Centro de optometría y centro de refracción: norma técnica No. 12-2020­DRACES / Optometry Center and Refraction Center: Technical Standard No. 12-2020 ­ DRACES

Un poco apagada la tinta del documento y dificulta un poco la lectura DRACES [Departamento de Regulación, Acreditación y Control de Establecimientos de Salud] Este documento tiene como objeto "la regulación, autorización y control de los centros de optometría y centro de refracción, en concordancia con el Reglamento para la Regulación, Autorización, Acreditación y Control de Establecimientos de Atención para la Salud, Acuerdo Gubernativo No. 376-2007." Es de carácter obligatorio. Contiene además, las definiciones de los conceptos relacionados al tema principal, además de la infraestructura que deberá tener cada centro, incluidos el equipo y recurso humano y técnico.

Rogue stem cell clinics.

Cell therapies hold significant promise for the treatment of injured or diseased musculoskeletal tissues. However, despite advances in research, there is growing concern about the increasing number of clinical centres around the world that are making unwarranted claims or are performing risky biological procedures. Such providers have been known to recommend, prescribe, or deliver so called 'stem cell' preparations without sufficient data to support their true content and efficacy. In this annotation, we outline the current environment of stem cell-based treatments and the strategies of marketing directly to consumers. We also outline the difficulties in the regulation of these clinics and make recommendations for best practice and the identification and reporting of illegitimate providers. Cite this article: Bone Joint J 2020;102-B(2):148-154.

The Affordable Care Act Decreased the Proportion of Uninsured Patients in a Safety Net Orthopaedic Clinic.

BACKGROUND: The Patient Protection and Affordable Care Act (ACA) was approved in 2010, substantially altering the economics of providing and receiving healthcare services in the United States. One of the primary goals of this legislation was to expand insurance coverage for under- and uninsured residents. Our objective was to examine the effect of the ACA on the insurance status of patients at a safety net clinic. Our institution houses a safety net clinic that provides the dominant majority of orthopaedic care for uninsured patients in our state. Therefore, our study allows us to accurately examine the magnitude of the effect on insurance status in safety net orthopaedic clinics. QUESTIONS/PURPOSES: (1) Did the ACA result in a decrease in the number of uninsured patients at a safety net orthopaedic clinic that provides the dominant majority of orthopaedic care for the uninsured in the state? (2) Did the proportion of patients insured after passage of the ACA differ across age or demographic groups in one state? METHODS: We retrospectively examined our longitudinally maintained adult orthopaedic surgery clinic database from January 2009 to March 2015 and collected visit and demographic data, including zip code income quartile. Based on the data published by the Rhode Island Department of Health, our clinic provides the dominant majority of orthopaedic care for uninsured patients in our state. Therefore, examination of the changes in the proportion of insurance status in our clinic allows us to assess the effect of the ACA on the state level. Univariate and multivariable logistic regression analyses were used to determine the relationship between demographic variables and insurance status. Adjusted odds ratios and 95% CIs were calculated for the proportion of uninsured visits. The proportion of uninsured visits before and after implementation of the ACA was evaluated with an interrupted time-series analysis. The reduction in the proportion of patients without insurance between demographic groups (ie, race, gender, language spoken, and income level) also was compared using an interrupted time-series design. RESULTS: There was a 36% absolute reduction (95% CI, 35%-38%; p < 0.001) in uninsured visits (73% relative reduction; 95% CI, 71%-75%; p < 0.001). There was an immediate 28% absolute reduction (95% CI, 21%-34%; p < 0.001) at the time of ACA implementation, which continued to decline thereafter. After controlling for potential confounding variables such as gender, race, age, and income level, we found that patients who were white, men, younger than 65 years, and seen after January 2014 were more likely to have insurance than patients of other races, women, older patients, and patients treated before January 2014. CONCLUSIONS: After the ACA was implemented, the proportion of patients with health insurance at our safety net adult orthopaedic surgery clinic increased substantially. The reduction in uninsured patients was not equal across genders, races, ages, and incomes. Future studies may benefit from identifying barriers to insurance acquisition in these subpopulations. The results of this study could affect orthopaedic practices in the United States by guiding policy decisions regarding health care. LEVEL OF EVIDENCE: Level III, therapeutic study.

