Know About Migraine : Home Remedies, Treatment And Cause

A migraine is a throbbing painful headache, usually on one side of the head, that is often initiated or "triggered" by specific compounds or situations (environment, stress, hormones, and many others). They occur more often in women (75%, approximately) and may affect a person’s ability to do common tasks.

Migraine Symptoms:
Throbbing pain, usually on one side of a person's head, can be intense enough to cause a person to be unable to do simple tasks or to work. The headache pain may radiate toward the eyes, forehead, or temple and make a person develop nausea, vomiting, vision problems, and sensitivity to normal light or mild exertion.

Trigger:
Flashing Lights: Migraine headaches are often triggered to occur when the person is exposed to a specific set of circumstances. One of the most common triggers is strong flickering light. For example, faulty fluorescent lights, a television picture rapidly going on and off, or sunlight reflected off of waves in a lake or the ocean are all potential triggers.

How to Calculate PQI #3: Diabetes Long-term Complications Admission Rate

Diabetes is a complicated disease. But don’t confuse this thought with the term “diabetes complications”! Complications generally occur after years of high blood glucose. The blood vessels become damaged unless you can keep your glucose levels in a healthy range most of the time. The range of complications span from being simply annoying to actually life threatening. The lesser conditions include dry and itchy skin, mild gum disease, a tendency to be more susceptible to colds and flu, and in women, yeast infections. The more serious complications - some life-changing or life-threatening - include eye disease, kidney disease, nerve disease and heart disease.

Numerator
All discharges age 18 years and older with ICD-9-CM principal diagnosis code for diabeteslong-term complications (renal, eye, neurological, circulatory, or complications not otherwise specified). 

How to Calculate PQI #2: Perforated Appendix Admission Rate

A perforated appendix is one of the complications of acute appendicitis. If appendicitis is left untreated, ischemic necrosis of a portion of appendiceal wall may occur, leading to perforation. An appendicolith is thought to be associated with a higher probability of perforation. Perforation of the appendix is more common among the elderly population due to an increased frequency of late and atypical presentation of appendicitis, delay in diagnosis, delayed decision for surgery and to the age-specific physiological changes.

Population Measured (Denominator)
Discharges, for patients ages 18 years and older, with any-listed ICD-CM diagnosis codes for appendicitis. Discharges are assigned to the denominator based on the metropolitan area or county of the patient residence, not the metropolitan area or county of the hospital where the discharge occurred.

How to Calculate PQI #1 Diabetes Short-Term Complications Admission Rate

Population Measured (Denominator)
After applying the exclusions outlined in the next section, all inpatient utilization of the member were counted. Percentage can be counted based on the member count or by the IP admit count.

Beneficiaries are excluded from the population measured if they:
• were under the age of 18
• were enrolled in Medicare managed care (a Medicare Advantage plan) for any month during the performance period
• were enrolled in Medicare Part A only or Medicare Part B only for any month during the performance period
• resided outside of the United States, its territories, and its possessions for any month during the performance period
• Hospitalizations are excluded from the measure outcome if:
• the hospital admission is a transfer from a hospital, skilled nursing facility, intermediate care facility, or other health care facility
• the hospitalization is missing a principal diagnosis
• the discharge had any diagnosis code for sickle-cell anemia or HB-S disease, or any diagnosis or procedure code for immunocompromised state (bacterial pneumonia
component measure only)
• the discharge had any diagnosis code for kidney/urinary tract disorder or any diagnosis or procedure code for immunocompromised state (urinary tract infection component measure only)
• the discharge had any diagnosis code for chronic renal failure (dehydration component measure only)





NUMERATOR:
ICD-9-CM    Description
250.10    Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled
250.11    Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled
250.12    Diabetes with ketoacidosis, type II or unspecified type, uncontrolled
250.13    Diabetes with ketoacidosis, type I [juvenile type], uncontrolled
250.20    Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled
250.21    Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled
250.22    Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled
250.23    Diabetes with hyperosmolarity, type I [juvenile type], uncontrolled
250.30    Diabetes with other coma, type II or unspecified type, not stated as uncontrolled
250.31    Diabetes with other coma, type I [juvenile type], not stated as uncontrolled
250.32    Diabetes with other coma, type II or unspecified type, uncontrolled
250.33    Diabetes with other coma, type I [juvenile type], uncontrolled

