams: Their relation to life events. Trauma and Dreams, 231–248. https://doi.org/10.4159/9780674270534-019
Background and Rationale
Hypodipsia, or decreased thirst sensation, can significantly impact patient health, particularly when it leads to dehydration. This condition can exacerbate the risk of kidney malfunction, a notable concern with the use of certain medications, including GLP-1 agonists. GLP-1 agonists, known for their appetite-suppressing effects, may inadvertently suppress thirst due to their interaction with the dopamine system, which plays a crucial role in the rewarding properties of eating and drinking.
The mechanism of thirst regulation involves the lamina terminalis located beneath the third ventricle of the brain, where specific cells lie outside the blood-brain barrier. The act of drinking water is perceived as rewarding well before any detectable change in blood osmolarity occurs, suggesting that the gratification from drinking does not solely depend on physiological needs for water balance but also involves the brain's reward systems, particularly those governed by dopamine. Given that GLP-1 agonists and certain dopaminergic drugs, such as stimulants, can modulate this system, there is a plausible link between these medications and the suppression of thirst.
Proposal
It is proposed to introduce a new ICD-10 code specifically for Drug-Induced Hypodipsia, with subdivisions to account for the different classes of drugs implicated, namely:
1. Hypodipsia - Drug Induced from GLP-1 Agonists: This category would address the specific risk associated with GLP-1 agonist therapy, highlighting the need for healthcare providers to advise patients on the importance of regular fluid intake, regardless of their perceived need to drink.
2. Hypodipsia - Drug Induced from Dopaminergic Drugs (e.g., Stimulants): Given the broader impact of dopaminergic drugs on the reward system and their potential to suppress thirst, this category would encompass a wider range of medications that could lead to hypodipsia, thereby alerting clinicians to monitor hydration status in patients prescribed these drugs.
Clinical Implications and Recommendations
The introduction of these specific ICD-10 codes would facilitate better patient monitoring, targeted interventions, and research into the prevalence and outcomes of drug-induced hypodipsia. It would also serve as a critical reminder for healthcare providers to educate patients about the importance of maintaining adequate hydration, especially those on GLP-1 agonists or dopaminergic medications, who might not experience normal thirst cues. Such proactive measures could significantly mitigate the risk of dehydration and its associated complications, improving patient safety and outcomes in populations vulnerable to drug-induced hypodipsia.
References
Giustina, A., Allora, A., Frara, S., Spina, A., & Mortini, P. (2022). The Hypothalamus. The Pituitary, 301–340. https://doi.org/10.1016/b978-0-323-99899-4.00002-0
Lee, M. D., & Clifton, P. G. (2010). Role of the serotonergic system in appetite and ingestion control. Handbook of Behavioral Neuroscience, 331–345. https://doi.org/10.1016/s1569-7339(10)70088-6
McKay, N. J., Kanoski, S. E., Hayes, M. R., & Daniels, D. (2011). Glucagon-like peptide-1 receptor agonists suppress water intake independent of effects on Food Intake. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 301(6). https://doi.org/10.1152/ajpregu.00472.2011
Wysokiński, A., Sobów, T., Kłoszewska, I. et al. Mechanisms of the anorexia of aging—a review. AGE 37, 81 (2015). https://doi.org/10.1007/s11357-015-9821-x
Introduction and Rationale
Caffeine addiction, often referred to as caffeine dependence, manifests as a compelling urge to consume caffeine despite potential adverse health effects or disruption to daily functioning. Characterized by symptoms of tolerance, withdrawal, and an inability to control use, caffeine addiction significantly impacts individuals' physical and psychological well-being. While the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes caffeine withdrawal, it does not formally acknowledge caffeine addiction as a disorder. Given the widespread consumption of caffeine and evidence suggesting a subset of individuals experience problematic use, there is a critical need for the ICD-10 to include specific codes for caffeine addiction. This inclusion would aid in diagnosis, treatment, and research, fostering a deeper understanding of its prevalence and impact.
