Brand New Day HMO: Double XX – Digital Appointment – Addressing COPD Protections

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20200311-W – Coordinated Digital Appointments with Brand New Day Contractors – Doctors Bera & Mojica – Developer – Keith Torkelson MS

https://brandnewdayhmo.blogspot.com/2020/03/msg-product-coordinated-digital.html

Keith E Torkelson MS: Date Chartered = 3/11/20

Feature Pictures

"Speedy In Hospital"

Primary Source for This Report (Parent Document)

01_Assess_COPD_18010908_Risk Update

Blog

Blogger Title

Double XX – Digital Appointment – Addressing COPD Protections – By Keith Torkelson, MS

Google Plus Information

External Quality Review - Smoking Cessation Efforts – Health Related Engagement – Physical Examination (2018) - CMS – COPD – Stars – Risk Factors

Charter Date – 20180910-M

Authorship – KE Torkelson MS

Editor - AVEY

Table - Digital Physical – Article Format

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Article	Primary Blog	Fully Executed
-
Hub	AnimaCules
Celery	HEALTHMAN	20180907-F
COPD	BND	20180910-M
PHR/Patient Portals	HEALTHMAN
Tests	Clozapine RX	20180831-F
HRE	AnimaCules
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Table - Digital Physical – Article Format – Last Reviewed: 20180902-SUN:

Table – Digital Physical - Blog Format - Related Blogs Associations – Physical Cluster

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Blog	Primary - Post	Secondary - Post
-
AnimaCules (Hub)	Homepage	HRE
BND	COPD
Clozapine RX	Lab Testing
HEALTHMAN	Celery	PHR & Portals
-

Table - Related Blogs Associations – Physical Cluster – Last Reviewed: 20180831-F:

Partners

Abstract – Executive Summary-

The Subject for this report is Keith E Torkelson AKA Buster. This report has been developed and published in preparation for Keith’s upcoming Physical Exam with Team Chester D Mojica (CDM-PCP). Keith prepares in advance for his Health Related Engagements (HREs) making him a ProSumer (MSG Reserve Word). This is the third in a series of reports addressing this year’s (2018) Physical Exam. The other reports addressed: Nutrition and Blood Glucose Levels (BGLs) and Laboratory Testing. In preparation for this fall quarter’s smoking cessation efforts we have derived a measurement tool. We are Mentalation Solutions Group or MSG. The tool yields our Aerobic Mitigation Effort Score or AMES. On 20180907-F as a baseline we calculated Keith’s AMES at 73.5%. Our AME Tool at this point is 17 Items. Back in 2014 Keith was assigned by CDM to get a VAPE system. To date Keith has failed to get the VAPE to work for him. Our COPD control subject is ”MO”. We investigated Chantix as an alternative. Chantix does not look like a promising smoking deterrent for Keith. Keith is now 59 years old. Brand New Day (BND) is in place to help Keith yet the CMS grades BND’s overall services and supports as just above average.

Solution Resistant – Superior Services & Supports Required

Keith needs superior services and support to succeed with his cessation efforts. We introduce one of our Therapeutic Breathing Methods here in this report. On 20170904 Team CDM offered up a Spirometry Exam. About Spirometry Keith was awarded 89%. A notation on the event record declared 89% as (N) for Normal. Keith has tried many Smoking Cessation Efforts (SCEs). We address the majority of them here in this report. Keith had a rather large family growing up. There are several family members that had cigarette smoking issues. We include Keith’s latest Chest X-rays in this report. We also addressed two COPD Screening methods here. The first put Keith at a Stage I or Mild COPD level (20150919-SAT). The second screening tool (Online) gives Keith a Score of 4 or less with 10 being the worst case (20180829-W). Finally we are in the vetting phase of picking paper assessments to track our Cessation Efforts. Enjoy!