[ISO 9001:2015 Certification in Quality Management]. / Zertifizierung des Qualitätsmanagements nach DIN EN ISO 9001:2015.

Quality management improves the structures, processes and results of organizations of all kinds. Many practices and clinics have their existing quality management system certified according to ISO 9001, (e.g., to check their own quality management system or to obtain a testimonial against third parties). The latest version ISO 9001:2015 contains some changes, both structurally and in terms of content. These changes can be met with reasonable efforts. An ISO 9001:2015 certification represents a value for your organization, but these advantages are often not directly measurable.

Servicio de Clínicas Móviles, Ministerio de Salud y Asistencia Social: Acuerdo ministerial No. 474-2014 / Mobile Clinics Service, Ministry of Health and Social Assistance: Ministerial Agreement No. 474-2014

Este proyecto, tiene el objetivo de llevar los servicios médicos y odontológicos básicos a los lugares de concentración masiva de personas, especialmente a población de escasos recursos. Esta nueva modalidad, está adscrita a la estructura institucional del Mspas y su naturaleza es operativa, por lo que funcionarán a nivel de áreas de salud, quienes serán responsables de elaborar un plan operativo anual de mantenimiento, reparación, funcionamiento y programación de las jornadas médicas de las Clínicas Móviles, así como designar el personal de apoyo necesario.

Accreditation of ambulatory facilities.

With the continued growth of ambulatory surgical centers (ASC), the regulation of facilities has evolved to include new standards and requirements on both state and federal levels. Accreditation allows for the assessment of clinical practice, improves accountability, and better ensures quality of care. In some states, ASC may choose to voluntarily apply for accreditation from a recognized organization, but in others it is mandated. Accreditation provides external validation of safe practices, benchmarking performance against other accredited facilities, and demonstrates to patients and payers the facility's commitment to continuous quality improvement.

[Ethics in aesthetic surgery]. / Ethique de la chirurgie esthétique.

The use of aesthetic medicine and surgery is increasingly popular, and becomes a true phenomenon of society. Many women and men are asking for such treatments. A large proportion of the population carry the idea that this branch of medicine is a true consumer product. The acts of aesthetic medicine and surgery are not without consequences. They produce important changes in the human body, and carry risks of complications that must be taken into account. The overrated media interest of this subject produce commercial drifts that act against the general health of the patients. The invasive acts of medical aesthetics must be placed in a precise legal and ethical framework to protect the patients. A project of a new Belgian law is on the way, awaiting for publication in "Le Moniteur": this law (proposed by Senator Dominique Tilmans) clarifies the competences required for performing non-surgical aesthetic treatments and specific aesthetic invasive treatments. Other projects of law are being studied, and will concern publicity, information of the public, and rules of private clinics where aesthetic invasive acts are performed. Recent international news have shown, with the PIP breast prosthesis scandal, that surveillance of the medical aesthetic field is mandatory. To provide a better protection of patients, the legislator has decided legislate over the subject.

[Effect of the change in the law of contract on the development of medical service units]. / Auswirkungen des Vertragsarztrechtsänderungsgesetzes auf die Entwicklung der Medizinischen Versorgungszentren.

On January 1, 2004, the medical service unit was founded in Germany. However, one of the results of the reform in 2007 was that most of the advantages of medical service units were no longer idiosyncratic to this legal form, but granted to individual general practitioners as well. Since then, a decline in the foundation of medical service units by medical doctors can be observed. Today, the medical service unit rather seems to be a means for hospitals expanding in the intermediary medical sector and, maybe, a re-foundation of the former hospital-owned polyclinics.