MikeLigalig.com

Ah, one can admire how technology has changed the last 58 years.

ha ha ! ay kulirezz!

Major OTZ diay ning toyota'ha?

This looks like the Filipino kind of spaghetti. I can see the diced hot dogs.

It brings great pride to our island that a fellow BOL-ANON is representing the nation in the Olympics. I am also sure that it brings great pride for the people and town of JAGNA that one of her own is representing the nation in the Olympics. We are very proud of you, Mr. Jalnaiz!

Congratulations to our kababayans! God bless you all and Padayon kamo tanan!

Quote from: ako ay si ako on July 28, 2012, 04:36:13 PM
I'm a BSBA Management Accounting student @ Holy Name University in Bohol and we're currently making our thesis. I wanna ask you what can you say about the ff:

* the electric consumption in bohol
* the availability of electric power in bohol
* is bohol in need of another independent power source?
* how is the economic growth of bohol affected by the high cost of electric power in the province?

1. You can find the answer by going to the power source and asking for raw statistical data , perhaps any central tendency and related information.

2. The second question can be ascertained by asking either the electricity provider in Bohol; ask for any relevant statistical as well as multivariate analysis on said resource provisions they may be responsible for promulgating.

3. This is an objective question that you would have to answer yourself , which you will need to forward into an expositional statement in the context of your paper

4. One can say that electricity growth is the independent variable; the economic growth of the province is the dependent variable. The dependent variable depends on the outcome as well as the manipulation of the said independent variable.

Good luck on your thesis. It looks like it will be a rather interesting one.

Way Sapayan, Bai Bags! See you around the forum and God Bless you too!

Quote from: LanggamTamsi2 on July 29, 2012, 03:50:27 PM
eating roast beef for our dinner..it's soooo filling..busog nako.

he he he ! o wow! can i try, too?

Quote from: LanggamTamsi2 on July 29, 2012, 03:49:07 PM
wow very expenssive shoes..di man cguro na maguba or di ba kaha mahilis.

he he he, its actually quite sturdy and handy especially when one is walking around the hospital for 12 hours a day. Most of all, very comfortable for the foot.

Ma luod ta ani...

Quote from: bagets on July 28, 2012, 05:25:05 PM
well compared to western countries, inosente pa kaayo ang Pinas when it comes to PWDs but at least something has been done with the passing of the so-called "Magna Carta for PWDs" which was signed into law sometime in 2007 then some provisions were added in 2009 but still full implementation, recognition and acceptance by all stakeholders needs more time and effort.

Bai Bags, you're totally correct that the Philippine government is late to implement amendments for the rights and social services opportunities for persons with disabilities , but the good thing is that the government has implemented these laws into the constitution. Its encouraging and inspiring to hear that there are opportunities out there for people with disabilities. In that particular societal context, its good to know that our society is progressing in the right direction.

he he he, yes, mag kita kita jud ta. i am looking to build a house in tagbilaran within the immediate future.

Many of these homeless people have behavioral as well as cognitive problems, many have depression. Having pets actually helps them cope with their situation. Everyone needs a friend, and these animals provide an immediate sense of companionship. The hospital that I do my rotations in actually have mentally ill patients and we allow the visitations of therapy dogs as well as therapy cats to help them cope as well as to uplift them.

It is even proven that having cats helps reduce the risk of cardiovascular strikes for patients who suffer with cardiovascular problems; compared to patients who don't have cats or pets, who are statistically prone to having cardiovascular strikes.

Quote from: hubag bohol on July 28, 2012, 09:44:00 PM
What disrespect for a fellow Balingsyanhon! That is Bugsay's brain!

saba dinha, kahibalo man ta tanan imoha ni! bwahahahaha!

i cannot deny that my brain probably will look the same.

Quote from: islander on July 28, 2012, 09:25:10 PM
this needs immediate lobotomy.

hahahahaha mao ba? estoryaheee bi!

Quote from: islander on July 28, 2012, 09:20:34 PM
welcome, gets.  bahalag ba- or wang-, basta gets, this forum is for you.

he he he basta ready si bagets for a dynamic interaction. welcome gajod diri!

Quote from: bagets on July 28, 2012, 06:20:08 PM
tnx for the welcome doc lorenz.

nanglaktod man gud ko ni-deretso ra ko ug comment sa mga thread nga wa na moagi sa introduction portion, my bad.

taga calamay country ko lumad bol-anon, pabagets bagets pero wanggets na diay. enjoy kog basabasa sa mga gipang-post labinag way tihik-tihik ug way lubad-lubad.

God bless us all...

Kumusta Bai Bags,

Maayo kai ning join ka namo diri sa Tubag Bohol , amohang virtual payag. Duol duol ra man pod diay ta, bai, kai taga southern bohol man pod man ko. Kana si Isles, taga Valencia na sija. Si Bai Hubag taga Dimiao na sija.

I know of another member here who is also from Jagna, ijang nick name niya diri ay "Buwadsanga"

Welcome and God Bless us all!