Legacy Publication – In Scope

Legacy Papers/Publications – Assignment of Accountability

James J Krueger MD COPD Course for Brand New Day by Keith E Torkelson MS – Chartered: August 19, 2017

http://brandnewdayhmo.blogspot.com/2017/08/james-j-krueger-md-copd-course-for.html

COPD Course Satisfaction Survey (Content Assessment)

Parent Document = 01_Assignment_COPD_17070801_Gibbs BND 6.2.1

Excerpt - TimeSpent

We might have better spent the time (some four hours) learning and working on our plan to increase our chances to quit smoking. Our goal here is to help Brand New Day and their Network deliver a better Smoking Cessation Product (SCP). We get the inkling that Doctor Krueger sized his students up during the first lesson and said it wasn’t worth his time. Doctor Krueger did not return for the second, fifth, and sixth lesson. Over six (6) weeks the student attrition rate was substantial. That’s the consumers’ manner of saying for them this is non-sense. 20170815-TU: Our legacy report is about thirty pages. That equates to processing about six (6) pages per lesson session. Our rigor exceeded that of 5/6 instruction staff.

List – Acronyms and AcroCodes Overall

-
AcroCode	Meaning
-
BND	Brand New Day
CMS	Centers for Medicare and Medicaid Services
CCCHC	Central City Community Health Center
COPD	Chronic Obstructive Pulmonary Disease
DND	Did Not Deter
EBR	Experimental Bunny Rabbit
HCP	Health Care Professional
HEDIS	Healthcare Effectiveness Data and Information Set
MAI	Methods Applied Inventory
MSG	Mentalation Solutions Group
NIS	Not In Scope
NSC	Not Strongly Correlated
PCP	Primary Care Physician
ROC	Route Of Choice
S&C-MD	Stop & Call A Doctor
-

List – Acronyms and AcroCodes Overall

Embedded Acronym Lists

We have also included more Acronyms. They are embedded with the sections for which they apply.

List of Tables – Matrices – Figures

Table - Digital Physical – Article Format

Table – Digital Physical - Blog Format - Related Blogs Associations – Physical Cluster

Legacy Publication – In Scope

List – Acronyms and AcroCodes Overall

List of Tables – Matrices – Figures

Table – Tests & Interventions – Tracking The Interval

Table - COPD Screening Results – KE Torkelson

Figure – Spirometry Reference

Figure – Spirometry Results (8/21/2018)

Figures - Chester Mojica Ordered Radiographs

Table – Family History – Smoking Cigarettes – Focus “Torkelson’s” (TorkelCentric)

Table - AcroCodes – Context of Experimentation

Table - History – Smoking Cessation - Methods Applied Inventory (MAI)

Table - Spirometry Cutoff Values (%)

Table – Acronyms & AcroCodes – Spirometry & Dependency

Figure - Spirometric Graph

Table – Acronyms and 2018 HEDIS Measures – Addressing COPD

Table – Acronyms For HEDIS Related

Table - HEDIS Areas - In Scope COPD Related - PCP

Table – Adverse Reactions to Chantix (Varenicline)

Figure – VAPE Related

Table – Smoking and COPD - Mitigation Efforts

Appendix - COPD Related Images (Current)

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List of Tables – Matrices – Figures (Acronyms)

	-
Acrocode	Assessment	Note
	-
HEDIS	Add HEDIS	COPD Interventions
ASI	Addiction Severity Index	[STAYED]
ProQOL	Professional Quality Of Life	For Cessation Efforts
QOL	Quality Of Life	For Cessation Efforts
COPD-S	COPD Screener (Online)	Results Here
	-

Table – Tests & Interventions – Tracking The Interval (Acronyms)

-
Acrocode	Test	Here
-
O2	1-Spirometry Results	X
-
BGL	Blood Glucose Level
CBC	Complete Blood Count
C-HR	Cough-Hack Results	X
COPD-S	COPD Risk Screener Per COPD Foundation
FFC-BND	2017 BND/CCCHC Frequent Flyer Course	X
IMR	In Motion Results
J-RR	Jogging Return Results
SPFS	Smoking Protective Factors Scale
SUR	Swimming Underwater Results
YCT	Yoga Count Tally
-

Table – Tests & Interventions – Tracking The Interval (Acronyms)

Defining the Interval

Our COPD management interval begins October 1, 2018 until we have a year without using tobacco in any form.