Proposal for New ICD-10 Codes
We propose the introduction of specific ICD-10 codes under the category of “Mental and Behavioral Disorders Due to Psychoactive Substance Use,” (specifically, under code F15.929 for caffeine intoxication and code F15.93 for caffeine withdrawal), focusing on caffeine addiction. These codes would enhance the ability of healthcare providers to identify and treat individuals suffering from this condition, promoting more targeted and effective interventions.
Criteria for Caffeine Addiction
The proposed diagnostic criteria for caffeine addiction include experiencing at least three of the following over a 12-month period:
· Increased tolerance to caffeine.
· Withdrawal symptoms upon cessation.
· Consumption of larger amounts or over a longer period than intended.
· Persistent desire or unsuccessful efforts to cut down use.
· Significant time spent in activities necessary to obtain, use, or recover from caffeine's effects.
· Continued use despite knowledge of adverse physical or psychological problems.
· Sacrifice of social, occupational, or recreational activities.
Prevalence and Need for Recognition
Studies indicate that a significant percentage of caffeine users exhibit dependence criteria, with estimates suggesting up to 30% of users demonstrating problematic use. The varied prevalence rates underscore the necessity for formal recognition and coding within the ICD-10 to accurately reflect the disorder's impact and guide healthcare strategies.
Current ICD-10 Coding Limitations
Although the ICD-10 includes codes for caffeine intoxication and withdrawal, the absence of codes for caffeine addiction limits comprehensive care and research. By introducing specific codes for caffeine addiction, healthcare professionals can better document, study, and address this condition.
Proposed Benefits
· Enhanced Clinical Recognition and Treatment: Specific ICD-10 codes will enable healthcare providers to accurately diagnose and treat caffeine addiction, leading to improved patient outcomes.
· Facilitated Research: Standardized diagnostic criteria will promote research into caffeine addiction, advancing understanding of its epidemiology, etiology, and treatment.
· Informed Public Health Strategies: Better data on caffeine addiction will inform public health initiatives aimed at reducing the prevalence and impact of this condition.
Conclusion
The introduction of ICD-10 codes for caffeine addiction is a necessary step toward recognizing the significant health implications of problematic caffeine use. By formalizing these diagnostic criteria, we can improve patient care, enhance research capabilities, and inform more effective public health strategies. We urge the adoption of these proposed codes to address the growing concern over caffeine addiction and its consequences on individual and public health.
References
Addicott, M. A. Caffeine Use Disorder: A Review of the Evidence and Future Implications. Current Addiction Reports 1(3), 186-192.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Juliano, L. M., & Griffiths, R. R. A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology 176(1), 1-29.
Meredith, S. E., Juliano, L. M., Hughes, J. R., & Griffiths, R. R. (2013). Caffeine use disorder: a comprehensive review and research agenda. Journal of Caffeine Research 3(3), 114–130.
Striley, C. W., Griffiths, R. R., & Cottler, L. B. Caffeine Use Disorder: An Item Response Theory Analysis of DSM-IV/ICD-10 Criteria. American Journal of Addiction 20(1), 72–81.
Sweeney, M.M., Griffiths, R.R. (2023). Disorders Due to Substance Use: Caffeine. In: Tasman, A., et al. Tasman’s Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-030-42825-9_49-1
World Health Organization. (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization
Executive Summary
This proposal focuses on making the International Classification of Diseases, Tenth Revision (ICD-10) more user-friendly and accessible by addressing numerous components of its overall structure including search capabilities, its accessibility features, and compliance with the Americans with Disabilities Act Amendments Act (ADAAA) requirements. Adopting the proposed changes and enhancements to the ICD-10 will result in dramatic improvements to this de facto standard used globally in healthcare systems.
1. Reconsider the Nomenclature: Prioritizing Nouns over Adjectives
· Rationale: Currently, some of the classification names are challenging to understand, particularly for those outside medical professionals or those starting their professional training. A simple change such as placing Nouns before Adjectives would align with the natural language processing patterns, making it easier and quicker for users to understand and locate conditions. For instance, "Diabetes Mellitus, Type 2" is mirrored better to our mental processing than "Type 2 Diabetes Mellitus." Ideally, both would be present.
· Implementation: A comprehensive review and revision/enhancement of the coding guidelines to prioritize the essential subject of the disorder in the nomenclature would be required. This requires a systematic review and modification of current codes and descriptions.