Quote from: Vistabel on July 21, 2012, 01:01:29 AM
The Arab Dog vs. the Israeli Dog

The Israelis and Arabs realized that, if they continued fighting, they would someday end up destroying the whole world. So, they decided to settle their dispute with an ancient practice: A duel of two, like David and Goliath. This duel would be a dog fight.

The negotiators agreed each side would take 5 years to develop the best fighting dog they could. The dog that won the fight would earn its people the right to rule the disputed areas. The losing side would have to lay down its arms for good.

The Arabs found the biggest, meanest Doberman's and Rottweiler's in the world. They bred them together and then crossed their offspring with the meanest Siberian wolves.

They selected only the biggest, strongest puppy of each litter, fed it the best food and killed all the other puppies. They used steroids and trainers in their quest for the perfect killing machine. And after the 5 years were up, they had a dog that needed steel prison bars on its cage. Only expert trainers could handle this incredibly nasty and ferocious beast.

When the day of the big dog-fight finally arrived, the Israelis showed up with a very strange-looking animal, a Dachshund that was 10 feet long!

Everyone at the dogfight arena felt sorry for the Israelis. No one there seriously thought this weird, odd-looking animal stood any chance against the growling beast over in the Arab camp. All the bookies took a look and predicted that the Arab dog would win in less than a minute.

As the cages were opened, the Dachshund very slowly waddled towards the center of the ring.

The Arab dog leaped from its cage and charged the giant ''wiener-dog''. As he got to within an inch of the Israeli dog, the Dachshund opened its jaws and swallowed the Arab beast whole in one bite. There was nothing left but a small puff of fur from the Arab killer dog's tail floating to the ground.

The stunned crowd of international observers, bookies and media personnel let out a collective gasp of disbelief and surprise.

The Arabs approached the Israelis, muttering and shaking their heads in disbelief. "We do not understand," said their leader, "Our top scientists and breeders worked for 5 long years with the meanest, biggest Doberman's, Rottweiler's and Siberian wolves, and they developed an incredible killing machine of a dog!"

The Israelis replied. "Well, for 5 years, we have had a team of Filipino plastic surgeons from Vicky Bello working to make an alligator look like a Dachshund.

bwahahaha! yataps!

he he he, sigoro DUI ning tawhana...

he he he, bantay ka dinha dong, bantay'a imong sugar level....

The prospect of building an electrical windmill in Bohol would require pertinence in the part of the congressional representatives for the province as well as total transparency in their part to ensure that the funds that would be dispersed for such a project won't be tampered with. Far too often have we noticed numerous "failed" projects all in guise of funding and increasing electricity for the people , yet in reality, significant portions of such funding went into the pockets of greedy men. And as consequence, these so called "projects" remained unfinished.

Ako ay si ako,

Do you happen to know sila to sila ? as well as kadto bitaw didto?



Regards,
Dr. Lorenzo

Hmm, so these four questions are part of the criteria for your thesis, eh? What specifics does the grading rubric entail?

I'm sure the electrical engineers and other engineering minds would be more than happy to give you their thoughts.

Ako ay si ako,

Welcome sa among virtual payag diri sa Tubag Bohol dot com. Enjoy your stay here.

Bagets,

Welcome to Tubag Bohol dot com. Enjoy your stay here!

Quote from: bagets on July 28, 2012, 02:21:54 PM
kana ako avatar taga dana ko, ang iladong canuba beach sa jagna

he he he mao ba? ning bisita ko sa inyohang dapita last summer of 2010. guapo na bitaw ang iyohang lugar, jagna seems to be a busy up and coming town. ako taga valencia (sa sawang). regards, bai bags.

It's quite inspiring to hear about Mr. Drake's humanitarian impact. The human services impact of the deaf/ mute school will continue to shape the lives of disabled people. In fact, I was quite happy to hear that the city of tagbilaran also provides training for the blind -- per se in massage therapy. It is inspiring to hear that the local government units as well as some private businesses endorsing the employment of persons with vision, hearing problems. Padayon!

1. The brain is supplied / fed by the internal carotid artery, a subdivision of the common carotid artery, which is itself a division of the Aorta.

hmmmm, i'm a left brained dominant , yet write with my right hand.

present:

On Monday, James Holmes, the lead suspect in the Colorado shooting that killed 12 people, made his first public appearance in court, where the presiding judge gave prosecutors a week to formally charge him. His hair dyed a bright reddish-orange, Holmes appeared somewhat dazed, prompting speculation that he was on medication. The eerie footage of Holmes' court appearance gave few insights into the mind of the accused mass murderer, who allegedly showed up at a midnight showing of The Dark Knight Rises in the Denver suburb Aurora heavily armed and in full body armor. But a slew of reports in recent days has helped observers piece together an emerging portrait of the 24-year-old.

1. He was a shy boy
James Eagan Holmes "was known as a very quiet young man, introverted but pleasant," say Carol D. Leonnig and Joel Achenbach at The Washington Post. His father is a mathematician, his mother a nurse, and he grew up "in an upper middle-class community of picturesque hacienda-style homes surrounded by hills and canyons" in San Diego, Calif., say Susan Gembrowski, Marisol Bello, and Trevor Hughes at USA Today. Former high school classmates say he "liked to play cards, video games, and watch movies [with them as a teenager]," says Matt Stevens at The Los Angeles Times.