Table – Combined COPD Screening Results – KE Torkelson

COPD Population Screener (Online)

https://www.copdfoundation.org/Screener.aspx

Results Up Front

-
Time Stamp	Method	Your Score
-
20150919-SAT	Online Screening	4/10 (#/MAX)
20170914-TH	Spirometry	89%
20180829-W	Online Screening	Between 0-4
-

Table – Combined COPD Screening Results – KE Torkelson

Interpretation

High spirometry scores are favorable. The online screening tool uses a 0 not risk to 10 maximum risk Scale. The following is a sample of what they the COPD Foundation E-reported back to us. “Your total score is between 0 and 4. Your total score is between 0 and 4. If your total score is 5 or more, your breathing problems may be caused by chronic obstructive pulmonary disease (COPD). The higher your score, the more likely you are to have COPD. If you are experiencing problems with your breathing, please share your answers to the five-question screener with your Healthcare Professional (HCP). Only your HCP can decide if you have COPD. Your HCP can also help evaluate your breathing problems by performing a breathing test, also known as spirometry.”

FYI > See more at: http://www.copdfoundation.org/Results.aspx#sthash.1LjQCAT6.dpuf

COPD Population Screener - COPD Risk Screener - COPD Foundation

https://www.copdfoundation.org/Screener.aspx

COPD Statistic

“24 million Americans have COPD, but 12 million do not know that they have it. Are you one of the missing millions? Please take this 5 question risk screener - it takes less than a minute to find out if you are at risk for COPD.”

Interpreting Spirometry I of II

[INSERT STAGES OF COPD FIGURE]

Figure – Spirometry Reference

COPD Stage Chart

[INSERT SPIROMETRY RESULTS]

Figure – Spirometry Results (8/21/2018)

Interpretation

Combined – Stages Screener with Spirometry Summary – Context COPD

We define a chronic cough as a non-productive cough that occurs daily. We define smoker’s cough as any non-productive cough. We define a productive cough as one that moves mucus up and out of the airways. We don’t spit up many of our productive coughs. Periodically we intentionally spit out the sputum to check its’ viscosity and color. If our sputum is green in color we consciously take action. We will discuss some of our actions later on. For our spirometry test dated 9/14/17 (reported to us on 8/21/2018) Team Mojica (PCP) gave us an eighty-nine (89) percent. Any way we look at it this is a favorable value. So in many ways we are in the COPD Prevention Phase (CPP).

Figures - Chester Mojica Ordered Radiographs

[INSERT X-RAYS]

Chest X-Ray 2018 for Keith Torkelson

X-ray (Radiograph) Interpretation (AVEY’s Part)

I just never know when I am going to be called in for a second opinion. The subject of this report is Keith E Torkelson AKA Buster. I am the AVEY construct. I have no experience interpreting X-rays. These x-ray look scary to me because it looks like a human with not head, arms or anything below the diaphragm. Buster called me in because when he was in Veterinary Radiology (Soft Tissue) class he had a bit of trouble. We just came up with an idea. We are going to take the frontal few and Photoshop it to increase contrast and maybe bring out some hidden color. Applying Photoshop is one of my tasks around Mentalation Solutions Group (MSG). Our goal is to rule out all white areas from being problematic. In addition, Buster suffered at least on bout with Pneumonia. We are looking for some scar tissue. Enough said! Outcome for our tweaked radiograph can be found at the end.

-
-

Table – Family History – Smoking Cigarettes – Focus “Torkelson’s” (TorkelCentric)

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Member	Relation	Born	Cigarette Smoking Status	Role Model
-
1-GGT	Biological Father	1922	No V Cigars (?)
2A-JET	Biological Mother	1923	Yes
2B-JMB	Biological First Aunt Mother’s Younger Sister	1925	Yes	Yes
A-LAK	Sibling – 1^stof 6	1947	Never
B-CET	Sibling – 2^nd of 6	1948-1969	Yes	Yes
C-KGT	Sibling – 3^rd of 6	1949	Yes – Quit
D-CDB	Sibling – 4^thof 6	1952	Yes – Quit
E-CMF	Sibling – 5^th of 6	1955	Tried Once
F-KET	Subject Here - 6 of 6 (9)	1959
JPB	Uncle by Marriage	1915	No
Uncle Kendall	Uncle by Blood Mom’s older brother		Yes
JVB	JPB’s Younger Brother		Yes