· Benefits: This simple modification will noticeably enhance the intuitiveness of the classification system thereby increasing user-friendliness, especially for non-specialists or those in training.
1. Streamline Search Capabilities
· Incorporate Mechanism for Misspelled Entries: Incorporating a robust search function that can handle misspellings and typographical errors can be a substantial time saver. Implementing algorithms that suggest corrections or provide the most relevant results despite inaccuracies in the query can be game-changing.
· Leverage Natural Language Processing (NLP): NLP can be utilized to handle conversational or varied input styles, accommodating for different terminologies or phrasings used by diverse healthcare professionals.
· Refine Semantic Search: Enhance the search engine to interpret and comprehend context and semantics, rather than just seeking an exact match. This allows users to trace codes based on associated terms, presenting symptoms, or medical conditions.
1. Develop a Standardized XML Schema for Nosology
· Rationale: Currently there is no standardized XML schema specifically for nosology, although health-related data can be structured to some extent using HL7 standards, in particular the Clinical Document Architecture (CDA) standard.
· Benefits: Developing a standardized XML schema specifically for nosology can offer multiple benefits:
o Improved Interoperability: A standardized XML schema facilitates better communication and data exchange between different healthcare systems. This can increase interoperability and seamless sharing of disease-related information across various platforms.
o Consistency and Accuracy: Having a standardized format ensures that all data are recorded and classified uniformly, reducing discrepancies and increasing the accuracy of information.
o Enhanced Analysis: Standardization allows for easier aggregation of disease data, which can facilitate advanced analysis, like tracking disease patterns and conducting epidemiological studies.
o Facilitates Automation: A standardized XML schema can handle automated systems better. For instance, computer-based patient record systems can easily decipher and use the data, which will enhance automated decision support in healthcare.
o Faster Transactions: Standardized data may be validated and processed quicker, leading to faster transactions, a critical feature in scenarios like clinical trials and other time-sensitive situations.
o Reusability: A standard XML schema can be reusable across different systems and applications dealing with nosology, reducing the effort and cost of developing new schemas for each system.
o Enhanced Accessibility: This schema can be configured to be easily understandable and accessible for various stakeholders in healthcare, including researchers, doctors, data analysts, and public health officials.
o Regulatory Compliance: A standardized schema may be more likely in sync with specified data structure requirements set by healthcare regulatory bodies, which will facilitate compliance reporting.
o Efficient Training: Training healthcare personnel and researchers on using one standardized format for recording and retrieving data may be more efficient than multiple different systems.
o Promotion of Research: A standardized XML schema for nosology can promote research by making disease-related data more accessible to researchers globally. It encourages collaboration and comparison of data between different studies.
1. Incorporate Accessibility Features for Differently-abled
· For Visually Impaired Users:
o Seamless Compatibility with Screen Readers: Ensure that the digital variant of the ICD-10 is fully compatible with screen readers. This includes proper tagging of elements, alt text for images, ensuring intuitive guidance for navigation.
o Text-to-Speech (TTS) Integration: Adopt TTS technology to read out the codes and associated descriptions clearly, providing hassle-free access for individuals who heavily rely on auditory senses.
o High-Contrast and Large-Text Options: Cater to users with restricted vision by offering user interfaces that support high-contrast modes and adaptable text sizes.
· For Users with Auditory Impairments:
o Ensure Visual Alerts and Instructions: A well-designed visual guide, cues, and text instructions ought to replace or supplement audio alerts, ensuring all notifications and directions are universally accessible.
o Closed Captioning and Sign Language Interpretation: Every multimedia content and instructional video must support closed captioning and sign language interpretation options.
1. Assure Compliance with ADAAA
· Perform Comprehensive Accessibility Testing: Conduct rigorous testing with individuals who represent a range of disabilities to identify and promptly address any potential user accessibility hurdles.
· User-Centered Design Approach: Champion a user-oriented design philosophy involving professional and personal feedback from distinctive users with disabilities, fostering a system that caters to each user's needs efficaciously.
· Ongoing Updates and Support: Chart out a protocol for regular updates encompassing technological advancements and user feedback to consistently meet accessibility prerequisites.
