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Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review medicine valium buy frumil 5 mg amex. Chronic Care Model and shared care in diabetes: randomized trial of an electronic decision support system medicine in spanish purchase frumil pills in toronto. Improved blood pressure control associated with a large-scale hypertension program medications that cause weight gain buy frumil 5 mg low price. Active care management supported by home telemonitoring in veterans with type 2 diabetes: the DiaTel randomized controlled trial medicine yoga cheap frumil amex. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. Different paths to high-quality care: three archetypes of top-performing practice sites. Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus. Twelve evidence-based principles for implementing self-management support in primary care. Practicelinked online personal health records for type 2 diabetes mellitus: a randomized controlled trial. Community health ambassadors: a model for engaging community leaders to promote better health in North Carolina. The PatientCentered Outcomes Research Institutedpromoting better information, decisions, and health. Closing the quality gap: a critical analysis of quality improvement strategies (vol. Treatment intensification and risk factor control: toward more clinically relevant quality measures. Standardizing terminology and definitions of medication adherence and persistence in research employing electronic databases. Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. Systematic review of health disparities for cardiovascular diseases and associated factors among American Indian and Alaska Native populations. Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events. Do social inequala ities exist in terms of the prevention, diagnosis, treatment, control and monitoring of diabetes Health disparities among youth with type 1 diabetes: a systematic review of the current literature. Glucose control in diabetes: the impact of racial differences on monitoring and outcomes. Diabetes control with reciprocal peer support versus nurse care management: a randomized trial. Peer mentoring and financial incentives to improve glucose control in African American veterans: a randomized trial. Self-management education programmes by lay leaders for people with chronic conditions. The impact of social support on outcomes in adult patients with type 2 diabetes: a systematic review. The impact of culturally competent diabetes care interventions for improving diabetesrelated outcomes in ethnic minority groups: a systematic review. National Voluntary Consensus Standards for Ambulatory Cared Measuring Healthcare Disparities [Internet], 2008. Lack of insurance coverage for testing supplies is associated with poorer S12 Strategies for Improving Care Diabetes Care Volume 39, Supplement 1, January 2016 glycemic control in patients with type 2 diabetes. Diabetes mellitus and risk of dementia: a metaanalysis of prospective observational studies. Carbohydrates for improving the cognitive performance of independent-living older adults with normal cognition or mild cognitive impairment. Relative risk of diabetes, dyslipidaemia, hypertension and the metabolic syndrome in people with severe mental illnesses: systematic review and metaanalysis.

Offeror must complete and sign all required forms medicine 1975 lyrics cheap 5 mg frumil with mastercard, including all required written material symptoms jet lag buy frumil 5mg on-line, by the proposal closing date and time symptoms of kidney stones order cheap frumil. The Offeror must clearly indicate if any of the information contained in the proposal is confidential or proprietary in nature by applying a legend to the page that indicates confidential or proprietary information is contained on said page symptoms 2 days before period buy genuine frumil on line. Further, the Offeror must indicate which paragraph contains confidential or proprietary information by inseding the words "confidential/proprietary information" in bold type, enclosed by parentheses at the beginning of the paragraph containing such information. Offerors are to submit each volume in an unbound original (suitable for photocopying) with five (5) additional bound copies, and one (1) "read only" Compact Disc. If submitting an offer for more than one (1) Facility, one (1) proposal is reguesfed, with notations where information does not apply universally. Proposals and amendments shall be submitted in sealed envelopes prior to the proposal closing date and time with the solicitation number annotated immediately below the return address on the envelope. Sealed proposals shall be submitted to the address noted on page 1, block 5 of the Solicitation, Offer and Award proposals will not be accepted. Prospective Offerors are asked to bear in mind that all material submitted should be directly pertinent to the requirements of the solicitation. Extraneous narrative, elaborate brochures, uninformative public relations material, and other similar documents shall not be submitted. Failure to submit all required documentation by proposal closing date may result in disqualification of the proposal from further consideration. Cover Page: Listing name and address of Offeror, date of proposal and signature of authorized official. A brief biography of the Person or Persons who will administer any resulting Contract. For the purpose of responding to this solicitation, Offeror will not be required to purchase insurance, but must show the ability to provide such insurance as specified in Section H. Complete reference information for all institutions or government agencies to which the Offeror has rendered similar services. This shall include a list of any contracts, which have been canceled or terminated, an explanation on why the contracts were canceled, and the name and phone number of a contact Person from the institution or government agency that canceled or terminated the contract. Offeror shall include a list of all legal actions pending against their organization and the outcomes of the finaljudgments. Documentation from the appropriate state entity that indicates that the Offeror is properly certified to conduct business in the State of Texas (e. Other organizational, biographical or financial information deemed relevant by the Offeror. Project Schedule: A time schedule shall be submitted by the Offeror that outlines the entire project from award of Contract to when full operation can begin. The schedule shall reflect a Contract start date of September 1,2017: Volume One, Section 2 - Contract Forms this Section shall contain the following completed Contract sections (on original forms) with original signatures, where applicable: A. Page 1, Solicitation, Offer and Award Form (with amendment(s) signed amendment(s) attached to this form); noted on this page or B. Prospective Offerors shall ensure that all material submitted should be directly pertinent to the requirements of this Request for Proposals and shall be formatted as to specific requirement of Section C. The Department has the authority to deem the proposal non-responsive if detailjustification in a line item format is not provided. Other Operating Costs: Offeror shall outline and provide costs related to any additional line items that would qualify as an additional service that would enhance the operation of the Facility. Offeror shall detail and explain any other costs to Offeror associated with this proposal. Offeror shall also disclose its profit margin in providing the Services requested by the Department in this proposal. The following Contract sections shall be completed and included in this Section: 1. An electronic copy compatible with Microsoft Excel@ shall also be submitted; and 2.

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There is a negligible to moderate potential for encountering minor shallow gas and negligible to low potential for shallow water flow within the limit of investigation medicine 360 buy 5mg frumil fast delivery. The 3-D volume used for this assessment is identified as cvxtgs Justice kdm angle 10 30 spec enh Stk Pangolin 102119 medicine zanaflex buy 5mg frumil mastercard. There is a negligible to moderate potential for minor shallow gas accumulations and negligible to low potential for overpressured sands symptoms for pregnancy 5 mg frumil with visa. The nearest bathymetric highs include Horn Dome and Whiting Dome treatment bladder infection effective frumil 5 mg, about 3 miles to the southeast and 5. The strata between Horizons 10 and 20 (Unit 2, 226 ft to 511 ft bml) consists of hemipelagic clays and bedded turbidites of clays and silts. An erosional surface may be encountered roughly mid-unit at about 413 ft bml where some variations in a normal strength curve could occur. Very thin sandysilt or sand seams may be interspersed in the lower half of the unit. Thin sand seams are possible within a portion of Unit 5 and within Unit 7 (2,249 ft to 3,038 ft and 3,663 ft to 6,000 ft bml). Although there is no indication on the seismic of direct hydrocarbon indicators at the surface location, there is a moderate potential for encountering minor gas accumulations near the base of Unit 3 from 1,106 ft to 1,276 ft bml. A low potential for encountering shallow gas exists across the fault crossing between 2,103 ft to 2,249 ft bml and within possible thin sand layers in Unit 7 (3,663 ft to 6,000 ft bml). A negligible potential for shallow gas exists within between the seafloor to 1,106 ft bml, 1,276 ft to 2,103 ft bml, and 2,249 ft to 3,663 ft bml. The potential for shallow water flow at this well location is considered negligible to low. The Study Area lies approximately 28 miles north of the mapped extents of the shallow water flow prone Blue Unit and, regionally, is classified as a low risk zone for encountering shallow water flow (Ostermeier et al. There is a low potential for shallow water flow within possible sand layers within Unit 5 (2,103 ft to 3,038 ft bml) and below Horizon 60 to the Limit of Investigation (3,663 ft to 6,000 ft bml). A negligible potential for overpressured sands is assessed for the fine-grained sediments within Units 1-4 and Unit 6 (seafloor to 2,103 ft and 3,038 ft to 3,663 ft bml). There are no potential sites for deepwater benthic communities within 2,000 ft of the proposed wellsite. The strata between Horizons 10 and 20 (Unit 2, 242 ft to 536 ft bml) consists of hemipelagic clays and bedded turbidites of clays and silts. Very thin sandy-silt or sand seams may be interspersed in the lower half of the unit. Thin sand seams are possible within a portion of Unit 5 and within Unit 7 (2,364 ft to 3,124 ft and 3,700 ft to 6,000 ft bml). The anomaly is located in the lower portion of the Unit 7 sequence // 4 Shallow Gas. Although the amplitude threshold did not meet the criteria for mapped anomalies, the events are associated with disturbed reflectors that could represent some accumulations of shallow gas along the fault. Although there is no indication on the seismic of direct hydrocarbon indicators at the surface location, there is a moderate potential for encountering minor gas accumulations across the fault and the lower portion of the unit from 4,757 ft to 6,000 ft bml. A low potential for encountering shallow gas exists within possible thin sand layers in the upper portion of Unit 7 between 3,700 ft to 4,757 ft bml. A negligible potential for shallow gas exists between the seafloor to 3,700 ft bml. There is a low potential for shallow water flow within possible sand layers within Unit 5 (2,055 ft to 3,124 ft bml) and below Horizon 60 to the Limit of Investigation (3,700 ft to 6,000 ft bml). A negligible potential for overpressured sands is assessed for the fine-grained sediments within Units 1-4 and Unit 6 (seafloor to 2,055 ft and 3,124 ft to 3,700 ft bml). The potential for shallow water flow at this well location is considered negligible to Results No seafloor hazards or constraints are defined by the available data at the proposed surface location. There is a negligible to low potential for encountering overpressured sands and negligible to moderate potential for minor shallow gas.