Table – Family History – Smoking Cigarettes – Focus “Torkelson’s”

-
-

Vignette – Staging For Original Sin

Two smoking related events occurred for us circa 1963 when Buster was four (4) years old. We will never know the exact order of the two. One day two neighborhood delinquents, Dave and Bob, said we could “Follow” them up to the Thrifty Drug Store about a mile away. Again, we would have been about age four (4). They were five (5) years older than us, thus nine (9) years old. We are not sure if Dave and Bob premeditated their Thrifty Plan while we walked or if they said just before entering what they wanted us to do for them. We followed precisely through for them by shoplifting balloons and cigars. On the way home they encouraged us to smoke one of the “Cheap” cigars. Around the same time Sharon, Dave’s younger sister (Born 1959) stole five dollars from her mother’s purse. She asked us to go to Zinda’s Liquor Store to buy candy. Zinda’s was halfway closer than Thrifty’s. The majority of the candy at that time was penny/nickel. We only picked a few items. In the end she got in trouble.

How is it Original Sin?

OK. Now to the Original Sin part. In 1963 as much as possible we sought respite over at our mother’s sister’s house. Our mother’s younger sister, our aunt, was a smoker. Actually she is ninety-three (93) right now and still smoking cigarettes. One day we got up early to find her cigarettes on the kitchen counter. When she was in the kitchen rather than use a lighter she would lite her cigarette of the gas burner. When we saw her pack of cigarettes next to the stove we took one out then ignited it off one of the four gas burners. We had all but taken two (2) puffs when she appears asking Keith Edward: Are you smoking? We crushed the burning cigarette in our right hand and shoved it down the garbage disposal. Simultaneously we responded: “No”. This was for us our Original Sin.

Table - AcroCodes – Context of Experimentation

-
AcroCode	Meaning

DND	Did Not Deter
EBR	Experimental Bunny Rabbit
MAI	Methods Applied Inventory
ROC	Route Of Choice
-

Table - AcroCodes – Context of Experimentation

Table - History – Smoking Cessation - Methods Applied Inventory (MAI)

-
Method	Period [Circa]	Outcome	Note
-
Cold Turkey	1982	3 years success - In remission	Response to Pneumonia
Gum	[2000]	DND
Lozenge	[2000]	Made mouth itchy
Nicotine Patch	[2000]	Chemical Burns
Nicotine Anonymous	[2009]	Scary	Old People with Emphysema
Pipe Smoking	On and off Stopped in [2013]	With vanilla pipe tobacco – my Fav ROC
VAPE	2014	DND	EBR
Wellbutrin	[2005]	Increased Preoccupation	Removes any satisfaction
Theraflu Nighttime	>10 Years	Treatment V Preventive
Chantix	2018	Unlikely alternative	Cost may exceed Benefits

First Reviewed: 20170709-SUN: Lived Experience for Buster – Brought Forward: 20180829-W: Last Updated: 20180907-F:

Interpretation

We put down smoking from roughly 1983-1985. It was a wonderful period of aerobic activity. At the present time VAPE Experiment 2014 is for us a failure. Our Theraflu prevention strategy actually has worked for others and as well as us multiple times. The basic theme of our Theraflu prevention is to take it twice a year when we are not suffering COPD symptoms. We take it for the pre-summer temperature change and the pre-winter temperature change. As you will see later Chantix is not a viable option for us. We didn't list it yet periodically we are prescribed antibiotics for non-respiratory concerns. For example earlier this year (2018) we were given antibiotics for a tooth implant. We are always vigilant to notice any effects these antibiotics have on our pulmonary system. We have an idea! Just as we can get good bacteria to re-colonize our Gastrointestinal Tract (GIT) i.e. with user-friendly bacteria (pro-biotic) after an antibiotic regimen so goes the concept with our airways. We suggest a pro-biotic inhaler. In a different live we would make a killing with this notion. As far as we can see the need for this product is an unmet need.