2. He was a brilliant student
Though awkward and shy, Holmes "once seemed bound for big things," say Jack Healy and Serge F. Kovaleski at The New York Times. He won scholarships and internships as a high school science student, and graduated "at the top of the top" of his class at the University of California, Riverside. Holmes was one of six pre-thesis doctoral students to win a grant from the National Institutes of Health to study neuroscience at the University of Colorado, Denver. However, "by this spring, Holmes had begun to struggle with poor test scores," say Leonnig and Achenbach. "He eventually decided to quit school," and was in the process of withdrawing from the graduate program at the time of the shooting.

3. He allegedly prepared for the shooting for months
Exploiting a "virtual absence of any laws regulating ammunition sales," Holmes amassed a "6,000-round arsenal legally and easily over the internet," says Healy at The Times. Over the course of four months, "Holmes received more than 50 packages at his Aurora apartment and the University of Colorado medical school," says Nicholas Riccardi at The Associated Press. He bought his first handgun, a Glock, on May 22 at a brick-and-mortar gun store in the Denver area. He bought a shotgun less than a week later, and an AR-15 rifle a week after that. On July 7, he bought another pistol. He allegedly emerged from an exit into the theater wearing a "ballistic helmet, gas mask, throat-protector, tactical vest, and pants," says Riccardi, "such complete protective gear that responding officers almost mistook him for a member of the SWAT team."

4. His apartment has a 'mad scientist' vibe
Holmes' stereo reportedly began to blast loud techno music at midnight, when Holmes was allegedly at the theater, before automatically switching off suddenly at one o'clock. His apartment was rigged with "an intricate series of explosive booby traps, seemingly designed to kill anyone who entered while pursuing his trail," say Healy and Kovaleski. According to NBC's Chris Hansen, who viewed a police video of the apartment's interior, the booby-trap equipment includes wires, a jug full of bullets, two black boxes with red blinking lights, and green soda bottles filled with fluid. Pierre Thomas at ABC News says Holmes "was really like a mad scientist, really like a villain in a movie." In addition, police have reportedly found a Batman poster and a Batman mask in the apartment.

Quote from: bugsay on July 28, 2012, 01:40:36 PM
naa pa ko's itlog anang panahuna pero basin nag ong-ong na..

he he he, you were still in the primordial swamp that was your father's vas deferens.

Bagets, taga asa ka sa Jagna?

Quote from: chicogon on July 26, 2012, 05:52:41 AM
Aw, dako-dako man diay pod nga lote at 842 sqm... almost as big sa yuta akong napalit sa Cabawan. Di lang parehag presyo. Tabangan ta mog ampo duna moy makit-ang buyer. Basin si Doc Lorenz intresado ani 

he he , lami bitaw ang lugar. I have relatives in Baranggay Mangga. My grand-uncle used to be the baranggay captain in that area (the late Mr. P Lucino; the brother of my paternal grandfather, Mr. Rustico Lucino Sr.) I am quite fond of the fish market in mangga. In my opinion, the best fish market in all of Tagbilaran. I frequented that place regularly during my last vacation in Bohol in '10.

To Ate Lumine, I do hope you will be able to sell you property. If your property is still for sale , maybe later on I will check it out the next time I am in Bohol next year.

Your price is reasonable.

Quote from: bagets on July 28, 2012, 09:05:15 AM
more than a boholano - ang term ani semantics man siguro di ko sure..my take on this is that, Mr Drake is more than a bol-anon, which is true, to those who claim to be bol-anons but has done nothing to improve, promote, contribute or develop anything related to the republic of bohol and the bol-anons as well..

Well said, Bagets. You have an interesting username , btw.

And yes, welcome to Tubag Bohol!

Quote from: lumine on July 06, 2012, 11:40:51 PM
ferotex, we always stay at Dao Diamond every time we visit my family in Bohol. and like you, i really admire him for letting the friendly deaf and mute work in that hotel.

I did not know that, Ate Lumine. Then the owner of the hotel should be commended for his civil endeavors to bring opportunity for those with physical limitations per se those who are deaf and mute. Truly very commendable!

The next time I am in Bohol I will check this place out.

Best,

Quote from: TUBAGBOHOL.com on July 27, 2012, 10:13:44 PM

Corruption at Philippine DPWH Obvious

ingon sigoro ang usang bajeh (kanang ning wear ug hijjab) sa ubang bata: "Yallah Yallah !" 

Quote from: bagets on July 28, 2012, 09:49:30 AM
dili man intawon ni sa 'Pinas

he he he, sigoro sa ARMM region ni...

Lipay lagi....

The newly married Mr. & Mrs. Kim

   

Quote from: statesville on July 28, 2012, 10:24:57 AM
bitayon pinatuwad unya paasuhan....

Ma kujapan man gud ta og maka basa ta sa ining klasehang news'a. Di ko kasabot ngano ana'on man gajud ang tigulang sa mga batan-on.
Asa naman ang respeto sa mga tigulang? Dili ba diay maluluoy ang mga tawo sa karong panahon sa mga tigulang tawo nga wa nay defenses?