1. Build a Supportive Ecosystem
· Accessible Training Materials: Develop training programs and materials that are universally accessible. This should include creating multimedia content with interpretations in braille, audio guides, and videos with sign language interpretation, amongst others.
· Exemplary Support Services: Users with disabilities should have access to dedicated and impeccable support services, aiding them to use the ICD-10 system effectively and effortlessly.
1. User-Friendly Interface Design
· Simplified Navigation: Design the interface of the ICD-10 system with navigation features that are intuitive and easy to understand. This includes clear labeling, easy-to-understand icons, and consistent placement of important features on the pages.
· Optimized Layout: Optimally arrange the information on the screen to help users find what they are looking for more quickly. Important information or frequently used features should be prominently displayed and easily accessible.
· Mobile Compatibility: Ensure that the design is compatible with various devices, including smartphones and tablets, which are increasingly being used by healthcare professionals.
· Bi-directional Dictionary: Integrate a dictionary that can work in both directions i.e., code to condition and condition to code. This can prove especially helpful for users who, for instance, only know the code but not the condition it represents, or vice versa.
1. Multilingual Support
· Language Options: Add support for multiple languages to accommodate a diverse user base. This will make the ICD-10 system more user-friendly for healthcare professionals around the world.
· Language-Specific Search: Include a language-specific search option to allow users to search for codes and other information in their preferred language.
1. Personalized User Experience
· User Profiles: Implement user profiles that save individual preferences, such as commonly used codes or favorite features, making the tool more efficient for repeated use.
· Customizable Display: Allow users to customize the way the information is displayed according to their preference, such as changing the font size, color themes, or layout.
1. Enhanced Data Management
· Bulk Import/Export: Add the ability to import or export data in bulk to allow healthcare organizations to effectively manage their coding data. This functionality can save a lot of time when dealing with large datasets.
· Data Security: Ensure that all user data is securely stored and transmitted, conforming to requirements of Health Insurance Portability and Accountability Act (HIPAA) and General Data Protection Regulation (GDPR).
· REST API Development: The ICD-10 website should provide an API through which queries to the database can be made. This will greatly simplify the development of automation systems that rely upon ICD-10 coding.
1. Feedback Mechanism
· User Feedback: Implement a user feedback system where users can report bugs, propose new features, or provide other feedback about their experience with the ICD-10 system.
· Regular System Updates: Use the feedback to regularly update the system, ensuring it continues to meet the evolving needs of its users and keeps up with changes in the healthcare industry.
Conclusion
Implementing these recommendations will significantly improve the user-friendliness, accessibility, and practicality of the ICD-10 coding system, leading to more accurate, effective, and efficient healthcare practices.
Executive Summary
This proposal advocates for the establishment of specific ICD-10 codes to categorize health conditions directly related to the use of technology. The introduction of these codes is crucial for recognizing and addressing the growing impact of technology on health, improving diagnosis, treatment, and prevention of technology-related conditions.
Background
The pervasive use of digital devices and technology has led to the emergence of new health conditions and the exacerbation of existing ones. Conditions such as digital eye strain, tech neck, and repetitive strain injuries from device use are becoming increasingly common, reflecting the significant role that technology plays in modern life. Despite their prevalence, there is currently a lack of specific ICD-10 codes to report and manage these conditions systematically.
Proposal Details
1. Creation of ICD-10 Codes: We propose the introduction of new ICD-10 codes within a distinct category for technology-related health conditions. These codes would allow for the classification of conditions based on the type of technology use and the specific health issue. Proposed codes could include:
· TR01: Digital Eye Strain from Screen Use
· TR02: Tech Neck from Prolonged Device Use
· TR03: Repetitive Strain Injury from Computer Use
· TR04: Sleep Disorders Related to Blue Light Exposure
1. Clinical Guidelines for Diagnosis and Management: Develop and disseminate clinical guidelines that utilize the new codes, providing healthcare providers with clear criteria for diagnosing, reporting, and managing technology-related health conditions. These guidelines should emphasize ergonomic practices, breaks during technology use, and other preventive measures.