Table - History – Smoking Cessation - Methods Applied Inventory (MAI)

-
Method	Period [Circa]	Outcome	Note
-
Cold Turkey	1982	3 years success - In remission	Response to Pneumonia
Gum	[2000]	DND
Lozenge	[2000]	Made mouth itchy
Nicotine Patch	[2000]	Chemical Burns
Nicotine Anonymous	[2009]	Scary	Old People with Emphysema
Pipe Smoking	On and off Stopped in [2013]	With vanilla pipe tobacco – my Fav ROC
VAPE	2014	DND	EBR
Wellbutrin	[2005]	Increased Preoccupation	Removes any satisfaction
Theraflu Nighttime	>10 Years	Treatment V Preventive
Chantix	2018	Unlikely alternative	Cost may exceed Benefits

First Reviewed: 20170709-SUN: Lived Experience for Buster – Brought Forward: 20180829-W: Last Updated: 20180907-F:

Interpretation

Interpreting Spirometry II > Acronyms After Results

[INSERT 2017 SPIROMETRY RESULTS]

Figure – 2017 Spirometry Results

Spirometry Results – Provider = Central City Community Health Center (GG)

COPD Related Images

How do you interpret spirometry results?

“Begin by looking at the forced vital capacity (FVC) to determine if it's within a normal range. Next, look at the forced expiratory volume in one second (FEV1) to see if it's within normal limits. If the FVC and the FEV1 are both normal, stop at this step—the spirometry test is normal. Mar 31, 2018”

Spirometry: What to Expect and How to Interpret Your Results

FYI > https://www.healthline.com/health/spirometry

Table - Spirometry Cutoff Values (%)

-
Parameter	Adults – OK Value	Margin
-
FVC Result	>80%
FEV1 Result	>80%
FEV1/FVC ratio	>70%
-

Table - Spirometry Cutoff Values (%)

OKV,OK Value

Now we return to our 9/14/17 spirometry results. On 8/21/2018 someone in Central City Community Health Center (CCCHC) Team Mojica Clerical got smart and printed us out a “Summary Of Today’s Visit". It provided us with a lot of the information we needed for our reports. If you notice above for Spirometry we’re given an eighty-nine (89) percent (%)-N. We assume the N means Normal. We are not sure which Parameter they are reporting to us. Yet 89% is OK across all Parameters.

Table – Acronyms & AcroCodes – Spirometry & Dependency

-	-
Acrocode	Meaning
-	-
FVC	Forced Vital Capacity
FEV1	Forced Expiratory Volume in one second
DND	Did Not Deter
DOC	Drug Of Choice
ROC	Route Of Choice
EBR	Experimental Bunny Rabbit
BND Sub	Brand New Day Subsidized
-	-

Spirometry Basics

Figure - Spirometric Interpretation Graph

Reset Near Zero – Deep Tissue Massage Approaches (DTMAs)

For us the Spirometric Interpretation Graph (SIG) since it was introduced to us in General Physiology class was straightforward. We have a few notes to make here. Our Spirometry results were reported as a percentage. This graphs “Y” axis reports Volume in Liters. We prefer the Volume approach. The integral we would to discuss is the Residual Volume (RV). Try as one may, it’s very difficult for one’s self to expresses the RV. Yet now, with decreasing frequency, we contract a back-walker. It is always a female weighing about 100 pounds. When our back-walker is compressing our lung region we consciously express our air with each step she makes. We figure she pushes out an extra half liter or so of RV. We here at MSG call this Resetting Near Zero (RN0). We have our next RN0 scheduled for this month (September 2018). We call this a Therapeutic Breathing Method (TBM). We find the same walking can also detect pain and problems with one’s HEART.

Performance Challenge(s)

How is it than COPD moves up on our roster for work done? One, we are in a window without green mucus. We would like to avoid green mucous this winter. We live in an environment where over half of the some odd twelve (12) people are suffering COPD and making annoying COPD noises. One of the people that we sleep within earshot wakes and keeps us up at night with the Full Monty of COPD noises. We call the Full Monty: Snort – Cough – Hack. As winter approaches our comrades are likely to get worse. Finally, we have a reality check to process. One of our friends, Mike C, is a Veteran. He has been diagnosed with a small mass in one lung lobe. It is very likely he suffers with Malignant Tumor. Further he says the Veteran’s Administration (Boise Idaho) believes that his mass in inoperable. We really do not wish to go this far. So this report in earnest begins our Preventative Measures. We are very fortunate to have been given the opportunity to prevent Exacerbation [SPELLED].