The young should honor and give respect to their elders, most especially their parents as well as their grandparents who raised them in knowledge of Christ!

    To feed the hungry: "For I was hungry and you gave me to eat." Mt. 25:35

    To give drink to the thirsty: "...I was thirsty and you gave me to drink..." Mt. 25:35

    To clothe the naked: "I was...naked and you clothed me..." Mt. 25:36

    To visit the imprisoned: "I was in prison and you came to me." Mt. 25:36

    To shelter the homeless: "...I was a stranger and you took me in..." Mt. 25:35

    To visit the sick: "...I was sick and you cared for me..." Mt. 25:36

    To bury the dead: "Amen, I say to you, insofar as you did it for one of these least of my brothers, you did it for me." Mt. 25:40

    To admonish the sinner: "...there will be more joy in Heaven at the repentance of one sinner than at ninety-nine of the righteous who had no need of repentance." Lk. 15:7

    To instruct the ignorant: "Go into the whole world and proclaim the good news to all creation." Mk. 16:1

    To counsel the doubtful: "Peace I leave with you, my peace I give to you...Let not your hearts be troubled..." Jn. 14:27

    To comfort the sorrowful: "Come to me, all you grown weary and burdened, and I will refresh you." Mt. 11:28

    To bear wrongs patiently: "...Love your enemies, do good to those who hate you, bless those who curse you." Lk. 6:27-28

    To forgive all injuries: "And forgive us our debts, as we forgive our debtors." Mt. 6:12

    To pray for the living and the dead: "Father, I desire that they, too, may be with me where I am..." Jn. 17:24

“Whatever you do for the least of my brothers and sisters, you do for me.” (Matthew 25:40)

“When the Son of Man comes in his glory, and all the angels with him, he will sit on his glorious throne. 32 All the nations will be gathered before him, and he will separate the people one from another as a shepherd separates the sheep from the goats. 33 He will put the sheep on his right and the goats on his left.

34 “Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. 35 For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36 I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’


-Matthew 25: 31-36

Quote from: islander on July 28, 2012, 03:10:36 AM
time will help me get over the bittersweet memory of puppee, but it was one scene related to her that may haunt me forever. 

once, i brought breakfast leftovers of rice, fish and meat loaf, which i've mixed and pressed with my bare hands.  i placed the plastic bowl in front of puppee, but before she could help herself to her dog food for the day, a lethargic white-haired woman walking by suddenly picked up the bowl and ate the food meant for the dog.  puppee, ever the bright-eyed gentle dog that she was, simply looked.  i was too stunned to react.  then the woman, with eyes downcast, disappeared as suddenly as she came.  i never saw her again.

strangely, it was one instance of dog feeding when i forgot to mix canned dog food with the leftovers.  but thinking this to reassure myself is puny at best.  it's simply impossible to get over that scene.   

Don't worry, Isles, because in your kindness , in helping out and reaching out to the dog, you also have helped the poor who needed that food. What you do for the least of them, you do for Christ Our Lord. Keep on doing your works of mercy, Isles, for surely, mercy will be your crown in heaven.

It is sometimes quite overwhelming to bear the fact that there are so many people, legions, in the society that we live who do not have the luxuries as well as the resources as we and who are living in much more wanting states as we. It is with honest and genuine fraternity what I have to say to you, Isles, : A job well done. For your tireless efforts to helping the most helpless of living things in our society -- who have no resource to talk and are unable to convey their own feelings and thoughts with human speech. For all that , you deserve recognition of your kindness to these animals, these friends. Keep up the good work, Isles.

Mercy comes to those who give mercy.....

http://www.youtube.com/watch?v=z5IFlGWXdHI#ws

http://www.youtube.com/watch?v=V63V8iNNSAs#ws

That Charles Darwin was incapacitated by seasickness for much of his historic voyage on the HMS Beagle may not be surprising. But the author of The Origin of Species experienced disabling nausea and vomiting for most of his life, and a researcher has now put a name to that illness -- cyclical vomiting syndrome.

Symptoms of the syndrome are an "extraordinary" match with Darwin's description of the illness that often incapacitated him into adulthood, said Dr. John Hayman, associate professor of anatomy and developmental biology at Monash University in Melbourne, Australia. He offered his diagnosis in a report posted online in December.

"My original thought was that he may have had abdominal migraine, but his symptoms did not match exactly," Dr. Hayman wrote in an e-mail. "Abdominal migraine led me to CVS, and here the symptoms seem to match."

Darwin's illness has been attributed over time to hypochondria, panic disorder, middle ear damage, arsenic poisoning from prescribed drugs and Chagas' disease from an insect bite. Dr. Hayman points out that those theories have been disallowed.

But a diagnosis of CVS fits, due to its episodic nature and association with motion sickness and atopic dermatitis, which is also among Darwin's symptoms. And the syndrome is brought on by stress -- even pleasurable stress, Dr. Hayman said.

