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Usually, when getting pregnant becomes difficult, it leads to a situation where a woman faces infertility issues. As infertility is a never-ending illness in which conceiving becomes impossible either due to health conditions or a poor environment. Here find out the reasons why it becomes challenging to become pregnant?

What is Depression? Every individual experiences feelings of worthlessness, sadness, and negativity. It is when these feelings spiral out of control and consume the individual to an extent that his/her normal life is disrupted, that depression arises. Depression is a serious medical condition and can significantly weaken the individual both physically and mentally. What are the causes and risk factors of depression? In medical terms, depression is due to a decreased amount of certain chemicals in the brain. Depression has a genetic basis, i.e. depression may run in family. It can also be triggered by an event such as the loss of a loved one, losing a job, etc. There are some hormonal problems like decreased thyroid levels that can also lead to depression. Depression can also follow after the diagnosis of a serious illness and leads to impaired treatment of the disease. It is accompanied by the feeling of not getting well and hence ignoring the medication and the other activities that have been advised by the doctor. Risk factors Traumatic past, abuse, neglect Loss of a loved one Serious medical conditions like Parkinson's disease, etc. Also Read: How to Prevent Depression in Elderly What are the symptoms of depression? Persisting feeling of sadness, anxiety Low self-esteem Feeling worthless Pessimistic mindset Decreased appetite Difficulty in sleeping Oversleeping Inability to concentrate Talking, walking slowly Constantly feeling tired Loss of interest in activities that were previously enjoyable Decreased sexual desire Weight loss Headache Abdominal cramps Having ideas about death, contemplating suicide What are the investigations for depression? As such there are no investigations for depression. If the symptoms listed above continue for more than two weeks, the person is diagnosed with depression. Investigations advised by the doctor can be - Thyroid function tests Cortisol levels in the blood What is the treatment of depression? The treatment is both

Course "HIPAA for the Compliance Officer" has been pre-approved by RAPS as eligible for up to 12 credits towards a participant's RAC recertification upon full completion. Overview: I will be going into great detail regarding you practice or business and how it relates to the HIPAA Security/Privacy Rule, Areas covered will be history of HIPAA, privacy vs security, business associates, changes for 2016, audit process, paper based PHI, HIPAA and suing, texting, email, encryption, medical messaging, voice data and much, much, more I will uncover myths versus reality as it relates to this very enigmatic law based on over 600 risk assessments performed as well as years of experience in dealing directly with the Office of Civil Rights HIPAA auditors. I will also speak to real life audits conducted by the Federal government (I've been on both sides of these audits) what your highest risks are for being fined (some of the risk factors may surprise you). In addition, this course will cover the highest risk factors for being sued for wrongful disclosures of PHI and the manner in which patients are now using state laws to sue for wrongful disclosures. Don't always believe what you read online about HIPAA, especially as it relates to encryption and IT, there are a lot of groups selling more than is necessarily required. Why you should attend: This lesson will be addressing how practice/business managers (or compliance offers) need to get their HIPAA house in order before the imminent audits occur. It will also address major changes under the Omnibus Rule and any other applicable updates for 2016. There are an enormous amount of issues and risks for covered entities and business associates these days. I will speak on specific experiences from over 17 years of experience in working as an outsourced compliance auditor, expert witness on HIPAA cases, and thoroughly explain how patients are now able to get cash remedies for wrongful disclosures of private health information. More im

Are you struggling with the fact that you really don't know anything about how to get into shape? If you're busy living in yesterday's errors, many of your decisions will be founded on guilt and shame instead of what you really want (and need) to accomplish to achieve your goals. Real change comes from day-to-day choices and becoming mindful and basing your choices on what you need now (rather than what you did or didn't do yesterday) will make your exercise life much more passable. What if I can offer you a solution that will help you to attain greatness, to become a success and learn about the best ways to get in shape? In this book, you will learn about: - Navigate the Astral Plane - MIRROR MADNESS - The Health Zen - Vitamin Vitality - Native American Healing - Boost your Health with Gua Sha - Beautiful Body Essential - Secret of Food Combination - Lose Weight Fasting - Child Diet - many other useful things!