[INSERT MIKE’S IMAGES]

Mike C - Friend and Veteran

Mass in Mike Cs Lung

Table – Acronyms and 2018 HEDIS Measures – Addressing COPD

-	-
Acrocode	Measure	Impact 2018
-	-
MSC	Medical Assistance With Smoking and Tobacco Use Cessation	Little
PNU	Pneumococcal Vaccination Status for Older Adults	Likely
PAOA	Physical Activity in Older Adults	Likely
AAB	Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis	(*)
TRC	Transitions of Care	Little
MMA	Medication Management for People With Asthma	(**)
PCE	Pharmacotherapy Management of COPD Exacerbation	Unneeded
SPR	Use of Spirometry Testing in the Assessment and Diagnosis of COPD	Likely
-	-

Table – Acronyms and 2018 HEDIS Measures – Addressing COPD

Behind The Scenes

Obviously our Primary Care Physician (PCP) is taking measures to help us with COPD Management behind the scenes. The table above was born out some national material offered to help out practitioners such as PCPs. This is population medicine and we only address it to help round things out. (*) We already discussed antibiotics a bit. Our PCP does not prescribe fo r us antibiotics much. (**) For 2018 we haven’t executed our Drive By Inhaler Method (DXIM). We will hold DXIM for our Cessation Report - Smoking (CR-S). We included as link just in case you are interested in population health and what we used to derive our COPD HEDIS table above.

Sample HEDIS Reference

HEDIS Technical Resources > HEDIS 2018 > Volume 1: Narrative - Summary Table of Measures, Product Lines and Changes - HEDIS 2018 Measures - Applicable to: Commercial/Medicaid/Medicare - Changes to HEDIS 2018 - Effectiveness Of Care

> NCQA HEDIS 2018 Measures (2017-06-28)

Table – Acronyms For HEDIS Related


AcroCode	Meaning	Margin

COPD	Chronic Obstructive Pulmonary Disease
HEDIS	Healthcare Effectiveness Data and Information Set
NIS	Not In Scope
NSC	Not Strongly Correlated
PCP	Primary Care Physician
RAS	Relative Resource Use for People With Asthma
RCO	Relative Resource Use for People With COPD
RRU	Relative Resource Use

Sample HEDIS Reference

> NCQA HEDIS 2018 Measures (2017-06-28)

Table – Acronyms For HEDIS Related


AcroCode	Meaning	Margin

COPD	Chronic Obstructive Pulmonary Disease
HEDIS	Healthcare Effectiveness Data and Information Set
NIS	Not In Scope
NSC	Not Strongly Correlated
PCP	Primary Care Physician
RAS	Relative Resource Use for People With Asthma
RCO	Relative Resource Use for People With COPD
RRU	Relative Resource Use

Table - HEDIS Areas - In Scope COPD Related - PCP

-
Area		2012-2018 Trend
-
Effectiveness Of Care		Improving
Access/Availability Of Care		Improving
Experience Of Care		Improving
Utilization And Risk Adjusted Utilization		NIS
Relative Resource Use (RRU)		NSC
Health Plan Descriptive Information		SoSo
Measures Collected Using Electronic Clinical Data Systems		Evidence Lacking
-

Table - HEDIS Areas - In Scope COPD Related – PCP - Last Update: 20180907-F:

CMS Stars - We See Stars Again

As of today, September 7, 2018 (Friday) the CMS Stars score for 2019 has not been published over the Internet. For some reason we cannot find any CMS Stars for our PCP’s office. Our insurance provider is Universal Care Brand New Day (BND). For 2018 CMS awarded BND 3.5 Stars (5.0 being best) for their overall performance. Much of our efforts have been devoted to helping BND reap the rewards of earning 4.5 Stars or Better. We have been at it five (5) years now. We have little more to offer. Thus we will begin reallocating time away from them and their Stars. On the upside, BND is such a poor performing program they have provided to us many real world problems to investigate. They have helped us here at MSG develop our External Quality Review Skills (EQRSs). Next we address Guidelines For Relative Resource Use (RRU).