Although CVS is primarily a disease of children, it may persist into adulthood or appear for the first time in adulthood. "This disease is neither well-known nor well-recognized, particularly in adults, although it was first described in the English literature in 1882," Dr. Hayman said.

The chronic, intermittent condition also has been linked to genetic abnormalities, and Darwin's mother and uncle had symptoms of the illness, Dr. Hayman wrote.

Darwin experienced the disorder before he boarded the Beagle and was aware he could feel worse at sea. While aboard on Dec. 30, 1831, he wrote in his diary: "Wretchedly out of spirits and very sick. I often said before starting that I had no doubt I should frequently repent of the whole undertaking, little did I think with what fervour I should do so."

Darwin also seemed to recognize that the syndrome could be triggered by pleasurable events. After his voyage, he told a former shipmate that he could not bear a visit from him. "Twice lately I could not resist seeing old friends ... and the excitement made me so ill afterwards that I have been advised not to do so again," Darwin wrote.

He underwent many medical treatments without lasting improvement, Dr. Hayman said. The most famous was cold water therapy at a British clinic.

Dr. Hayman was surprised that Darwin accomplished so much in his life, considering his struggles with CVS. "He was fortunate in having a very supportive wife, devoted servants and loyal colleagues. And, of course, he was wealthy -- he did not have to work for a living. But above all, it was his great intellect and powers of observation and deduction that drove him even when sick."

Darwin likely was affected by CVS for at least 50 years, although the syndrome became less severe in his later life, Dr. Hayman said. Darwin died in 1882 at 73 with symptoms of heart failure and cardiac ischemia.

http://www.ama-assn.org/amednews/2010/01/18/prsc0118.htm

Physicians, both employed and independent, need to take steps to ensure they are receiving the appropriate share of pay-for-performance or value-based purchasing bonuses, medical consultants say.

Whether the quality pay program is from a health system, insurer, accountable care organization, patient-centered medical home or some other model, physicians need to understand what metrics they have to meet. In addition, doctors need to determine how to meet them and ensure they have the tools to do so.

Several surveys by health care consulting firms suggest that the days of most employed physicians earning a straight salary and independent ones being paid strictly on volume appear to be ending. A survey of 182 health care organizations by the international business consultancy Hay Group released Oct. 17, 2011, found that 66% incorporated quality measures into incentive programs for physicians.

Another study of 424 health care organizations by consultants Sullivan, Cotter and Associates released Jan. 10 found that 72% linked a portion of pay to quality.

The metrics used, how many there are and how much can be earned vary widely. For staff physicians, quality incentive programs primarily will be worked out with their employer. Independent physicians may work with initiatives from several payers.

“Physicians need to push to get details in order to understand how their individual decisions affect the metric,” said Angela Bakker Lee, PhD, managing principal for health care providers with ZS Associates in Philadelphia. “If it’s not clear, you have got to ask.”

Information about the quality program should be provided by the sponsoring entity. Key questions for physicians: Will the assessment of the practice or the physician be based on insurance claims data or an audit of medical records? Will the practice be judged on improvement or whether it hits a particular target? Will a bonus be received only if the full target is met, or is there some prorating for lesser achievements? What will a health system or insurer provide to make it more likely that a physician can achieve the metric? Is it a reasonable target? Health care consultants say goals shouldn’t be too easy, but they should be possible.

“It’s important that the goal be attached to a measure that is realistic but be a stretch,” said James Otto, a senior principal with Hay Group.

Such programs tend to be non-negotiable by physicians, although independent doctors usually have an option not to participate.

Although the programs may not be negotiable, physicians can decide how to take advantage of them. Experts say physicians may find themselves juggling more than one set of measures. The recommendation is to analyze which are most worth the effort and focus on no more than three to five at a time. Measures should be relevant to the practice. For instance, a practice is unlikely to gain much from working with quality markers related to COPD if the practice has very few patients with the condition. When the program is just beginning, the targets should be fairly easy to hit.

“Early successes can be very motivating,” said Jeff Wasserman, vice president of strategy for Culbert Healthcare Solutions, a health care consulting firm in Boston.
Figure out how to get there

Once the quality measures have been identified and prioritized, the next question is how to meet them. In most situations, payers or health systems will tell a physician where they want clinical care quality to go, but it is usually up to him or her and other members of the care team to decide how to get there.

But you can’t know where you’re going if you don’t know where you’ve been. The organization sponsoring the quality program should provide baseline data. This usually takes about a year to collect from the practice and should help identify whether achieving a particular measure is feasible.

“They have to know where they are in order to know if something is attainable,” said Jeffrey Milburn, an independent consultant with the MGMA Health Care Consulting Group. “If they are supposed to get to 85% compliance and they are currently running at 30%, maybe that’s not a reasonable level.”

Medical consultants say doctors need to work with others at the practice to determine how a metric can be achieved. Is there something about how a physician works that needs to be changed? Does it need to be easier for patients to arrange care with other appropriate health professionals? Do staffers with specific characteristics need to be brought on board?

“Your goal should be to try to get the metric to be part of the workflow,” said Todd Shuman, MD, director of quality at Roper St. Francis Healthcare, a 657-bed system in Charleston, S.C.

For instance, if the metric is focused on colorectal cancer screening, does there need to be a reminder in the charts of patients of a certain age that this issue needs to be discussed during a visit? Or does the medical practice need a system for setting appointments for appropriate patients to have this screening? Or is that the job of the larger medical system, if a practice is attached to one?

“Sometimes, the practice needs to make the appointment for the patient,” Milburn said. “Sometimes it’s up to the group or the facility. The doctors have got to be involved and understand who’s doing what and how to implement the program.”
Make sure you have the tools

This next step may mean bringing in additional staff such as a case manager or allowing another entity to place personnel in your office. For instance, the third annual Healthcare Case Management e-survey of 153 hospital, insurance, physician and other health care organizations released May 14 by the Healthcare Intelligence Network found that 90% used embedded case managers in 2012. An embedded case manager may be provided by a health system or an insurer. Or a practice may be given money to hire its own.

Even without additional staff, physicians need to get buy-in from others at the practice. Quality bonuses of employed physicians are usually dependent not only on their performance but also on that of the department and the institution. Independent physicians may find that meeting various quality metrics requires cooperation from other staff. This could mean devising a performance program for them as well.

“Doing well on quality measures is a team sport,” said Brent Asplin, MD, president of Fairview Medical Group in Minneapolis, which in April 2011 shifted compensation for its 500 employed physicians to a model that bases about 40% of the total on quality measures. “It takes everyone working towards the same goals.”

But the key thing, say most health care consultants, is getting regular data on how the practice is doing. A survey of 4,500 health professionals by ZS Associates released May 14 found that 55% of primary care physicians and 54% of specialists said they did not receive sufficient progress updates. One of the complaints about the Medicare Physician Quality Reporting System program is that data given back to physicians come in so late that it is impossible make changes.

Medical practice consultants say getting data as close to real time as possible helps practices gauge progress and adjust. If that is not doable, weekly or monthly reports may get a practice where it wants to go. A physician’s performance should be compared against that of others in the group or national benchmarks.

“Things improve if we can show data, and the data is believable, and we can benchmark that data against something,” Dr. Shuman said. “Physicians respond to that.”

But the most critical piece of advice is not to ignore the move toward quality pay. The consensus is that this trend is not going away. According to a survey of 204 hospital executives released June 5 by Forbes Insights and sponsored by Allscripts Healthcare Solutions, 73% agreed completely or somewhat that physicians needed to shift from volume to value immediately. Thirty-nine percent expected a quarter of total revenue to be linked to value-based purchasing within five years. Seventeen percent said it would comprise half of revenue. So if a quality program is not available in a medical practice’s area, consultants suggest devising one in-house to be prepared for those that emerge in the future.

“If you want to have some control over your destiny, start getting together with your staff to figure out the most important metrics,” Wasserman said. “Develop some of your own benchmarks. When you have the data to demonstrate what you can do, start approaching the payers. Be a little more proactive, and tell them why these are the important things in your area.”

http://www.ama-assn.org/amednews/2012/07/23/bisa0723.htm

   

Early analysis from the world's first ever efficacy trial of an experimental vaccine against dengue fever shows promising results. In a study involving 4,000 children in Thailand, the vaccine appeared to prevent infection by three of the four circulating strains of the virus and showed an excellent safety profile, its French drug maker Sanofi told the press on Wednesday.

The purpose of Sanofi's dengue vaccine is to prevent dengue disease in children and adults living in endemic areas of Asia and Latin America, and also for children and adults travelling to endemic countries, such as expatriates, military personnel, and their families.

Michel De Wilde, Executive Vice President of Research and Development at Sanofi Pasteur, the vaccines division of Sanofi, said the results of the trial "represent a key milestone in the quest to develop a safe and efficacious human vaccine against dengue".

"This is also an important development for global public health, since there is currently no specific treatment or prevention for dengue," he added.
Dengue Disease
The rate of dengue, a mosquito-borne infection found in tropical and sub-tropical regions, has risen dramatically around the world in recent decades, mostly in urban and semi-urban areas. It is also spreading geographically: a recent outbreak in Florida shows that dengue is now reaching continental USA outside the endemic areas of Hawaii and Puerto Rico.

There are currently 50 to 100 million people infected every year, and over 40% of the world's population, that is over 2.5 billion people, are estimated to be at risk, says the World Health Organization (WHO).

There are four related but distinct viruses that cause dengue fever. The infection causes flu-like symptoms, and occasionally develops into hemorrhage and shock, known as severe dengue, a leading cause of serious illness and death among children in some Asian and Latin American countries.

There is currently no effective treatment for dengue fever, and the only way to control its spread at present is to control the mosquito.

The US Food and Drug Administration (FDA) has given Sanofi's experimental dengue vaccine fast track status, meaning the federal agency recognizes such a vaccine potentially meets an important unmet need for a serious disease.
The Thailand Trial
The Sanofi Pasteur dengue vaccine candidate is a live attenuated vaccine, given as 3 doses, 6 months apart (month 0, month 6, and month 12 of the trial).