2. Educational Initiatives: Implement education and awareness programs targeting healthcare professionals, patients, and the public to increase awareness about the health risks associated with technology use and strategies for prevention. Education should also focus on promoting a healthy balance between technology use and physical activity.
3. Research and Surveillance: Encourage research into the prevalence, mechanisms, and effective treatment of technology-related health conditions. Use the new ICD-10 codes to facilitate consistent data collection and analysis, supporting epidemiological studies and the development of targeted interventions.
Benefits
· Improved Patient Care: The introduction of specific ICD-10 codes for technology-related health conditions will enable more accurate diagnosis and tailored management, potentially reducing the incidence and severity of these conditions.
· Enhanced Data Collection and Research: Specific codes will facilitate the collection of standardized data, supporting research into the impact of technology on health and informing the development of effective prevention and treatment strategies.
· Informed Public Health Strategies: Better understanding and tracking of technology-related health conditions will inform public health strategies aimed at mitigating these issues, including recommendations for technology use, ergonomics, and digital wellness programs.
Conclusion
The creation of ICD-10 codes for technology-related health conditions is an essential step in recognizing and addressing the health impacts of our increasingly digital world. By providing a framework for accurate diagnosis, reporting, and management, these codes will enhance patient care, support research, and inform public health initiatives designed to promote healthier interactions with technology. We strongly advocate for the adoption of these proposed codes to improve healthcare outcomes and address the challenges posed by the digital age.
References
Agbo, C., Mahmoud, Q., & Eklund, J. (2019). Blockchain technology in Healthcare: A systematic review. Healthcare, 7(2), 56. https://doi.org/10.3390/healthcare7020056
Gell, N. M., Rosenberg, D. E., Demiris, G., LaCroix, A. Z., & Patel, K. V. (2013). Patterns of technology use among older adults with and without disabilities. The Gerontologist, 55(3), 412–421. https://doi.org/10.1093/geront/gnt166
Mitzner, T. L., Boron, J. B., Fausset, C. B., Adams, A. E., Charness, N., Czaja, S. J., Dijkstra, K., Fisk, A. D., Rogers, W. A., & Sharit, J. (2010). Older adults talk technology: Technology usage and attitudes. Computers in Human Behavior, 26(6), 1710–1721. https://doi.org/10.1016/j.chb.2010.06.020
Skinner, H., Biscope, S., Poland, B., & Goldberg, E. (2003). How adolescents use technology for health information: Implications for health professionals from Focus Group Studies. Journal of Medical Internet Research 5(4). https://doi.org/10.2196/jmir.5.4.e32
Vargo, D., Zhu, L., Benwell, B., & Yan, Z. (2020). Digital technology use during covid 19 pandemic: A rapid review. Human Behavior and Emerging Technologies, 3(1), 13–24. https://doi.org/10.1002/hbe2.242
Executive Summary
This proposal seeks the establishment of specific ICD-10 codes for E-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI). The recognition of EVALI with dedicated codes within the ICD-10 classification system is critical for accurate diagnosis, epidemiological tracking, and the development of effective treatment protocols. These codes would also facilitate research into the condition and inform public health strategies aimed at reducing the incidence of EVALI.
Background
EVALI is a recently identified health condition associated with the use of e-cigarette or vaping products. It presents with a variety of pulmonary symptoms ranging from mild to severe, including cough, shortness of breath, and chest pain, often accompanied by gastrointestinal symptoms and fever. The identification and classification of EVALI have been challenging due to the lack of specific diagnostic codes, leading to potential underreporting and variability in treatment approaches.
Proposal Details
1. Creation of ICD-10 Codes: We propose the introduction of new ICD-10 codes under a distinct category for EVALI. This category would include codes that specify the severity, symptoms, and outcomes of the condition. Proposed codes could include:
· EV01: EVALI with predominantly respiratory symptoms
· EV02: EVALI with mixed respiratory and gastrointestinal symptoms
· EV03: EVALI with acute respiratory distress syndrome (ARDS)
· EV04: EVALI with complications requiring mechanical ventilation
1. Clinical Guidelines for Diagnosis and Management: Develop comprehensive clinical guidelines that utilize the new EVALI codes, providing healthcare providers with clear criteria for diagnosis, reporting, and management. These guidelines should emphasize the importance of patient history regarding e-cigarette or vaping product use.