[INSERT BND CMS STARS]

Brand New Day's 2018 CMS Stars Scores

Summary Relative Resource Use (RRU)

Relative Resource Use (RRU) is a measurement methodology developed by The National Committee for Quality Assurance (NCQA). “NCQA is an independent 501(c)(3) nonprofit organization in the United States. The NCQA works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation”. RRU might be an indicator for Performance Earned Value (PEV-MSG) about services such as doctor visits and hospital stays. RRU is a quality evaluation. Two factors are of importance. First is the amount of services. Some call this "Dosage". The other factor is Quality Of Care (QOC). The NCQA hopes to determine the relationship between QOC and Dosage. Our part as a Consumer is to submit our Biennial Health Outcomes Survey (HOS). Being the company people we are we submitted are assigned HOSs for: 2018, 2016, and 2014. In 2014 The Myers Group (TMG) had the contract to administer and process the HOS’s. Since 2014 TMG somehow lost the HOS contract to SPH Analytics (SPH). How is it we here at MSG we know these things? As far back as 2014 we wanted our tabulated HOS results back. Myer’s referred us to NCQA. NCQA thought we were a provider and gave us instructions to set up a Provider Account. It was a ditto with SPH. Yet as a BND company person we did our part since our Biennial HOS contributes to BND’s annual CMS Stars Score.

Table – Adverse Reactions to Chantix (Varenicline)

Stop using (Chantix) Varenicline and call your doctor at once if you have (*):

-
Adverse Effects/Affects	S&C-MD	Tolerable	Seriously Intolerable
-
A seizure (convulsions)	*		X
Abnormal (vivid, unusual, or strange) Dreams	*
Aggression	*
Agitation	*	X
Anger
Anxiety			X
Constipation		X
Depression	*		X

Flatulence		X
Hostility	*		X
Irritability		X
-

Table – Adverse Reactions to Chantix (Varenicline) - S&C-MD is Stop and Call Doctor - Last Reviewed: 20180909-SUN:

Table – Adverse Reactions to Chantix (Varenicline)

Stop using (Chantix) Varenicline and call your doctor at once if you have (*)


Adverse Effects/Affects	S&C-MD	Tolerable	Seriously Intolerable

Mood or behavior changes	*
Nausea			X
New or worsening mental health problems	*		X
Rash			X
Restlessness		X
Sleep disturbance			X
Sleepwalking	*		X

Thoughts about suicide or hurting yourself	*
Trouble sleeping	*		X
Vomiting
Weight Gain
Withdrawal

Table – Adverse Reactions to Chantix (Varenicline) - S&C-MD is Stop and Call Doctor - Last Reviewed: 20180909-SUN:

Summary > Is Chantix Worth A Risk? = Not Really

Vignette - Control Person – Mike O. (“MO” - AESP – “Speedy”)

We have known Mike “Speedy” O. since 2012. On 20171030-M we visited him at Fountain Valley Hospital. He was in the Infectious Disease Ward (IDW). We captured the moment on “film” for posterity. Since we have known "Speedy" (2012) he has been a heavy cigarette smoker. He had attended one session of six about The COPD Class (BND-TCC). "Speedy" was diagnosed with Flu and a secondary bacterial infection (Pneumonia). After looking at the IV Medications the Hospital was giving him we thought that maybe he would die. Yet, he responded well to treatment and came back home. Since his discharge, for the most part “Speedy" has been a nonsmoker. He still makes COPD noises. He does not attend any “Program” anymore. Last Wednesday (9/5/18) his landlady said to us: I think Speedy has Alzheimer’s (ALZ). Speedy may have Narcolepsy. We find it getter harder to bring him into reality. Yet most importantly Ever since the COPD Class “Speedy" has been our COPD Control Subject (CCS). We really do not wish to go into the hospital to quit smoking!

[INSERT SPEEDY PHOTOS]

Speedy Before

-
Speedy During
Dying Gracefully

Buster's Control Selfie (2018)

Assignment Special COPD Meeting – 2017 Past Blast

Nearing the end of this report we revisit doctor James J Krueger MD. HIs 2017 six (6) session COPD Course was ineffective for us. BND day is not a very good resource for helping us with our COPD work. Yet we’re very grateful for our BND subsidized 24-Hour Fitness membership. We are leveraging this membership to make measurable progress about COPD and Smoking Cessation.