Are you struggling with the fact that you really don't know anything about how to get into shape? If you're busy living in yesterday's errors, many of your decisions will be founded on guilt and shame instead of what you really want (and need) to accomplish to achieve your goals. Real change comes from day-to-day choices and becoming mindful and basing your choices on what you need now (rather than what you did or didn't do yesterday) will make your exercise life much more passable. What if I can offer you a solution that will help you to attain greatness, to become a success and learn about the best ways to get in shape? In this book, you will learn about: - Navigate the Astral Plane - MIRROR MADNESS - The Health Zen - Vitamin Vitality - Native American Healing - Boost your Health with Gua Sha - Beautiful Body Essential - Secret of Food Combination - Lose Weight Fasting - Child Diet - many other useful things!

Overview: You need to attend in order to control your own destiny. Get involved up front instead of being a "sitting duck". More Audits are coming and government & private payers are increasing their budgets for increased audit activity around the health care provider industry. The Department of Justice is zeroing in on providers who are aberrant. Private insurance special investigations units are also gearing up and local prosecutors who are hungering for these types of prosecutions are all part of building machinery to eliminate fraud and abuse in the nation's health care system. The concern about the audit/investigative machine that has been developed should create horrendous concern for the health care provider community, because these entities will have to come up with results. Don't become one for their "results". Areas Covered in the Session: Overview of audit risks 14 Strategies to tackling auditors: i.e. Appoint Audit Manager Appoint Audit Committee Proactively seek out info from audit visitors Respond quickly to audit visitor requests Identify On Site control person Provide strong support for onsite control person Onsite control person must be close to the visitors Audit committee to meet daily with visitors Respond quickly to early findings Request feedback from visitors Request Exit conference Carefully review preliminary findings Respond to final report Correct problem findings Who Will Benefit: Health Care Professionals Health Service Providers Compliance Officers CEO's Corporate Attorneys Speaker Profile Joseph R. Batte is president of Kristall Associates, a compliance, and risk assessment specialist for the health care provider community as well as the litigation support community. He is a former special agent with the US Office of Inspector General and participated in the development of that Departments compliance guidance's. He is a nationally known speaker on compliance and has authored the book "Doctors are from Jupiter, Compliance is from

Following are the list of items that can really help you get rid of toxins in your blood and tar.

Course "New HIPAA Audit and Enforcement Activities: Being Prepared to Show your Compliance " has been pre-approved by RAPS as eligible for up to 12 credits towards a participant's RAC recertification upon full completion. Overview: We will be discussing the history and evolution of HIPAA Privacy/Security and the major points you need to understand to proactively protect your practice or business from the imminent federal auditing process: * History of HIPAA * HITECH * HIPAA Omnibus Rule * How to perform a HIPAA Security Risk Assessment * What is involved in a Federal audit and how is it conducted * Risk factors for a federal audit * How to avoid a Federal audit * Business Associates and HIPAA audits * EHR and HIPAA * Business Continuity/Disaster Recovery Planning * Assessing your contractors and sub-contractors * In depth discussions on IT down to the nuts and bolts * Risk factors that can cause an audit (low hanging fruit) * New rules which grant states ability to sue citing HIPAA on behalf of a patient * New funding measures Why should you attend : The evolutions of this enigmatic law and how what was once relative benign in terms of enforcement is now fully funded and aggressive. Learn what you can do to be prepared for an audit and how to lower risks of ever being audited. It is absolutely imperative that you are proactive and not reactive with your compliance program, this is a necessary evil and you need to protect your practice or your business and limit risks from the imminent Federal audits. Join me in keeping up with this very confusing law and take advantage of all the templates and information provided as part of the seminar. Areas Covered in the Session: * HIPAA -Brief History * HIPAA Privacy Rule vs HIPAA Security Rule * HITECH Act * Breach Notification Rule * Omnibus Rule and audits * Business Associates and audits * Current Court Cases (precedence) * Paper Based PHI Concerns and how to lower risk

Quality Assurance in Nursing Healthcare: Quality assurance in nursing is about assuring quality in nursing by ensuring that practices are compliant with quality standards. This is a full-fledged profession with its own educational and experience requirements. Quality assurance in nursing has to be understood from the standpoint of quality assurance and compliance. Quality assurance in nursing is about ensuring adherence to quality standards as mandated by nursing regulatory bodies. Quality assurance in nursing assesses what healthcare processes are in place and what else needs to be implemented to better the system. Where do quality assurance nurses work? Professionals who make a career out of quality assurance in nursing are employed in various healthcare settings. They could work in clinics or small or large hospitals. Professionals who make a career in quality assurance in nursing are licensed registered nurses. Since they are registered nurses, they should also obtain a licentiate. To get this, they should complete a prerequisite approved nursing program. The exam for getting licensure is the National Council Licensure Examination for Registered Nurses (NCLEX-RN), a computer-based examination. A higher level of education for those in quality assurance in nursing is a master's degrees inhealth care quality or a near degree. In some healthcare organizations, this is required at entry level. Some of the works they do in maintaining quality assurance in nursing include: Reviewing reports or files to make sure that activities contained in them are following regulatory clinical standards Collaborating with colleagues from other departments to which nursing is related either directly or indirectly Interacting with other hospitals or organizations, if the need arises For professionals pursuing a career in quality assurance in nursing, the ability to analyze data and manage cases is a must, as a major part of their work involves these. They should also be prompt abou

Overview: I will be talking to specifics of HIPAA and the emergency room setting, do's and don'ts as well as dispelling myth vs reality. This lesson will be addressing how compliance officers need to get their HIPAA house in order as HIPAA is now fully enforced and the government is not using kid gloves any more. It will also address major changes under the Omnibus Rule and any other applicable updates for 2016 and beyond. There are an enormous amount of issues and risks for hospitals these days especially with the new legislation involving patient cash remedies for wrongful disclosure. I will speak on specific experiences from over 17 years of experience in working as an outsourced compliance auditor, expert witness on HIPAA cases within the ER, and thoroughly explain how patients are now able to get cash remedies for wrongful disclosures of private health information. More importantly I will show you how to limit those risks by simply taking proactive steps and utilizing best practices. Why should you Attend: What can and can't we do in the hectic emergency room with patient information? What are the new liabilities involved? How can we ensure security but also ensure patient care? This once rarely enforced law has changed and you need to know what's going on! What factors might spurn a HIPAA audit? …are you doing these things? Why are the Feds enforcing after all these years? State laws are now also more strict increasing liability for patient remedies! We will be discussing some of the changes taking place in Washington with the Health and Human Services in regards to the enforcement of the HIPAA laws already on the books. I will go over some of the new changes specifically affecting the emergency room setting I will also be discussing factors might cause an unwanted visit or letter from the Office of Civil Rights and how to prepare for a potential audit Areas Covered in the Session: Updates for Omnibus Emergency Room Do's and Don'ts in the ER Ambulato

Food Safety and Security are two faces of the coin : Food safety and security are two different, but closely related concepts. Although part of the same aspect, they vary in their application and meaning. Both are equally important in ensuring that populations of the world get food that is sufficient and nutritious. Food safety and security are complete without each other. Food safety complements food security, and vice versa. Food safety : Food safety is essentially about the safety of the ingredients that go into food. If food is being sourced from a farm, the food makers have to ensure that the farm has ensured safety standards in producing this food. Food safety is concerned about the amount of chemicals and fertilizers used in production of food. It is also concerned with how much residual pesticide, which could cause harm to humans when the food that is grown using it, is left in the final product, and so on. Food safety is related to and is dependent on factors such as demographics, inputs that go into the cultivation and production of food, availability of water for production of safe food, the use of energy sources in the safe production of food, climate change, etc. Now, food security : Food security, on the other hand, is about more about the food supply chain. When food arrives from the producer to the consumer, it goes through a complex chain that can many times span entire continents. Food may also be sourced and consumed locally. In either case, there is a need to ensure that the points that food travels in and reaches are secure. Ensuring quality throughout : The aim of food security is to ensure that food which travels through many chains and stages should be clean at all these stages. This means that security has to be ensured from rodents and other forms of disturbances at the agricultural fields in which food is produced, then at the granaries in which it is stored, at the routes that it travels, then at the location at which food is pr