ICD-10-CM    Description
E10.10    Type 1 diabetes mellitus with ketoacidosis without coma
E10.11    Type 1 diabetes mellitus with ketoacidosis with coma
E10.641    Type 1 diabetes mellitus with hypoglycemia with coma
E10.65    Type 1 diabetes mellitus with hyperglycemia
E11.00    Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
E11.01    Type 2 diabetes mellitus with hyperosmolarity with coma
E11.641    Type 2 diabetes mellitus with hypoglycemia with coma
E11.65    Type 2 diabetes mellitus with hyperglycemia
E13.00    Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
E13.01    Other specified diabetes mellitus with hyperosmolarity with coma
E13.10    Other specified diabetes mellitus with ketoacidosis without coma
E13.11    Other specified diabetes mellitus with ketoacidosis with coma
E13.641    Other specified diabetes mellitus with hypoglycemia with coma

NUMERATOR Exclude cases:
•transfer from a hospital (different facility) 
•transfer from a skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF) 
•transfer from another health care facility
•MDC 14 (pregnancy, childbirth, and puerperium)

ACUTE AND CHRONIC AMBULATORY CARE –SENSITIVE CONDITION

AMBULATORY CARE –SENSITIVE CONDITION or PQIs can be categorized into two basic category: Acute Conditions Composite & Chronic Conditions Composite. The measures are adapted from the area- level Prevention Quality Indicators (PQIs), which were developed by the Agency for Healthcare Research and Quality (AHRQ) and include measures of potentially avoidable hospitalizations.

Acute ACSC Composite:
The Acute Conditions Composite is a hospitalization during the performance period with a primary diagnosis of one or more of the following conditions:
- Bacterial Pneumonia (PQI #11)
- Urinary Tract Infection (PQI #12) 
- Dehydration (PQI #10)

Chronic ACSC Composite:
- Short-Term Complications from Diabetes (PQI #1)
- Long-Term Complications from Diabetes (PQI #3)
- Uncontrolled Diabetes (PQI #14)
- Lower Extremity Amputation among Patients with Diabetes (PQI #16)
- Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults (PQI #5)
- Heart Failure (PQI #8)

Why Should You Take Pomegranate Juice!!

Pomegranate juice is made from the fruit of the pomegranate. It is used in cooking both as a fresh juice and as a concentrated syrup. Pomegranate juice contains more than 100 phytochemicals. The pomegranate fruit has been used for thousands of years as medicine.

Today, pomegranate juice is being studied for its many health benefits.

Here are some of the potential benefits.

1. Antioxidants: Like many fruit juices, pomegranate juice contains antioxidants, especially polyphenols. What's more, pomegranate juice contains antioxidants at higher levels than do many other fruit juices. Antioxidants are thought to provide several heart-protecting benefits, including reducing low-density lipoprotein (LDL, or "bad") cholesterol.

2. Vitamin C: The juice of a single pomegranate has more than 40 percent of your daily requirement of vitamin C. Vitamin C can be broken down when pasteurized, so opt for homemade or fresh pomegranate juice to get the most of the nutrient.

3. Cancer prevention: Pomegranate juice recently made a splash when researchers found that it may help stop the growth of prostate cancer cells.

4. Alzheimer’s disease protection: The antioxidants in the juice and their high concentration are believed to stall the progress of Alzheimer disease and protect memory.

5. Digestion: Pomegranate juice can reduce inflammation in the gut and improve digestion. It may be beneficial for people with Crohn’s disease, ulcerative colitis, and other inflammatory bowel diseases.

6. Anti-inflammatory: Pomegranate juice is a powerful anti-inflammatory because of its high concentration of antioxidants. It can help reduce inflammation throughout the body and prevent oxidative stress and damage.

7. Arthritis: Flavonols in pomegranate juice may help block the inflammation that contributes to osteoarthritis and cartilage damage. The Juice might have potential effects on osteoporosis, rheumatoid arthritis, and other types of arthritis and joint inflammation.

8. Heart disease: Pomegranate juice is in the running as the most heart-healthy juice. It appears to protect the heart and arteries. The juice improves blood flow and keeps the arteries from becoming stiff and thick. It may also slow the growth of plaque and buildup of cholesterol in the arteries. However those who take blood pressure and cholesterol medications like statins should not take this.

9. Blood pressure: Drinking pomegranate juice daily may also help lower systolic blood pressure.

10. Antiviral: Pomegranate juice can prevent illness and fight off infection. Pomegranates have also been shown to be antibacterial and antiviral in lab tests.

As you should do with any herbal or dietary supplement, talk to your doctor about pomegranate juice before you start drinking it regularly as a supplement. Pomegranate juice may cause dangerous side effects when it interacts with certain prescription medications, such as the blood thinner warfarin (Coumadin, Jantoven) and angiotensin-converting enzyme (ACE) inhibitors, including captopril (Capoten), enalapril (Vasotec) and lisinopril (Prinivil, Zestril).

Some Delicious Foods That Make You Look Older

Food gives our bodies the energy we need to function. Food is also a part of traditions and culture. Howevera continuously poor diet can accelerate the aging process of your skin (and teeth) over time. Here, 14 foods to consume in moderation in order to look as young as you feel.
1. Sweets: Sugar overload may kick-start a process called glycation. When you eat more sugar than your cells can process, the excess sugar molecules combine with proteins, creating "advanced glycation end products" (appropriately referred to as "AGES"). Too much sweet stuff is also bad for your smile.

2. Alcohol: A healthy liver means healthy skin. Alcohol affect your liver function. So your skin can develop a variety of issues, like acne, sallowness, and wrinkles. To top it off, alcohol is dehydrating and bad for your sleep, which was associated with accelerated aging

3. White wine: White wine falls into its own category because of its surprising dental damage. While a glass of red will give you instant "wine mouth," the acid in white wine damages your enamel and makes your teeth more prone to longer-lasting stains.

4. Charred meat: That black char on your burger may contain pro-inflammatory hydrocarbons, which could present a problem since inflammation breaks down the collagen in your skin.

5. Salty foods: Salty foods can make you retain water and cause a 'puffy' look.

6. Processed meats: Deli meat, sausage, and bacon. "Many of these meats have sulfites and other preservatives, which can trigger inflammation in the skin, and accelerate the appearance of aging.

7. Spicy food: Spicy food aggravates rosacea-prone skin, but it can also do damage during menopause. Spicy food dilates your blood vessels, menopausal women may find their skin looking blotchy and less youthful during this time.

8. Red meat: Fatty meat generates free radicals.  Free radicals are in search of missing electrons, they snag electrons from healthy cells, damaging them in the process. This damage ultimately affects your skin's ability to protect itself and generate collagen.

Tricks To Clear A Stuffy Nose and Sinuses

As winter draws closer and temperatures drop, cold viruses begin to run rampant, infecting helpless victims and spreading like wildfire. You’ve probably already noticed that no matter where you go, a chorus of sneezing passersby seems to follow you. In an attempt to keep yourself healthy, you take echinacea tablets, gargle with salt water, and load up on vitamin C. But every year, no matter what, it starts to happen… You feel that scratch in your throat. You notice a dull ache in your sinuses.
You can follow the following direction to clear a stuffy nose:
1. Use a humidifier: A humidifier provides a quick, easy way to reduce sinus pain and relieve a stuffy nose.
2. Take a shower: Ever had a stuffy nose and found that you could breathe so much better after a hot shower? There’s a good reason for that. The steam from a shower helps to thin out the mucus in your nose and reduce inflammation. Taking a hot shower can help your breathing return to normal, at least for a little while. If you dont want to take a shower at least breathing in steam from hot water in a sink.
3.Stay hydrated: Keep the fluids flowing when your nose is stuffed up. Almost all liquids can help keep you hydrated when you’re sick. These include water, sports drinks, and even juice. They help thin the mucus in your nasal passages, pushing the fluids out of your nose and decreasing the pressure in your sinuses.
4. Use a saline spray: Take hydration one step further with saline, a salt-water solution. Using a nasal saline spray can increase the moisture in your nostrils. The spray helps thin the mucus in your nasal passages.
5. Drain your sinuses: It’s not the most glamorous task, but you can flush your clogged nostrils with a neti pot. A neti pot is a container designed to flush mucus and fluids out of your nasal passages.
6. Use a warm compress: A warm compress may help unclog a stuffy nose by opening the nasal passages from the outside. To make a warm compress, first soak a towel in warm water. Squeeze the water out of the towel, then fold it and place it over your nose and forehead.
7. Try decongestants: A decongestant medication can help reduce swelling and ease pain associated with irritated nasal passages. Many decongestants are available without a doctor’s prescription. They come in two forms: nasal spray and pill. Common decongestant nasal sprays include Afrin and Sinex. Common decongestant pills include Sudafed and Sudogest.
8. Take antihistamines or allergy medicine: You may want to take an antihistamine or allergy medicine if your stuffy nose is the result of an allergic reaction. Both types of medications can reduce the swelling in your nasal passages, helping to unclog your stuffy nose. Combination medicines that contain both an antihistamine and a decongestant can relieve the sinus pressure and swelling caused by allergic reactions.

'Potato Woman' - With Hundred of Thousands of Tumor

'Potato Woman' Hosine Ara Begum

 The locals shun her and call her the Potato Woman. She is covered in hundreds of tumors. Hosineara Begum was born with a pimple on her upper lip. Once A roadside doctor sliced it off for her and tiny bumps scattered across her body and later those turner  into tumors, some of which have grown to size of tennis balls.



Hosineara Begum is living with hundreds of huge tumors covering her entire body for last six decades has told how she has been shunned by fellow villagers - who call her the Potato Woman.

The Poor lady cannot talk, eat or wear clothes properly.  Most of the time she wraps herself with soft cotton in an attempt to ease the pain.

Hosineara said: 'The tumors hurt. These hurt badly. I scratch all day and sometimes even blood comes out. I cannot take this pain anymore.

'No one talks to me or meets me. People even turn around if they see me from a distance.

'Children are sacred of me. Even my grandson who is only three sometimes cries when he sees me.

'I live like an outcast. I think the only way I can be freed from this pain is by death.'

What is comorbidity ?

In medicine, comorbidity is the presence of one or more additional diseases or disorders co-occurring with a primary disease or disorder. The term can indicate either a condition existing simultaneously but independently with another condition or a related medical condition. Comorbidity also implies interactions between the illnesses that affect the course and prognosis of both.

‘Comorbidity’ was defined by Feinstein (1970) as “any distinct clinical entity that has co-existed or that may occur during the clinical course of a patient who has the index disease under study” (pp. 456 –7). Within psychiatry, comorbidity is commonly
used to refer to the overlap of two or more psychiatric disorders (Boyd, Burke, Gruenberg, et al., 1984). Comorbidity between substance use disorders and other mental disorders has gained increasing prominence in psychiatry and psychology within the past few decades (Wittchen, 1996). Angold and colleagues have recently drawn a distinction between two types of comorbidity (Angold, Costello, & Erkanli, 1999).
Homotypic comorbidityrefers to the co-occurrence of mental disorders within a diagnostic grouping (Angold et al., 1999). The co-occurrence of two different substance use disorders (e.g. cannabis and alcohol) is an example of homotypic
comorbidity. Heterotypic comorbidity refers to the co-occurrence of two disorders from different diagnostic groupings (Angold et al., 1999). This might include, for example, the co-occurrence of a substance use disorder and an anxiety disorder.

whatever is the definition, the final point is Comorbidity is associated with worse health outcomes, more complex clinical management, and increased health care costs. In the United States, about 80% of Medicare spending is devoted to patients with 4 or more chronic conditions, with costs increasing exponentially as the number of chronic conditions increases.