The safety and efficacy trial was conducted in 4,002 children aged 4 to 11 years in Thailand, as a partnership between Sanofi Pasteur and the Mahidol University under the patronage of the Thai Ministry of Public Health in Muang district of the Ratchaburi Province.

Sanofi say the vaccine generated antibody response for all four dengue virus serotypes and early analysis of the trial results show evidence of protection against three of the four virus serotypes circulating in Thailand.

The company say they are still analysing the results to understand why the vaccine failed to protect against the fourth virus serotype "in the particular epidemiological context of Thailand".

The most important news, they say, is the results confirm the "excellent safety profile" of the experimental vaccine.

The full data is now being reviewed by experts and public health officials, and the intention is to publish the results of the study in a peer-reviewed journal for scrutiny by the scientific community later this year.

Large scale phase III trials of the dengue vaccine are already under way. These involve 31,000 participants in 10 countries, 5 in Asia (the Philippines, Vietnam, Malaysia, Indonesia, and Thailand) and 5 in Latin America (Mexico, Colombia, Honduras, Puerto Rico and Brazil).

The studies are expected to generate important extra data about how the vaccine performs against the four circulating dengue viruses in a wider population in varied settings.

Written by Catharine Paddock PhD
Copyright: Medical News Today

Quote from: islander on July 25, 2012, 10:23:10 PM
all the time; nothing beats new knowledge.  ikaw lorenz natawo sa ikatulo ug napulo ka adlaw sa tingbukad sa hubag sa hidapdapon.  maajong adlawng natawhan!

He he he ! I never knew the original Bisaya word for July, but now I know that it is Hidapdapon. Lawom kaayo uy!

And yes Isles you are so right, it's always good to learn something new.

Welcome to Tubag Bohol, Marie.

it looks like a motorcycle batman would drive.

Quote from: islander on July 24, 2012, 03:35:20 PM
flew to cebu.  daghanang libaong sa langit uy.  kurog jamo ang eroplano tungod tingali sa tropical depression.  ambot ba ani.  di na pod ko kalahos ug bohol kay grabe kuno ang bawod, according to my sis.

I hope your flight back to Cebu was A-OK? How's everything in Manila these days, Isles?

he he he mao ba?

Quote from: islander on July 25, 2012, 12:08:27 AM
maybe lorenz should also consider this motorcycle in addition to the porsche car.

bwahaha! the porsche is my "work" car, but the flintstone-like bicycle is my "relaxing" vehicle.

Quote from: statesville on July 26, 2012, 04:26:16 AM
Ni Guam P. Logroño

Wednesday, July 25, 2012

BISAN pa man sa pangidaron nga 94-anyos, nahimo gihapon sa usa ka lolo ang paglugos sa iyang 34-anyos nga apo nga amang ug bungol niadtong Domingo sa alas 10 sa buntag sa Barangay Laguna, lungsod sa Dalaguete.

Apan ang kaidlad ni Lolo Matador (di tinuod niyang ngan) sa pagdagan sa bakilid bisan sa iyang katiguwa­ngon wa magsilbe kay nadakpan siya sa kapulisan sa lungsod sa Dalaguete nianang hapon sa samang adlaw.

Kini human moreklamo ang inahan sa biktima nga anak sa suspek.

Niadtong Lunes gipasakaag kasong pagpanglugos si Lolo Matador human nasuta sa paghiling sa pink room sa Vicente Sotto Memorial Medical Center (VSMMC) nga positibong gihilabtan ang apo nga special child.

NASAKPAN

Si PO1 Cielito Suerte, sakop sa alert team sa Dalaguete Police kinsa usa sa mga ningdakop kang Lolo Matador, nga nahinabi sa Sun.Star Superbalita nag­kanayon nga ang inahan sa biktima dunay gilakaw niadtong Dominggo sa buntag.

Apan kay sila rang tulo sa suspek ug sa iyang anak nga special child sa balay kay ang uban niyang mga anak niini nagtrabaho na sa dakbayan sa Sugbu, iya ning gibilin sa apuhan.

Sanglit naandan na niya kining gibuhat kay masuko usab ang apuhan nga ibilin ang biktima sa ilang mga silingan.

Wa siya magdahom nga dunay dautang plano ang iyang amahan sa iyang anak.

Sa pag-abot sa inahan gikan sa lakaw, sirado ang pultahan hinungdan nga didto siya miagi sa pikas nga pultahan sa balay.

Didto iyang nakit-an sa akto ang suspek nga hubo ang tibuok lawas nagpatong sa iyang anak nga ang sapot niini diha na sa may tuhod.

Tungod sa iyang kalagot, iyang gisukmag ang suspek, gidabudahan ug gibira aron mapalayo sa iyang anak.

NASUKO PA

Ang suspek nasuko, nikuha og sundang dayon gigukod ang inahan sa biktima hinungdan nga nikaratel sa pagdagan ug nangayog panabang sa mga silingan tungod sa gibuhatan niini.

“Pagkakita sa suspek nga nanggawas ang mga silingan, mikaratel sab sa pagdagan.

Gilatasan ang bakilid daw murag wala panumbalinga bisan pa man sa iyang pangidaron,” asoy ni Suerte.

Ang inahan nitawag gilayon sa iyang mga anak nga nagtrabaho sa dakbayan sa Sugbo ug gipahibawo ang kapulisan.

Sa ilang pagrespondi sa lugar ilang gisikop ang suspek nga wa mosukol, apan nanghimakak nga iyang nahimo ang krimen ngadto sa iyang apo.

“Wala nako siya hilabti. Ako ra intawon nga gihagwa-hagwa ang akong apo,” matod pa sa suspek dihang gidakop nilang mga police.

Apan sa pag-abot niini sa police station niangkon sa krimen ug niluhod ngadto sa inahan sa biktima nga nangayog pasaylo sa iyang gihimo.

Matod pa ni Suerte nga positibo nga nahilabtan ang biktima, apan way duga sa lalake nga nakuha.

Gituohan nila nga taud-taud nang nahilabtan sa suspek ang biktima apan niadto lang Dominggo sa buntag nasakpan.

Gipadayag niini nga dugay nang panahon nga ibilin sa inahan ang biktima ngadto sa apohan kun dunay lakaw sanglit masuko kini kun ibilin sa laing tawo.

Dugang nakuha nilang impormsayon nga ang suspetsado, gawas nga bugoy kaniadto, daghan usab kining mga babaye atol sa iyang kabatan-on.

Human ma-biyudo nitipon nalang nila sanglit dili mo­kuyog sa mga anak niini.

Gipatik sa mantalaang SuperBalita Cebu Hulyo 26, 2012.

Kining krimen, lami ni siya ibitayon dali.

Quote from: TUBAGBOHOL.com on July 26, 2012, 04:52:18 AM
94 years old nang-rape ug apo nga amang ug bungol? this bastard should be shot in public.

Direct and straight to the point.

Do you not know that your body is a temple of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honor God with your body.
â€"1 Corinthians 6:19-20

"But will God really dwell on earth with men? The heavens, even the highest heavens, cannot contain you. How much less this temple I have built!"

â€"2 Chronicles 6:18

Carry each other's burdens, and in this way you will fulfill the law of Christ.
â€"Galatians 6:2

May God himself, the God of peace, sanctify you through and through. May your whole spirit, soul and body be kept blameless at the coming of our Lord Jesus Christ.

â€"1 Thessalonians 5:23

Pleurodesis


is a medical procedure in which the pleural space is artificially obliterated. Pleurodesis is done to prevent recurrence of pneumothorax or recurrent pleural effusion. It can be done chemically or surgically. Surgical pleurodesis is performed via thoracotomy or thoracoscopy. This involves mechanically irritating the parietal pleura, often with a rough pad. Moreover, surgical removal of parietal pleura is an effective way of achieving stable pleurodesis.

The beauty of medical terms is that it is composed of the following:

1. Root word
2. prefix
3. suffix
4. combining form

In the case of this surgical procedure we have the following:

GASTR = is latin for stomach
DUODEN = refers to the duodenum of the small intestine
OSTOMY = surgical procedure of creating a whole / an opening

Surgical Strategy:

Gastroduodenostomy

is a surgical procedure where the doctor creates a new connection between the stomach and the duodenum. This procedure may be performed in cases of stomach cancer or in the case of a malfunctioning pyloric valve.

Ganglionectomy

is the surgical removal of a ganglion. The removal of a ganglion cyst usually requires a ganglionectomy. Such cysts usually form on the hand, foot or wrist and may cause pain or impair body function. Aspiration of the cyst and steroid injections are typically performed first. If they fail, the cyst is excised under local, regional or even general anesthetic. Ganglionectomies are also performed for other reasons, such as the treatment of chronic pain.

Hippocratic Oath: Modern Version

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

Hippocratic Oath: Classical Version

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this artâ€"if they desire to learn itâ€"without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

Quote from: Lorenzo on July 27, 2012, 01:09:15 PM
A physician is someone who knows everything and does nothing.
A surgeon is someone who does everything and knows nothing.
A psychiatrist is someone who knows nothing and does nothing.
A pathologist is someone who knows everything and does everything too late.

-Anonymous

bwahahaha! ma offended man sigoro ang psychiatrists diri anihang quote...

A physician is someone who knows everything and does nothing.
A surgeon is someone who does everything and knows nothing.
A psychiatrist is someone who knows nothing and does nothing.
A pathologist is someone who knows everything and does everything too late.

-Anonymous

http://www.youtube.com/watch?v=gmF_bG5IVnM#

Quote from: islander on July 27, 2012, 01:51:59 AM
perhaps after i get a handle on why the rain is so oa.

ha ha ha! i do wonder ... if that rain also has a particular rhythm...

Quote from: TUBAGBOHOL.com on July 26, 2012, 08:19:48 PM

Alamada Falls in North Cotabato

I wonder if the water is bugnaw. This reminds me of a particular sapa in Liloan Island in Southern Leyte that I went to ; the sapa was frigid cold. I loved it !