Overview: This presentation will introduce the participants to changing role of the panoramic x-ray machine in dental offices today. Its expanding role in extra oral exposures and enhanced diagnostic capabilities is forever changing the path of dental x-ray imaging. Digital radiography is rapidly improving in diagnostic quality and loweringthe radiation exposure with ultra-low dose technology. We can have extra oral 2D bite wings and periapical x-rays with less radiation and greater diagnostic capability than traditional intraoral x-rays. The time has come that all dentists should have access to 3D-Cone Beam Computer Tomography. It is rapidly becoming the standard of care. Why should you Attend: Digital radiography is rapidly changing in today's dental offices. The new technology is revolutionizing patient flow and improving diagnosis. Dr. Jesek is at the forefront of this technology, using both 2D and 3D radiography. Seminar attendees will get easy to understand approach, which enables deep learning and provides tools they can use when they get back to the office Monday morning. Areas Covered in the Session: CBCT can be used to in areas of general dentistry to improve patient acceptance and quality of treatment outcomes. General and Restorative Dentistry Oral Surgery Implant Dentistry Endodontics Periodontics Orthodontics Sleep Apnea/Air way Who Will Benefit: Dentists Hygienists Assistants Speaker Profile : Dr. Warren Jesek graduated from Millikin University with a B.A. in biology and chemistry. After, he completed graduate work studies in anatomy at the University of Nebraska before attending Loyola University Dental School where he received his dental degree in 1979. He has maintained a private general practice in Decatur, Illinois since 1979. Unique to the area, his practice houses a crown and bridge laboratory with three technicians focusing on CAD/CAM milling technology to produce metal-free inlays, crowns and bridges. Dr. Jesek continued his training

Overview: I will be talking to specifics of HIPAA in the hospital setting, , do's and don'ts as well as dispelling myth vs reality. This lesson will be addressing how compliance officers need to get their HIPAA house in order as HIPAA is now fully enforced and the government is not using kid gloves any more. It will also address major changes under the Omnibus Rule and any other applicable updates for 2016 and beyond. There are an enormous amount of issues and risks for hospitals these days especially with the new legislation involving patient cash remedies for wrongful disclosure. I will speak on specific experiences from over 17 years of experience in working as an outsourced compliance auditor, expert witness on HIPAA cases within the hospital setting, ER setting, and thoroughly explain how patients are now able to get cash remedies for wrongful disclosures of private health information. More importantly I will show you how to limit those risks by simply taking proactive steps and utilizing best practices. Why should you Attend: What can and can't we do in the hospital setting with patient information? What are the new liabilities involved? How can we ensure security but also ensure patient care? This once rarely enforced law has changed and you need to know what's going on! - there are new liabilities! What factors might spurn a HIPAA audit? …are you doing these things? Why are the Feds strictly enforcing after all these years? State laws are now much tougher increasing liability for patient remedies! We will be discussing some of the changes taking place in Washington with the Health and Human Services in regards to the enforcement of the HIPAA laws already on the books. I will go over some of the new changes specifically affecting the hospital as well as the emergency room setting I will also be discussing factors might cause an unwanted visit or letter from the Office of Civil Rights and how to prepare for a potential audit Areas Covered in the Sessi

Course "Marketing Products without Getting Hammered by FDA" has been pre-approved by RAPS as eligible for up to 12 credits towards a participant's RAC recertification upon full completion. Overview: With this seminar you will learn how to navigate FDA's legal requirements and its interpretations for enforcement purposes. The agency now applies the principles of cognitive psychology to aid in its determination of what a message really conveys. This becomes a new factor in trying to stay within FDA's legal corral. This conference will provide insight on how to manage your marketing activity and gauge what regulatory risks your business is willing to accept. You will learn how corporate management requires cooperation between marketing, regulatory affairs, legal counsel, manufacturing, engineering and finance departments. You will understand that a weak link in any department leaves the entire corporation vulnerable to FDA enforcement. Most importantly, you will understand the boundaries that FDA uses and how easy it is to cross them. With information from this course, you can step back and rationally evaluate your firm's regulatory profile for advertising and promotion. Why should you attend: If you go "off label" with advertising and promotion, you become embroiled in FDA's advertising and promotion requirements. For devices, the law is weak and lacks legal clarity. For drugs, FDA's law and regulations are extensive and have violated Constitutional protections. Depending on your point of FDA's promotion and advertising requirements can help you or hurt you? There is an inherent conflict in interests. In any case, you need to identify practical criteria to make marketing decisions. That begs the question of whether or not marketing managers and regulatory affairs managers will even try to agree on an issue. FDA's Center for Devices and Radiological Health (CDRH) has never issued a comprehensive guidance on advertising and promotion. You are on your own. CDER has esta

Course "Texting and E-mail with Patients: Patient Requests and Complying with HIPAA " has been pre-approved by RAPS as eligible for up to 12 credits towards a participant's RAC recertification upon full completion. Overview: With the recent advances in portable technology, more and more organizations and their users are taking advantage of mobile devices to save time and get work done more efficiently. Texting, portable e-mail, and Apps are revolutionizing the ways health care providers interact with their patients and get their work done. But the use of these devices comes with hidden costs of compliance, especially if they lead to a reportable breach under HIPAA or state laws. HIPAA Privacy and Security Officers have been struggling to keep up with the use of the devices to protect patient privacy and avoid compliance issues. Even if these devices aren't in formal use in your organization, you need to act now to anticipate their use and make sure they are used properly. This session is designed to provide intensive, two-day training in HIPAA compliance as it relates to the use of mobile devices, including how to use them with Protected Health Information, the policies and procedures you need to have in place to use them securely, and how to manage issues of the "BYOD" phenomenon. The session provides the background and details for any manager of health information privacy and security to know what issues to look for with mobile devices, what needs to be done for HIPAA compliance, and what can happen when compliance is not adequate. Audits and enforcement will be explained, as well as privacy and security breaches and how to prevent them. Numerous references and sample documents will be provided. The session will be valuable for both newcomers to HIPAA compliance as well as seasoned veterans. HIPAA compliance will be explained and discussed in detail, from the basics through the latest changes and new technology issues, so that the attendee will have a coherent u

Overview: The presentation takes the participant through the steps needed to ensure a successful health care computer system implementation. Once presented the participant will see the logic of the tools and processes and be able to apply them to their system implementation. The tools and processes presented in this material have been developed by implementing health care systems for over 40 years and seeing what has worked and WHY it has worked. These tools and processes have been equally and successfully applied to the implementation of large, complex systems and smaller, simpler systems for large, multidepartment organizations and for small health care organizations. The process focuses on establishing the project's implementation expectations, identifying meaningful metrics for success, establishing project plans, assigning individual accountabilities and responsibilities, establishing and executing project tasks, monitoring project progress and validating project success. To establish viable project expectations, the presentation addresses the need for bringing all of the stakeholders (organization owners, providers and management, operations staff, IT staff and the vendor) into establishing common and realizable expectations. These are reviewed in context of the organization's current environment and its short and long term goals and are considered as a critical part of the implementation completion process. In the case of turning around an already troubled or failed system implementation, the process emphasizes the tasks of reassessing the project stakeholder expectations - why they decided the system would help the organization and what they expected to get from the system. Next the process shows the participant how to convert these expectations to realistic and measurable project success metrics. The process focuses on learning how to separate "so what" metrics from meaningful and measurable metrics. In addition, the process provides direction regardin

Healthcare fraud and abuse: Healthcare fraud and abuse are different but related kinds of malpractice. They affect everyone concerned: the patient, the healthcare unit, the healthcare sector, and eventually, the economy. Healthcare fraud and abuse are serious malpractices that can have very grave consequences for the patient, the hospital and the healthcare sector. They can also cost taxpayers heavy amounts of money. Healthcare fraud: There is some distinction between healthcare fraud and healthcare abuse. Healthcare fraud is said to happen, according to medicare.gov, when Medicare gets billed for a service or supply the end user never gets. These fraudulent claims result in loss of billions of dollars of revenue to Medicare each year. Healthcare fraud could be said to happen when: False statements are submitted knowingly or facts are misrepresented with the purpose of obtaining a federal health care payment for claims for which the person is not entitled A person knowingly solicits, pays, or/and accepts a payment with the intention of inducing or rewarding referrals for services or items that any of the federal healthcare programs reimburse Eligibility is falsified Prohibited referrals are made for select, designated health services Healthcare abuse: Although related, healthcare fraud and abuse are not totally similar to each other in spirit. A healthcare abuse can be when physicians do not comply with or bypass established good medical practices or administer treatments that are not necessary. This is less serious than fraud in terms of intent, but carries the same consequences: loss of billions of dollars to the exchequer and potential damage the patient's health and the physician's and/or healthcare provider's reputation. Some examples of healthcare abuse These are some of the examples of healthcare abuse: When services that are not medically warranted are performed and charged for When services and/or supplies are charged in excess of their actual value

Overview: With the recent advances in portable technology, more and more organizations and their users are taking advantage of mobile devices to save time and get work done more efficiently. Texting, portable e-mail, and Apps are revolutionizing the ways health care providers interact with their patients and get their work done. But the use of these devices comes with hidden costs of compliance, especially if they lead to a reportable breach under HIPAA or state laws. HIPAA Privacy and Security Officers have been struggling to keep up with the use of the devices to protect patient privacy and avoid compliance issues. Even if these devices aren't in formal use in your organization, you need to act now to anticipate their use and make sure they are used properly. This session is designed to provide intensive, two-day training in HIPAA compliance as it relates to the use of mobile devices, including how to use them with Protected Health Information, the policies and procedures you need to have in place to use them securely, and how to manage issues of the "BYOD" phenomenon. The session provides the background and details for any manager of health information privacy and security to know what issues to look for with mobile devices, what needs to be done for HIPAA compliance, and what can happen when compliance is not adequate. Audits and enforcement will be explained, as well as privacy and security breaches and how to prevent them. Numerous references and sample documents will be provided. The session will be valuable for both newcomers to HIPAA compliance as well as seasoned veterans. HIPAA compliance will be explained and discussed in detail, from the basics through the latest changes and new technology issues, so that the attendee will have a coherent understanding of not only the rules, but also how to think about compliance and make sound compliance decisions on a day-to-day basis in the context of mobile devices. Agenda Day One Day one sets the stage with an ov

Overview: The objectives of this course will be to go over the specific risks associated with business associates as it relates to HIPAA compliance. I will uncover myths versus reality as it relates to this very enigmatic law based on over 600 risk assessments performed as well as years of experience in dealing directly with the Office of Civil Rights HIPAA auditors. Times have changed and unfortunately many businesses are losing clients or unable to get new clients due to problems with their compliance program or lack of a compliance program. I will demonstrate from real life audits conducted by the Federal government what your highest risks are for being fined (some of the risk factors may surprise you). In addition this course will cover the highest risk factors for being sued for wrongful disclosures of PHI and the manner in which patients are now using state laws to sue for wrongful disclosures. States are being encouraged by the Federal government to implement new laws to remedy their citizens. Why should you Attend: Protect your business! Business associates are now required to comply directly with the HIPAA legislation! Many businesses are losing clients or unable to get clients because of compliance issues. We will be discussing the changes taking place in Washington DC with the Health and Human Services in relating to new risks business associates face under HIPAA. I will also be discussing factors might cause an unwanted visit or letter from the Office of Civil Rights and how to prepare for the audit and deal with the Feds Areas Covered in the Session: Updates for 2016 What to do if a client requires more than just a signed business associate agreement Fines Policy and Procedure Who Will Benefit: Any business associates who work with medical practices or hospitals (i.e. billing companies, transcription companies, IT companies, answering services, home health, coders, attorneys, etc) Speaker Profile Brian Tuttle is a Certified Professional in H

Ensuring Patient Safety in Surgical Environments is Critical for Healthcare Providers A critical component of patient safety relates to surgical environments. Surgical theaters are prone to causing a high degree of harm. This can be from a number of sources. Patient safety in surgical environments can be from any microbe or fungus in any of the accessories used during surgery, such as ECG machine, the echo machine, or other related ones. A host of external factors can impinge upon patient safety in surgical environments Patient safety in surgical environments can also be compromised on account of the use of infected items such as swabs, sponges, knives, forceps, needles, catheters, tubes or any other such accessories or instruments. Patient safety in surgical environments can also get affected by the presence of microscopic allergens and molds in any bedding or clothing item. Even germs transmitted from the caregivers can be a source of lack of patient safety in surgical environments. Another major source where patient safety in surgical environments can suffer is when items are left behind in patients��� bodies by the surgeon. There have been innumerable cases of entire surgical items being left behind in the patient, even in the best hospitals, when surgery is performed by the best surgeons. Get a proper understanding of the underlying causes What do all these point to? These point to the fact that all the factors mentioned above are manmade and are preventable. So, understanding the root of the problem is the key to ensuring patient safety in surgical environments. East and west carry differences Any approach to a solution for ensuring patient safety in surgical environments has to start with the understanding that different healthcare and surgical environments exist in different parts of the world. A surgical environment in Germany for instance is vastly different from that in say, Ghana. So, an individualized approach is what is needed. It is to be note