As discussed above symptoms quotes frumil 5mg otc, other diagnoses to consider include pregnancy symptoms enlarged spleen discount frumil 5mg on line, hyperandrogenism shinee symptoms buy discount frumil on line, thyroid disease medicine 8 iron stylings order frumil with amex, hyperprolactinemia, imperforate hymen, malnutrition, and excessive exercise. Unless history or physical exam suggests any of these, they are less likely in this patient. In the absence of pubertal delay or any significant history or physical exam findings suggestive of the diagnoses listed above, no further workup is needed for this patient as this is most likely normal puberty. Very high levels point to a problem with ovarian production of estrogen (lack of feedback inhibition) and very low levels point to a problem with the pituitary or hypothalamus ability to send a signal to the ovary. If any of the other diagnoses mentioned in the differential were suspected, relevant labs should be obtained (e. Again, in this patient, it would not be necessary until she fits the definition of primary amenorrhea. Diagnosis: the differential diagnosis is listed in the "Clinical Reasoning" section above. If this 13 year old is otherwise healthy and has breast development, the diagnosis in this case is normal pubertal development. A fourteen-year-old female well known to your practice makes an appointment to see you alone regarding a desire for contraception. While many states provide minors with the ability to obtain contraception without the involvement of parents, it is important to encourage the patient to discuss sexuality and sexual decision-making with her parents. Trying to keep contraception hidden makes compliance more challenging and may put an adolescent at higher risk for pregnancy. In addition, adolescents often lack a clear understanding of consequences and may not view sexual activity as a risk behavior (e. Involving adults can help provide perspective regarding health outcomes resulting from sexual activity. Discussions about contraception with this adolescent should include a conversation about alternative ways to express intimacy and affection besides sexual intercourse. If she still plans to have sex or wants to be prepared in case the opportunity arises, a discussion regarding the advantages and disadvantages of various methods should be pursued. Condoms, combined estrogen/progesterone methods (oral contraceptive pills, the transdermal patch, the intravaginal ring), and progesterone-only methods (intramuscular injections of depot medroxyprogesterone acetate, or Depo-Provera) are commonly used forms of birth control in the younger adolescent population. She should consider ease of use, ability to adhere to the contraceptive regimen, privacy of method, and side effects when choosing a form of birth control. Although children generally cannot receive medical care without the consent of their parents, adolescents under the age of 18 years are given the ability consent to their own health care in certain situations. While it is preferred to have a parent involved, it has been shown that some adolescents may not seek care for certain problems, such as sexual health, if a parent must be involved, thereby placing them at risk for negative health outcomes. Often they are able to consent to any health care if they are pregnant, are a parent, are married, or are fully and legally emancipated from their parents. In this case, the patient (in most states) would be able to seek contraception from her physician without her parents being involved. As they transition from childhood to adulthood, adolescents need to develop a sense of independence and autonomy from their parents. The ability to talk with a physician alone and in confidence not only reinforces this developmental task, but it also helps the physician build rapport with the adolescent, while also providing an opportunity for teens to talk about or seek care for issues they feel uncomfortable addressing with parents. Stressing the concept of privacy rather than secrecy, the concept of confidentiality should be discussed openly with adolescents and their parents from the initial visit. Everyone should be aware from the outset that when a parent is asked to leave the room during a visit, the content of the discussion will remain confidential between adolescent and heath care team, with a few exceptions such as concerns for self-harm (e. While it would be ideal for this adolescent to discuss contraception and sexual decision-making with a parent, she can opt to keep the discussion confidential. Your responsibility to the parent is to protect the welfare of the adolescent and act in her best interest. If you have concerns that she may be in an unsafe relationship, you may need to violate the confidentiality for the ultimate benefit and protection of the patient. But discussions about contraception, and even the decision to initiate contraception, can remain confidential (although you should make sure you know the specific confidentiality and consent provisions in your own state, as the specifics vary from state to state).