Know about Risk Adjustment Model

Risk adjustment model means an actuarial tool used to predict health care costs based on the relative actuarial risk of enrollees in risk adjustment covered plans.

Each enrollee risk score is based on the individual’s demographic and health status information. A risk score is calculated as the sum of these demographic and health factors weighted by their estimated marginal contributions to total risk. It is calculated based on the relative to average expenditures.

For example:
–Average = $1,000
–Female, 57 = $500 = .5 risk factor
–Condition A = $700 = .7 risk factor
–Risk Score = 0.5 + 0.7 = 1.2

There are many different model available in the health care arena-
1. Age/Sex risk model
2. Rx Risk model
3. Institutional Utilization Risk model
4. Combination of Rx and Institutional Utilization Risk Model
5. Demography base risk model

All these model also can be classified under 2 major category- Concurrent and Prospective.

For any kind of risk adjustment it is not just the data that matters but, as importantly, how do you use the data. Interpretation of the risk data is also important. To get a true picture of your selected population you also need to normalized the score.

one way to reduce the risk for comparing composite indices made up of apples with oranges is to use normalization. Normalization serves the purpose of bringing the indicators into the same level.

The most common method to normalized the risk score is Standardization.  It converts all indicators to a common scale with an average of zero and standard deviation of one.

The average of zero means that it avoids introducing aggregation distortions stemming from differences in indicators’ means. The scaling factor is the standard deviation of the indicator across.

how is it done
The rankings are calculated using ‘z-scores‘ (calculated for each criterion as the actual value minus the mean of the criterion, divided by the standard deviation of the criterion).

The raw score on each measure is converted to a z-score ((‘score’-‘mean score’)/’standard
deviation of scores’)

By taking account of the standard deviation within any one criterion, this method aims to provide a more sophisticated analysis of the differences, and indeed the similarities in some measures, between blogs or webpages.

The z-score of any one criterion is calculated as = (actual value – mean of criterion)/standard deviation of criterion.
(will be continued)

How Can You Use 'Charlson index' To get Risk Score

The Charlson comorbidity index predicts the mortality for a patient who may have a range of comorbid conditions, such as heart disease, AIDS, or cancer . Te original model includes a total of 22 conditions. Each condition is assigned a score of 1, 2, 3, or 6, depending on the risk.

Clinical conditions and associated scores are as follows:

Score 1: Myocardial infarct, congestive heart failure, peripheral vascular disease, dementia, cerebrovascular disease, chronic lung disease, connective tissue disease, ulcer, chronic liver disease, diabetes.
Score 2: Hemiplegia, moderate or severe kidney disease, diabetes with end organ damage, tumor, leukemia, lymphoma.
Score 3: Moderate or severe liver disease.
Score 6: Malignant tumor, metastasis, AIDS.

How it works:
Scores are summed to provide a total score to predict mortality. Many variations of the Charlson comorbidity index have been presented, including the Charlson/Deyo, Charlson/Romano, Charlson/Manitoba, and Charlson/D'Hoores comorbidity indices.

For a physician, this score is helpful in deciding how aggressively to treat a condition. For example, a patient may have cancer with comorbid heart disease and diabetes. These comorbidities may be so severe that the costs and risks of cancer treatment would outweigh its short-term benefit.

Anyone can also modified the model based on their available clinical data. If you have more conditions available in you data you can score them based on their risk. Also you can set the score based on the average cost of the condition.

Getting Risk Score From the Index:
Each member get the sum of the score point based on the assigned score. Now get the average of the total score for the population. Divide the each members score by the average. If anyone want they can weighted them by the member eligibility period.