Educational Initiatives: Launch education and awareness programs targeting healthcare providers, patients, and the public about the risks associated with e-cigarette or vaping product use and the potential for EVALI. These programs should include information on recognizing early symptoms and seeking timely medical care.
Research and Surveillance: Encourage research into the causes, mechanisms, and treatments of EVALI, leveraging the new ICD-10 codes for consistent data collection and analysis. Establish surveillance systems to monitor the incidence, prevalence, and outcomes of EVALI, contributing to ongoing public health efforts to mitigate the impact of vaping products.
Benefits
Improved Patient Care: The introduction of specific ICD-10 codes for EVALI will enable healthcare providers to accurately diagnose and manage the condition, potentially improving patient outcomes.
Enhanced Data Collection and Research: Specific codes will facilitate the collection of standardized data on EVALI, supporting research and enabling public health authorities to track trends and identify risk factors associated with vaping product use.
Informed Public Health Strategies: Better data and understanding of EVALI will inform public health strategies and interventions aimed at reducing the use of e-cigarettes and vaping products, particularly among vulnerable populations.
Conclusion
The creation of ICD-10 codes for E-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI) represents an essential step in addressing this emerging public health issue. By providing a mechanism for accurate diagnosis and reporting, these codes will enhance patient care, support research, and inform effective public health strategies to combat the harmful effects of vaping. We strongly advocate for the prompt adoption of these proposed codes to improve health outcomes and safeguard public health.
References
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Executive Summary
This proposal advocates for the creation of a dedicated ICD-10 category for Interactive Video Addiction Disorders, encompassing a spectrum of disorders arising from the compulsive use of various digital media forms. Despite the increasing prevalence and significant impact on mental and physical health, these disorders are not adequately categorized within the current ICD-10 framework. A separate category would facilitate precise diagnosis, inform treatment strategies, and spur further research into these emerging disorders.
Background and Rationale
Interactive Video Addiction Disorders, including gaming, pornography, social media, and other digital media addictions, have emerged as significant behavioral health concerns. These disorders share common mechanisms such as reward pathways activation, escapism, and the compulsion loop, contributing to their addictive potential. The prevalence of these disorders varies globally, with estimates suggesting a significant impact across different populations and age groups, including children and adolescents. The current ICD-10 classification lacks specific codes to adequately represent these disorders, hindering effective clinical management and research efforts.
Proposal for New ICD-10 Category and Sub-Categories
· New ICD-10 Category: “Addiction to Interactive Video and Digital Media” (AIVDM)
· Sub-Categories:
o AIVDM1: Interactive Video Gaming Disorder
o AIVDM2: Interactive Pornography Addiction
o AIVDM3: Interactive Social Media Disorder
o AIVDM4: Online Dating Addiction
o AIVDM5: Smartphone Addiction
o AIVDM6: Internet Addiction
o AIVDM7: Streaming and Video Content Addiction
o AIVDM8: Online Shopping Addiction
Justification and Benefits
1. Enhanced Clinical Recognition: Specific codes will enable healthcare providers to accurately diagnose and differentiate between various forms of digital media addictions, leading to more tailored and effective treatment plans.
2. Facilitated Research: Dedicated ICD-10 codes will promote research into the prevalence, risk factors, and treatment outcomes of these disorders, contributing to the development of evidence-based interventions.
3. Public Health Strategy: Standardized classification will inform public health initiatives aimed at addressing and mitigating the impact of digital media addiction on society, particularly among vulnerable populations such as youth.
4. Global Consistency: Aligning with the proposed ICD-11 classification for Interactive Digital Media Use Disorder, these codes would ensure consistency in diagnostic criteria and reporting standards worldwide.
Conclusion
The introduction of a separate ICD-10 category for Interactive Video Addiction Disorders is imperative to address the growing challenge posed by the addictive use of digital media. By recognizing these disorders with specific codes, the medical community can better understand, treat, and prevent the adverse effects associated with digital media addiction. We urge the adoption of this proposal to enhance patient care, support research, and guide public health strategies in the digital age.
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