Special Topic – The VAPE Fix

[INSERT VAPE CLASS SALES]

Figure – VAPE Related

Marketing for BND's VAPE Promotion

Vape Summary

Since 2014 when we failed to get our VAPE investment of some odd $75.00 to pay off for us. Since 2014 we have interviewed about one dozen VAPE users. On Average they report they were not able to get their VAPE systems to substitute for smoking until after a month of daily usage. Buster’s main problem with the VAPE is it gives him a dry smoker’s cough. Starting October (2018) we are going to give it a try anew. How many lengths would you go to to quit smoking? See our Smoking Mitigation Efforts (SMEs) below.

Table – Smoking and COPD - Mitigation Efforts

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##	Aerobic Effort	BND Subsidy	Pending (X)	Value	QUANT
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01	Acupuncture		X	SoSo	0.5
	Chase the Bus	Yes		High	1.0
	Costal Breathing (Mindful)			SoSo	0.5
	Diaphragmatic Breathing (Mindful)			High	1.0
05	Exercising Chest Muscles (Mindful)			SoSo	0.5
	Intimacy			High	1.0
	Jogging			High	1.0
	Karaoke			High	1.0
	Labor			SoSo	0.5
10	Reduction Daily # of Cigarettes			Low	0.0
	Sleep			High	1.0
	Super Deep Tissue Massage		X	High	1.0
	Swimming (Breath Holding)	Yes	X	High	1.0
	Theraflu Evaluation		X	High	1.0
15	VAPE			Low	0.0
	Walking			SoSo	0.5
17	Yoga	Yes		High	1.0
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	CALC (SUM/Items) =				12.5/17.0
	Aerobic Mitigation Effort Score (AMES) =				73.5%
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Table – Smoking and COPD - Mitigation Efforts: Date Calculated & Last Reviewed: 20180907-F:

This Is The End

Images @ The End

Rework of Chest X-ray - Photoshop > Inverted > Equalized

Now that Speedy has quit smoking his dementia is worsening

We had hoped that the tax money we pay

Would help us quit smoking by now

That is our typical AO2

Spirometry Related Information

Transparency About Personal Health Records

Promote- WorldWafers

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6 comments:

Derek RooneyMay 13, 2019 at 11:04 AM
I had COPD for 9 years. My first symptoms were dry cough, chest tightness and shortness of breath. My first chest x-ray only showed bronchitis. Finally I went to a pulmonologist and was diagnosed with COPD.i have used all the medication yet they don’t work, last year December I was told by a formal emphysema patient to use totalcureherbsfoundation. com herbal treatment which I really did,i was surprise the herbal products effectively get rid of my COPD totally. When you get where you cannot breathe it may be too late. Good luck to each and every one that will be trying their herbal treatment .
Felix LinaJuly 6, 2019 at 1:01 AM
I am not sure of the cause of COPD in my case. I smoked pack a day for 12 or 13 years, but quit 40 years ago. I have been an outdoor person all my adult life. Coughing started last summer producing thick mucus, greenish tint to clear. I tried prednisone and antibiotics, but no change. X-rays are negative, heart lungs and blood and serum chemistries all are normal. I have lung calcification from childhood bout with histoplasmosis. I am 75 years old and retired.My current doctor directed me to totalcureherbsfoundation.com which I purchase the COPD herbal remedies from them ,they are located in Johannesburg, the herbal treatment has effectively reduce all my symptoms totally, am waiting to complete the 15 weeks usage because they guaranteed me total cure.
parvinaJanuary 13, 2020 at 10:40 PM
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FlorenceJuly 8, 2021 at 1:33 PM
I started on COPD Herbal treatment from Ultimate Life Clinic, the treatment worked incredibly for my lungs condition. I used the herbal treatment for almost 4 months, it reversed my COPD. My severe shortness of breath, dry cough, chest tightness gradually disappeared. Reach Ultimate Life Clinic via their website www.ultimatelifeclinic.com. I can breath much better and It feels comfortable!

Monday, September 10, 2018

Double XX – Digital Appointment – Addressing COPD Protections – By Keith Torkelson, MS

6 comments: